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BACKGROUND: Emerging evidence suggests that exercise may be an efficacious treatment for alcohol use disorder (AUD), but adherence is suboptimal. We examined factors associated with adherence to an exercise intervention for non-treatment seeking adults with AUD. METHODS: This secondary analysis of a randomized controlled trial included 95 physically inactive adults aged 18-75 years with clinician-diagnosed AUD. Study participants were randomly assigned to 12-weeks fitness centre-based, supervised aerobic exercise or yoga classes and asked to attend at least three times/week. Adherence was assessed both objectively (based on use of a keycard at entry) and subjectively using an activity calendar. The association between AUD and other predictor variables with adherence was assessed using logistic and Poisson regression models. RESULTS: Just under half of participants (47/95, 49%) completed ≥ 12 supervised exercise sessions. When both supervised classes and self-reported sessions were included, 32/95 (34%) participants completed ≤ 11 sessions, 28/95 (29%) did 12-23 sessions and 35/95 (37%) completed ≥ 24 sessions. In univariate logistic regression analyses, lower education was associated with non-adherence (

Exercise is a promising treatment option for individuals with alcohol use disorder, but qualitative studies are lacking. Our aim was to explore experiences of yoga and aerobic exercise among non-treatment-seeking adults with alcohol use disorder.Semi-structured qualitative interviews (face-to-face or telephone) with 12 participants from a randomised controlled trial. Qualitative content analysis was used to analyse data.One main category was identified, motivating and maintaining a lifestyle change, including four generic categories: (i) Initiating factors for lifestyle change, which describes how the concept of a lifestyle change initiated participants change; (ii) Influencing lifestyle change, explains how mood-enhancing effects from exercise influence exercise behaviours; (iii) Influencing physical and mental health, which describes how improvements in physical and mental health influence self-confidence and self-esteem; and (iv) Influencing alcohol consumption, which describes how exercise reduced alcohol cravings and that success in changing exercise behaviours made participants take healthier decisions regarding their alcohol intake.Exercise may help reduce alcohol intake, especially when presented in the context of a lifestyle change. Being able to self-select the type of exercise may increase compliance and optimise these benefits. Intentional planning and positive results from exercise may strengthen the individual's self-efficacy and increase the motivation to change behaviours associated with alcohol consumption.

Paul Welford,1 Josefine Östh,1 Sara Hoy,2 Susan L Rossell,3 Michaela Pascoe,4 Vinod Diwan,1 Mats Hallgren1 1Department of Global Public Health, Karolinska Institutet, Solna, Sweden; 2Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden; 3Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia; 4Institute for Health and Sport, Victoria University, Melbourne, Victoria, AustraliaCorrespondence: Mats Hallgren, Department of Global Public Health, Karolinska Institutet, Level 6, 1e Solnavägen, Solna, 11365, Sweden, Tel +46852480000, Email mats.hallgren@ki.sePurpose: To compare the effects on verbal fluency of a supported yoga-based exercise intervention to an aerobic exercise intervention and a wait-list control group.Participants and Methods: Eighty-two physically-inactive but otherwise healthy adults (mean age 72.5 years, range 65– 85, 77% female) were recruited into a 12-week, three-group, parallel randomized controlled trial. Participants were supported to complete ≥ 3 Hatha yoga classes per/week or ≥ 3 structured aerobic exercise sessions/week. A wait-list control group continued usual daily activities only. Verbal fluency, including total-FAS, animals, and verbs, was assessed before and after interventions. Group effects were assessed using analysis of covariance (ANCOVA).Results: Twenty-seven participants were randomized to yoga, 29 to aerobic exercise and 26 to a waitlist. At 12-week follow-up, compared to baseline, there were increases in mean total-FAS in the yoga (+5.0 words, p=0.002) and aerobic exercise groups (+6.6 words, p=0.004). Mean total-FAS in the wait-list control group remained stable (− 0.5 words, p=0.838). There were medium-magnitude estimated treatment effects on total-FAS for yoga versus wait-list control and aerobic exercise versus wait-list control: Hedges’ g=0.51 (p=0.213) and 0.57 (p=0.098) respectively. In addition, small-to-medium magnitude estimated treatment effects were seen on animals and verbs for yoga versus wait-list control and aerobic exercise versus wait-list control: g=0.28 (p=0.155), 0.19 (p=0.766) and 0.50 (p=0.085), 0.59 (p=0.233) respectively.Conclusion: Participation in yoga or aerobic exercise was associated with estimated improvements in verbal fluency compared to a non-active control group. Yoga and aerobic exercise may be promising approaches by which to promote cognitive function among older adults.Trial Registration: DRKS00015093, U1111-1217-4248.Keywords: physical activity, verbal fluency test, executive function, cognitive aging, healthy aging

ObjectiveTo estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias.DesignSystematic review and meta-analysis with meta-regression.Data sourcesThe Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651).Eligibility criteria for selecting studiesRandomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group.ResultsForty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=−0.946, 95% CI −1.18 to −0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=−0.998, 95% CI −1.39 to −0.61, k=20), supervised exercise interventions (SMD=−1.026, 95% CI −1.28 to −0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=−0.666, 95% CI −0.99 to −0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)).ConclusionExercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

Sedentary behavior (SB) is associated with depression, yet little is known about the relationship between different types of SB (e.g., passive versus mentally-active) with depression and potential biological mediators of these associations. We used cohort data from the 1958 National Child Development Study (n = 4,607;50.4% women), employing the 44y wave as baseline, and the 46y, 50y and 55y waves as follow-up. TV-viewing and watching videos (i.e., passive SB), and time sitting while doing light activities such as deskwork or driving a car during worktime (i.e., mentally-active SB) were self-reported by participants. Depression diagnosis was self-reported during the initial and follow-up waves and the participants answered the CIS-R at 44y. Waist circumference, C-reactive protein, and glycated hemoglobin were assessed at baseline and examined as potential mediators. We created Cox proportional hazards regression models, adjusting for gender, education, employment status, physical activity, tobacco smoking, and alcohol consumption at baseline. There were 636 cases of incident depression over 47,184 person-years. Passive SB was associated with higher hazards of incident depression (HR: 1.43; 95%CI: 1.19–1.71), while there was no association with mentally-active SB. Waist circumference (coefficient: -0.03; 95%CI: -0.05; -0.01; 9.2%) and C-reactive protein (coefficient: -0.03; 95%CI: -0.04; -0.01; 8.3%), but not glycated hemoglobin, partly mediated the association with passive SB. Higher durations of time spent in mentally-passive SB can increase risk of incident depression. The mediating contributions of waist circumference and C-reactive protein point to possible inflammatory-related mechanisms and suggest potential benefits of jointly addressing metabolic and mental health.

Objective To examine recent trends in bullying and mental health problems among adolescents and the association between them. Method A questionnaire measuring mental health problems, bullying at school, socio-economic status, and the school environment was distributed to all secondary school students aged 15 (school-year 9) and 18 (school-year 11) in Stockholm during 2014, 2018, and 2020 (n = 32,722). Associations between bullying and mental health problems were assessed using logistic regression analyses adjusting for relevant demographic, socio-economic, and school-related factors. Results The prevalence of bullying remained stable and was highest among girls in year 9; range = 4.9% to 16.9%. Mental health problems increased; range = + 1.2% (year 9 boys) to + 4.6% (year 11 girls) and were consistently higher among girls (17.2% in year 11, 2020). In adjusted models, having been bullied was detrimentally associated with mental health (OR = 2.57 [2.24–2.96]). Reports of mental health problems were four times higher among boys who had been bullied compared to those not bullied. The corresponding figure for girls was 2.4 times higher. Conclusions Exposure to bullying at school was associated with higher odds of mental health problems. Boys appear to be more vulnerable to the deleterious effects of bullying than girls.

A comprehensive understanding of the mechanisms of action is important if yoga-based interventions are to be used in the prevention and/or treatment of mental health symptoms. We, therefore, aimed to examine the evidence base and mechanisms underlying the benefits of yoga-based interventions on mental health, with a focus on psychological, physiological and neurobiological mechanisms. A narrative review was conducted of scoping reviews, systematic reviews and meta-analysis of yoga-based interventions with a focus on psychological, physiological and neurobiological mechanisms linking yoga-based interventions with mental health. A single author conducted a search of the literature using a number of databases (PubMed, Web of Science, Scopus, Google Scholar). Search terms included but were not limited to “yoga*”, “asana*,” “psych*”, “neuro*”, “stress”, “autonomic”, “mental illness”, “mental health”, “cytokine” and “endocrine”. A total of 22 studies were included in this narrative review. These studies report that yoga-based interventions decrease stress reactivity, influence physiological markers of stress reactivity including changes in blood pressure, heart rate, cortisol or cytokine levels, resulting in overall improved health and well-being, in diverse populations of adults. Yoga-based interventions influence psychological processes involved in the regulation of mood and emotion, including self-compassion, dispositional mindfulness, rumination, meta-cognition, attention and memory. Finally, yoga-based interventions result in structural and functional changes in several brain regions. Yoga-based interventions impact multiple processes of mental health; however, further research should explore the potential interaction between these processes as it is possible that effects may be synergistic rather than in silos.

Purpose: The associations of screen-time (ST) and physical activity (PA) with adolescent mental health are largely well-established. However, there is limited and inconsistent evidence for the ST, PA, and anxiety relationship. Methods: We cross-sectionally examined associations between anxiety symptoms with various ST modes and PA levels. Participants (n=1756, n=995 female) living in the Republic of Ireland completed self-report questionnaires assessing individual ST modes (watching TV, using a computer for fun and using a smartphone), PA levels (low, moderate, and high) and anxiety symptoms were measured by the State-Trait Anxiety Inventory. Multiple linear regressions investigated associations between ST modes and anxiety symptoms while controlling for covariates. We stratified the sample according to PA level and gender to assess their impact on the ST-anxiety relationship. Results: Computer (β=0.094 p≤0.001) and phone use (β=0.084, p≤0.002) were associated with higher anxiety symptoms. TV viewing was not associated with anxiety symptoms. PA level appeared to moderate the association between phone use and anxiety symptoms, such that those with higher PA levels had no observable associations between phone use and anxiety symptoms. No moderating effect was observed for computer use in the full sample or for males but was observed in females. Conclusions: These differential findings highlight the complex nature of these associations among adolescents. Prospective studies of the relationship between screen-time and physical activity with anxiety are needed.

Objective:. Exercise has established efficacy in people with anxiety and stress-related disorders. Dropouts from randomized controlled trials (RCT's) pose a threat to the validity of the evidence, with dropout rates varying across studies. We conducted a meta-analysis to investigate the prevalence and predictors of dropout rates among adults with anxiety and stress-related disorders participating in exercise RCT's. Methods:. Two authors searched major electronic databases up to 07/2020. We included RCT's of exercise interventions in people with anxiety and stress-related disorders that reported dropout rates. A random effects meta-analysis and meta-regression were conducted. Results:. Fourteen RCT's involving 16 exercise interventions (n=369, mean age 20.7 to 67.7years; 38.4% male) were included. The trim-and-fill-adjusted prevalence of dropout across all studies was 22.4% (95%CI = 15.0% to 32.0%). Applying controlled motivation strategies (P2 = 0%; N=16). Limitations:. Potentially important moderators of dropout, such as the severity of mental health symptoms and illness duration were insufficiently available. Conclusions:. Exercise is well tolerated by people with anxiety and stress-related disorders and drop out in RCT's is comparable to control conditions. Thus, exercise is a feasible treatment, in particular when autonomous motivation strategies are included and when the intervention is delivered by healthcare professionals with expertise in exercise prescription.

Interruptions to time spent sitting can ameliorate detrimental metabolic-health consequences of high volumes of sedentary time, but their potential mental health benefits have not been examined. We used the Swedish Health Profile Assessment database, a general health assessment offered to all employees working for companies or organisations connected to occupational and health services. Cross-sectional analyses examined data from 40,550 employees (60% male, mean age = 42 years), collected in 2017-2019. Participants reported the proportion of time (almost always; 75% of the time; 50% of the time; 25% of the time; and almost never) usually spent in leisure-time sedentary behaviours; and, separately, the frequency (never; rarely; sometimes; often; and very often) of interruptions (every 30 min) to sedentary time. Logistic regression models assessed associations of sedentary time, and the frequency of interruptions to sedentary time, with depression/anxiety symptoms. Fully adjusted models included physical exercise. Compared to those in the lowest sedentary time category, those in the medium and high categories had 1.52 (95% confidence interval (CI) = 1.40-1.66) and 3.11 (95% CI = 2.82-3.42) higher odds of frequent depression/anxiety symptoms, respectively. Compared to those who never/rarely interrupted their sedentary time, those who reported interruptions sometimes, often and very often had 0.72 (95% CI = 0.65-0.80), 0.59 (95% CI = 0.53-0.65), and 0.53 (95% CI = 0.46-0.59) lower odds of depression/anxiety symptoms, respectively. In stratified analyses, more frequent interruptions to sedentary time were associated with lower odds of depression/anxiety symptoms, except among those in the lowest interruptions categories (never/25% of the time). More regularly interrupting sitting during leisure-time may reduce the odds of experiencing symptoms of depression and anxiety. ispartof: TRANSLATIONAL PSYCHIATRY vol:10 issue:1 ispartof: location:United States status: published

While physical inactivity is associated with adverse psychological outcomes, less is known about the psychological outcomes associated with sedentary behaviour, and specifically, its mentally active and passive forms. The COVID-19 pandemic represents a unique opportunity to study associations between these variables in light of widespread stay-at-home mandates and restrictions on outdoor exercise/social activities. Using a cross-sectional dataset acquired during the COVID-19 pandemic in Australia, we examined whether physical activity and sedentary behaviour were associated with subjective quality of life (sQoL) and subjective cognitive dysfunction, and whether these associations were mediated by depressive symptoms.658 participants (males = 169, females = 489) self-reported data on physical activity and sedentary behaviour in an online survey during May 2020-May 2021. Data on physical activity and sedentary behaviour (both mentally active and passive types) was compared according to whether it was collected during or out of a lockdown period. Regression models were used to test associations of physical activity and sedentary behaviour with sQoL and subjective cognitive dysfunction, and whether these associations were mediated by depression severity.Physical activity was beneficially associated with sQoL, whereas sedentary behaviour (both total hours and the reduction of mentally active/increase in mentally passive behaviour) was detrimentally associated with sQoL. These associations were mediated by depression severity. Physical activity and sedentary behaviour were also indirectly associated with subjective cognitive dysfunction by virtue of their associations with depression severity.There are important differences in the psychological correlates of mentally passive and active sedentary behaviours. Our findings suggest that health promotion strategies should focus on not only increasing physical activity but also reducing

IntroductionSubstance use disorder (SUD) is characterized by cognitive impairment, especially executive dysfunction. Executive function is recognized as an important determinant of treatment outcome as it is associated with dropout rate, attendance to therapy and potential relapse after treatment termination. Physical activity can have beneficial effects on cognitive function, but there is still a lack of knowledge regarding potential benefits of aerobic exercise for executive function in SUD treatment. The aim of this study is to examine the effect of aerobic high-intensity interval training (HIIT) on cognitive function and the subsequent effect on treatment outcome in patients with SUD.Methods and analysisThis study is a randomized controlled trial, including men and women ≥18 years with diagnosed SUD by ICD-10. The patients will be recruited from the department for inpatient treatment at Blue Cross - Lade Addiction Treatment Center, Trondheim, Norway. Participants will be randomized 1:1 into either HIIT (3x/week) + treatment as usual (TAU), or TAU alone. Study outcomes will be assessed at baseline, after eight weeks of intervention, and at 3- and 12-months follow-up. The primary outcome is to compare the change in executive function (via altered BRIEF-A score, Behavior Rating Inventory of Executive Function-Adult) measured between the two study groups after eight weeks. Secondary outcomes include mapping of cognitive function in different subgroups (e.g. type of substance, age, fitness level), collecting self-reported information about quality of life, craving, sleep quality, etc., as well as assessing compliance to TAU and long-term treatment outcome.Ethics and disseminationThe project was approved by the Regional Ethical Committee and will be performed in accordance with this protocol and the Declaration of Helsinki. Written informed consent will be obtained from all participants prior to inclusion. This project will explore a novel approach to how exercise can be applied in SUD treatment, beyond the well-known effects on physical health. We expect to achieve new knowledge in regard to what extent HIIT can improve cognitive abilities and subsequent treatment outcome in SUD.Trial registration numberhttps://www.clinicaltrials.gov/NCT05324085.

To compare the effects of yoga, aerobic exercise, and usual care on anxiety and depressive symptoms in non-treatment seeking adults with AUD.Parallel, three-group, open-label randomised (1:1:1) controlled trial with blinded follow-up assessment. Non-treatment seeking adults (aged 18-75 years) were recruited via advertisements in a free newspaper in Stockholm, Sweden. All participants had clinician-diagnosed AUD prior to randomisation. This trial excluded those who were physically active, or for whom supervised physical activity was contraindicated. Participants were randomly assigned to 12-weeks of aerobic exercise, yoga, or usual care (telephone counselling). The secondary outcome of interest was the Hospital Anxiety and Depression Scale (HADS), assessed at baseline and 12-week follow-up. Primary analyses consisted of linear regression models and followed intention-to-treat (ITT) principals.In total, 140 participants (mean age 53.7 years, SD=11.8) were recruited. Follow-up was completed for 42/45 participants randomised to TAU, 42/49 to aerobic exercise and 43/46 to yoga. ITT analyses included 126 trial participants. There were statistically significant within-group improvements in total HADS in all three intervention groups. Effect sizes for usual care and aerobic exercise were small (Hedges' g=0.48, 95% CI=0.16, 0.80 and g=0.41, 95% CI=0.09, 0.72, respectively), while yoga was associated with a large treatment effect (g=1.06, 95% CI=0.69, 1.43). There were significant between-group differences in these improvements favouring yoga (B=-2.15, 95% CI=-4.16, -0.15, p = .035) relative to usual care, but no significant differences between yoga and aerobic exercise. No injuries were reported.Findings support the recommendation of yoga for non-treatment seeking adults with AUD.

Higher levels of physical activity (PA) and screen time (ST) are associated with positive and negative mental health outcomes among adolescents, respectively. Research is needed to determine the interrelationship between ST and PA with depressive symptoms and the influence of ST modes. This study examines the associations between ST and PA level with depressive symptoms among 1756 adolescents (15.2 ± 1.6y; 995 female) in Ireland. Participants completed the Quick Inventory of Depressive Symptomatology and self-reported weekly ST (TV, computer, and phone use) and PA level (low, moderate, and high). Linear regressions examined associations between ST mode, PA level and relevant covariates with depressive symptoms in the full sample by gender, and in a sample stratified by PA level. Chi-square tests and one-way ANOVA examined gender differences in hours of ST, PA levels, and depressive symptoms. Differential associations were observed depending on the gender and ST mode. Higher levels of computer (β = 0.106, p ≤ 0.000) and phone use (β = 0.138, p ≤ 0.000) showed the strongest associations with depressive symptoms. PA level was inversely associated with depressive symptoms (β = - 0.175, p ≤ 0.000). When the sample was stratified by PA level, only associations between phone use and depressive symptoms were moderated by PA level for males and females. These findings highlight the complex interrelationships between ST, PA, and depressive symptoms, and that associations may vary based on gender and ST mode. This may have implications for future interventions. Increasing PA and reducing ST should be targeted concurrently with consideration given to different media and genders. Future research should explore longitudinal and prospective associations.

Background: Screen-based device use could increase the risk of adolescent depression. Distinct modalities of screen-use may have differential effects on mental health. We used compositional data analysis to examine how theoretically replacing different screen-uses with exercise might influence future adolescent emotional distress. Methods: In 4,599 adolescents (55% female) from a nationally-representative, prospective cohort, we used time-use diary data at age 14 to estimate daily screen use (television, social media, video game, general computer use) and exercise (team sport and individual exercise). The outcome was emotional distress at age 17, assessed using the emotional symptoms subscale of the Strengths and Difficulties Questionnaire. Results: Theoretically replacing 60 min of total screen time with exercise at age 14 was associated with a 0.05 (95%CI -0.08, -0.02) score reduction on the emotional symptoms’ subscale at 17 in fully-adjusted models. Replacing 60 min of television or social media use with team sports was associated with a reduction of 0.17 (95%CI, -0.31, -0.04) and 0.15 (95%CI, -0.29, -0.01) in emotional symptom scores, respectively. We found no change in emotional symptom scores when replacing video game or general computer use with team sport, or when replacing any screen time with individual exercise. Limitations: No direct measure of depressive symptoms at follow-up. Conclusions: Replacing any screen time with exercise could reduce emotional distress, but the largest effect sizes were associated with replacing time in television watching and social media with team sports. Recommendations to limit screen-use in adolescents may require a nuanced approach for protecting mental health.

In order to develop adequate public health interventions, there is a need to explore whether people with an alcohol use disorder (AUD) not requiring inpatient treatment do have compromised physical health and are consequently a population at risk. We cross-sectionally compared physical fitness and physical activity levels in community patients with an AUD with healthy matched controls in Uganda. Fifty community patients (42 men, median age=32.0 years, interquartile range=10.7 years) and 50 age-, gender- and body mass index-matched controls performed a 6-minute walk test (6MWT), and completed the Simple Physical Activity Questionnaire (SIMPAQ). Differences between groups were assessed with a t-test or Mann Whitney U test when appropriate. Community patients with AUD have significantly lower 6MWT [median=480.0 (interquartile range=109) versus 802.5 (121.2) m, P

BACKGROUND: Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD. METHODS: Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back). RESULTS: A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011]. CONCLUSIONS: Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist.

Background: As distinct from mentally-active sedentary behaviors (e.g. reading), passive sedentary behaviors (e.g. TV-viewing) have been linked to a higher risk of depression, but the underlying mechanisms are unclear. We examined the potential mediating role of sleep problems in prospective relationships of passive sedentary behaviors with major depressive disorder (MDD). Method: In 1997, 43 863 adults were surveyed and responses linked to clinician diagnoses of MDD until 2010. The questionnaire included items on sedentary behavior and sleep problems (Karolinska Sleep Questionnaire). Cox proportional hazard models and the ‘counterfactual approach’ were used to identify potential mediating effects of sleep problems in the association of passive sedentary behavior and MDD. Results: Of the total sample, 3,065 (7.6%) were excluded for having indications of depression at baseline. Of 33,116 participants with complete data (mean age = 51.3 years, SD = 15.7, 64% female); 472 (1.4%) incident cases of MDD were identified during the 13-year follow-up. In Cox regression analyses, higher durations of passive sedentary behavior (≥3 h/day versus

Background : Sedentary behavior (SB) may be a risk factor for depression in middle- and old age adults. The aim of this study was to examine cross-sectional and longitudinal relationships between SB and depression in a large national sample of Irish people aged 50 and older taking into account a wide range of previously identified influential factors. Methods : Data from the Irish Longitudinal Study on Ageing survey were analyzed (wave 1: 2009–2011, wave 2: 2012–2013). Depression was assessed with the Center for Epidemiologic Studies Depression scale. Total weekday SB and control variables were self-reported. Multivariable logistic regression and mediation analysis were conducted to assess the associations. Results : The final sample consisted of 6903 individuals aged ≥50 years (63.6 ± 9.2years; 52.1% female). After full adjustment for age, gender, social class, current smoking, physical activity, mobility, pain, cognition, chronic physical conditions, disability, anxiety, loneliness, and social network, the association between SB and depression was not statistically significant (OR=1.06; 95%CI=0.60–1.89). Mediation analysis showed that the association is explained by social network (mediated percentage 23.1%), physical activity (20.3%), loneliness (13.2%), chronic physical conditions (11.1%), and disability (7.9%). Cross-sectional analysis showed that SB is significantly associated with depression even after full adjustment. Limitations : SB was self-reported. Conclusions : Factors closely linked with SB such as social isolation, loneliness, physical inactivity, chronic physical conditions, and disability may play a major role in depression among middle-aged and older people. Lifestyle interventions focusing on reductions in depression in this population need to consider these factors.

The purpose of this study was to compare the functional exercise capacity of patients with alcohol use disorders (AUD) with an age-, gender-, and body mass index (BMI)-matched healthy control group. Thirty patients (22 males, 40.4 ± 10.5 years, illness duration = 9.7 ± 9.3 years) and healthy control subjects (22 males, 40.2 ± 10.7 years) participated. Participants performed a 6-min walk test (6MWT) to assess their functional exercise capacity, were asked about musculoskeletal problems and dyspnea, executed a standing broad jump to assess their muscular strength, and completed the International Physical Activity Questionnaire (IPAQ). Patients also filled in the Positive Affect and Negative Affect Schedule (PANAS) and Alcohol Use Disorders Identification Test (AUDIT). Our data show that patients with AUD walked a significantly shorter distance on the 6MWT (649.0 ± 72.9 m vs. 724.4 ± 89.0 m, p = 0.001). In patients with AUD, the variance in standing broad jump score explained 43.6% of the variance in the 6MWT score. The current study demonstrates that impaired muscle strength is negatively associated with functional outcomes in patients with AUD. Exercise interventions should be investigated in order to assess whether they can ameliorate muscle strength and daily life functioning of this vulnerable population. ispartof: ALCOHOL vol:82 pages:47-52 ispartof: location:United States status: published

Background: There is a growing recognition of the importance of encouraging people with alcohol use disorders (AUD) to become more active as an achievable strategy to reduce the disability-associated burden. Objective: We investigated whether physical activity and sedentary behaviour in men with AUD contribute to their quality of life (QoL). Methods: Fifty male Ugandan inpatients with AUD (33.0±10.7 years) completed the World Health Organization Quality of Life Assessment brief version, Simple Physical Activity Questionnaire and the Alcohol Use Disorders Identification Test while waist circumference, body mass index and blood pressure were assessed. Linear multiple regression analysis explored the total variance in QoL explained by all predictor variables. Results: SIMPAQ walking and SIMPAQ exercise explained 46% of the variability in physical QoL, 45% of the variability in psychological QoL, and 40% of the variability in environmental QoL. The SIMPAQ walking score predicted 37% of the variability in social QoL. Conclusion: The current findings suggest that higher levels of walking and exercising are associated with a better QoL. Our study therefore provides a platform for future research to investigate the role of physical activity on QoL levels in people with AUD, also in low resourced settings in low-income countries such as Uganda. Keywords: Physical activity; exercise; alcohol; quality of life.

Detrimental associations of sedentary behaviors with depression have been identified, but findings are inconsistent. We propose a novel approach to the classification and analysis of sedentary behaviors, which differentiates between those that are passive (e.g., television viewing) and mentally active (e.g., reading). Available evidence is summarized, and research questions relating to measurement, causal relationships, and mechanisms are considered.

Introduction: Loneliness is widespread and associated with deleterious outcomes in middle-aged and older age people in low- and middle-income countries (LMICs). Physical activity is one potential psychosocial strategy with the potential to reduce loneliness in this population. Thus, the aim of this study was to explore associations between physical activity (PA) and loneliness in middle-aged and older people from six LMICs. Materials and methods: Data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Self-reported data on loneliness and PA (as assessed by the Global Physical Activity Questionnaire) were collected. Participants were dichotomized into those who do and do not meet the international recommendation of 150 minutes of moderate to vigorous PA per week. Associations between loneliness and PA were examined using logistic regressions. Results: Among 34 129 individuals aged 50 years or older, the prevalence of loneliness was higher among those not meeting the PA guidelines in all countries, although this difference was not significant in Mexico and South Africa. After full adjustment, not meeting PA guidelines was positively associated with loneliness in the meta-analysis based on country-wise estimates, with a moderate level of between-country heterogeneity being observed (OR = 1.31; 95% CI, 1.07-1.61; I2 = 48.7%). At an individual country level, statistical significance was only reached in Ghana (OR = 1.89; 95% CI = 1.44-2.49). Discussion: Our data suggest that physical inactivity and loneliness commonly co-occur in adults aged 50 years or older in LMICs overall but that this association differs by country. Longitudinal studies are required to confirm these findings and investigate potential mechanisms that may inform future interventions.

Recent findings support positive effects of acute aerobic exercise on worry, state anxiety, and feelings of energy and fatigue among young adult women with subclinical, or analogue, generalized anxiety disorder (GAD). However, exercise effects among young adult men with analogue GAD are unstudied. PURPOSE: This study replicated initial findings of positive effects of acute vigorous-intensity aerobic exercise on worry, state anxiety, and feelings of energy and fatigue among young adult women with analogue GAD, examined responses among young adult men with analogue GAD, and explored sex-related differences and moderation by physical activity level, trait anxiety, depression, and poor sleep status. METHODS: Thirty-five young adults (21.4 ± 2.3 yr; 19 males; 16 females) with Penn State Worry Questionnaire scores ≥45 (60 ± 8) completed two counterbalanced 30-min conditions: treadmill running at ~71.2% ± 0.04% HR reserve and seated quiet rest. Outcomes included worry, worry engagement, absence of worry, state anxiety, and feelings of energy and fatigue. RESULTS: No outcome or moderator differed at baseline between sexes. Exercise significantly improved state anxiety (P < 0.04; d = 0.27) and feelings of energy (P < 0.001; d = 1.09). Small nonsignificant improvements were found for worry (d = 0.22), worry engagement (d = 0.18), and feelings of fatigue (d = 0.21). The magnitude of improvements in worry, worry engagement, absence of worry, and feelings of energy were stronger among females. Significant large, potentially clinically meaningful increases in feelings of energy were found among women (d = 1.35) and men (d = 0.92). A nonsignificant, but potentially clinically meaningful, moderate reduction in worry (d = 0.53) was found among women. High-trait anxiety and poor sleep quality were supported as moderators. CONCLUSIONS: Findings replicated positive effects of acute aerobic exercise among young adult women with analogue GAD, and extended to support for positive effects among young adult men with analogue GAD

Objective Regular physical activity (PA) is associated with less self-reported anxiety, but prospective studies linked to clinician diagnoses of anxiety disorder remain scarce. We examined whether the PA levels recommended for general health are related to anxiety symptoms and disorders. Method In total, 43,863 Swedish adults were surveyed in 1997 and responses linked to medical registers until 2010. Weekly durations of habitual moderate and vigorous leisure time PA were self-reported. Cross-sectional and prospective relationships between the total duration (minutes) of PA, 0–149 (‘below’), 150–299 (‘achieve’), and ≥300 min (‘exceed’) with self-reported anxiety symptoms and incident anxiety disorder were explored. Associations were explored using logistic and Cox proportional hazard regression models. Results Of 27,053 participants with complete data (mean age = 49.0 years, SD = 15.9, 66% female), 76% met the recommended duration of PA (≥150 min), and 38% exceeded this duration. At baseline, 2573 participants (9.5%) reported elevated anxiety symptoms. In cross-sectional analyses, engaging in ≥150 min of MVPA/week was associated with 24% (OR = 0.76, 95% CI = 0.68–0.86) lower odds of anxiety symptoms. Exceeding the weekly duration was associated with 36% (OR = 0.64, 95% CI = 0.57–0.72) lower odds. During the 13-year follow-up, 198 incident cases of anxiety disorder (0.8%) were identified. No significant prospective relationships were found. Conclusions Engaging in leisure time PA at levels recommended for general health may reduce the risk of elevated anxiety symptoms. As the incidence of anxiety disorder was likely under-estimated, further prospective studies are needed to determine the relationship between PA and incident anxiety disorder.

AIMS: Exercise is increasingly being studied as treatment for alcohol use disorder (AUD). We examined the effects of an acute bout of exercise on alcohol craving, heterogeneity of response, and factors associated with reductions in craving. METHODS: Within the context of a randomized controlled trial, we conducted an exploratory, single-arm study. In total, 117 adults with AUD (52.7 years; SD = 12.3; 68.4% female) and indications of alcohol craving (Desire for Alcohol Questionnaire, DAQ-short version total score >8) were included. The intervention was a 12-min sub-maximal fitness test performed on a cycle ergometer. We examined changes in participant's self-rated desire for alcohol immediately before and after exercise. Personal, clinical, and exercise-related factors associated with reductions (≥0.5 SD) in craving were identified using hierarchical logistic regression. RESULTS: In the total sample craving reduced from pre-to post-exercise (p

Objectives-\ud \ud Data from high-income countries (HICs) indicate that sedentary behavior is negatively associated with moderate-to-vigorous physical activity (MVPA) in young people. We examined associations between leisure-time sedentary behavior (LTSB) and MVPA in adolescents from 47 low- and middle-income countries (LMICs).\ud \ud Study design-\ud \ud Cross-sectional study.\ud \ud Methods-\ud \ud Data from the Global school-based Student Health Survey were analyzed in 140,808 adolescents (13.8 ± 1.0 years; 49% girls). Time spent in LTSB was a composite variable assessing time spent sitting and playing computer games, watching TV, talking with friends during a typical day. The PACE + Adolescent Physical Activity Measure assessed MVPA levels. The association between ≥3 h/day of LTSB and adequate physical activity levels (every day last week 60 min MVPA) was explored with multivariable logistic regression analyses.\ud \ud Results-\ud \ud The prevalence of ≥3 h/day of LTSB and 60 min of MVPA/day last week were 26.3% (girls 26.2%; boys 26.5%) and 15.3% (girls 12.1%; boys 18.4%), respectively. LTSB of ≥3 h/day versus

BackgroundFrequent use of screen-based devices could be a modifiable risk factor for adolescent depression, but findings have been inconsistent and mostly from cross-sectional studies. We examined prospective associations of video gaming, social media, and internet use with depressive symptoms in adolescents.MethodsA total of 11 341 adolescents from the Millennium Cohort Study, a representative, UK population-based. The main outcome was depressive symptoms from a Moods and Feelings Questionnaire (age 14). Exposures were frequency of video game, social media, and internet use (age 11). Physical activity (effect modifier) was measured by self-report.ResultsThe fully adjusted models indicated that boys playing video games most days, at least once a week, and at least once a month at age 11 had lower depression scores at age 14 by 24.2% (IRR = 0.77, 95% CI 0.66–0.91), 25.1% (IRR = 0.75, 95% CI 0.62–0.90), and 31.2% (IRR = 0.69, 95% CI 0.57–0.83), compared with playing less than once a month/never. In girls, compared with less than once a month/never, using social media most days at age 11 was associated with 13% higher depression scores at age 14 (IRR = 1.13, 95% CI 1.05–1.22). We found some evidence of associations between using the internet most days and depressive symptoms compared with less than once a month/never in boys (IRR = 0.86, 95% CI 0.75–1.00). More frequent video game use was consistently associated with fewer depressive symptoms in boys with low physical activity, but not in those with high physical activity.ConclusionsDifferent types of screen-time may have contrasting associations with depressive symptoms during adolescence. Initiatives to address adolescents’ screen-time may require targeted approaches.

Purpose: To describe physical activity habits, sedentary behavior, and cardiorespiratory fitness levels among alcohol abstainers, hazardous and non-hazardous drinkers. Design: Cross-sectional study with data collected between 2017-19. Setting: Sweden. Subjects: Adults aged 18-65 years (n = 47,559; 59.4% male). Measures: During a routine health assessment, participants answered validated single-item questions regarding: habitual physical activity, structured exercise, and the percentage of time spent sedentary during leisure-time (past 30 days), and completed a 6-minute cycle ergometer test (V02max) to determine cardiorespiratory fitness (CRF). Participants were categorized as alcohol abstainers, non-hazardous drinkers or hazardous drinkers (low/high) based on the Alcohol Use Disorders Identification Test (AUDIT-C) cut-points for men and women. Analysis: Logistic regression models stratified by sex and age. Results: Compared to non-hazardous drinkers, the heaviest drinkers were less physically active (males: OR = 1.38, CI = 1.13-1.67, p = .001; females: OR = 1.41, CI = 1.01-1.97, p = .040) and more sedentary during leisure time (males: OR = 1.94, CI = 1.62-2.32, p = .000; females: OR = 1.62, CI = 1.21-2.16, p = .001). Apart from young females, the heaviest drinkers also did less structured exercise than non-hazardous drinkers (males: OR = 1.22, CI = 1.15-1.51, p = .000; females: OR = 1.43, CI = 1.15-1.78, p = .001). The strongest associations were seen among adults aged 40-65 years (shown here). High-hazardous drinking was associated with low CRF among older males only (OR = 1.19, CI = 1.00-1.41). Conclusion: Middle-aged adults with AUDIT-C scores of ≥6 (women) and ≥7 (men) were less physically active and more sedentary during leisure time and may be appropriate targets for physical activity interventions.

Background\ud Several tests are available to assess the different components of physical fitness, including cardiorespiratory fitness, muscular strength, and flexibility. However, the reliability and validity of physical fitness tests in people with mental disorders has not been meta‐analyzed.\ud \ud Aims\ud To examine the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders.\ud \ud Methods\ud Studies evaluating the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders were searched from major databases until January 20, 2020. Random‐effects meta‐analyses were performed pooling (1) reliability: test–retest correlations at two‐time points, (2) convergent validity between submaximal tests and maximal protocols, or (3) concurrent validity between two submaximal tests. Associations are presented using r values and 95% confidence intervals. Methodological quality was assessed using the Quality Appraisal of Reliability Studies and the Critical Appraisal Tool.\ud \ud Results\ud A total of 11 studies (N = 504; 34% females) were included. Reliability of the fitness tests, produced r values ranging from moderate (balance test‐EUROFIT; [r = 0.75 (0.60–0.85); p = 0.0001]) to very strong (explosive leg power EUROFIT; [r = 0.96 (0.93–0.97); p = 0.0001]). Convergent validity between the 6‐min walk test (6MWT) and submaximal cardiorespiratory tests was moderate (0.57 [0.26–0.77]; p = 0.0001). Concurrent validity between the 2‐min walk test and 6MWT (r = 0.86 [0.39–0.97]; p = 0.0004) was strong.\ud \ud Conclusion\ud The present study demonstrates that physical fitness tests are reliable and valid in people with mental disorders.

BACKGROUND: Exercise is increasingly being used in the treatment of alcohol use disorder (AUD). We examined the short-term effects of acute exercise on alcohol craving, mood states and state anxiety in physically inactive, non-treatment seeking adults with AUD. METHODS: Exploratory, single-arm study. In total, 140 adults with AUD (53.7 ± 11.8 years; 70 % female) were included in a randomized controlled trial (RCT) to study effects of physical activity on alcohol consumption. This acute exercise study was nested within the larger RCT. The intervention was a 12-minute sub-maximal fitness test performed on a cycle ergometer. Participants self-rated their desire for alcohol (DAQ) and completed mood (POMS-Brief) and state anxiety (STAI-Y1) questionnaires 30-minutes before exercise, immediately before, immediately after, and 30-minutes post. Ratings of perceived exertion (RPE) were collected. Effects of exercise were assessed using RM-ANOVA and dependent sample t-tests with effect sizes (Hedges g). RESULTS: In total, 70.6 % had mild or moderate AUD (DSM-5 criteria = 4.9 ± 2). The intervention was generally perceived as 'strenuous' (RPE = 16.1 ± 1.6). In the total sample, there was a main effect of time with reductions in alcohol craving [F(3,411) = 27.33, p < 0.001], mood disturbance [F(3,411) = 53.44, p < 0.001], and state anxiety [F(3,411) = 3.83, p = 0.013]. Between-group analyses indicated larger magnitude effects in those with severe compared to mild AUD, however, AUD severity did not significantly moderate the within-group improvements: group x time interaction for alcohol craving [F(6,411) = 1.21, p = 0.305]. Positive effects of exercise were maintained 30-minutes post-exercise. CONCLUSION: A short bout of aerobic exercise reduced alcohol craving and improved mood states in adults with AUD. ispartof: DRUG AND ALCOHOL DEPENDENCE vol:220 ispartof: location:Ireland status: published

Objectives People with alcohol use disorders (AUD) are at a higher risk for physical co-morbidities. Consequently, their daily life functioning needs to be reliably assessed and followed-up. We examined the reliability of the 6-min walk test (6MWT) in a cohort of inpatients with AUD. Secondary aims were to assess minimal detectable changes (MDC95 ), practice effects and associations of the 6MWT with demographical and clinical variables. Methods Two 6MWTs were administered within 3 days to 45 (32♂) inpatients with a DSM-5 diagnosis of AUD. Physical complaints before and after the 6MWT were recorded. Patients performed a standing broad jump to assess muscle strength and completed the International Physical Activity Questionnaire, the Positive Affect and Negative Affect Schedule (PANAS) and Alcohol Use Disorders Identification Test. Results Patients walked 636.3 ± 82.3 meters and 638.1 ± 77.6 meters at the first and second test. The intraclass correlation coefficient was 0.94 (95% confidence interval 0.90-0.97). The MDC95 was 15 meters for men and 9 meters for women. No practice effect was detected. The presence of feet or ankle problems or pain before the test, dyspnea after the test, impaired muscle strength and lower PANAS positive affect scores were independently related to shorter 6MWT distance accounting for 67.3% of the variance. Conclusion The 6MWT is a reliable tool for evaluating the functional exercise capacity in inpatients with AUD. Health care professionals should consider musculoskeletal and respiratory symptoms when interpreting fitness test outcomes in this vulnerable population.

There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.

BackgroundSedentary behaviour can be associated with poor mental health, but it remains unclear whether all types of sedentary behaviour have equivalent detrimental effects.AimsTo model the potential impact on depression of replacing passive with mentally active sedentary behaviours and with light and moderate-to-vigorous physical activity. An additional aim was to explore these relationships by self-report data and clinician diagnoses of depression.MethodIn 1997, 43 863 Swedish adults were initially surveyed and their responses linked to patient registers until 2010. The isotemporal substitution method was used to model the potential impact on depression of replacing 30 min of passive sedentary behaviour with equivalent durations of mentally active sedentary behaviour, light physical activity or moderate-to-vigorous physical activity. Outcomes were self-reported depression symptoms (cross-sectional analyses) and clinician-diagnosed incident major depressive disorder (MDD) (prospective analyses).ResultsOf 24 060 participants with complete data (mean age 49.2 years, s.d. 15.8, 66% female), 1526 (6.3%) reported depression symptoms at baseline. There were 416 (1.7%) incident cases of MDD during the 13-year follow-up. Modelled cross-sectionally, replacing 30 min/day of passive sedentary behaviour with 30 min/day of mentally active sedentary behaviour, light physical activity and moderate-to-vigorous activity reduced the odds of depression symptoms by 5% (odds ratio 0.95, 95% CI 0.94–0.97), 13% (odds ratio 0.87, 95% CI 0.76–1.00) and 19% (odds ratio 0.81, 95% CI 0.93–0.90), respectively. Modelled prospectively, substituting 30 min/day of passive with 30 min/day of mentally active sedentary behaviour reduced MDD risk by 5% (hazard ratio 0.95, 95% CI 0.91–0.99); no other prospective associations were statistically significant.ConclusionsSubstituting passive with mentally active sedentary behaviours, light activity or moderate-to-vigorous activity may reduce depression risk in adults.

Screening and brief intervention in primary care for hazardous alcohol use is potentially a means to improve public health but is seldom implemented. There are few comparisons with general practitioner screening for other lifestyle habits.Repeated cross-sectional surveys from 2004, 2008, and 2012 in Sweden were used (N = 28,935) to document general practitioner visitors' reports on being asked and advised about alcohol, tobacco, diet, and physical activity when visiting primary care.Screening increased for all health behaviors, with the most apparent increase found for alcohol use.Screening for alcohol use can efficiently be integrated into health care, along with that for other lifestyle habits.

Regular physical activity (PA) appears to protect against the emergence of depression, but prospective studies linked to clinician diagnoses of major depressive disorder (MDD) remain scarce. It is also unclear whether PA levels recommended for general health are prospectively related to depression onset. We explored these relationships in a cohort of adults followed over 13 years. In total, 43,863 Swedish adults were surveyed in 1997 and responses linked to clinician-diagnosed MDD obtained from specialist medical registers until 2010. Weekly durations of habitual moderate (including walking) and vigorous PA were self-reported. Relationships between total durations of PA, 0-149 ('below'), 150-299 ('achieve'), and ≥300 min ('exceed') with incident MDD were explored using survival analysis with Cox proportional hazards regression. Models were adjusted for relevant covariates. Those with indications of depression at baseline were removed from the primary analyses. Of 25,520 participants with complete data (mean age = 49 years, SD = 16, 65% female), 76% met the recommended weekly duration of PA (≥150 min), and 38% exceeded this duration (≥300 min). During 13-years follow-up 549 MDD cases (1.5%) were identified (incidence rate = 111 cases per 100,000 person-years). Compared to participants who were below, those who exceeded the recommended weekly duration (≥300 min/week) had 29% reduced risk of depression onset (HR 0.71, 95% CI = 0.53-0.96). A non-significant inverse association was observed among those who achieved the minimum duration of 150-min/week (HR 0.86, 95% CI = 0.64-1.14). Habitual PA levels that exceed the duration recommended for general health may reduce the risk of clinician-diagnosed major depression in adults. ispartof: PREVENTIVE MEDICINE vol:118 pages:38-43 ispartof: location:United States status: published

Objective: To compare the effects of yoga and aerobic exercise (AE) on wellbeing in physically inactive, but otherwise healthy older adults. A secondary objective was to assess and compare the frequency of adverse events associated with yoga and AE. Design: Twelve-week, three-group, parallel randomized controlled trial with blinded follow-up assessment. Interventions: Participants were supported to complete ≥ 3 Hatha yoga classes/week or ≥ 3 AE sessions/week. A wait-list control (WLC) group continued usual daily activities. Main outcome measure: Change in wellbeing, assessed using the Satisfaction with Life Scale (SWLS) and Life Satisfaction Index-Z (LSI),at baseline and at 12-week follow up. Results: In total, 82 adults (mean age 72.5 years, range 65-85, 77% female) were recruited. Of these, 27 were randomized to yoga, 29 to aerobic exercise and 26 to wait-list control. Medium-magnitude treatment effects (Hedges' g) were seen for yoga versus WLC and AE versus WLC(SWLS, g = 0.65 and 0.56; LSI, g = 0.54 and 0.54, respectively). In per-protocol analyses, larger effect sizes were found (SWLS, g = 0.72 and 0.66; LSI, g = 0.76 and 0.76, respectively). Adverse events were less frequent in the yoga group (6/27; 22%) compared to AE (10/27; 37%). Conclusions: Among physically inactive older adults, participation in yoga or AE was associated with beneficial effects on subjective wellbeing when compared to a non-active control group. Yoga was associated with fewer injuries and may be especially suitable for older adults (DRKS 00015093).

OBJECTIVE: The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators. METHOD: Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I2=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations. CONCLUSIONS: Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region. ispartof: AMERICAN JOURNAL OF PSYCHIATRY vol:175 issue:7 pages:631-648 ispartof: location:United States status: published

Introduction and aims Novel treatments for substance use disorders are needed. Acute bouts of exercise can improve mood states in non-clinical populations, but effects in those with poly-substance dependence are understudied. We examined the feasibility and short-term effects of three types of exercise on drug cravings, self-esteem, mood and positive/negative affect in nine poly-drug-dependent inpatients. Design and methods Using a cross-over design, changes in the four study outcomes were assessed immediately before exercise and on four separate occasions post-exercise (immediately after, then at 1, 2 and 4 h post-exercise) enabling patterns of change over time (analysis of covariance) to be observed. Results Participants were willing and able to engage in different non-laboratory based exercises. Football was associated with non-significant short-term reductions in drug cravings. A similar trend was seen for circuit-training, but not walking. Football and circuit-training were associated with brief improvements in mood and positive/negative affect. No adverse events were reported. Discussion and conclusions Football, circuit training and walking are feasible therapeutic activities for inpatients with poly-substance dependence. Controlled trials are needed to determine the long-term effects of these activities.

Cigarette smoking is associated with multiple adverse health outcomes. When smokers attempt to quit smoking, one of the leading predictors of relapse are cravings. Recent research shows a relationship between positive and negative affect, exercise, and cravings, but the exact nature of this relationship has yet to be understood. This study explored the relationships between positive and negative affect and cravings in a sample of participants with elevated levels of depressive symptoms (N = 202; 68.8% female; mean age = 46.1 years) who were enrolled in a smoking cessation trial to test the efficacy of a 12-week exercise intervention relative to a health education control on smoking outcomes. Data on affect and craving were gathered before weekly study intervention sessions, and data on cravings were gathered again after each session. The results showed that negative affect had a significant and positive association with cravings before an exercise or health education session. After the session, positive and negative affect were not significant predictors of changes in cravings from pre-session. However, regardless of level of positive or negative affect participants in the exercise condition showed greater reductions in craving pre- to post-class than those in the control condition. These findings suggest that negative affect is associated with cravings, but cravings can be mitigated by exercise.

Behavioural interventions show promising results among patients with mild- to moderate depression. However, whether tobacco use moderates the effects of these interventions is not known. In the present study, we examined whether patients suffering from mild-to-moderate depression differed in their response to prescribed physical exercise or internet-based cognitive behavioural therapy (ICBT) according to their current tobacco use. We conducted a secondary analysis of data from 740 participants in a multicentre randomised controlled trial comparing physical exercise, internet-based cognitive behavioural therapy and treatment as usual (Regassa study). Information on current daily tobacco use was self-reported at baseline. Linear and logistic regression were used to examine the treatments' effect (reduction in depression score) in the subgroups of tobacco users (n=154) and non-users (n=586). We found that baseline tobacco use did not significantly moderate the association between treatment type and post-treatment depression severity. Both interventions (exercise and ICBT) resulted in a reduction of depression scores that was similar among non-users and users of tobacco, albeit formally statistically significant only among non-users. Physical exercise on prescription and ICBT can be used in the clinical management of depressed patients, with similar prognostic advantage among tobacco users and non-users.

Background Exercise is an effective treatment for depression but non-adherence is common. The aim of this study was to determine the level of adherence to an exercise intervention, specifically factors associated with adherence in a depressed population. Methods This study reports the secondary analysis from a randomized controlled trial. The 310 participants were aged 18–67 years and affected by mild to moderate depression i.e. scoring ≥10 on the Patient Health Questionnaire-9 (PHQ-9). Adherence to an exercise intervention (light, moderate, vigorous, performed three times a week for 12 weeks) was measured using pulse watches or self-reports (78.4% vs. 21.6%). Factors associated with adherence were explored using negative binomial regression models. Results Adherers (≥12 sessions, 32.7%) exercised on average 22.9 (SD = 7.4) times, while sub-adherers (1–11 sessions, 26.9%) attended on average 4.7 (SD = 3.1) sessions. Around 40% of participants were non-adherers (0 sessions). Tobacco use and hazardous alcohol use were associated with a lower adherence while flexibility at work was associated with higher adherence. Conclusion Tobacco use, hazardous alcohol use and flexibility at work can influence adherence to an exercise program among depressed people and should be considered when applying exercise interventions.

Within the self-determination theory and the trans-theoretical model (stages of change) frameworks, we investigated motives for physical activity adoption and maintenance in men with alcohol use disorder (AUD). Fifty Ugandan patients completed the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3) to assess exercise motives, the Patient-centred Assessment and Counselling for Exercise (PACE) to determine stage of change and the Alcohol Use Disorders Identification Test. The relationship between motives for physical activity and stage of change was investigated using ANOVA with post-hoc Scheffe tests. Multivariate analyses found significantly higher levels of introjected, identified and integrated motivation in the action and maintenance stage versus the pre-action stage. There were no differences in intrinsic motivation between the stages of change. Our results suggest that in order to adopt and maintain an active lifestyle the most important source of motivation comes from the benefits that may be obtained rather than from the inherent pleasure or challenge associated with it. The study provides a platform for future research to investigate the importance of autonomous motivation within physical activity interventions for people with AUD.

Objectives To examine the short-term effects of exercise on drug craving in poly-drug-dependent inpatients, duration of effects, differences between exercise types, explore the relationship between craving and mood, and possible moderators. Design Multicenter randomized control trial (RCT) with a crossover design. Methods 38 (25 completed) inpatients (37.3 ± 6.4 years; 84 % male) from three treatment centers participated in soccer, circuit training and control condition in random order for 45-min. Craving was assessed with a self-rated visual analog scale (VAS), mood with Feeling scale (FS), immediately before and after each condition and 1, 2, and 4 h post interventions. Ratings of perceived exertion (RPE) and heart rate were assessed. Intervention effects were assessed using linear mixed effects model, including moderator analyses. Results Exercise sessions were perceived as “somewhat hard” to “hard”. Compared to control, there was an immediate reduction in craving after soccer and circuit training (β = −1.35, 95 %CI: 1.96, −0.75, p = 0.000; β = -1.44, 95 %CI: 2.06, −0.83, p = 0.000) that persisted for 4 h (β = −1.11, 95 %CI: 1.72, −0.49, p = 0.000; β = -0.85, 95 %CI: 1.49, −0.22, p = 0.008). Elevations in mood after soccer (β = 1.08, 95 %CI: 0.41, 1.76, p = 0.002) and circuit training (β = 0.99, 95 %CI: 0.32, 1.67, p = 0.004) were significantly larger than control. Depressive disorder and primary drug of use might moderate the effect. Conclusion Reduced drug cravings and elevated mood following soccer and circuit training were observed in people with poly-SUDs. Single exercise sessions can be an effective strategy to alleviate craving and potentially prevent relapse and treatment drop-out.