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A Meta-Meta-Analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations
Abstract
Amidst strong efforts to promote the therapeutic benefits of physical activity for reducing depression and anxiety in clinical populations, little focus has been directed towards the mental health benefits of activity for non-clinical populations. The objective of this meta-meta-analysis was to systematically aggregate and quantify high-quality meta-analytic findings of the effects of physical activity on depression and anxiety for non-clinical populations. A systematic search identified eight meta-analytic outcomes of randomised trials that investigated the effects of physical activity on depression or anxiety. The subsequent meta-meta-analyses were based on a total of 92 studies with 4310 participants for the effect of physical activity on depression and 306 study effects with 10,755 participants for the effect of physical activity on anxiety. Physical activity reduced depression by a medium effect [standardised mean difference (SMD) = −0.50; 95% CI: −0.93 to −0.06] and anxiety by a small effect (SMD = −0.38; 95% CI: −0.66 to −0.11). Neither effect showed significant heterogeneity across metaanalyses. These findings represent a comprehensive body of high-quality evidence that physical activity reduces depression and anxiety in non-clinical populations.
... The WHO describes PA as bodily movement produced by skeletal muscles that require energy expenditure during leisure time, transport, and work, and SB as sitting or lying down, including time spent sitting at work, watching television, and for other leisure activities [4]. PA and SB have wide-ranging effects on people's physical and mental health [5][6][7][8][9]. PA can protect against negative health effects such as metabolic conditions, depression, and cognitive decline [10]. ...
... We tested the independent variables sex, age, occupation, life satisfaction, COVID-19 history, health, weight change, and time (2019, 2020, and 2022) and their interactions in relation to the dependent variables PA and SB level with univariate analysis of variance. The independent variables were chosen based on previous research [5][6][7][8][22][23][24][25]. In the interaction model, only significant interactions were reported. ...
... This may be explained by less extensive restrictions compared with other countries [18], and that vaccination had begun. One may also speculate whether people have become accustomed to seeking new solutions for PA during the pandemic, which has a positive impact on life satisfaction [8]. Those who had the opportunity to work from home might have been able to adapt their activities and, as described by Birimoglu Okuyan (2022), maintain good levels of physical and mental health [41]. ...
Physical activity (PA) and sedentary behavior (SB) affect people’s physical and mental health. The aim was to examine changes in PA and SB in a Swedish population: at three time points: 2019, 2020, and 2022, i.e., before and during the COVID-19 pandemic. Pre-pandemic PA and SB, i.e., 2019, were assessed retrospectively in 2020. Associations between PA and SB with sex, age, occupation, COVID-19 history, weight change, health, and life satisfaction were also examined. The design was repeated cross-sectionally. The main findings demonstrate the PA levels decreased between 2019 and 2020, and between 2019 and 2022, but not between 2020 and 2022. The SB increase was most evident between 2019 and 2020. Between 2020 and 2022, results showed a decrease in SB, but SB did not reach pre-pandemic levels. Both sexes decreased their PA over time. Although men reported more PA sex, they did not have any association with PA changes. Two age groups, 19–29 years and 65–79 years, decreased their PA over time. Both PA and SB were associated with COVID-19, occupation, age, life satisfaction, health, and weight change. This study underlines the importance of monitoring changes in PA and SB as they have relevance for health and well-being. There is a risk that the levels of PA and SB do not return to pre-pandemic levels in the population.
... Physical activity is generally accepted as having positive effects on mental health and wellbeing (Mikkelsen et al. 2017;Wiese et al. 2018). Its positive impact on symptoms of depression and anxiety has been proven in both clinical (Ashdown-Franks et al. 2020) and nonclinical populations (Rebar et al. 2015). Regular moderate physical activity was also shown to have beneficial effects on sleep quality (Kredlow et al. 2015;Wang and Boros 2021). ...
... The return to decreased physical activity levels after the post-intervention measurement could be the reason for the lack of a longer term effect. Again, the results underline the importance of regular physical activity over longer periods for beneficial effects on negative aspects of mental health (Rebar et al. 2015). In contrast to previous research that reported longitudinal associations or positive effects of physical activity on PMH Precht et al. 2022), happiness (Zhang and Chen 2019), and well-being (Harris 2018), the present study found no effects of the physical activity intervention on PMH (rejection of Hypothesis 3b). ...
Aim
Tendencies of problematic smartphone use (PSU) have risen during the past decade. As PSU is consistently linked to mental health issues, measures to prevent its appearance and to promote mental health are urgently required.
Subject and Methods
The present study investigated the impact of three interventions on health behavior, PSU, positive mental health (PMH), and depression and anxiety symptoms. Overall, 503 persons from Germany (Mage = 29.19, SDage = 10.51, range: 18–79) participated in the study. Over 14 days, the three experimental groups (a) reduced their daily smartphone use time by 60 minutes, (b) increased their daily level of physical activity by 30 minutes, and (c) combined both measures. The control group continued its behavior as usual. Outcomes were assessed via online surveys at five measurement time points (baseline, intermediate, post-intervention, and 1 and 3 months after the intervention).
Results
All interventions resulted in a significant increase in weekly physical activity and in reduced symptoms of PSU, depression, and anxiety. Furthermore, the smartphone reduction and the combination of both measures contributed to a significant reduction of participants’ daily smartphone use and higher levels of PMH. The effects of the reduction of smartphone use time and its combination with increased physical activity were more stable in the longer term than the increase in physical activity only.
Conclusion
Combined with an increase in physical activity, the reduction of smartphone use time could serve as an efficient and cost-effective measure for the prevention of PSU and the promotion of mental health.
... It comprises three main components: (1) the number of close confidants, (2) the sense of caring for others and connecting with neighbors, and (3) the availability of practical assistance. The following were the coded response options for the first item: "No one" (coded: 1), "1-2" (25), " "3-5(26), and" 6 or more" (22), The second item's answer possibilities were coded: "no interest" (coded 1), "little interest" (25), "neither great nor little interest" (26), "some interest" (22), "great interest" (27). The third item's answer possibilities were coded as follows: "very difficult" (coded:1), "difficult" (25), "neither easy nor difficult" (26), "easy" (22), and "very easy" (27). ...
... The following were the coded response options for the first item: "No one" (coded: 1), "1-2" (25), " "3-5(26), and" 6 or more" (22), The second item's answer possibilities were coded: "no interest" (coded 1), "little interest" (25), "neither great nor little interest" (26), "some interest" (22), "great interest" (27). The third item's answer possibilities were coded as follows: "very difficult" (coded:1), "difficult" (25), "neither easy nor difficult" (26), "easy" (22), and "very easy" (27). By adding the scores from each component, the OSS-3's overall score was computed. ...
Background: Mental illnesses are very common and difficult to manage, impacting roughly 12% of the worldwide population in 2019; however, adolescence is a critical period for the development of many diseases and future health habits. Medical literature has shown that solitude is a strong predictor of depression symptoms; additionally, social connectivity is essential to human life, so social relationship impairments are likely to cause depression. Mental health treatment is needed in Syria's war areas, camps of refugees, and displaced people within the country's borders, where conflict and migration have resulted in a high rate of trauma and significant mental illnesses among Syrians. This study adds to the literature by searching for possible links between these ranges of controllable variables and adding more information about Syria's mental health.
Methods: An online quantitative cross-sectional study was conducted between March and April 2022 in all 14 municipalities in Syria, using a structured questionnaire that assesses data on behaviors of health, health in general, well-being, and adult population quality of life.
Results: Among 1224 respondents (371 men and 853 women), women have shown higher levels of mental distress, sleep issues, low levels of engagement in structured activities, and a difficult work environment than men. Women who are experiencing mental anguish have reported being more sedentary, participating in less scheduled activities, and receiving less social support.
Conclusions: High sedentary time was found to have measurable links with women in mental distress. Low levels of engagement in structured activities and low leisure-time physical activity were observed in mental health distressed Syrian women. Sleep problems and hard financial were both seen in subjects with mental illness in both sexes.
... Sin embargo, se realizó un MA 2 para conocer el efecto del ejercicio en variables de sueño en adultos a partir de meta análisis previos [391] . Esto también lo han hecho otros investigadores en temas como el efecto del ejercicio en la depresión y la ansiedad [602] . ...
... También se mencionan las bases de datos utilizadas para realizar la búsqueda de meta análisis. En el MA 2 de ejercicio y sueño [391] se buscaron meta análisis en 8 bases de datos, mientras que en el MA 2 de ejercicio y depresión y ansiedad [602] solamente en tres bases; sin embargo, no existe una guía estandarizada para definir la cantidad 68 de bases de datos que se deban revisar. Se ha mencionado que se deben consultar al menos tres bases de datos especializadas en la temática para completar un meta análisis para garantizarse una apropiada cobertura de información y de diversidad de fuentes de información. ...
Este libro es la culminación de un proyecto para el mejoramiento de la labor docente y estudiantil inscrito en la Vicerrectoría de Docencia de la Universidad de Costa Rica con el código PD-EF-1503-2021. Los autores exponen argumentos basados en evidencia científica con el propósito de estimular investigación de alta calidad en las Ciencias del Movimiento Humano. A la vez, agradecen el apoyo de la Escuela de Educación Física y Deportes y del Centro de Investigación en Ciencias del Movimiento Humano de la Universidad de Costa Rica, así como a colegas investigadores con quienes han podido compartir y publicar sus investigaciones.
Esta es una obra que requiere conocimientos básicos en diseños de investigación y análisis estadístico; por lo que se presenta como un material de consulta de nivel intermedio a avanzado, que será especialmente útil en programas de maestría y doctorado. La obra se presenta en dos capítulos; uno acerca de avances metodológicos, y otro, que presenta avances estadísticos. El primer capítulo introduce conceptos actualizados referentes a metodologías de investigación utilizadas en estudios publicados en revistas científicas de alta calidad, de manera que los lectores puedan apreciar metodologías de vanguardia que se utilizan para responder preguntas de investigación relevantes para las Ciencias del Movimiento Humano.
El segundo capítulo introduce técnicas novedosas de análisis de datos que se han incorporado al universo de los investigadores para poder afrontar la cada vez más compleja cantidad de información recopilada en los estudios. Además, la integración de ambos capítulos ofrece nuevas oportunidades para el trabajo inter, multi y transdisciplinario, aceptando con humildad que un proceso de investigación se ve claramente favorecido por las diferentes perspectivas de profesionales unidos para resolver los principales problemas que afronta la sociedad en la búsqueda del conocimiento.
... Research shows a clear connection between physical activity (PA) and mental health with meta-analytic studies linking PA to depression, anxiety, and quality of sleep (Kredlow et al., 2015;Rebar et al., 2015). In addition, a systematic review and metaanalysis by Rosenbaum et al. (2014) shows that PA interventions can reduce ...
... Other than fitness training or running, increasing daily step count does not require specific equipment, trainers, costs or much effort, and it can easily be implemented into the daily lives of people as step count could easily be increased by small changes in daily habits, like taking the stairs instead of the elevator. While many studies show connections between PA and anxiety (Carter et al., 2021;Rebar et al., 2015), this is not the case in our data. However, our results are reflected in a current study that shows no correlation between anxiety and step count measured via a smartphone app (Moshe et al., 2021). ...
While there are studies connecting everyday physical activity (PA) to mental health, they mostly use self-report measures for PA which are biased in multiple ways. Nevertheless, a realistic assessment of everyday PA is important for the development and implementation of low-threshold public health interventions. Therefore, we want to analyze the relationship between objectively measured daily steps and mental health. We included 1451 subjects from a subsample of the population-based LIFE-Adult-Study (2011-2014) with an average age of 55.0 years, 52.1% were female. We analyzed the effects of PA (step count measured via SenseWear Pro 3) on depression (CES-D), anxiety (GAD-7), and quality of sleep (PSQI). The regression analysis showed a significant negative association between low to moderate PA [Incidence rate ratio: 0.87 (0.77; 0.98)] as well as high to very high PA [0.84 (0.74; 0.95)] and depression and no significant associations between PA and anxiety [l-m: 0.98 (0.81; 1.18)/h-vh: 1.00 (0.82; 1.21)] or quality of sleep [l-m: 0.94 (0.84, 1.06)/h-vh: 0.92 (0.82, 1.03)], controlling for sociodemographic variables and personality. Low-threshold interventions that increase daily step count could be a useful approach for the prevention of depression. The use of objective PA measurement for research is highly encouraged.
... 18 Furthermore, symptoms of depression, anxiety, and stress have been found to be negatively correlated with exercise in both clinical and general populations. 19,20,21 This relationship seems to be bidirectional, meaning that people with high levels of symptoms of depression, anxiety, and stress were less likely to exercise, whereas people that exercised more were less likely to have such symptoms. 22,23 Nevertheless, other researchers found that exercise and symptoms of depression, anxiety, and stress were not related. ...
... [13][14][15][16][26][27][28][29] It is worth noting that here was a weak negative correlation between depression and anxiety symptoms and leisuretime exercise, which corroborates existing studies. 19,20,21 However, no correlation was found between stress symptoms and leisure-time exercise, which contrasts previous researchers. 21 This differentiation could be attributed to the sample characteristics, since our sample was non-clinical. ...
One of the issues that have risen the past few decades due to excessive use of technological advances is internet gaming disorder (IGD). Past research has concluded that there is a negative association between IGD and exercise as well as a positive association between IGD and attention deficit hyperactivity disorder (ADHD). However, the existing studies on these subjects are scarce. Furthermore, researchers have showcased that symptoms of depression, anxiety and stress are positively associated with IGD and ADHD but negatively associated with exercise. Consequently, maybe these symptoms mediate the relationships between IGD, exercise and ADHD. The purpose of the present study is to investigate the relationship between IGD and exercise as well as between IGD and ADHD. A correlational study was conducted on 515 adults through Google forms. The Internet Gaming Disorder Scale-Short-Form was used to detect IGD symptoms, the Leisure-Time Exercise Questionnaire was utilized so as to evaluate participants' leisure - time exercise habits, and the Barkley Adult ADHD Rating Scale was used to assess ADHD symptoms. Furthermore, the Depression, Anxiety and Stress Scale-21 was utilized to evaluate symptoms of depression, anxiety, and stress. It was found that there is a negative correlation between IGD symptoms and leisure time exercise as well as a positive correlation between IGD symptoms and ADHD symptoms. Moreover, when taking all the variables that were examined into consideration, it was indicated that inattention symptoms and impulsivity symptoms were significantly associated with IGD symptoms whereas symptoms of depression were partially and significantly mediating the association between IGD symptoms and Attention deficit as well as the association between IGD symptoms and Impulsivity. The findings of the current study suggest that people who deal with IGD symptoms tend to exercise less on their free time. Additionally, people with more IGD symptoms display not only more ADHD symptoms, symptoms of inattention and impulsivity specifically, but also more symptoms of depression. Therefore, clinicians should evaluate the possible coexistence of such symptoms when treating people with IGD, in order to prevent as well as treat more efficiently IGD and its consequences.
... Previous studies have demonstrated that physical activity and nutrition can contribute to individual well-being (e.g., Hua et al., 2015;Rebar et al., 2015). Supporting H1, the present findings further indicated the beneficial effects Sex was coded as 0 = male and 1 = female. ...
The present research reports the findings of three studies, with objectives to demonstrate the impacts of health-promoting behaviors on psychological well-being as well as the mediating roles of sense of control (SOC) and perceived severity of COVID-19 in these relationships. Study 1 was a cross-sectional survey conducted in 473 middle-aged and older Chinese adults before the COVID-19 pandemic to assess their health-promoting behaviors, personal mastery and perceived constraints, life satisfaction, and depressive symptoms. Study 2 was conducted during the second wave of the COVID-19 outbreak in Hong Kong (between March to April 2020), in which 292 participants from Study 1 were successfully contacted to report their emotional responses to the pandemic. Using a different sample, Study 3 was a longitudinal study that measured 495 participants' health-promoting behaviors, personal mastery and perceived constraints at baseline, and their perceived severity and mental health outcomes during the outbreak of omicron cases in Hong Kong (i.e., the fifth wave of the COVID-19 outbreak) in March 2022. All three studies demonstrate that the beneficial effects of health behaviors can be extended to psychological well-being and reveal possible underlying mechanisms through enhancing one's SOC and lowering perceived severity of the COVID-19 outbreak. These results provide important insights to future health promotion programs for improving psychological resources and psychological well-being of middle-aged and older adults in face of disease-related threats.
... S. Kim et al., 2012;Ng et al., 2017) and mental illness (Hosker et al., 2019;Oddie et al., 2014) with minimal side effects (Vina et al., 2012). Physical activity is effective at reducing depression and anxiety in neurotypical populations (Kandola, Ashdown-Franks, Stubbs, Osborn, & Hayes, 2019;McDowell et al., 2019;Rebar et al., 2015) and emerging evidence suggests the same may be true for people with ADHD (Da Silva et al., 2020;Den Heijer et al., 2017;K. M. Fritz & O'Connor, 2016). ...
Objective:
The mental health of adults with ADHD was compared to neurotypical controls, and associations between cardiorespiratory fitness (CRF) and mental health were examined.
Method:
Seventy-two participants (n = 36 with ADHD) completed demographic questions assessing ADHD and mental health symptoms. CRF was estimated using the 6-Minute Walk Test and a self-perception question.
Results:
Those with ADHD had significantly poorer mental health outcomes than controls (p < .001), with 50% of adults with ADHD reporting moderate to extremely severe symptoms of depression, anxiety, and stress. Critically, lower CRF was associated with worse depression, anxiety, and stress (all p ≤ .03) across both groups. Within the ADHD group, those with higher estimated CRF had significantly lower stress. Among participants with less severe ADHD symptoms, those with higher perceived CRF had significantly lower depressive symptoms.
Conclusion:
In our cross-sectional study, participants with ADHD had poorer mental health than neurotypical controls, and higher fitness was associated with better mental health.
... Physical activity is an important health-related behavior that can be used to treat and prevent depression and anxiety, including in the non-clinical population 1) . In the working population, its effectiveness has also been confirmed 2) . ...
Objectives: This study explored the perceptions of workers regarding mobile health (mHealth) services for physical activity and mental health. Methods: Single, online, one-on-one, 60-minute semi-structured interviews were conducted with workers living or working in Tokyo, Japan. The transcribed text corpus of the interviews was used as data to explore their perceptions. The top 200 nouns in the utterances were extracted and modeled using a bag of words (BoW) and embedded into a two-dimensional space. Results: The interviews extracted 476 utterances with 1,294 nouns from the 12 workers (7 males and 5 females). A total of 10 themes were estimated from the top 200 nouns. The participants mostly agreed that physical activity was effective in improving their mental health. They needed individualized, attractive, and easy mHealth services. Other estimated themes were: limited effects of non-leisure physical activity on mental health, lower priority on physical activity rather than sleep and rest, reluctance to share the data within the groups, and difficulties in wearing the devices to measure physical activity due to work rules. Conclusion: Workers' perceptions of mHealth services were consistent with previous findings: the need for individualization, attraction, and ease of use. In the working population, mHealth services for physical activity and mental health should consider working conditions and focus on leisure-time physical activity. Social sharing might not be a mandatory technique because of the private topics and variety of associations between physical activity and mental health.
... heart rate, respiration), and avoidance, may also critically interact with uptake of and adherence to exercise. Furthermore, there are broader psychological benefits to exercise beyond the overall score reduction on anxiety or depressive scales that are typically reported for clinical [5] and subclinical populations [2]. Thus, an important bidirectional relationship may apply. ...
Background
Physical exercise has been shown to reduce anxiety and depression symptoms, the most common mental health disorders globally. Despite the benefits of exercise in anxiety and depression, the symptoms of these disorders may directly contribute to a lack of engagement with exercise. However, mental health-related barriers and benefits to exercise engagement have not been addressed in quantitative research. We introduce the development and psychometric validation of the Mental health-related barriers and benefits to EXercise (MEX) scale.
Methods
Three samples were collected online prospectively (sample 1 n = 492; sample 2 n = 302; sample 3 n = 303) for scale refinement and validation with exploratory and confirmatory factor analysis. All participants were generally healthy adults, aged 18–45, and had no history of severe mental illness requiring hospitalization and no physical disability impacting over 50% of daily function.
Results
We identified a 30-item, two-factor model comprising 15 barrier and 15 benefit items. Overall model fit was excellent for an item-level scale across the three samples (Comparative Fit Index = 0.935–0.951; Root-Mean-Square Error of Approximation = 0.037–0.039). Internal consistency was also excellent across the three samples (α = 0.900–0.951). The barriers subscale was positively correlated with symptoms of anxiety, depression and stress, and negatively correlated with measures of physical activity and exercise engagement. The benefits subscale was negatively correlated with symptoms of anxiety, depression and stress, and positively correlated with measures of physical activity and exercise engagement.
Conclusion
The MEX is a novel, psychometrically robust scale, which is appropriate for research and for clinical use to ascertain individual and/or group level mental health-related barriers and benefits to exercise.
... Exercise is well established as a therapeutic tool to improve metabolic and reproductive health outcomes in women with PCOS 21,22 , however, the impact on mental health and HRQoL is less clear 23,24 . In populations with other chronic conditions, exercise is known to be an effective tool for promoting positive mental health 25,26 . Existing research into the effect of exercise on mental health and HRQoL in women with PCOS suggests that exercise interventions may promote improvements in these outcomes 23,27,28 , however, large heterogeneity between studies makes it difficult to draw conclusions regarding the exercise requirements to promote mental health benefits. ...
Women with PCOS have substantially greater symptoms of depression and anxiety, and a lower health-related quality of life (HRQoL) compared to women without PCOS. The aim of this study was to determine if high-intensity interval training (HIIT) could provide greater improvements in mental health outcomes than standard moderate-intensity continuous training (MICT). Twenty-nine overweight women with PCOS aged 18–45 years were randomly assigned to 12 weeks of either MICT (60–75% HRpeak, N = 15) or HIIT (> 90% HRpeak, N = 14). Outcome measures included symptoms of depression, anxiety and stress (DASS-21), general HRQoL (SF-36) and PCOS specific HRQoL (PCOSQ) collected at baseline and post-intervention. Reductions in depression (Δ − 1.7, P = 0.005), anxiety (Δ − 3.4, P < 0.001) and stress (Δ − 2.4, P = 0.003) scores were observed in the HIIT group, while MICT only resulted in a reduction in stress scores (Δ − 2.9, P = 0.001). Reductions in anxiety scores were significantly higher in the HIIT group compared to the MICT group (β = − 2.24, P = 0.020). Both HIIT and MICT significantly improved multiple domain scores from the SF-36 and PCOSQ. This study highlights the potential of HIIT for improving mental health and HRQoL in overweight women with PCOS. HIIT may be a viable strategy to reduce symptoms of depression and anxiety in women with PCOS, however, large-scale studies are required to confirm these findings.
Trial registration number: ACTRN12615000242527.
... (2) Physical activity promotes relaxation: physical activity can help relax muscles and release tension that builds up during stress. (3) Physical activity improves mental health: physical activity can help reduce symptoms of depression and anxiety and improve self-esteem [46,47]. Other than physical activity, the effectiveness of breathing exercises such as diaphragmatic breathing [48], progressive muscle relaxation [49], meditation [50], yoga [51], gratitude journaling [52], listening to music [53], and autogenic training [54] is evident. ...
Detrimental effects of chronic stress on healthcare professionals have been well-established, but the implementation and evaluation of effective interventions aimed at improving distress coping remains inadequate. Individualized mHealth interventions incorporating sensor feedback have been proposed as a promising approach. This study aimed to investigate the impact of individualized, sensor-based mHealth interventions focusing on stress and physical activity on distress coping in healthcare professionals. The study utilized a multi-arm, parallel group randomized controlled trial design, comparing five intervention groups (three variations of web-based training and two variations of an app training) that represented varying levels of individualization to a control group. Both self-reported questionnaire data (collected using Limesurvey) as well as electrocardiography and accelerometry-based sensory data (collected using Mesana Sensor) were assessed at baseline and post-intervention (after eight weeks). Of the 995 eligible participants, 170 (26%) completed the post-intervention measurement (Group 1: N = 21; Group 2: N = 23; Group 3: N = 7; Group 4: N = 34; Group 5: N = 16; Control Group: N = 69). MANOVA results indicated small to moderate time-by-group interaction effects for physical activity-related outcomes, including moderate to vigorous physical activity (F(1,5) = 5.8, p = ≤0.001, η2p = 0.057) and inactivity disruption (F(1,5) = 11.2, p
... The recent release of the Canadian 24-Hour Movement Guidelines for Adults places an even greater emphasis on the importance of engaging in sufficient amounts of physical activity and sleep to achieve health benefits (Ross et al., 2020). For instance, evidence from several meta-analyses have shown that regular physical activity engagement provides numerous mental health benefits including, but not limited to reduced risk of depression and anxiety as well as improved affect and mental wellbeing (Guo et al., 2022;Pearce et al., 2022;Rebar et al., 2015;Rosenbaum et al., 2014;White et al., 2017). A recent study by Santos et al. (2023) predicted that failure to improve physical activity levels worldwide between 2020 to 2030 would result in 215.7 million new cases of depression and anxiety, representing 43% of all new cases of preventable non-communicable diseases. ...
... Indeed, research has shown that lifestyle behaviours are amenable to change via intervention during emerging adulthood (Wickham et al., 2020). Further, meta-analyses have shown that increased physical activity, dietary improvement, smoking cessation and other lifestyle modifications may improve mental health outcomes (Martland et al., 2020;Opie et al., 2015;Rebar et al., 2015;Taylor et al., 2014). As such, a next step for researchers is to explore the efficacy of integrated lifestyle interventions for improving mental health outcomes among emerging adults. ...
Background:
Little research has examined how lifestyle behaviours cluster together to contribute to mental health outcomes. The current study aimed to identify latent classes of emerging adult lifestyle behaviours (diet, physical activity, sedentary time, smoking, alcohol, cannabis, and other drug use) at age 20 years and their associations with depression, anxiety, and stress symptoms at age 22 and 27 years.
Methods:
Participants were 616 emerging adults enrolled in the Raine Study. Lifestyle classes at baseline were identified using latent class analysis. Longitudinal associations between latent class membership and risk of depression, anxiety, and stress symptoms were examined using logistic regression models.
Results:
Three lifestyle classes were identified: Class 1 (healthier pattern, n = 399 [64.8 %]), Class 2 (predominantly female, high substance-use, low physical activity pattern, n = 121 [19.6 %]), and Class 3 (predominantly male, high substance-use, poor diet pattern, n = 96 [15.6 %]). Following adjustment, Class 2 were at a higher risk of depression, anxiety, and stress symptoms at age 22 years, and a higher risk of anxiety and stress symptoms at age 27 years, compared to Class 1.
Limitations:
This study was limited by reliance on self-report data, lack of available indicators for parental socioeconomic status, and some measurement inconsistencies across variables. Adherence to lifestyle clusters over time was not assessed.
Conclusions:
Latent classes of lifestyle behaviours were identified among emerging adults, and differences in mental health outcomes were found among the classes at two prospective time points. Future research and prevention strategies for common mental disorders should target emerging adults and focus on lifestyle patterns.
... Lastly, physical activity also promotes mental health and may have therapeutic effects for clinical depression and anxiety disorders (Taquet et al., 2016;Chekroud et al., 2018;Sakai et al., 2021), which is another aspect of brain health. Interested readers may refer to other extensive reviews Physical Activity Guidelines Advisory Committee 2018; Hu et al., 2020) or meta-analyses (Cooney et al., 2013;Rebar et al., 2015;Schuch et al., 2016;White et al., 2017;Klil-Drori et al., 2020) for further information. ...
Physical activity is one of the modifiable factors of cognitive decline and dementia with the strongest evidence. Although many influential reviews have illustrated the neurobiological mechanisms of the cognitive benefits of physical activity, none of them have linked the neurobiological mechanisms to normal exercise physiology to help the readers gain a more advanced, comprehensive understanding of the phenomenon. In this review, we address this issue and provide a synthesis of the literature by focusing on five most studied neurobiological mechanisms. We show that the body's adaptations to enhance exercise performance also benefit the brain and contribute to improved cognition. Specifically, these adaptations include, 1), the release of growth factors that are essential for the development and growth of neurons and for neurogenesis and angiogenesis, 2), the production of lactate that provides energy to the brain and is involved in the synthesis of glutamate and the maintenance of long-term potentiation, 3), the release of anti-inflammatory cytokines that reduce neuroinflammation, 4), the increase in mitochondrial biogenesis and antioxidant enzyme activity that reduce oxidative stress, and 5), the release of neurotransmitters such as dopamine and 5-HT that regulate neurogenesis and modulate cognition. We also discussed several issues relevant for prescribing physical activity, including what intensity and mode of physical activity brings the most cognitive benefits, based on their influence on the above five neurobiological mechanisms. We hope this review helps readers gain a general understanding of the state-of-the-art knowledge on the neurobiological mechanisms of the cognitive benefits of physical activity and guide them in designing new studies to further advance the field.
... The excerpts from the next article makes physical activity Physical Activity (PA) significantly reduces the risk of viral infections [46,47] and levels of anxiety [48,49]. In addition to its short-term benefits, regular PA lowers one's risk of suffering from chronic health conditions (e.g., diabetes, coronary heart disease, and hypertension) which are cited as the most frequent comorbidities in recent studies of COVID-19. ...
... Hal ini bertentangan dengan beberapa penelitian sebelumnya yang menunjukkan hasil signifikan pada kedua variabel dan menyatakan bahwa aktivitas fisik merupakan faktor penting dalam penurunan risiko maupun gejala depresi. 21,22 Penelitian ini memiliki hasil yang serupa dengan penelitian Hermanto dimana aktivitas fisik dan kejadian depresi tidak memiliki hubungan yang signifikan secara statistik. 19 Toseeb et al. juga melaporkan bahwa gejala depresi tidak signifikan diprediksi oleh aktivitas fisik. ...
Latar belakang: Peningkatan gejala depresi terjadi pada mahasiswa kedokteran tahun kedua disebabkan beban berat dan materi pembelajaran yang semakin sulit. Padatnya jadwal perkuliahan dan kegiatan kemahasiswaan menyebabkan kurangnya aktivitas fisik yang akan berhubungan dengan peningkatan gejala depresi. Metode: Penelitian ini merupakan penelitian analitik dengan desain potong lintang dan menggunakan teknik total sampling dengan jumlah subjek penelitian 93 mahasiswa Program Studi Kedokteran Fakultas Kedokteran Universitas Tanjungpura tahun kedua. Alat ukur penelitian menggunakan kuesioner Global Physical Activity Questionnaire (GPAQ) untuk mengukur tingkat aktivitas fisik dan Beck Depression Inventory II (BDI II) untuk mengukur tingkat depresi. Data dianalisis menggunakan uji korelasi Spearman Rank. Hasil: Berdasarkan uji statistik didapatkan nilai p=0,707 dengan nilai koefisien korelasi (r)=-0,040. Kesimpulan: Tidak terdapat hubungan antara tingkat aktivitas fisik dan tingkat depresi pada mahasiswa tahun kedua Program Studi Kedokteran Fakultas Kedokteran Universitas Tanjungpura.
... MMA can also increase self-control skills, and reduce hostile thoughts [7]. In addition to children and adolescents physical activity has been shown to reduce symptoms in adults with clinical and non-clinical anxiety or depression [2,15]. Participating in leisure time physical activities is linked to lower levels of anxiety within adults [16]. ...
Background
Physical activity benefits physical and mental health. However, limited research investigates if physical activity can improve outcomes from the grieving process following the death of a parent.
Methods
Semi-structured interviews were conducted with 14 individuals ( n = 8 female; age M = 31.2 years), who had experienced the death of a parent when they were aged between 10 and 24 years old, using retrospective recall. Data were analysed inductively using thematic analysis.
Results
Six themes were identified. Physical activity was seen as; 1) ‘ Therapeutic’ ; providing an 2) ‘ Emotional Outlet’ and created a strong sense of 3) ‘ Social Support’ . Alongside it 4) ‘ Builds Confidence’ , and led to 5) ‘ Finding Yourself’ and 6) ‘ Improved Health and wellbeing’ (physical and psychological).
Conclusion
Physical activity has the potential to provide positive experiences following a parental bereavement. It can provide a sense of freedom and was seen to alleviate grief outcomes, build resilience, enable social support and create a stronger sense of self. Bereavement support services for young people who have experienced death of a parent should consider physical activity as a viable intervention to support the grieving process.
... PA could reduce the symptoms of anxiety, fatigue, loneliness, depression, and mood state [109]. A significant positive correlation was documented between PA and mental well-being [70]. ...
Introduction
Earlier studies demonstrated a decreased level of physical activity (PA) during the COVID-19 pandemic. Therefore, we aimed to systematically review the relevant studies among various age groups and explore the impact on physical and mental health.
Methods
We searched and retrieved all relevant articles using the keywords on the online databases of PubMed, Embase, and Cochrane from the start of the pandemic until May 3rd, 2021. A two-phase screening process of identified records was carried out to shortlist the most relevant studies. First, the studies were evaluated based on their title/abstract, and then the full-text of included studies was thoroughly read. The eligible studies based on the eligibility criteria were included in this review.
Results
A total of 57 studies were included based on the eligibility criteria. Lockdowns and infection with SARS-CoV-2 have led to a decreased level of PA in the general population compared to the pre-pandemic era. Men had significantly less PA compared to women in some studies, probably due to higher pre-pandemic PA. The level of PA among those with chronic diseases also significantly diminished, putting them at a higher risk of cardiovascular incidents. Sedentary lifestyles have dominated people’s life, including adolescents and university students. The increased levels of mental health issues, such as depression, anxiety, and occupational stress, have been suggested to contribute to the decreased PA. On the other hand, the decreased PA appeared to lead to more mental health issues. Fortunately, the decreasing trend of PA seemed to taper towards the end of the quarantines.
Conclusion
Overall, the COVID-19 pandemic and subsequent quarantines reduced PA among all age groups and both sexes and had detrimental effects on people's physical and mental health. We suggest countries implement strategies to alleviate restrictions and encourage people to exercise in safe environments and prepare healthy routines for themselves.
... Physical activity has a multitude of benefits for physical and mental health. For instance, robust observational and experimental evidence indicates that regular physical activity or exercise can help prevent or manage multiple chronic physical conditions, such as cardiovascular disease, metabolic syndrome, and cancer, as well as chronic psychiatric conditions, such as depression and anxiety [1][2][3][4]. Despite these benefits, globally, more than 25% of adults and more than 80% of adolescents do not meet recommended minimum levels of physical activity [1,5]. ...
A growing body of research is exploring the potential added health benefits of exercise when performed outdoors in nature versus indoors. This systematic review aimed to compare the effects of exercise in outdoor environments versus indoor environments on psychological health, physical health, and physical activity behaviour. We searched nine databases from inception to March 2021 for English language, peer-reviewed articles: MEDLINE, Embase, PubMed, Scopus, Web of Science, CINAHL, SportsDiscus, GreenFile, and CENTRAL. We included randomized and non-randomized trials that compared multiple bouts of exercise in outdoor versus indoor environments, and that assessed at least one outcome related to physical health, psychological health, or physical activity behaviour. Due to minimal outcome overlap and a paucity of studies, we performed a narrative synthesis. We identified 10 eligible trials, including 7 randomized controlled trials, and a total of 343 participants. Participant demographics, exercise protocols, and outcomes varied widely. In the 10 eligible studies, a total of 99 comparisons were made between outdoor and indoor exercise; all 25 statistically significant comparisons favoured outdoor exercise. Interpretation of findings was hindered by an overall high risk of bias, unclear reporting, and high outcome heterogeneity. There is limited evidence for added health or behaviour benefits of outdoor exercise versus indoor exercise. Rigorous randomized controlled trials are needed with larger samples and clear reporting.
... p = 0.020), this result is similar to the present study. Recent research has documented the advantages of exercise or physical activity in terms of health and psychological gains (Rebar et al., 2015;White et al., 2017). In addition, regular physical activity can result in positive behavioural changes, improving mental health by promoting skills to cope with stressful events arising from the COVID-19 pandemic (Alsalhe et al., 2020;Puccinelli et al., 2021). ...
Background:
During the coronavirus disease 2019 (COVID-19) pandemic, undergraduate students were exposed to symptoms of psychological suffering during remote classes. Therefore, it is important to investigate the factors that may be generated and be related to such outcomes.
Objective:
To investigate the association between fear of COVID-19, depression, anxiety, and related factors in undergraduate students during remote classes.
Methods:
This cross-sectional study included 218 undergraduate students (60.6% women and 39.4% men). Students answered a self-administered online questionnaire designed to gather personal information, pandemic exposure, physical activity level, fear of COVID-19 using the "Fear of COVID-19 Scale," symptoms of depression using the Patient Health Questionnaire-9, and anxiety using General Anxiety Disorder-7.
Results:
Undergraduate students had a high prevalence of depression and anxiety (83.0% and 76.1%, respectively) but a low prevalence of fear of COVID-19 (28.9%) during remote classes. Multivariate analysis revealed that women who reported health status as neither good nor bad and who had lost a family member from COVID-19 had the highest levels of fear. For depression and anxiety, the main related factors found were female gender, bad health status, insufficiently active, and complete adherence to the restriction measures.
Conclusion:
These findings may be used to develop actions to manage symptoms of anxiety and depression among students, with interventions through physical activity programs to improve mental health.
... Smoking (25), alcohol use (26), body mass index (BMI) (27), physical activity (28), socioeconomic status (29), and a history of skin disease with pruritus (30) were considered as possible confounders because of their known association with psychological symptoms. ...
Pruritus has an extensive impact on functional, social and psychosocial behaviour. The association between pruritus and psychological well-being has mostly been studied among selected patient groups, whereas population-based studies are lacking. The aim of this study was to determine the association between pruritus and insomnia, quality of life, depression and anxiety at the population level in the general population. A cross-sectional population-based study was conducted in 2012 to 2013. Study subjects (n = 6,809) belonging to the Northern Finland Birth Cohort 1966 Study participated in a large follow-up study at the age of 45-47 years. They completed an extensive health questionnaire including questions on pruritus and several previously validated questionnaires regarding symptoms of psychosocial well-being. Pruritus affected 19.9% of the study subjects weekly, being more common in women than in men (p < 0.001). A significant association was found between both localized and generalized pruritus and symptoms of insomnia, depression, anxiety and decreased quality of life. The association was seen even in those with mild psychological symptoms/insomnia, and it affected both sexes. The severity of psychological symptoms increased with increasing frequency of pruritus. In conclusion, pruritus has a multiple effect on psychosocial well-being. Physicians should consider possible psychosocial symptoms in patients with pruritus.
... Low PA levels are associated with an increased prevalence of anxiety [12]. Similarly, a metaanalysis of 92 studies concluded that PA has a significant medium effect in reducing symptoms of depression and a low effect in reducing symptoms of anxiety [13]. On ...
Most research support positive relationships between physical activity and mental health. However, possible moderating variables of these relationships have also been identified, such as age, gender, level of physical activity, and the scope of physical activity. This study aimed to analyze the relationships between physical activity and mental health levels in undergraduate students, assessing whether these associations can change depending on the level of physical activity (low, medium, or high) and the setting (occupational, commuting, or leisure time physical activity) in which it was performed. A descriptive and cross-sectional study was conducted. The sample comprised 847 undergraduate students. Physical activity and mental health were measured by the Global Physical Activity Questionnaire (GPAQv2) and the General Health Questionnaire (GHQ-12). We found relationships between students’ physical activity level and their mental health status. The higher the total physical activity, the better their mental health scores. High levels of commuting and leisure time physical activity is also associated with better mental health, while only moderate levels of occupational physical activity are associated with better mental health status. Regarding the possible associations between physical activity and vulnerability to mental health problems, with the fully adjusted regression model, leisure time and occupational physical activity remain protective of a poor state of mental health. Leisure time physical activity, performed at a high level, and moderate occupational physical activity seems to be the best combination of physical activity to reduce students’ vulnerability to potential mental health problems.
... Increases in levels of stress, anxiety and depression are the main mental disorders reported in the confinement situation due to the COVID-19 pandemic (Maher et al., 2021;Ugbolue et al., 2020). In this research, the most affected group was the physically less active, whose PIL test values converge towards the existential void zone, which can be explained, since they do not enjoy the protective effect of PA on mental states associated with anxiety, stress and depression (De Mello et al., 2013;Mammen & Faulkner, 2013;Rebar et al., 2015). This result is in agreement with that reported by Faulkner et al. (2021), who found that in a sample of people from the United Kingdom,New Zealand,Ireland,and Australia (N = 8,425;44.5 ...
Social isolation and widespread confinement in many countries has caused a decrease in physical activity (PA) and an increase in levels of stress, anxiety and depression. The purpose in life is part of the psychological well-being of people, and having a clear purpose allows them to face adversity. In this sense, the influence of PA on psychological well-being in confinement situations makes it necessary to study and promote it by educational and government entities. The objective of this work was to evaluate the incidence of an intervention program with PA (Move at home) on the purpose in life during a period of mandatory confinement due to COVID-19. 360 university students divided into three groups participated: control (Sedentary, Thirst), and experimental (group with low physical activity, BAct, and physically active, Act). The experimental groups underwent a PA intervention program for 11 weeks, from the beginning to the end of the mandatory confinement. A weekly online questionnaire was collected, recording the PA level (min/week) and the results of the PIL test (purpose in life). The PA level decreased significantly at the beginning of the confinement and increased significantly in the easing phases. The intervention program was able to contribute to maintaining the PA level in the participants. Physical activity has a positive effect on purpose in life and the practice of some physical exercise on a regular basis could be a crucial tool to face a state of mandatory confinement.Keywords: health, sport, coronavirus, life purpose, emotions
... Furthermore, sufficient PA behavior promotes cognitive functioning, quality of life, and academic achievement (Kelly et al., 2014;Pedersen & Saltin, 2015;Pedišić et al., 2014;Wald, Muennig, O'Connell, & Garber, 2014). Although there are a wide variety of cross-sectional, randomized control trials (RCTs), and reviews that have examined the benefit of regular PA, most of these studies have combined university students with adult populations or specifically focused on children (Asmundson et al., 2014;Biddle & Asare, 2011;Rebar et al., 2015;Rhodes et A systematic review of peer-reviewed literature published from 2010 to July 2020 was conducted. Studies were only included from 2010 to explicitly examine one generation of undergraduate students and to include the most recent interventional research. ...
The purpose of this review was to systematically review the published research on the effect of physical activity (PA) interventions on PA behavior among university students. A PA intervention was defined as participants engaging in PA and measuring changes in PA from pre- to post-intervention. Studies were eligible for inclusion if they were (1) published in peer-reviewed English-language journals, (2) included undergraduate university students, (3) implemented a PA intervention, and 4) assessed PA via self-report or direct measures. Fourteen studies met the inclusion criteria and were analyzed in this review. PA interventions were more effective than other techniques or control settings in improving PA behavior in university student participants. The review discusses sample characteristics, study design, PA behavior measurement, PA intervention implementation, and the theoretical frameworks of the studies, along with limitations of the research and suggestions for future researchers.
... In alignment with previous research, the current study supports that exercise benefits mental health in adult population (Carek et al., 2011;Rebar et al., 2015;Bernstein and McNally, 2018). However, in this study, only participants of the CoD group reduced depression, anxiety and stress levels after the intervention. ...
... Previous research reports that depressive and anxiety symptoms are positively correlated with loneliness (Hawkley & Capitanio, 2015;Meltzer et al., 2013;Richardson et al., 2017), and negatively associated with physical activity (Ashdown-Franks et al., 2020). Furthermore, a wide range of studies show that physical activity and exercise can improve depressive and anxiety symptoms (Ashdown-Franks et al., 2020;Oberste et al., 2020;Rebar et al., 2015) and also specifically the co-occurrence of these symptoms (Oftedal et al., 2019). Therefore, we hypothesize that the presence of depressive and anxiety symptoms reduces the beneficial effect of physical activity on loneliness the following moment, and that it enhances the negative effect of loneliness on physical activity the following moment. ...
Adolescents and young adults are at high risk for experiencing loneliness, a well-established risk factor for mental health symptoms. Being physically active is known to reduce feelings of loneliness. We explored the association between physical activity and loneliness using the experience sampling method, allowing us to investigate moment-to-moment variations on the within-person level. The sample consisted of 784 participants (58.0% females), aged 15–25 years (mean 16.9 years). They responded to a questionnaire ten times a day for six days. We hypothesized an inverse bidirectional relationship between within-person physical activity and within-person loneliness. Additionally, we hypothesized an interaction effect of the within-person affective valence and of depression and anxiety symptoms. Univariate multilevel models were used. Results did not show a significant association between physical activity and loneliness on the within-person level, but there was a significant interaction effect where physical activity was associated with less subsequent loneliness at moments with high affective valence. These findings indicate that only when physical activity is experienced as something young people enjoy doing, feel competent about and when it does not require too much effort, it decreases feelings of loneliness the subsequent moment. There was no significant interaction effect with depression and anxiety symptoms. In conclusion, the results of this study give us a better understanding of the association between physical activity and loneliness in young people. This study highlights the importance of contextual factors when investigating psychosocial outcomes of physical activity.
... In alignment with previous research, the current study supports that exercise benefits mental health in adult population (Carek et al., 2011;Rebar et al., 2015;Bernstein and McNally, 2018). However, in this study, only participants of the CoD group reduced depression, anxiety and stress levels after the intervention. ...
A growing body of research suggests that physical activity and exercise enhance a wide range of cognitive and affective wellbeing, including executive functions (Ludyga et al., 2020; Ishihara et al., 2021), memory (Wanner et al., 2020; Aghjayan et al., 2022), creative thinking (Aga et al., 2021; Chen et al., 2021), stress resilience (Arida and Teixeira-Machado, 2021; Belcher et al., 2021), and mental health (Chen et al., 2017; White et al., 2017). Exercise has also been recommended for the treatment of dementia (Cardona et al., 2021) and major depression (Cooney et al., 2013). However, it is still unclear what type, frequency and duration of physical activity and exercise bring the maximal benefits to a specific outcome in a specific population. Furthermore, how findings reported so far can be incorporated into people's everyday life and in educational and psychiatric contexts also remain unaddressed. Finally, the underlying psychological and neurobiological mechanisms of the benefits of physical activity and exercise are still largely unclear. This Research Topic comprises twelve papers that help address these unsolved issues and advance our understanding of the cognitive and affective benefits of physical activity and exercise. Specifically, four important topics emerged from these studies.
Firstly, even a short bout of physical activity or exercise at relatively low intensity may have cognitive and affective benefits. A real-life study by Matsumoto et al. reported that compared to using the elevator, stair-climbing at one's usual pace for three floors roundtrip boosted divergent creative thinking, as assessed by the Alternate Use test. Ando et al. found that both 30 min of aerobic and resistance exercise at a light intensity (40% peak oxygen uptake) reduced participants' reaction time on a Go/No-Go task that measures executive function. However, changes in cognitive performance were not associated with several peripheral biomarkers, including adrenaline, noradrenaline, cortisol, lactate, etc., which calls for further in-depth investigation on other potential mechanisms underlying the cognitive benefits of physical exercise. Physical activity and exercise at low intensities may also improve mental health and have anti-depressant effects. Legrand et al. found that brisk walking for 30 min either in an urban or a green, natural environment reduced participants' negative affect. However, only walking in the green, natural environment increased participants' positive affect, which emphasized the superior benefits of “green exercise” (Chen, 2018; Li et al., 2022). Given that depressed patients often have reduced exercise motivation and physical fitness, Sakai et al. developed an exercise program consisting of 15–25 min of cycling twice a week at an intensity that approaches but never goes higher than subjects' ventilatory threshold (considered light to moderate in intensity). In a pilot study, the authors reported promising therapeutic effects of this program in depressed patients.
Secondly, the effect of high intensity exercise on cognitive performance may depend on the characteristic of exercise and participants. A review by Sudo et al. found that cognitive performance during acute high intensity aerobic exercise is generally impaired while no impairment and even improvement is observed when cognitive tasks are administered over 6 min after high intensity exercise. They also found that cognitive impairment during high intensity exercise is more likely to occur to individuals with low physical fitness and during cycling than running. Age may be another moderating factor but more research is required to reach sound conclusions. The authors also discussed the underlying mechanism of such cognitive-exercise interaction, including regional cerebral blood flow, cerebral oxygenation and metabolism, neurotransmitters, and neurotrophic factors. In contrast to during high intensity exercise, cognitive performance during moderate intensity exercise may be more likely to be enhanced. In a study by Zheng et al., participants stayed sedentary (seating) or exercised on a cycle ergometer at 50% maximal aerobic power for 15 min while simultaneously performed a n-back task and undergone functional near-infrared spectroscopy (fNIRS). It was found that the reaction time for the n-back task was faster in the cycling than seating condition, which was accompanied by reduced concentration of oxygenated hemoglobin in several brain areas, including the dorsolateral prefrontal cortex. Ballester-Ferrer et al. investigated the effects of a 10-week high-intensity functional training program, in which all-out running, jumping rope, or muscle endurance exercise were performed for 10–30 min, 3 times per week. The authors found that while participants in the control group without such training showed no improvement on reaction time on tasks such as the Choice Reaction Test and Interference Test throughout the 10-week period, participants in the training group demonstrated shorter reaction time on these tasks. However, the effect of the training program on psychological wellbeing was absent.
Thirdly, studies have been using mediation analysis to uncover the mechanisms of the benefits of physical activity and fitness. Potoczny et al. found that the effect of Karate training on satisfaction with life was fully mediated by self-control and reappraisal. Hernández-Jaña et al. found that cardiorespiratory fitness and speed-agility fitness but not muscular fitness mediated the association between BMI/central fatness and cognitive performance on eight tasks evaluating working memory, psychomotor speed, and fluid and logical reasoning, etc. Together with evidence that adiponectin, a hormone released by adipocytes, mediates the antidepressant-like and hippocampal neurogenesis enhancing effect of wheel running in mice (Yau et al., 2014), the latter study highlights the interaction between fitness and fatness in influencing cognitive and affective wellbeing.
Fourthly, given that many individuals especially females (Clemente et al., 2016) are physically inactive, there are a number of ways for people to increase physical activity and use physical activity as a strategy to boost cognitive and affective wellbeing in everyday life. As suggested by Legrand et al., one may want to walk to work or walk for one bus stop while commuting and when walk, one may walk to choose greener routes. As suggested by Matsumoto et al., in the workplace, one may want to take the stairs rather than using the elevator whenever possible. Brown and Kwan suggested another strategy, replacing screen time with physical activity. Using isotemporal substitution analysis, the authors found that replacing screen time with moderate-to-vigorous physical activity or sleep is associated with enhanced mental wellbeing. Furthermore, Shen et al. suggests that rather than pure physical activity, activities that simultaneously require cognitive processing may bring greater benefits. The authors found that 8 weeks of Tai Chi Chuan, a mindfulness exercise that tries to integrate the body and mind, improved inhibitory control performance as indicated by reduced reaction time on a flanker task more than that by 8 weeks of brisk walking. Using resting-state functional magnetic resonance imaging (fMRI), the authors found that the improved inhibitory control performance was correlated with spontaneous neural activity in the left medial superior frontal gyrus. Finally, Almarcha et al. suggests that compared to exercise programs prescribed by other people, co-designed exercise programs with inputs from the participants may bring greater benefits. The authors found that whereas a co-designed 9-week exercise program improved self-reported mental health in seven of eight scales used, a prescribed exercise program improved mental health only in three scales.
... Physical activity is an important health-related bodily activity for treating and preventing depression and anxiety [1]. Daily physical activity protects against depressive moods experienced by individuals in their daily lives [2]. ...
Background:
Digital data on physical activity are useful for self-monitoring and preventing depression and anxiety. Although previous studies have reported machine or deep learning models that use physical activity for passive monitoring of depression and anxiety, there are no models for workers. The working population has different physical activity patterns from other populations, which is based on commuting, holiday patterns, physical demands, occupations, and industries. These working conditions are useful in optimizing the model used in predicting depression and anxiety. Further, recurrent neural networks increase predictive accuracy by using previous inputs on physical activity, depression, and anxiety.
Objective:
This study evaluated the performance of a deep learning model optimized for predicting depression and anxiety in workers. Psychological distress was considered a depression and anxiety indicator.
Methods:
A 2-week longitudinal study was conducted with workers in urban areas in Japan. Absent workers were excluded. In a daily survey, psychological distress was measured using a self-reported questionnaire. As features, activity time by intensity was determined using the Google Fit application. Additionally, we measured age, gender, occupations, employment status, work shift types, working hours, and whether the response date was a working or nonworking day. A deep learning model, using long short-term memory, was developed and validated to predict psychological distress the next day, using features of the previous day. Further, a 5-fold cross-validation method was used to evaluate the performance of the aforementioned model. As the primary indicator of performance, classification accuracy for the severity of the psychological distress (light, subthreshold, and severe) was considered.
Results:
A total of 1661 days of supervised data were obtained from 236 workers, who were aged between 20 and 69 years. The overall classification accuracy for psychological distress was 76.3% (SD 0.04%). The classification accuracy for severe-, subthreshold-, and light-level psychological distress was 51.1% (SD 0.05%), 60.6% (SD 0.05%), and 81.6% (SD 0.04%), respectively. The model predicted a light-level psychological distress the next day after the participants had been involved in 3 peaks of activity (in the morning, noon, and evening) on the previous day. Lower activity levels were predicted as subthreshold- and severe-level psychological distress. Different predictive results were observed on the basis of occupations and whether the previous day was a working or nonworking day.
Conclusions:
The developed deep learning model showed a similar performance as in previous studies and, in particular, high accuracy for light-level psychological distress. Working conditions and long short-term memory were useful in maintaining the model performance for monitoring depression and anxiety, using digitally recorded physical activity in workers. The developed model can be implemented in mobile apps and may further be practically used by workers to self-monitor and maintain their mental health state.
... In addition to duration, physical activity guidelines suggest children accrue a variety of intensities in their movements throughout the day, with greater amounts of energetic play being best for children's health and development (World Health Organization, 2019). For instance, walking or stretching is good for restoring attention (Bailey et al., 2018) whereas higher intensities like running and jumping jacks protect heart health and reduce feelings of anxiety and depression (Helgerud et al., 2007;Rebar et al., 2015). The continuum of intensity ranges from standing to light walking to higher intensities in the "huff and puff" category that result in a higher heart rate or get children out of breath. ...
Self-regulation is a critical emergent developmental competency that lays the foundation for children’s later psychosocial health and academic achievement. Recent work indicates that physical activity and energetic play opportunities support children’s self-regulation in the early childhood classroom. Many early childhood programs offer opportunities for children to engage in play, but teachers are rarely seen modeling physically active behaviors and face barriers to integrating opportunities for energetic play with early academic skills. Early childhood educational settings hoping to support children’s self-regulation development can provide multiple opportunities for children to observe teachers modeling physical activity, provide teacher support and scaffolding for physically active learning centers, and engage children in meaningful energetic play while promoting a range of academic skills. This article provides 10 research-based guidelines for supporting children’s self-regulation development through physical activity in early childhood classrooms.
Background:
Post-exertional malaise (PEM) is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) yet its diverse manifestations make it difficult to recognize. Brief instruments for detecting PEM are critical for clinical and scientific progress.
Objective:
To develop a clinical prediction rule for PEM.
Method:
49 ME/CFS and 10 healthy, sedentary subjects recruited from the community completed two maximal cardiopulmonary exercise tests (CPETs) separated by 24 hours. At five different times, subjects reported symptoms which were then classified into 19 categories. The frequency of symptom reports between groups at each time point was compared using Fisher's exact test. Receiver operating characteristics (ROC) analysis with area under the curve calculation was used to determine the number of different types of symptom reports that were sufficient to differentiate between ME/CFS and sedentary groups. The optimal number of symptoms was determined where sensitivity and specificity of the types of symptom reports were balanced.
Results:
At all timepoints, a maximum of two symptoms was optimal to determine differences between groups. Only one symptom was necessary to optimally differentiate between groups at one week following the second CPET. Fatigue, cognitive dysfunction, lack of positive feelings/mood and decrease in function were consistent predictors of ME/CFS group membership across timepoints.
Conclusion:
Inquiring about post-exertional cognitive dysfunction, decline in function, and lack of positive feelings/mood may help identify PEM quickly and accurately. These findings should be validated with a larger sample of patients.
Studies have demonstrated that physical activity (PA) is negatively associated with academic procrastination. However, there is limited research on the mechanism underlying this relationship. This study aims to explore the relationship between PA and academic procrastination by investigating the roles of physical self-perceptions and self-esteem. 916 college students (650 females; Mean age = 19.11, SD age = 1.04) participated in the study. Participants completed the Physical Activity Rating Scale-3, the Physical Self-Perceptions Profile, the Rosenberg Self-Esteem Scale, and the Academic Procrastination Questionnaires. Descriptive statistics, Pearson’s correlation, and mediating effect analysis were carried out using SPSS 25.0. The results showed that (a) PA, physical self-perceptions, and self-esteem were negatively correlated with academic procrastination, (b) self-esteem mediated the association between PA and academic procrastination, and (c) physical self-perceptions and self-esteem sequentially mediated the association between PA and academic procrastination. These findings have deepened our understanding on the relationship between PA and academic procrastination, highlighting important approaches to deal with academic procrastination.
Background:
High-grade inflammation represents a critical contribution to the onset of depression and might be manageable by physical activity (PA). Nevertheless, no study has examined synergistic interactions of insufficient PA and high values of the systemic immune-inflammation index (SII) on psychological problems.
Objective:
We investigated independent and synergistic interactions of insufficient PA and high SII levels on stress, anxiety, and depression in T2DM patients.
Methods:
A cross-sectional research design with 294 T2DM patients was conducted. An XP-100 automated hematology analyzer was used to evaluate inflammatory biomarkers. Depression, Anxiety, and Stress Scale-21 items and a standardized questionnaire about PA were respectively used to measure psychological problems and metabolic equivalent of task (MET)-h/week.
Results:
A multiple linear regression demonstrated that patients with insufficient PA were significantly more likely to have higher stress (β = 1.84, 95% confidence interval (CI) = 1.03-2.65), anxiety (β = 1.88, 95% CI = 1.81-2.96), and depression (β = 2.53, 95% CI = 0.82-4.24) than those with active PA. A high SII level was a key predictor and was most strongly associated with stress (β = 2.61, 95% CI = 2.02-3.20), anxiety (β = 3.16, 95% CI = 2.37-3.94), and depression (β = 3.72, 95% CI = 2.49-4.96) compared to those who had low SII levels. Notably, additive interaction results showed that combining insufficient PA and a high SII level had a significantly escalated 1.71-fold risk of stress, 1.82-fold risk of anxiety, and 2.69-fold risk of depression.
Conclusions:
Active PA and a low SII had a positive synergistic effect of decreasing psychological problems.
Unlabelled:
The COVID-19 pandemic has forced social isolation affecting all areas of life. It also affected the functioning of schools and universities. Many countries have introduced full or partial distance learning. The aim of the study was to assess the level of physical activity and student mood of the Faculty of Physiotherapy of the Academy of Physical Education in Wrocław (Poland) and students of the Faculty of Health of the ODISSE University in Brussels (Belgium) after a year of the study conducted in a mixed mode due to contact restrictions resulting from the COVID-19 pandemic and checking which of the analyzed factors increases the risk of depression to the greatest extent.
Material and methods:
297 students from the 2nd to 4th year of full-time studies took part in the observation. The academic year 2020/2021 was assessed. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) recommended for this type of analysis by WHO. The GPAQ questionnaire enables the assessment of activity performed at work, movement, and leisure time and assesses the time of sitting or resting in a supine position. The Beck Depression Inventory was used to assess mental health. The subjects also completed a questionnaire concerning selected somatic features and describing their living conditions in the previous year.
Results:
In the group of Polish students, classes conducted in a completely remote mode accounted for about 50%, while in the group of Belgian students, about 75%. In the described period, 19% of students from Poland and 22% of students from Belgium were infected with COVID-19. The median of the results of the Beck Depression Scale in both groups was lower than 12 points (7 points in the AWF group and 8 points in the ODISSE group, respectively). A detailed analysis showed that in both study groups, more than 30% of students received results showing a depressed mood. A total of 19% of the surveyed students of the University of Physical Education and 27% of the ODISSE students were characterized by a result indicating mild depression. The results of the GPAQ questionnaire show that the total physical activity, including work/study, recreation, and mobility was 16.5 h a week for students from Poland and 7.4 h a week for students from Belgium.
Conclusions:
Both groups of subjects reached all the thresholds recommended by the WHO as a sufficient level of weekly physical activity. A group of students of the Faculty of Physiotherapy of the University of Physical Education in Wrocław was characterized by more than twice as high (statistically significant) level of weekly physical activity as compared to the group of participants from the ODISSE University in Brussels. In both study groups, more than 30% of students experienced a lowered mood of varying intensity. It is necessary to monitor the mental state of students and, in the event of obtaining control results at a similar level, to implement psychological assistance for willing participants.
Objective: Despite the well-documented benefits of regular physical activity (PA), many university students are physically inactive. Multiple factors, including perceived barriers and benefits and environmental factors (e.g., availability of exercise facilities), predict PA engagement behaviours in university students. This study primarily evaluated the barriers and facilitators to PA engagement in Zimbabwean undergraduate students using the Exercise Benefits and Barriers Scale. We also evaluated the correlates of exercise barriers and benefits to PA levels, mental health disorders and health-related quality of life (HRQoL). We recruited 465 university students. Data were analysed through descriptive statistics and logistic regression using SPSS Version 27.
Results: The mean perceived benefits and barriers to PA were 95±11.4 and 28.6±5.4, respectively. The most perceived benefits were in the physical performance and life enhancement domains, while lack of exercise infrastructure and physical exertion were the most perceived barriers. Food insecurity and the risk of CMDS were associated with increased odds of experiencing barriers to exercise. Not using substances and a higher self-rated HRQoL were associated with increased odds of a high perception of exercise benefits. It is needful to improve access to on-campus exercise facilities and campus-wide health promotional interventions to enhance PA amongst university students.
Objective
To synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations.
Design
Umbrella review.
Data sources
Twelve electronic databases were searched for eligible studies published from inception to 1 January 2022.
Eligibility criteria for selecting studies
Systematic reviews with meta-analyses of randomised controlled trials designed to increase physical activity in an adult population and that assessed depression, anxiety or psychological distress were eligible. Study selection was undertaken in duplicate by two independent reviewers.
Results
Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=−0.43, IQR=−0.66 to –0.27), anxiety (median effect size=−0.42, IQR=−0.66 to –0.26) and psychological distress (effect size=−0.60, 95% CI −0.78 to –0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions.
Conclusion and relevance
Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.
PROSPERO registration number
CRD42021292710.
People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.
Greater cortisol reactivity to stress is often assumed to lead to heightened negative affective reactivity to stress. Conversely, a growing body of evidence demonstrates mood-protective effects of cortisol elevations in the context of acute stress. We administered a laboratory-based stressor, the Trier Social Stress Test (TSST), and measured cortisol and emotional reactivity in 68 adults (48 women) between the ages of 25 and 65. In accordance with our pre-registered hypothesis (https://osf.io/t8r3w) and prior research, negative affective reactivity was inversely related to cortisol reactivity assessed immediately after the stressor. We found that greater cortisol response to acute stress is associated with smaller increases in negative affect, consistent with mood-protective effects of cortisol elevations in response to acute stress.
Objective:
Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) are implicated in numerous illnesses including depression. The literature is mixed regarding the relationship between n-3 PUFA levels and depression, and studies based on self-reported dietary n-3 PUFA intake may not accurately reflect in vivo levels.
Method:
The current cross-sectional analysis examined the relationship between erythrocyte levels (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and depressive symptoms (Center for Epidemiologic Studies Depression Scale; CESD), adjusting for health-related factors and omega-3 supplement use in 16,398 adults assessed at the Cooper Clinic in Dallas, Texas for preventative medical examinations between April 6, 2009, and September 1, 2020. A three-stage hierarchical linear regression was conducted to examine the EPA and DHA levels on CES-D before and after inclusion of cardiorespiratory fitness (CRF) and high sensitivity C-reactive protein (hs-CRP) in the model.
Results:
DHA level, but not EPA level, was significantly associated with CES-D scores. Taking omega-3 supplements was associated with lower CES-D scores even when adjusting for CRF, while hs-CRP was non-significantly associated with CES-D scores. These findings suggest that DHA levels are related to depressive symptom severity. Omega-3 PUFA supplement use was associated with lower CES-D scores when controlling for EPA and DHA levels.
Conclusion:
The findings from this cross-sectional study suggest that lifestyle and/or other contextual factors unrelated to EPA and DHA levels may also be associated with depressive symptom severity. Longitudinal studies are needed to evaluate the role of health-related mediators among these relationships.
Due to the pandemic caused by the SARS-CoV-2 virus (COVID-19) from March 16th to May 18th 2020. the lectures at the Faculty of Sports and Psysical Education, University of Niš, took place exclusively through online learning platforms. The faculties of sports and physical education are content-wise and methodogically specific in comparison to other faculties. The aim of this study is to identify the degree to which students were able to complete their academic commitments, what their motivation for learning was, what variables affected their ability to do so, and how anxious they were throughout the epidemic. In total, 364 students from the Faculty of Sports and Physical Education, representing all undergraduate and graduate academic years, took part in the online study. The research was conducted using a questionnaire consisting of self-assessment of mastered material in all subjects (five-point scale), the degree of motivation for distance learning (five-point scale), questions about factors that hindered students in learning and anxiety scales (AT-29, Tovilović and Novović, 2009). The results show that 68.6% of students managed to fulfill more than 60% of the obligations from the course per year. The largest number of students was mostly motivated (51.3%), while 17.9% were highly motivated for online learning. Less than 10% of all respondents were not motivated at all (7.4%). The largest number of students (42.6%) fulfilled their academic obligations in the percentage of 60 to 80%, while 33% of students fulfilled their obligations between 80 and 100%. The research showed that the biggest obstacle in online learning is the lack of direct contact and communication between students with colleagues and professors (36%), as well as technical problems, which represent a barrier for 16.8% of respondents. The results showed that there is a statistically significant difference in the degree of anxiety between male and female students (Sig. = .001), with higher values of anxiety recorded in female students.
Background
Due to the limitation of drug treatment and other adverse reactions, many psychological treatments always adopt rehabilitation training or non-drug intervention methods, while physical exercise is considered as an auxiliary way. A mass of literature has verified the therapeutic benefits of physical exercise to reduce depression and anxiety in clinical populations. However, little attention is paid to the mental health benefits of exercise for non-clinical populations. The purpose of this meta-analysis is to systematically aggregate and quantify findings of the effect of physical exercise on depression and anxiety in non-clinical populations, through which to evaluate whether physical exercise intervention as a non-drug means can effectively improve the depressive and anxious moods of college students.
Significance
This paper combines sport and psychotherapy and links kinesiology and psychology, which can deepen readers' understanding and stimulate their interest in the practice of sport and exercise psychology. The 2019 novel coronavirus disease (COVID-19) has swept the world, causing a global epidemic with serious physical and psychological consequences, and this study may help policymakers and health care professionals to make effective recommendations for psychological interventions for college students.
Methods
The study was based on five electronic databases: CNKI, Wan Fang Data, SinoMed, PubMed, and Web of Science. The quality of the selected articles was evaluated by the PEDro scale. The Meta-Analysis was performed using R-4.0.4, which computed pooled estimates of effect size and respective 95% confidence intervals (95% CI) for intervention. Bias and sensitivity analyses were calculated to explore the source of heterogeneity, and subgroup analyses were performed according to time, frequency, and event.
Results
Synthesizing all the trials, the results show that the study heterogeneity of physical exercise on the improvement of depressive mood in college students is relatively high (I²=63%, P<0.01), which has a medium effect (SMD=-0.63, 95% confidence interval=-0.80 to -0.46). The results reveal low heterogeneity in anxious mood (I²=36%, P = 0.04), with a medium effect (SMD=-0.58, 95% confidence interval=-0.71 to -0.44).
Conclusion
The Meta-Analysis confirms the effective and positive role of physical exercise in reducing depressive and anxious moods of college students. Physical exercise can be used as a non-medical method to improve the mental health state of college students and promote full development. Further research should evaluate the impact of various sports and specific exercise prescriptions on college students' negative emotions, so as to apply them to complementary and alternative therapies.
Background:
Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood.
Objective:
We used an iterative approach to better understand users' selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets.
Methods:
Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior).
Results:
Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants' interactions with the platform (ie, the type of target selected, the time spent viewing the selected target's profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target's profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior.
Conclusions:
Capturing physical activity-based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity-based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity.
Although the acute effect of exercise on behavioral cognitive performance is well-documented in the exercise psychology field, a comprehensive evaluation on neuroelectric brain activity that determines healthy cognitive functioning following acute exercise is lacking. This systematic review included 39 studies examining acute exercise effects on P3 of event-related potential through its amplitude and latency, which reflect the amounts of attentional resources allocated to and the processing speed for categorizing a stimulus. Exercise has small effects on increasing amplitude and decreasing latency. The amplitude effect was moderated by age and the type, intensity, and duration of exercise, with a smaller effect being observed for individuals aged ≤18 and 19–35 than >60 years, for high-intensity than moderate-intensity exercise, for high-intensity interval training exercise than aerobic, resistance, and combined exercise, as well as for exercise lasting ≤10 and 11–20 than exercise lasting 21–30 min. The latency effect was moderated by exercise duration, with 11–20 min exercise showing a smaller effect than exercise lasting ≤10 min. These results demonstrated that acute exercise enhances allocation of attentional resources and processing speed needed to implement cognitive processes underlying goal-directed behavior. Further, these effects may be manipulated through targeting specific age groups and prescribing specific exercise parameters.
Aim:
The aim of this study is to investigate the efficacy of a physical activity intervention on burden and healthy lifestyle behavior in family caregivers of schizophrenia.
Method:
A randomized, controlled trial was conducted to evaluate the effect of physical activity program on burden and healthy lifestyle behavior in family caregivers of patients with schizophrenia. The "Physical Activity Program" consisted of 5 min of warm-up activities as the initial segment, 20 min of rhythmic exercises as the activity segment, 5 min of cool down exercises as the final segment and 30 min of free walking. The program consisted of 8 sessions. The Zarit Caregiver Burden Scale and the Healthy Lifestyle Behavior Scale were applied to the physical activity and control groups ahead of the program's implementation. A total of 60 caregivers were randomly distributed to the intervention (n = 30) and control groups (n = 30). Post-intervention measurement was completed by 60 caregivers and all the caregivers completed the intervention.
Results:
Significant differences were found on the Zarit Caregiver Burden Scale score and Healthy Lifestyle Behavior score between the groups.
Conclusion:
Future research should examine with larger sample groups, carry out interventions, and apply the physical activity intervention by targeting caregivers, along with different interventions.
Objectives
This meta-analysis sought to determine the effect of exercise training on improving the health-related quality of life of patients with type 2 diabetes.
Methods
Three sources of scientific information were searched, including PubMed, Scopus, and the Cochrane Library. Google Scholar, was also searched manually. This search was limited to studies published in English until July 2021.
Results
The exercise training has positive effects on improving the health-related quality of life in diabetic patients and the effect size was equal to hedges’ g = 0.57 and the confidence interval was between [0.44 and 0.69].
Conclusion
The results indicate the favorable effects of exercise training on the health-related quality of life of patients with diabetes. It is also necessary to talk more about the effect of exercise on the health of patients with diabetes in the area of health policy and include it in health guidelines.
Thriving, the psychological experience of both vitality (or energy) and learning, is often elusive. Rather than growing, developing, and feeling energized, workers report stagnation and depletion. While much of the research on thriving at work has focused on what managers can do to promote thriving amongst workers, we highlight the means by which people are empowered to take control of their well-being. Workers can sustain their own thriving through three pathways: (1) by engaging in self-care, (2) creating and maintaining high quality relationships, and (3) building community within and outside the organization. We show that these three pathways are particularly important given the changing nature of more temporary and flexible work arrangements, increases in remote work, and the larger need for community embeddedness to address the many grand societal challenges that confront us.
OBJECTIVE: To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. METHODS: A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. FINDINGS: The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment. Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. CONCLUSION: Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 12 http://www.thecochranelibrary.com Buprenorphine for treating cancer pain (Protocol)
Implementing theory-based interventions is an effective way to impact physical activity (PA) practice among the population. This meta-analysis aimed to (a) determine the global effect of theory-based randomised controlled trials (RCTs) dedicated to the promotion of PA among adults, (b) measure the actual efficacy of interventions against their theoretical objectives, and (c) compare the efficacy of single- versus combined-theory interventions. A systematic search through databases and review articles was carried out. Our results show that theory-based interventions (n = 82) significantly impact the PA behaviour of participants (d = 0.31, 95% CI [0.24, 0.37]). While moderation analyses revealed no efficacy difference between theories, interventions based on a single theory (d = 0.35; 95% CI [0.26, 0.43]) reported a higher impact on PA behaviour than those based on a combination of theories (d = 0.21; 95% CI [0.11, 0.32]). In spite of the global positive effect of theory-based interventions on PA behaviour, further research is required to better identify the specificities, overlaps or complementarities of the components of interventions based on relevant theories.
Background
To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources.
Methods
A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations.
Results
Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality.
Conclusions
Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
To determine effects of physical activity on depressive symptoms (primary objective), symptoms of schizophrenia, anthropometric measures, aerobic capacity, and quality of life (secondary objectives) in people with mental illness and explore between-study heterogeneity.
MEDLINE, Cochrane Controlled Trials Register, PsycINFO, CINAHL, Embase, and the Physiotherapy Evidence Database (PEDro) were searched from earliest record to 2013.
Randomized controlled trials of adults with a DSM-IV-TR, ICD-10, or clinician-confirmed diagnosis of a mental illness other than dysthymia or eating disorders were selected. Interventions included exercise programs, exercise counseling, lifestyle interventions, tai chi, or physical yoga. Study methodological quality and intervention compliance with American College of Sports Medicine (ACSM) guidelines were also assessed.
Two investigators extracted data. Data were pooled using random-effects meta-analysis. Meta-regression was used to examine sources of between-study heterogeneity.
Thirty-nine eligible trials were identified. The primary meta-analysis found a large effect of physical activity on depressive symptoms (n = 20; standardized mean difference (SMD) = 0.80). The effect size in trial interventions that met ACSM guidelines for aerobic exercise did not differ significantly from those that did not meet these guidelines. The effect for trials with higher methodological quality was smaller than that observed for trials with lower methodological quality (SMD = 0.39 vs 1.35); however, the difference was not statistically significant. A large effect was found for schizophrenia symptoms (SMD = 1.0), a small effect was found for anthropometry (SMD = 0.24), and moderate effects were found for aerobic capacity (SMD = 0.63) and quality of life (SMD = 0.64).
Physical activity reduced depressive symptoms in people with mental illness. Larger effects were seen in studies of poorer methodological quality. Physical activity reduced symptoms of schizophrenia and improved anthropometric measures, aerobic capacity, and quality of life among people with mental illness.
PROSPERO registration #CRD42012002012.
An increasing number of studies have documented the effectiveness of qigong exercise in helping people reduce psychological stress and anxiety, but there is a scarcity of systematic reviews evaluating evidence from randomized controlled trials (RCTs) conducted among healthy subjects.
Thirteen databases were searched for RCTs from their inception through June 2013. Effects of qigong exercise were pooled across trials. Standardized mean differences (SMDs) were calculated for the pooled effects. Heterogeneity was assessed using the I2 test. The risk of bias was assessed using the Cochrane criteria.
Seven RCTs met the inclusion criteria. Two RCTs suggested that qigong exercise immediately relieved anxiety among healthy adults, compared to lecture attendance and structured movements only. Four RCTs suggested qigong exercise relieved anxiety (pooled SMD = -0.75; 95% CI, -1.11 to -0.40), and three RCTs suggested that qigong exercise reduced stress (pooled SMD = -0.88; 95% CI, -1.22 to -0.55) among healthy subjects following one to three months of qigong practice, compared to wait-list controls.
The available evidence suggests that qigong exercise reduces stress and anxiety in healthy adults. However, given the limited number of RCTs and their methodological flaws, further rigorously designed RCTs are needed.
The neuroscience of exercise is a growing research area that is dedicated to furthering our understanding of the effects that exercise has on mental health and athletic performance. The present study examined three specific topics: (1) the relationship between exercise and mental disorders (e.g. major depressive disorder, dementia and Parkinson's disease), (2) the effects of exercise on the mood and mental health of athletes, and (3) the possible neurobiological mechanisms that mediate the effects of exercise. Positive responses to regular physical exercise, such as enhanced functional capacity, increased autonomy and improved self-esteem, are frequently described in the recent literature, and these responses are all good reasons for recommending regular exercise. In addition, physical exercise may improve both mood and adherence to an exercise program in healthy individuals and might modulate both the performance and mental health of athletes. Exercise is associated with the increased synthesis and release of both neurotransmitters and neurotrophic factors, and these increases may be associated with neurogenesis, angiogenesis and neuroplasticity. This review is a call-to-action that urges researchers to consider the importance of understanding the neuroscience of physical exercise and its contributions to sports science.
Although the association between depression and excess mortality has been well established, it is not clear whether this is greater in major depression than in subthreshold depression.
To compare excess mortality in major depression with that in subthreshold depression.
We searched bibliographic databases and included prospective studies in which both major and subthreshold depression were examined at baseline and mortality was measured at follow-up.
A total of 22 studies were included. People with major depression had a somewhat increased chance of dying earlier than people with subthreshold depression but this difference was not significant, although there was a trend (relative risk 1.13, 95% CI 0.98-1.30, P = 0.1). The population attributable fraction was 7% for major depression and an additional 7% for subthreshold depression.
Although excess mortality may be somewhat higher in major than in subthreshold depression, the difference is small and the overall impact on excess mortality is comparable.
Funnel plots, and tests for funnel plot asymmetry, have been widely used to examine bias in the results of meta-analyses. Funnel plot asymmetry should not be equated with publication bias, because it has a number of other possible causes. This article describes how to interpret funnel plot asymmetry, recommends appropriate tests, and explains the implications for choice of meta-analysis modelThe 1997 paper describing the test for funnel plot asymmetry proposed by Egger et al 1 is one of the most cited articles in the history of BMJ.1 Despite the recommendations contained in this and subsequent papers,2 3 funnel plot asymmetry is often, wrongly, equated with publication or other reporting biases. The use and appropriate interpretation of funnel plots and tests for funnel plot asymmetry have been controversial because of questions about statistical validity,4 disputes over appropriate interpretation,3 5 6 and low power of the tests.2This article recommends how to examine and interpret funnel plot asymmetry (also known as small study effects2) in meta-analyses of randomised controlled trials. The recommendations are based on a detailed MEDLINE review of literature published up to 2007 and discussions among methodologists, who extended and adapted guidance previously summarised in the Cochrane Handbook for Systematic Reviews of Interventions.7What is a funnel plot?A funnel plot is a scatter plot of the effect estimates from individual studies against some measure of each study’s size or precision. The standard error of the effect estimate is often chosen as the measure of study size and plotted on the vertical axis8 with a reversed scale that places the larger, most powerful studies towards the top. The effect estimates from smaller studies should scatter more widely at the bottom, with the spread narrowing among larger studies.9 In the absence of bias and between study heterogeneity, the scatter will be due to sampling variation alone and the plot will resemble a symmetrical inverted funnel (fig 1⇓). A triangle centred on a fixed effect summary estimate and extending 1.96 standard errors either side will include about 95% of studies if no bias is present and the fixed effect assumption (that the true treatment effect is the same in each study) is valid. The appendix on bmj.com discusses choice of axis in funnel plots.View larger version:In a new windowDownload as PowerPoint SlideFig 1 Example of symmetrical funnel plot. The outer dashed lines indicate the triangular region within which 95% of studies are expected to lie in the absence of both biases and heterogeneity (fixed effect summary log odds ratio±1.96×standard error of summary log odds ratio). The solid vertical line corresponds to no intervention effectImplications of heterogeneity, reporting bias, and chance Heterogeneity, reporting bias, and chance may all lead to asymmetry or other shapes in funnel plots (box). Funnel plot asymmetry may also be an artefact of the choice of statistics being plotted (see appendix). The presence of any shape in a funnel plot is contingent on the studies having a range of standard errors, since otherwise they would lie on a horizontal line.Box 1: Possible sources of asymmetry in funnel plots (adapted from Egger et al1)Reporting biasesPublication bias: Delayed publication (also known as time lag or pipeline) bias Location biases (eg, language bias, citation bias, multiple publication bias)Selective outcome reportingSelective analysis reportingPoor methodological quality leading to spuriously inflated effects in smaller studiesPoor methodological designInadequate analysisFraudTrue heterogeneitySize of effect differs according to study size (eg, because of differences in the intensity of interventions or in underlying risk between studies of different sizes)ArtefactualIn some circumstances, sampling variation can lead to an association between the intervention effect and its standard errorChanceAsymmetry may occur by chance, which motivates the use of asymmetry testsHeterogeneityStatistical heterogeneity refers to differences between study results beyond those attributable to chance. It may arise because of clinical differences between studies (for example, setting, types of participants, or implementation of the intervention) or methodological differences (such as extent of control over bias). A random effects model is often used to incorporate heterogeneity in meta-analyses. If the heterogeneity fits with the assumptions of this model, a funnel plot will be symmetrical but with additional horizontal scatter. If heterogeneity is large it may overwhelm the sampling error, so that the plot appears cylindrical.Heterogeneity will lead to funnel plot asymmetry if it induces a correlation between study sizes and intervention effects.5 For example, substantial benefit may be seen only in high risk patients, and these may be preferentially included in early, small studies.10 Or the intervention may have been implemented less thoroughly in larger studies, resulting in smaller effect estimates compared with smaller studies.11Figure 2⇓ shows funnel plot asymmetry arising from heterogeneity that is due entirely to there being three distinct subgroups of studies, each with a different intervention effect.12 The separate funnels for each subgroup are symmetrical. Unfortunately, in practice, important sources of heterogeneity are often unknown.View larger version:In a new windowDownload as PowerPoint SlideFig 2 Illustration of funnel plot asymmetry due to heterogeneity, in the form of three distinct subgroups of studies. Funnel plot including all studies (top left) shows clear asymmetry (P<0.001 from Egger test for funnel plot asymmetry). P values for each subgroup are all >0.49.Differences in methodological quality may also cause heterogeneity and lead to funnel plot asymmetry. Smaller studies tend to be conducted and analysed with less methodological rigour than larger studies,13 and trials of lower quality also tend to show larger intervention effects.14 15Reporting biasReporting biases arise when the dissemination of research findings is influenced by the nature and direction of results. Statistically significant “positive” results are more likely to be published, published rapidly, published in English, published more than once, published in high impact journals, and cited by others.16 17 18 19 Data that would lead to negative results may be filtered, manipulated, or presented in such a way that they become positive.14 20 Reporting biases can have three types of consequence for a meta-analysis:A systematic review may fail to locate an eligible study because all information about it is suppressed or hard to find (publication bias) A located study may not provide usable data for the outcome of interest because the study authors did not consider the result sufficiently interesting (selective outcome reporting) A located study may provide biased results for some outcome—for example, by presenting the result with the smallest P value or largest effect estimate after trying several analysis methods (selective analysis reporting).These biases may cause funnel plot asymmetry if statistically significant results suggesting a beneficial effect are more likely to be published than non-significant results. Such asymmetry may be exaggerated if there is a further tendency for smaller studies to be more prone to selective suppression of results than larger studies. This is often assumed to be the case for randomised trials. For instance, it is probably more difficult to make a large study disappear without trace, while a small study can easily be lost in a file drawer.21 The same may apply to specific outcomes—for example, it is difficult not to report on mortality or myocardial infarction if these are outcomes of a large study. Smaller studies have more sampling error in their effect estimates. Thus even though the risk of a false positive significant finding is the same, multiple analyses are more likely to yield a large effect estimate that may seem worth publishing. However, biases may not act this way in real life; funnel plots could be symmetrical even in the presence of publication bias or selective outcome reporting19 22—for example, if the published findings point to effects in different directions but unreported results indicate neither direction. Alternatively, bias may have affected few studies and therefore not cause glaring asymmetry.ChanceThe role of chance is critical for interpretation of funnel plots because most meta-analyses of randomised trials in healthcare contain few studies.2 Investigations of relations across studies in a meta-analysis are seriously prone to false positive findings when there is a small number of studies and heterogeneity across studies,23 and this may affect funnel plot symmetry.Interpreting funnel plot asymmetryAuthors of systematic reviews should distinguish between possible reasons for funnel plot asymmetry (box 1). Knowledge of the intervention, and the circumstances in which it was implemented in different studies, can help identify causes of asymmetry in funnel plots, which should also be interpreted in the context of susceptibility to biases of research in the field of interest. Potential conflicts of interest, whether outcomes and analyses have been standardised, and extent of trial registration may need to be considered. For example, studies of antidepressants generate substantial conflicts of interest because the drugs generate vast sales revenues. Furthermore, there are hundreds of outcome scales, analyses can be very flexible, and trial registration was uncommon until recently.24 Conversely, in a prospective meta-analysis where all data are included and all analyses fully standardised and conducted according to a predetermined protocol, publication or reporting biases cannot exist. Reporting bias is therefore more likely to be a cause of an asymmetric plot in the first situation than in the second.Terrin et al found that researchers were poor at identifying publication bias from funnel plots.5 Including contour lines corresponding to perceived milestones of statistical significance (P=0.01, 0.05, 0.1, etc) may aid visual interpretation.25 If studies seem to be missing in areas of non-significance (fig 3⇓, top) then asymmetry may be due to reporting bias, although other explanations should still be considered. If the supposed missing studies are in areas of higher significance or in a direction likely to be considered desirable to their authors (fig 3⇓, bottom), asymmetry is probably due to factors other than reporting bias. View larger version:In a new windowDownload as PowerPoint SlideFig 3 Contour enhanced funnel plots. In the top diagram there is a suggestion of missing studies in the middle and right of the plot, broadly in the white area of non-significance, making publication bias plausible. In the bottom diagram there is a suggestion of missing studies on the bottom left hand side of the plot. Since most of this area contains regions of high significance, publication bias is unlikely to be the underlying cause of asymmetryStatistical tests for funnel plot asymmetryA test for funnel plot asymmetry (sometimes referred to as a test for small study effects) examines whether the association between estimated intervention effects and a measure of study size is greater than might be expected to occur by chance. These tests typically have low power, so even when a test does not provide evidence of asymmetry, bias cannot be excluded. For outcomes measured on a continuous scale a test based on a weighted linear regression of the effect estimates on their standard errors is straightforward.1 When outcomes are dichotomous and intervention effects are expressed as odds ratios, this corresponds to an inverse variance weighted linear regression of the log odds ratio on its standard error.2 Unfortunately, there are statistical problems because the standard error of the log odds ratio is mathematically linked to the size of the odds ratio, even in the absence of small study effects.2 4 Many authors have therefore proposed alternative tests (see appendix on bmj.com).4 26 27 28Because it is impossible to know the precise mechanism(s) leading to funnel plot asymmetry, simulation studies (in which tests are evaluated on large numbers of computer generated datasets) are required to evaluate test characteristics. Most have examined a range of assumptions about the extent of reporting bias by selectively removing studies from simulated datasets.26 27 28 After reviewing the results of these studies, and based on theoretical considerations, we formulated recommendations on testing for funnel plot asymmetry (box 2). The appendix describes the proposed tests, explains the reasons that some were not recommended, and discusses funnel plots for intervention effects measured as risk ratios, risk differences, and standardised mean differences. Our recommendations imply that tests for funnel plot asymmetry should be used in only a minority of meta-analyses.29Box 2: Recommendations on testing for funnel plot asymmetryAll types of outcomeAs a rule of thumb, tests for funnel plot asymmetry should not be used when there are fewer than 10 studies in the meta-analysis because test power is usually too low to distinguish chance from real asymmetry. (The lower the power of a test, the higher the proportion of “statistically significant” results in which there is in reality no association between study size and intervention effects). In some situations—for example, when there is substantial heterogeneity—the minimum number of studies may be substantially more than 10Test results should be interpreted in the context of visual inspection of funnel plots— for example, are there studies with markedly different intervention effect estimates or studies that are highly influential in the asymmetry test? Even if an asymmetry test is statistically significant, publication bias can probably be excluded if small studies tend to lead to lower estimates of benefit than larger studies or if there are no studies with significant resultsWhen there is evidence of funnel plot asymmetry, publication bias is only one possible explanation (see box 1)As far as possible, testing strategy should be specified in advance: choice of test may depend on the degree of heterogeneity observed. Applying and reporting many tests is discouraged: if more than one test is used, all test results should be reported Tests for funnel plot asymmetry should not be used if the standard errors of the intervention effect estimates are all similar (the studies are of similar sizes)Continuous outcomes with intervention effects measured as mean differencesThe test proposed by Egger et al may be used to test for funnel plot asymmetry.1 There is no reason to prefer more recently proposed tests, although their relative advantages and disadvantages have not been formally examined. General considerations suggest that the power will be greater than for dichotomous outcomes but that use of the test with substantially fewer than 10 studies would be unwiseDichotomous outcomes with intervention effects measured as odds ratiosThe tests proposed by Harbord et al26 and Peters et al27 avoid the mathematical association between the log odds ratio and its standard error when there is a substantial intervention effect while retaining power compared with alternative tests. However, false positive results may still occur if there is substantial between study heterogeneityIf there is substantial between study heterogeneity (the estimated heterogeneity variance of log odds ratios, τ2, is >0.1) only the arcsine test including random effects, proposed by Rücker et al, has been shown to work reasonably well.28 However, it is slightly conservative in the absence of heterogeneity and its interpretation is less familiar than for other tests because it is based on an arcsine transformation.When τ2 is <0.1, one of the tests proposed by Harbord et al,26 Peters et al,27 or Rücker et al28 can be used. Test performance generally deteriorates as τ2 increases.Funnel plots and meta-analysis modelsFixed and random effects modelsFunnel plots can help guide choice of meta-analysis method. Random effects meta-analyses weight studies relatively more equally than fixed effect analyses by incorporating the between study variance into the denominator of each weight. If effect estimates are related to standard errors (funnel plot asymmetry), the random effects estimate will be pulled more towards findings from smaller studies than the fixed effect estimate will be. Random effects models can thus have undesirable consequences and are not always conservative.30The trials of intravenous magnesium after myocardial infarction provide an extreme example of the differences between fixed and random effects analyses that can arise in the presence of funnel plot asymmetry.31 Beneficial effects on mortality, found in a meta-analysis of small studies,32 were subsequently contradicted when the very large ISIS-4 study found no evidence of benefit.33 A contour enhanced funnel plot (fig 4⇓) gives a clear visual impression of asymmetry, which is confirmed by small P values from the Harbord and Peters tests (P<0.001 and P=0.002 respectively).View larger version:In a new windowDownload as PowerPoint SlideFig 4 Contour enhanced funnel plot for trials of the effect of intravenous magnesium on mortality after myocardial infarctionFigure 5⇓ shows that in a fixed effect analysis ISIS-4 receives 90% of the weight, and there is no evidence of a beneficial effect. However, there is clear evidence of between study heterogeneity (P<0.001, I2=68%), and in a random effects analysis the small studies dominate so that intervention appears beneficial. To interpret the accumulated evidence, it is necessary to make a judgment about the validity or relevance of the combined evidence from the smaller studies compared with that from ISIS-4. The contour enhanced funnel plot suggests that publication bias does not completely explain the asymmetry, since many of the beneficial effects reported from smaller studies were not significant. Plausible explanations for these results are that methodological flaws in the smaller studies, or changes in the standard of care (widespread adoption of treatments such as aspirin, heparin, and thrombolysis), led to apparent beneficial effects of magnesium. This belief was reinforced by the subsequent publication of the MAGIC trial, in which magnesium added to these treatments which also found no evidence of benefit on mortality (odds ratio 1.0, 95% confidence interval 0.8 to 1.1).34View larger version:In a new windowDownload as PowerPoint SlideFig 5 Comparison of fixed and random effects meta-analytical estimates of the effect of intravenous magnesium on mortality after myocardial infarctionWe recommend that when review authors are concerned about funnel plot asymmetry in a meta-analysis with evidence of between study heterogeneity, they should compare the fixed and random effects estimates of the intervention effect. If the random effects estimate is more beneficial, authors should consider whether it is plausible that the intervention is more effective in smaller studies. Formal investigations of heterogeneity of effects may reveal explanations for funnel plot asymmetry, in which case presentation of results should focus on these. If larger studies tend to be methodologically superior to smaller studies, or were conducted in circumstances more typical of the use of the intervention in practice, it may be appropriate to include only larger studies in the meta-analysis.Extrapolation of a funnel plot regression lineAn assumed relation between susceptibility to bias and study size can be exploited by extrapolating within a funnel plot. When funnel plot asymmetry is due to bias rather than substantive heterogeneity, it is usually assumed that results from larger studies are more believable than those from smaller studies because they are less susceptible to methodological flaws or reporting biases. Extrapolating a regression line on a funnel plot to minimum bias (maximum sample size) produces a meta-analytical estimate that can be regarded as corrected for such biases.35 36 37 However, because it is difficult to distinguish between asymmetry due to bias and asymmetry due to heterogeneity or chance, the broad applicability of such approaches is uncertain. Further approaches to adjusting for publication bias are described and discussed in the appendix.DiscussionReporting biases are one of a number of possible explanations for the associations between study size and effect size that are displayed in asymmetric funnel plots. Examining and testing for funnel plot asymmetry, when appropriate, is an important means of addressing bias in meta-analyses, but the multiple causes of asymmetry and limited power of asymmetry tests mean that other ways to address reporting biases are also of importance. Searches of online trial registries can identify unpublished trials, although they do not currently guarantee access to trial protocols and results. When there are no registered but unpublished trials, and the outcome of interest is reported by all trials, restricting meta-analyses to registered trials should preclude publication bias. Recent comparisons of results of published trials with those submitted for regulatory approval have also provided clear evidence of reporting bias.38 39 Methods for dealing with selective reporting of outcomes have been described elsewhere. 40Our recommendations apply to meta-analyses of randomised trials, and their applicability in other contexts such as meta-analyses of epidemiological or diagnostic test studies is unclear.41 The performance of tests for funnel plot asymmetry in these contexts is likely to differ from that in meta-analyses of randomised trials. Further factors, such as confounding and precision of measurements, may cause a relation between study size and effect estimates in observational studies. For example, large studies based on routinely collected data might not fully control confounding compared with smaller, purpose designed studies that collected a wide range of potential confounding variables. Alternatively, larger studies might use self reported exposure levels, which are more error prone, while smaller studies used precise measuring instruments. However, simulation studies have usually not considered such situations. An exception is for diagnostic studies, where large imbalances in group sizes and substantial odds ratios lead to poor performance of some tests: that proposed by Deeks et al was designed for use in this context.4Summary points Inferences on the presence of bias or heterogeneity should consider different causes of funnel plot asymmetry and should not be based on visual inspection of funnel plots aloneThey should be informed by contextual factors, including the plausibility of publication bias as an explanation for the asymmetryTesting for funnel plot asymmetry should follow the recommendations detailed in this articleThe fixed and random effects estimates of the intervention effect should be compared when funnel plot asymmetry exists in a meta-analysis with between study heterogeneityNotesCite this as: BMJ 2011;342:d4002FootnotesContributors: All authors contributed to the drafting and editing of the manuscript. DA, JC, JD, RMH, JPTH, JPAI, DRJ, DM, JP, GR, JACS, AJS and JT contributed to the chapter in the Cochrane Handbook for Systematic Reviews of Interventions on which our recommendations on testing for funnel plot asymmetry are based. JACS will act as guarantor.Funding: Funded in part by the Cochrane Collaboration Bias Methods Group, which receives infrastructure funding as part of a commitment by the Canadian Institutes of Health Research (CIHR) and the Canadian Agency for Drugs and Technologies in Health (CADTH) to fund Canadian based Cochrane entities. This supports dissemination activities, web hosting, travel, training, workshops and a full time coordinator position. JPTH was funded by MRC Grant U.1052.00.011. DGA is supported by Cancer Research UK. GR was supported by a grant from Deutsche Forschungsgemeinschaft (FOR 534 Schw 821/2-2).Competing interests. JC, JJD, SD, RMH, JPAI, DRJ, PM, JP, GR, GS, JACS and AJS are all authors on papers proposing tests for funnel plot asymmetry, but have no commercial interests in the use of these tests. All authors have completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that they have no financial or non-financial interests that may be relevant to the submitted work.Provenance and peer review: Not commissioned; externally peer reviewed.References↵Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ1997;315:629-34.OpenUrlFREE Full Text↵Sterne JAC, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol2000;53:1119-29.OpenUrlCrossRefMedlineWeb of Science↵Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I. The case of the misleading funnel plot. 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Background
A systematic review is used to investigate the best available evidence of clinical safety and effectiveness of healthcare intervention. This requires methodological rigor in order to minimize bias and random error. The purpose of this study is to assess the quality of systematic reviews or meta-analyses for nursing interventions conducted by Korean researchers.
Methods
We searched electronic databases from 1950 to July 2010, including ovidMEDLINE, ovidEMBASE, and Korean databases, including KoreaMed, Korean Medical Database, and Korean studies Information Service System etc. Two reviewers independently screened and selected all references, and assessed the quality of systematic reviews or meta-analyses using the “Assessment of Multiple Systematic Reviews" (AMSTAR) tool.
Results
Twenty two systematic reviews or meta-analyses were included in this study. The median overall score (out of 11) for included reviews was 5 (range 2–11) and the mean overall score for AMSTAR was 4.7 (95% confidence interval 3.8-5.7). Nine out of 22 reviews were rated as low quality (AMSTAR score 0–4), 11 were rated as moderate quality (AMSTAR score 5–8), and two reviews were categorized as high quality (AMSTAR score 9–11).
Conclusions
The methodological quality of published reviews on nursing interventions conducted by Korean reviewers was assessed as low to moderate. In order to use the best available evidence in clinical decision making, reviewers should conduct systematic reviews or meta- analyses using rigorous research methods.
Behavioural and psychological symptoms of dementia (BPS) include depressive symptoms, anxiety, apathy, sleep problems, irritability, psychosis, wandering, elation and agitation, and are common in the non-demented and demented population.
We have undertaken a systematic review of reviews to give a broad overview of the prevalence, course, biological and psychosocial associations, care and outcomes of BPS in the older or demented population, and highlight limitations and gaps in existing research. Embase and Medline were searched for systematic reviews using search terms for BPS, dementia and ageing.
Thirty-six reviews were identified. Most investigated the prevalence or course of symptoms, while few reviewed the effects of BPS on outcomes and care. BPS were found to occur in non-demented, cognitively impaired and demented people, but reported estimates vary widely. Biological factors associated with BPS in dementia include genetic factors, homocysteine levels and vascular changes. Psychosocial factors increase risk of BPS; however, across studies and between symptoms findings are inconsistent. BPS have been associated with burden of care, caregiver's general health and caregiver depression scores, but findings are limited regarding institutionalisation, quality of life and disease outcome.
Limitations of reviews include a lack of high quality reviews, particularly of BPS other than depression. Limitations of original studies include heterogeneity in study design particularly related to measurement of BPS, level of cognitive impairment, population characteristics and participant recruitment. It is our recommendation that more high quality reviews, including all BPS, and longitudinal studies with larger sample sizes that use frequently cited instruments to measure BPS are undertaken. A better understanding of the risk factors and course of BPS will inform prevention, treatment and management and possibly improve quality of life for the patients and their carers.
BACKGROUND: Past episodes of depressive or anxiety disorders and subthreshold symptoms have both been reported to predict the occurrence of depressive or anxiety disorders. It is unclear to what extent the two factors interact or predict these disorders independently. AIMS: To examine the extent to which history, subthreshold symptoms and their combination predict the occurrence of depressive (major depressive disorder, dysthymia) or anxiety disorders (social phobia, panic disorder, agoraphobia, generalised anxiety disorder) over a 2-year period. METHOD: This was a prospective cohort study with 1167 participants: the Netherlands Study of Depression and Anxiety. Anxiety and depressive disorders were determined with the Composite International Diagnostic Interview, subthreshold symptoms were determined with the Inventory of Depressive Symptomatology-Self Report and the Beck Anxiety Inventory. RESULTS: Occurrence of depressive disorder was best predicted by a combination of a history of depression and subthreshold symptoms, followed by either one alone. Occurrence of anxiety disorder was best predicted by both a combination of a history of anxiety disorder and subthreshold symptoms and a combination of a history of depression and subthreshold symptoms, followed by any subthreshold symptoms or a history of any disorder alone. CONCLUSIONS: A history and subthreshold symptoms independently predicted the subsequent occurrence of depressive or anxiety disorder. Together these two characteristics provide reasonable discriminative value. Whereas anxiety predicted the occurrence of an anxiety disorder only, depression predicted the occurrence of both depressive and anxiety disorders.
School-based interventions are thought to be the most universally applicable and effective way to counteract low physical activity (PA) and fitness although there is controversy about the optimal strategy to intervene.
The objective of this review was to summarise recent reviews that aimed to increase PA or fitness in youth and carry out a systematic review of new intervention studies.
Relevant systematic reviews and original controlled and randomised controlled school-based trials with a PA or fitness outcome measure, a duration of ≥12 weeks, a sufficient quality and involvement of a healthy population aged 6-18 years that were published from 2007 to 2010 were included. Results In these reviews, 47-65% of trials were found to be effective. The effect was mostly seen in school-related PA while effects outside school were often not observed or assessed.
The school-based application of multicomponent intervention strategies was the most consistent, promising strategy, while controversy existed regarding the effectiveness of family involvement, focus on healthy populations at increased risk or duration and intensity of the intervention. All 20 trials in the review update showed a positive effect on in-school, out-of-school or overall PA, and 6 of 11 studies showed an increase in fitness. Taking into consideration both assessment quality and public health relevance, multicomponent approaches in children including family components showed the highest level of evidence for increasing overall PA. This review confirms the public health potential of high quality, school-based PA interventions for increasing PA and possibly fitness in healthy youth.
Past episodes of depressive or anxiety disorders and subthreshold symptoms have both been reported to predict the occurrence of depressive or anxiety disorders. It is unclear to what extent the two factors interact or predict these disorders independently.
To examine the extent to which history, subthreshold symptoms and their combination predict the occurrence of depressive (major depressive disorder, dysthymia) or anxiety disorders (social phobia, panic disorder, agoraphobia, generalised anxiety disorder) over a 2-year period.
This was a prospective cohort study with 1167 participants: the Netherlands Study of Depression and Anxiety. Anxiety and depressive disorders were determined with the Composite International Diagnostic Interview, subthreshold symptoms were determined with the Inventory of Depressive Symptomatology-Self Report and the Beck Anxiety Inventory.
Occurrence of depressive disorder was best predicted by a combination of a history of depression and subthreshold symptoms, followed by either one alone. Occurrence of anxiety disorder was best predicted by both a combination of a history of anxiety disorder and subthreshold symptoms and a combination of a history of depression and subthreshold symptoms, followed by any subthreshold symptoms or a history of any disorder alone.
A history and subthreshold symptoms independently predicted the subsequent occurrence of depressive or anxiety disorder. Together these two characteristics provide reasonable discriminative value. Whereas anxiety predicted the occurrence of an anxiety disorder only, depression predicted the occurrence of both depressive and anxiety disorders.
To develop more efficient programmes for promoting dietary and/or physical activity change (in order to prevent type 2 diabetes) it is critical to ensure that the intervention components and characteristics most strongly associated with effectiveness are included. The aim of this systematic review of reviews was to identify intervention components that are associated with increased change in diet and/or physical activity in individuals at risk of type 2 diabetes.
MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library were searched for systematic reviews of interventions targeting diet and/or physical activity in adults at risk of developing type 2 diabetes from 1998 to 2008. Two reviewers independently selected reviews and rated methodological quality. Individual analyses from reviews relating effectiveness to intervention components were extracted, graded for evidence quality and summarised.
Of 3856 identified articles, 30 met the inclusion criteria and 129 analyses related intervention components to effectiveness. These included causal analyses (based on randomisation of participants to different intervention conditions) and associative analyses (e.g. meta-regression). Overall, interventions produced clinically meaningful weight loss (3-5 kg at 12 months; 2-3 kg at 36 months) and increased physical activity (30-60 mins/week of moderate activity at 12-18 months). Based on causal analyses, intervention effectiveness was increased by engaging social support, targeting both diet and physical activity, and using well-defined/established behaviour change techniques. Increased effectiveness was also associated with increased contact frequency and using a specific cluster of "self-regulatory" behaviour change techniques (e.g. goal-setting, self-monitoring). No clear relationships were found between effectiveness and intervention setting, delivery mode, study population or delivery provider. Evidence on long-term effectiveness suggested the need for greater consideration of behaviour maintenance strategies.
This comprehensive review of reviews identifies specific components which are associated with increased effectiveness in interventions to promote change in diet and/or physical activity. To maximise the efficiency of programmes for diabetes prevention, practitioners and commissioning organisations should consider including these components.
depression remains a major public health problem that is most often evaluated and treated in primary care settings. The objective of this study was to examine the prevalence, treatment, and control of depressive symptoms in a national data sample using a common primary care screening tool for depression.
we analyzed a sample of adults (n = 4836) from 2005 to 2008 National Health and Nutrition Examination Survey data. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) to determine the overall prevalence, rates of treatment, and antidepressant control of mild, moderate, moderately severe, and severe depressive symptoms.
of the sample, 20.1% reported significant depressive symptoms (PHQ-9) score, ≥ 5), the majority of whom had mild depressive symptoms (PHQ-9) score, 5-9). Even among individuals with severe depressive symptoms, a large percentage (36.9%) received no treatment from a mental health professional or with antidepressant medication. Of those taking antidepressants, 26.4% reported mild depressive symptoms and 18.8% had moderate, moderately severe, or severe depressive symptoms.
despite greater awareness and treatment of depression in primary care settings, the prevalence of depressive symptoms remains high, treatment levels remain low, and control of depressive symptoms are suboptimal. Primary care providers need to continue to focus their efforts on diagnosing and effectively treating this important disease.
Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and agreement studies.
Eight experts in reliability and agreement investigation developed guidelines for reporting.
Fifteen issues that should be addressed when reliability and agreement are reported are proposed. The issues correspond to the headings usually used in publications.
The proposed guidelines intend to improve the quality of reporting.
To assess the effectiveness of exercise in adults with clinical depression.
The databases CINAHL, Embase, Cochrane Database of Systematic reviews, Cochrane Controlled Trials Register, MEDLINE, and PsycINFO were searched (1806-2008) using medical subject headings (MeSH) and text word terms depression, depressive disorder and exercise, aerobic, non-aerobic, physical activity, physical fitness, walk*, jog*, run*, bicycling, swim*, strength, and resistance.
Randomized trials including adults with clinical depression according to any diagnostic system were included.
Two investigators evaluated trials using a prepiloted structured form.
Thirteen trials were identified that fulfilled the inclusion criteria. Eight had adequate allocation concealment, 6 had a blinded outcome, and 5 used intention-to-treat analyses. The pooled standardized mean difference (SMD) calculated using a random-effects model was -0.40 (95% CI, -0.66 to -0.14), with evidence of heterogeneity between trials (I(2) = 57.2%, P = .005). There was an inverse association between duration of intervention and the magnitude of the association of exercise with depression (P = .002). No other characteristics were related to between-study heterogeneity. Pooled analysis of 5 trials with long-term follow-up (ie, that examined outcomes beyond the end of the intervention) suggested no long-term benefit (SMD, -0.01; 95% CI, -0.28 to 0.26), with no strong evidence of heterogeneity in this pooled analysis (I(2) = 23.4%, P = .27). There was no strong statistical evidence for small study bias (P > .27). Only 3 studies were assessed as high quality (adequately concealed random allocation, blinded outcome assessment, and intention-to-treat analysis). When we pooled results from these, the estimated beneficial effect of exercise was more modest (SMD, -0.19; 95% CI, -0.70 to 0.31) than the pooled result for all 13 studies, with no strong evidence of benefit.
Our results suggest a short-term effect of exercise on depression: on average, depression scores 0.4 of a standard deviation lower in clinically depressed patients randomly assigned to an exercise intervention at the end of that intervention compared to those randomly assigned to a none exercise group. There is little evidence of a long-term beneficial effect of exercise in patients with clinical depression.
The metafor package provides functions for conducting meta-analyses in R. The package includes functions for fitting the meta-analytic fixed- and random-effects models and allows for the inclusion of moderators variables (study-level covariates) in these models. Meta-regression analyses with continuous and categorical moderators can be conducted in this way. Functions for the Mantel-Haenszel and Peto's one-step method for meta-analyses of 2 x 2 table data are also available. Finally, the package provides various plot functions (for example, for forest, funnel, and radial plots) and functions for assessing the model fit, for obtaining case diagnostics, and for tests of publication bias.
Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency).
The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis.
We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours.Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities.
Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.
