ArticlePDF AvailableLiterature Review

Abstract

Depression is a very prevalent mental disorder affecting 340 million people globally and is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by the year 2020. In this paper, we review the evidence published to date in order to determine whether exercise and physical activity can be used as therapeutic means for acute and chronic depression. Topics covered include the definition, classification criteria and treatment of depression, the link between β-endorphin and exercise, the efficacy of exercise and physical activity as treatments for depression, properties of exercise stimuli used in intervention programs, as well as the efficacy of exercise and physical activity for treating depression in diseased individuals. The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.
REVIEW ARTICLE
Effects of exercise and physical activity on depression
P. C. Dinas Y. Koutedakis A. D. Flouris
Received: 14 December 2009 / Accepted: 26 October 2010 / Published online: 14 November 2010
ÓRoyal Academy of Medicine in Ireland 2010
Abstract
Introduction Depression is a very prevalent mental disor-
der affecting 340 million people globally and is projected to
become the leading cause of disability and the second leading
contributor to the global burden of disease by the year 2020.
Aim In this paper, we review the evidence published to
date in order to determine whether exercise and physical
activity can be used as therapeutic means for acute and
chronic depression. Topics covered include the definition,
classification criteria and treatment of depression, the link
between b-endorphin and exercise, the efficacy of exercise
and physical activity as treatments for depression, proper-
ties of exercise stimuli used in intervention programs, as
well as the efficacy of exercise and physical activity for
treating depression in diseased individuals.
Conclusions The presented evidence suggests that exer-
cise and physical activity have beneficial effects on
depression symptoms that are comparable to those of
antidepressant treatments.
Keywords Exercise Depression Physical activity
Mood b-Endorphin
Introduction
Depression is a very prevalent mental disorder affecting
340 million people globally—independently of age, sex,
and ethnic background—and is projected to become the
leading cause of disability and the second leading con-
tributor to the global burden of disease by the year 2020
[1,2]. Current evidence also shows that 9% of children by
age 14 have already experienced at least one episode of
severe depression [3], while up to 10% of adolescents are
affected by a major depressive disorder [4]. These statistics
are a consequence of the multi-faceted effects of depres-
sion on health and well-being [1]. Indeed, individuals
suffering from depression show low levels of mood, lack of
interest or pleasure, disrupted appetite or sleep, low self-
worth, feelings of guilt, deprived concentration and lack of
energy. Very often these problems become chronic and
lead to disability or, even worse to suicide attempts [1].
Recent reports conclude that depression can be reliably
diagnosed in primary care and can be treated through
pharmacological agents and psychotherapy with a 60–80%
success [5]. However, only 10–25% of those affected by
depression receive treatment for their condition, either due
to lack of resources and/or trained providers or the social
stigma associated with this condition [1,5]. Therefore, it is
very important to discover alternative therapeutic methods
for depression. In this light, encouraging evidence has
shown that exercise and physical activity have beneficial
effects on depression symptoms that are often comparable
to those of antidepressant treatments [6,7]. Yet, to our
knowledge, these new evidence linking exercise and
physical activity with depression have not been critically
evaluated. Therefore, in this paper, we review the evidence
published to date in order to determine whether exercise
and physical activity can be used as therapeutic means for
P. C. Dinas (&)Y. Koutedakis
Department of Sport and Exercise Science,
University of Thessaly, TEFAA Karies,
Trikala 42100, Greece
e-mail: pentinas@pe.uth.gr
A. D. Flouris
FAME Laboratory, Institute of Human Performance
and Rehabilitation, Centre for Research and Technology,
Thessaly, Greece
A. D. Flouris
Department of Research and Technology Development,
Biomnic Ltd., Trikala, Greece
123
Ir J Med Sci (2011) 180:319–325
DOI 10.1007/s11845-010-0633-9
acute and chronic depression. It is hoped that the infor-
mation provided will be valuable not only to physicians,
exercise psychologists and physiologists, but also to those
interested in personal or public health, politics and
economics.
Approach
A comprehensive search in PubMed and Science Direct
was conducted using MeSH terms that are germane to
acute and chronic depression (e.g., depression symptoms,
mood, depressive disorder, psychotherapy) in conjunction
with exercise and psychophysical mechanisms (e.g.,
exercise, physical activity, b-endorphin, opioids, seroto-
nin, pituitary gland). The search also included the articles
cited in the identified papers. All articles resulting from
the above methods were considered in this review, and
only those deemed irrelevant (i.e., not directly studying
the effects of exercise and physical activity on depres-
sion) were omitted. The following pages cover informa-
tion regarding exercise and physical activity as
treatments for depression, the endorphin hypothesis and
the hormonal effects of b-endorphins on depression, the
effects and the required frequency and mode of exercise
and physical activity on depression, as well as the
influence of an individual’s age on the successfulness
of exercise and physical activity interventions for
depression.
Definition, classification criteria and treatment
of depression
Depression represents a major illness with both health and
social consequences similar to chronic diseases such as
diabetes, congestive heart failure and hypertension [5].
According to the World Health Organization, depression is
an illness characterized by negative mood, decreased
interest for pleasure, feelings of guilt, uneasy sleep,
decreased appetite and energy, as well as poor brain con-
centration [1,2]. These feelings can be either acute or
chronic, resulting in a reduced interest for life which can
lead to extreme actions such as suicide [2]. The criteria
based on which classification of depression is accom-
plished are appointed by the International Classification of
Diseases (ICD-10) for worldwide use [8] and the Diag-
nostic and Statistical Manual of Mental Disorders (DSM-
IV) developed in the United States [9]. Generally, these
standardized criteria are used to separate ‘‘normal’
depressed mood caused, for instance, by disappointment,
from depressive disorders also known as ‘‘affective disor-
ders’’ and ‘‘mood disorders’’ [8,9].
Depression is normally treated with various pharma-
ceutical agents or psychotherapeutic interventions or a
combination of these. Current evidence shows that patients
seeing a primary care provider are more likely to have a
failed treatment than patients seeing a psychiatrist [10].
This, however, does not suggest that pharmacological
agents are unsuccessful in the treatment of depression.
Indeed, a large number of studies show that different
pharmacological treatments are successful in treating acute
depressive episodes [5]. In this light, a successful cooper-
ation between primary and specialty mental health sectors
is crucial, since most patients with depression first seek
help in primary care [1113]. Therefore, consultative roles
for mental health specialists have been recommended in
some countries to support primary care physicians in the
treatment of depression [14,15]. Relatively, recent evi-
dence suggests that an exercise science specialist may also
need to complement the primary care physicians and
mental health specialists in order to successfully tackle
depression symptoms and episodes [5]. For instance, it is
widely accepted that mood states are highly depended on
endorphin secretion [16]. Moreover, according to the
endorphins hypothesis, exercise augments endorphin
secretion which, in turn, reduces anxiety and depression
levels [17]. These notions are further discussed in the fol-
lowing section.
b-Endorphin and exercise
Endorphins are endogenous opioid polypeptide compounds
produced by the pituitary gland and the hypothalamus in
vertebrates during strenuous exercise, excitement, pain,
and they resemble the opiates in their abilities to produce
analgesia and a sense of well-being [16]. The opioid system
plays a key role in mediating analgesia and social attach-
ment and may also affect depression given the link between
b-endorphins and depression symptoms [1820]. To date,
b-endorphin secretion has been used for the diagnosis of
depression and it could be used as an agent in a therapeutic
strategy [21]. Moreover, available data have shown that the
l-opioidergic system is considerably involved in the eti-
ology of mental disorders, thus providing a rationale for the
use of l-opioid ligands such as b-endorphin in behavioral
therapies [16]. A recent meta-analysis concluded that the
mechanisms by which exercise may improve depression
remain uncertain mainly due to methodological limitations
of existing research [22]. Yet, based on recent biological
evidence linking the opioid system with mood and
depression [16,19,23], it seems reasonable to explore a
relevant hypothesis that has received considerable atten-
tion. According to the ‘endorphins hypothesis’, exercise
augments the secretion of endogenous opioid peptides in
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the brain reducing pain and causing general euphoria
(Fig. 1)[17,24,25]. In turn, the latter reduces anxiety and
depression levels [17,24]. These notions were confirmed
by a recent study showing an exercise-induced beneficial
effect of endorphins in mood, which suggests that further
research is warranted on the endorphins hypothesis [25].
A recent study investigated the endorphins hypothesis in
competitive long distance athletes (i.e., training [4 h per
week in the last 2 years) [26]. The participants underwent
positron emission tomography ‘‘ligand activation’’ [27],
toxicological examinations, and completed the visual ana-
log mood scales [28] at rest and after 2 h of endurance
running. Based on a large effect size, the results confirmed
the endorphins hypothesis demonstrating that exercise
leads to an increased secretion of endorphins which, in
turn, improved mood states [26].
b-Endorphin, an endogenous l-opioid receptor-selective
ligand [29], has received much attention in the literature
linking endorphins and depression or mood states.
b-Endorphin is primarily synthesized in the anterior pitui-
tary gland and cleaved from pro-opiomelanocortin, its
larger precursor molecule [30]. It reaches the circulation
either through secretion from the pituitary gland or via
projection into specific brain regions through nerve fibers
[30]. To date, clinical studies have shown an increased
level of b-endorphin and l-opioid receptors in plasma and
brain of patients suffering from depression and schizo-
phrenia [3135]. Moreover, clinical trials on patients with
different types of psychiatric disorders (i.e., depression,
schizophrenia and neuroses) demonstrated an antidepres-
sant effect of b-endorphin [36]. These results support,
in part, the endorphins hypothesis given that exercise of
sufficient intensity and duration can increase circulating
b-endorphin levels [30,37]. Indeed, b-endorphin levels of
women with cardiologic problems (syndrome of prolapsed
of maternal valve) show an increase following an exercise
session to a degree that constitutes treatment [38]. More-
over, a recent study demonstrated that exercise and phys-
ical activity increased b-endorphin levels in plasma with
positive effects on mood [39]. Interestingly, the researchers
reported that, independently of sex and age, dynamic and
anaerobic exercises increased b-endorphin, while resis-
tance and aerobic exercises seem to have only small effects
on b-endorphins [39]. In general, the evidence thus far
suggests that exercise-induced b-endorphin adaptations are
depended on the type of exercise and population tested, and
may differ in individuals with health problems. Further-
more, some of the proposed mechanisms inducing the
exercise-induced b-endorphin changes include analgesia,
lactate or base excess, and metabolic factors [30,37].
Nevertheless, the social element of exercise and its effects
on b-endorphin levels has not been examined. While
individualized and group-based interventions appear to be
equally beneficial for treating depression [40], we remain
naı
¨ve as to the effects of these protocols on b-endorphin
levels.
Exercise, physical activity and depression
It is known for some time that physical activity and exer-
cise are inversely associated with depression levels. A
relevant classic study was conducted by Paffenbarger and
colleagues [41] who examined questionnaires of 31,000
Harvard College graduates in 1962, 1966, 1977, and 1988.
Results showed that physically active individuals reported
lower depression levels than their physically inactive peers.
These results are supported by a more recent study that
examined 5,877 individuals aged 15–54 years showing that
physically active individuals report lower levels of
depression than non-active individuals [42]. Moreover,
there was an inverse linear relationship between physical
activity participation and depression with individuals
reporting as frequently active showing lower levels of
depression, individuals reporting as occasionally active
showing higher levels of depression and, finally, individ-
uals reporting as inactive showing the highest levels of
depression [42].
The beneficial effects of physical activity and exercise
on depression symptoms and general mood have been
confirmed in individuals of all ages. In children and ado-
lescents, a small beneficial effect of exercise in reducing
depression and anxiety scores has been recorded, yet the
small number of studies included and the clinical diversity
of participants, interventions and methods of measurement
limit the ability to draw conclusions [43]. In younger
adults, a previous investigation examined whether daily
activity and the tendency to participate in exercise are
Fig. 1 The endorphins
hypothesis mechanism
321
123
associated with mood states in a student cohort [44]. The
results showed that mood tends to be higher in a day an
individual exercises as well as that daily activity and
exercise overall are strongly linked with mood states. In
line with these findings, a recent study showed that exercise
significantly improves mood states in non-exercisers, rec-
reational exercisers, as well as marathon runners [45].
More importantly, the effects of exercise on mood were
twofold in recreational exercisers and marathon runners
[45].
In older adults, exercise interventions have shown very
promising results for alleviating symptoms of major
depression [46]. These findings are supported by a more
recent study examining the effects of physical activity in a
sample of depressed elderly patients showing that physical
activity is associated with reduced concurrent depression
[47]. Based on these findings, it was suggested that phys-
ical activity may be especially helpful in the context of
medical problems and major life stressors, while encour-
aging depressed elderly patients to engage in physical
activity is likely to have potential benefits on clinical
depression symptoms [47]. Finally, elderly who remain
physically active across time demonstrate lower levels of
depression symptoms compared to those who adopt inac-
tive lifestyles when they get older [48].
Exercise and physical activity as treatments
for depression
A recent meta-analysis reported a large clinical effect of
physical activity and exercise interventions on the
symptoms of depression for adults of both sexes [22].
More specifically, aerobic exercise indicated a moderate
clinical effect, while mixed and resistance exercise indi-
cated large effect sizes. Moreover, when compared
against other established treatments (i.e., cognitive
behavior therapy and antidepressants), exercise appears to
produce the same results [22]. Indeed, published evidence
shows that exercise and physical activity interventions are
generally successful in reducing depression symptoms.
For instance, a recent study found that patients with major
depression receiving aerobic exercise training performed
either at home or in a supervised group setting achieved
reductions in depression comparable to standard antide-
pressant medication (sertraline) and greater reductions in
depression compared to placebo controls [7]. Interest-
ingly, a different study reported that individuals with
major depressive disorder undergoing an aerobic exercise
program were as likely to be in remission as those taking
standard antidepressant medication (sertraline) or medi-
cation and exercise combined [49]. These results are
further supported by a study showing that a 4-month
aerobic exercise program was more successful in reducing
depression symptoms than a placebo and a pharmaco-
logical treatment [50]. In line with these findings, a recent
study demonstrated that an 8-month exercise program was
successful in improving depression symptoms in 40–60
year-old depressed women, unlike a pharmacological
treatment [51].
Properties of exercise stimulus
Methodological limitations in existing research preclude a
clear identification of the optimum exercise properties for
treating depression [22]. However, it is important to
acknowledge that the majority of relevant published evi-
dence suggests an inverted dose–response relationship
between exercise frequency and depression symptoms.
More specifically, a recent study examined the efficacy of
low-frequency (one aerobic session/week) and high-
frequency (3–5 aerobic exercise sessions/week) exercise
interventions for 8 weeks showing that high-frequency
exercise interventions are more efficacious in reducing
depression symptoms [40]. These findings are supported by
a Finnish study of 3,403 adults which demonstrated that
exercise frequency is inversely associated with depression
symptoms and overall well-being [52].
Based on evidence published to date, the duration of
exercise intervention is not clearly related to outcome [22].
On the other hand, some—but not all [43]—evidence
supports that more intense exercise regimes lead to larger
improvements in mood [5355], while aerobic ?resistance
training appears to generate stronger effects than aero-
bic ?flexibility training [53]. These results mirror the
finding that dynamic and anaerobic exercises have a more
potent effect on b-endorphin than resistance and aerobic
exercises [39]. Individualized and group-based interven-
tions appear to be equally beneficial for treating depression
[40]. Moreover, several sources of data—but not all
[22,40]—show that supervised physical activity programs
may produce more potent effects on depression than non-
supervised programs [7,56,57]. These findings may be
explained by the fact that depressed patients in unsuper-
vised programs fail to sustain a high-enough interest in
order to complete the prescribed intervention, as shown in a
previous study [58].
Exercise and physical activity for treating depression
in diseased individuals
Two previous studies examining the efficacy of exer-
cise interventions as a treatment for depression in seden-
tary individuals with hypertension reported significant
322
123
reduction of depression symptoms [57,59]. Previous work
in cardiovascular disease patients has shown that adding
high-intensity resistance training to an outpatient cardiac
rehabilitation aerobic exercise program is more efficacious
in improving mood and depression levels compared to
adding flexibility training [53]. Moreover, aerobic exercise
appears to be beneficial in improving depression symptoms
and quality of life in patients recovering from a heart attack
[60]. Therefore, there is some support to the notion that the
beneficial effects of exercise and physical activity on
anxiety and depression can reduce the risk for death from
cardiovascular illnesses, obesity and osteoporosis in car-
diovascular disease patients [61]. However, given that
classic depression treatments (i.e., not based on exercise/
physical activity) do not reduce the associated morbidity/
mortality in cardiac patients [62,63], the beneficial effects
of exercise and physical activity on cardiovascular mor-
bidity/mortality may be independent of their effects on
depression.
Discussion
Based on the presented evidence, it becomes clear that
exercise and physical activity have beneficial effects on
depression symptoms that are comparable to those of
antidepressant treatments. Research thus far is showing that
exercise and physical activity can be used as therapeutic
means for acute and chronic depression in the general
population as well as in hypertensive and cardiovascular
disease patients. In this light, the presented evidence sup-
ports that an exercise science specialist may need to
complement the primary care physicians and mental health
specialists in order to successfully tackle depression
symptoms and episodes.
Notwithstanding the attention on the effects of exercise
and physical activity on depression and the excitement for
the new discoveries in this area, our knowledge on the
biophysical mechanisms (e.g., b-endorphins) involved in
the exercise-induced decrease of depression symptoms is
incomplete. Moreover, methodological limitations in
existing research preclude a clear identification of the
optimum exercise properties for treating depression, while
the risks and cost effectiveness associated with relevant
interventions remain unknown. These topics should be
addressed by future research in order to improve and/or
standardize the exercise prescription for individuals with
depression symptoms.
Acknowledgments This work was supported in part by funding
from the European Union 7th Framework Program (FP7-PEOPLE-
IRG-2008 grant no. 239521).
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... Furthermore, "Subjective" questionnaire data on physical activity and/or exercise are also usually collected for a 1-week period. Because physical activity and exercise are recommended treatments for moderate depression [45] as well as for recurrent LBP [46], we chose to collect data on both for a period of 1 week. ...
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Background: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. Methods: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0-4 none, 5-9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. Results: The internal consistency of the PHQ-9-mFIN was high (Cronbach's α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson's correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, - 0.40 to - 0.67 and - 0.64) than for the Physical (range, - 0.08 to - 0.43 and - 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. Conclusions: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. Trial registration: NCT01465698 .
... In addition to the beneficial effects on physical health [1][2][3], performing physical activity (PA) in adulthood is related to a reduced risk of mental ill-health [4] and has been shown to be effective in reducing symptoms associated with depression [5,6]. Going beyond a clinical approach and considering mental health (MH) as a positive state of well-being related to an optimal psychological experience and functioning [7], there are several studies that find a positive relationship between PA and satisfaction with life (SWL) [8][9][10], i.e., the extent to which people value their present situation as an ideal situation [11]. ...
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Students suffer from a decrease in physical activity during their education period. This lower level of activity could affect, through various paths, their academic performance, mental health, and satisfaction with life. In these two studies, we assumed that vigor, a positive affect variable, would act as a mediating variable in the above relationship, and thus, we proposed an instrument for evaluating vigor in academic contexts. In Study 1, 707 undergraduates (59.7% women) responded to the vigor scale adapted for students to test factorial validation (through confirmatory factor analysis) and obtain reliability indicators. In Study 2, 309 undergraduates (55.3% women) completed a questionnaire measuring physical activity, mental health, satisfaction with life, vigor, and academic performance to test a structural model of the relationships between the variables to obtain construct validity. A measurement model with three related factors, each representing one dimension of vigor, optimally fit the data, and the reliability indices were adequate (Study 1). Moreover, the mediational model confirmed a complete influence of physical activity on satisfaction with life, academic performance, and mental health levels through students’ vigor levels with optimal adjusting values (Study 2). Proposing an instrument such as the Shirom-Melamed Vigor Measure for students allows the opening of a research venue that is focused on the study of positive affects in academic contexts, as well as the testing of the physical activity pathways of action in obtaining positive results.
... Physical activity, which is directly linked to health, has been effective in preventing and treating cancer, cardio-cerebrovascular disease, and metabolic syndrome [2][3][4] . Furthermore, physical activity is also helpful for mental or psychological health 5,6) . Good mental health can help people to work independently while coping with daily stresses 7) . ...
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[Purpose] This study investigated the relationship between physical activity and job stress among public office workers. [Participants and Methods] We examined the levels of physical activity and job stress of 488 male public officers in Seoul-city, Republic of Korea through self-reported questionnaires. The International Physical Activity Questionnaires and the Korean Occupational Stress Scale were used to evaluate physical activity and job stress, respectively. The level of physical activity was divided into three quantiles (low, moderate, high). [Results] We found no significant difference in job stress by physical activity level. Although a positive correlation between physical activity and job stress was found in the organizational system category, no significant difference was found in the categories of the physical environment, job demand, insufficient job control, interpersonal conflict, job insecurity, lack of reward, and occupational climate. [Conclusion] There was no apparent correlation between physical activity and job stress among public office workers.
... Also that the health status of refugees, ranging from prevalence of posttraumatic stress disorder (PTSD), depression, anxiety, issues with concentration or motivation, as well as physical health issues, are often not considered [21]. Research has shown that participation in PA can support psychosocial wellbeing, and may assist with recovering from mental illnesses such as depression [22,23], highlighting the need to focus on engagement in PA for CALD groups. A recent study evaluating experiences of treatment-targeted PA programs for traumaa icted refugees, found that participants built resilience and showed improvements in both physical and mental health outcomes, whilst the programs provided a break from other daily stressors and gave a sense of recovery [24]. ...
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Background There are numerous health and social benefits of physical activity (PA) participation, yet refugees who have settled into destination countries like Australia are less likely to play sport or exercise, or reach recommended daily PA levels if they do. There may be various correlates of PA which impact on participation, however cultural attributes and the process of cultural adaptation after resettlement, may be a key contributor, impacting on the health of resettlers. This research trialled a community-driven, culturally specific family PA program with Karen refugees settled in Australia. The aims of the program were to encourage participation through a culturally appropriate physical activity setting and provide Karen families with an opportunity to learn to be active together. Methods The grant-funded program consisted of a two-hour lifestyle educational module and a practical activity session held each week for eight weeks, including a six-month follow-up session post completion. Educational sessions covered relevant health topics, such as healthy eating, and practical activity sessions were tailored to meet Karen people’s cultural expectations and needs. All components of the intervention were co-designed with the participants. Results A total of 36 Karen adults and children varying in ages participated in the program, with an average rate of participation of 81.8% over eight weeks. The program was evaluated with surveys, interviews, and informal discussions with instructors and participants, as well as ethnographic methods of observation. Participants valued the program that met their needs. After completion of the program they requested to continue with a similar community-based PA program in the future. Conclusions This culturally appropriate and co-designed PA program effectively engaged Karen people and increased healthy lifestyle behaviours in the group, which they found valuable and meaningful. Future interventions and programs targeting resettled refugees should be co-designed with participants using culturally appropriate approaches.
... Unexpectedly, having a history of hypertension was a protective factor of suicidal/self-harm behaviors, especially among female and older cancer patients. A possible explanation is that patients with hypertension are usually advised to manage their stress, perform relaxation techniques (Abgrall- Barbry & Consoli, 2006), and engage in more physical activities (Semlitsch et al., 2013) for symptom control, all of which are beneficial to people's mental health (Chiesa & Serretti, 2009;Dinas et al., 2011;Song et al., 2013) and may potentially decrease the risk of suicidal/self-harm behaviors. ...
Article
Background Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. Methods Patients aged 10 or above who received their first cancer-related hospital admission (2002–2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. Results In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. Conclusions Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.
... Se reconoce como método terapéutico (Leyland, Currie, Anderson, Bradley y Ling, 2018;Stubbs et al., 2018) y aliado en los procesos de intervención en patologías como el estrés, la ansiedad y la depresión (Ashdown-Franks et al., 2018;Paluska y Schwenk, 2000). Las personas que reportan niveles de AF moderado o vigoroso son menos propensas a presentar altos niveles de estrés percibido Mücke, Ludyga, Colledge y Gerber, 2018), burnout, síntomas de depresión y ansiedad, en comparación con las personas que reportan un estilo de vida sedentario (Dinas, Koutedakis y Flouris, 2011;Trajkov et al., 2018). De igual modo, la AF se considera un factor protector en la aparición de síntomas asociados a trastornos de personalidad, estrés laboral o académico, ansiedad social, falta de habilidades sociales y disminución del impacto laboral y social (Mason y Holt, 2012). ...
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bjective. To explore the Physical Activity (PA) levels ‒Low, Medium and High‒ differences according to Health-Related Qualityof Life (HRQL). Method. 269 participants (M = 25.3, SD = 1.5) between, students, teachers and administrators of an academiccommunity of Pereira, Colombia. e PA was assessed with the International Physical Activity Questionnaire (IPAQ) and theHRQL through the SF-36. Results. ose who reported having a moderate PA level showed signicantly best vitality, mental healthoutcomes, and overall health (p < 0.05). While those with vigorous PA level averaged higher in overall health. e moderate andvigorous PA levels, compared to the low level, showed a higher score in general health and mental health (p < 0.05). Conclusion.is study provides evidence in favor of the link between PA and HRQL hypothesis; in addition, those subjects who self-report moderate and vigorous PA levels showed better HRQL in the social function, vitality, general health, and mental healthdimensions. Future studies should emphasize the different PA levels that will favor the HRQL, principally, in school population.
... Physical activity (PA) is bodily movement produced by skeletal muscles that requires energy expenditure, including activities undertaken while working, playing, carrying out household chores, travelling, and engaging in recreational activities [1]. PA during pregnancy is not only safe [1,2] but also helpful in improving physical health, controlling weight, alleviating back pain, accelerating postpartum recovery and reducing the risk of gestational diabetes, preeclampsia and operative delivery, as well as relieving depression and anxiety [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. To achieve good health, the World Health Organization (WHO) recommends that adults engage in at least 150 minutes of moderate-intensity PA throughout the week or an equivalent form of PA that achieves at least 600 metabolic equivalent task (MET) min/week [1,17]. ...
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Background Sufficient physical activity (PA) during pregnancy is beneficial for a woman’s health; however, the PA levels of Chinese women at different pregnancy stages are not clear. The aim of our study was to investigate PA changes during pregnancy and the association of population characteristics with PA change among Chinese women. Methods Data were obtained from 2485 participants who were enrolled in the multicentre prospective Chinese Pregnant Women Cohort Study. PA level was assessed in early pregnancy (mean=10, 5-13 weeks of gestation) and again in mid-to-late pregnancy (mean=32, 24-30 weeks of gestation) using the International Physical Activity Questionnaire short form (IPAQ-SF). Sufficient PA (≥600 MET min/week) in early pregnancy and insufficient PA in mid-to-late pregnancy indicated decreasing PA. Insufficient PA in early pregnancy and sufficient PA in mid-to-late pregnancy indicated increasing PA. The associations between demographic, pregnancy and health characteristics and PA changes were examined by multivariable logistic regression. Results Total energy expenditure for PA increased significantly from early (median=396 MET min/week) to mid-to-late pregnancy (median=813 MET min/week) (P
... The current research also indicated associations between physical exercise and suicidal ideation, similar to prior reports (Becker et al., 2018). Prior studies have associated poor physical exercise with depression and anxiety (Carek et al., 2011; and suggest that physical exercise may reduce depression (Dinas et al., 2011). Future studies should examine relationships among these domains longitudinally. ...
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Lockdown, social isolation, and interruption of daily life during the COVID-19 period have impacted many lives. University students are particularly vulnerable to such disruptions and may be particularly disposed to suicidal ideation, potentially creating a new public health crisis. This study aimed to assess suicidal ideation and associated factors among university students in Bangladesh during the early stages of the COVID-19 pandemic. A cross-sectional online survey was conducted using the Google form (Google survey tool) from April to May 2020. Initially, 3366 respondents voluntarily completed the survey form. Finally, 3331 surveys were included in the final analyses after removing incomplete surveys. The data ware reviewed, rechecked, and analyzed with SPSS (25.0 version) software. A total of 1979 (59.4%) males and 1352 (40.6%) females participated. Respondents were between the ages of 18 to 28 years (mean age 21.4 years [SD = 1.9]). The prevalence estimate of suicidal ideation was 12.8%. Potential risk factors included less sleep, excess sleep, cigarette smoking, past suicidal thoughts, suicide attempt history, family history of suicidality, depression, anxiety, and stress. Potential protective factors included being male, having lower SES, living in rural areas, regular physical exercise, and satisfactory study. Suicidal ideation was prevalent among Bangladeshi university students during the onset of the COVID-19 pandemic. Understanding the correlates of suicidal ideation may aid to develop targeted strategies to support students during and after the COVID-19 pandemic.
... Endogenous opioids can regulate emotion and emotional response (Bodnar and Klein, 2006). Exercise-induced increases in activity of endogenous opioids in the central and peripheral nervous system simultaneously cause feelings of euphoria and relieve pain (Dinas et al., 2011). Some studies revealed that antioxidant indicators tended to increase and pro-oxidant indicators tended to decrease after exercise training (de Sousa et al., 2017). ...
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Faced with a constant inundation of information and increasing pressures brought by the continuous development of modern civilization, people are increasingly faced with mental health challenges that are only now being actively researched. Mental illness is caused by brain dysfunction due to internal and external pathogenic factors that destroy the integrity of the human brain and alter its function. Regular participation in physical exercise can stimulate the cerebral cortex and simultaneously increase the supply of oxygen and nutrients, helping to preserve or restore normal functioning of the nervous system. In conjunction with other systems of the body, the nervous system constitutes the neuro-humoral regulation system responsible for maintaining the stable state of the human body. This paper is a systematic review of studies investigating the effects of exercise intervention on several common neuropsychological diseases, including depression, anxiety disorder, autism, and attention-deficit/hyperactivity disorder. Furthermore, we discuss possible physiological mechanisms underlying exercise-induced benefits and study limitations that must be addressed by future research. In many cases, drug therapy is ineffective and brings unwanted side effects. Based on the literature, we conclude that exercise intervention plays a positive role and that certain standards must be established in the field to make physical activity consistently effective.
Article
Background Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment. Objective The overarching goal of Project WHADE (Women’s Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women’s psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual). Methods Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims. Results Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020. Conclusions Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women’s PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population. International Registered Report Identifier (IRRID) DERR1-10.2196/19044
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This is the protocol for a review and there is no abstract. The objectives are as follows: 1.To determine whether exercise interventions reduce and/or prevent anxiety and/or depression among children and young people compared to other treatments or no treatment. 2.If so, what are the characteristics of the most effective interventions?
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This report describes the development of seven visual analogue mood scales (VAMS), using vertical 100 mm lines and simple, schematic faces representing the following mood states: sad, afraid, angry, tired, energetic, happy, and confused. Two studies are described in which 311 normal volunteers completed the VAMS, as well as the Profile of Mood States (in both studies) and the Beck Depression Inventory (in one study). Using the multitrait—multimethod technique, the VAMS were found to have excellent discriminant and convergent validity. In one study a separate set of VAMS, in which all words were removed from the scales, was also used. Participants' ratings on these No-Word VAMS were highly correlated with their ratings on the VAMS with corresponding words, indicating that the VAMS have content validity and would be accurately completed by patients with impaired language comprehension. These brief mood scales may prove useful in both clinical and research settings in which valid assessment of internal mood states in aphasic patients is required.
Article
β-endorphin was measured in the sera and nervous tissues of Albino Wistar rats 1, 3, 6 and 9 days after of intraperitoneal (ip) (2 mgkg-1/day) administration of amitriptyline. Control rats received the corresponding volume of saline. A lage increase in sera levels of β-endorphin (71.58 ± 3.22 pgmL-1) was found in experimental group where amitriptyline was injected once compared with the controls (34.46 ± 1.15 pgmL-1). Amitriptyline (ip) was given one injection per day for three, six and nine days. Daily amitriptyline injections (2 mgkg-1 ip) for nine consecutive days however, caused a slight increase in sera levels of β-endorphin (38.57 ± 4.18 pgmL-1) in comparison to control group (34.46 ± 1.15 pgmL-1). In the brain tissue the level of β-endorphin was significantly reduced on 1, 3, 6 and 9 days treatment of amitriptyline (ip).
Article
Objective: Exercise appears to be generally comparable to antidepressant medication in reducing depressive symptoms. The current study examines the effects of aerobic exercise, compared to antidepressant medication and placebo pill, on sexual function among depressed adults. Methods: Two hundred clinically depressed adults, aged 40 years and over, who were sedentary and generally overweight, were randomized to 4 months of Aerobic Exercise, Sertraline (Zoloft), or Placebo pill, for the treatment of depression. Exercise condition participants engaged in walking, running, or biking, 30 min/day, 3 days/week, to 70-85% of their heart rate reserve, in either a supervised group setting or independently at home. Before and following treatment, participants completed the Arizona Sexual Experiences Questionnaire (ASEX) and the Hamilton Rating Scale for Depression (HAM-D). An ANCOVA was performed to test the effects of treatment on post-treatment sexual function, controlling for age, sex, body mass index, diabetes, hypertension, pretreatment HAM-D scores, and pretreatment ASEX scores. Results: The treatment group main effect was significant (p = .02); exercisers had better post-treatment ASEX scores (adjusted ASEX M = 16.6) compared to the placebo group (adjusted ASEX M = 18.3; p = .01). Exercisers had post-treatment ASEX scores that were marginally better compared to the sertraline group, but this difference did not reach statistical significance (adjusted ASEX M = 17.9; p = .05). Conclusion: Aerobic exercise, which has been associated with reduced symptoms of depression comparable to antidepressant medication, appears to result in greater improvement in sexual function compared to placebo pill. A nonsignificant trend towards better sexual function among exercisers compared to antidepressant medication may be attributable to medication-related sexual side effects.
Article
This paper focuses on application of neuroscience techniques to exercise psychology for the purpose of obtaining better answers to questions about the effects of acute exercise on mood and other affective experiences. We do this through the lens of the popular idea that exercise can cause an endorphin-based high. Endogenous opioids and their interaction with other neurotransmitter systems are discussed, followed by a succinct historical account of the effects of acute exercise on endorphins and mood. Limitations of the approaches that have been taken are identified. A key message is that optimal progress toward truly understanding the psychological consequences of exercise will require that neuroscience techniques be combined with the strongest possible research designs.