Dose response association of objective physical activity with mental health in a representative national sample of adults: a cross-sectional study

Although higher physical activity (PA) levels are associated with better mental health, previous findings about the shape of the dose–response relationship between PA and mental health are inconsistent. Furthermore, this association may differ according to sedentary levels. We investigated the cross-sectional dose-response associations between objectively measured PA and mental health in a representative national sample of adults. We also examined whether sedentary time modified the PA – mental health associations. Based on 2007-2013 Canadian Health Measures Survey data, PA and sedentary time were measured using accelerometry among 8150 participants, aged 20 to 79 years. Generalized additive models with a smooth function were fitted to examine associations between minutes per day of moderate and vigorous PA (MVPA), light PA (LPA), daily steps (combined or not with sedentary time) and self-rated mental health. A significant curvilinear relationship between average daily minutes of MVPA and mental health was observed, with increasing benefits up to 50 minutes/day. For LPA, a more complex shape (monotonic and curvilinear) was found. For daily steps, inverted U-shaped curve suggested increasing benefits until a plateau between 5000 and 16000 steps. The MVPA-LPA combination was significantly associated with mental health but with a complex pattern. The tested PA-sedentary time combinations showed that increasing sedentary time decreased the positive PA-mental health associations. Non-linear dose-response patterns between the PA modalities and self-reported mental health were observed. Optimal doses of daily minutes of MVPA, LPA, MVPA combined with LPA and daily steps are independently associated with better mental health in adults. The results also suggest that PA-mental health associations could be hampered by daily sedentary time.

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Objectively measured physical activity and sedentary behaviors in a representative sample of Canadian adults with chronic disease(s) : a cross-sectional study

Background: Physical activity and sedentary behaviors are major determinants of quality of life in adults with one or more chronic disease(s). However, there are no Canadian representative population-based studies investigating objectively measured physical activity and sedentary behaviors in adults with and without chronic disease(s). Objective: To compare objectively measured physical activity and sedentary behaviors in a representative sample of Canadian adults with and without chronic disease(s). Methods: Data were obtained from the Canadian Health Measure Survey (CHMS) (2007-2013). Physical activity and sedentary behaviors were measured using accelerometry in Canadians aged between 35 and 79 years. Data are characterized as daily mean time spent in moderate to vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior, as well as steps accumulated per day. Chronic diseases (chronic obstructive pulmonary disease, diabetes, heart diseases, cancer) were assessed via self-report diagnostic or laboratory data. Four weighted multivariable analyses of covariance comparing physical activity and sedentary behavior variables among adults without and with one or more chronic diseases were conducted. Results: In the total, 6270 CHMS participants were included. Analyses indicated that 23.9%, 4.9% and 0.5% had one, two, and three or more chronic diseases. Adults with two or three and more chronic diseases had significantly lower daily duration of MVPA and LPA, lower daily step counts, and higher daily duration of sedentary behavior compared to adults with no chronic diseases, with low effect sizes. Conclusions: Canadian multimorbid adults might benefit from targeted interventions to increase physical activity and reduce sedentary behaviors.

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Daily objective physical activity and sedentary time in adults with COPD using spirometry data from Canadian Measures Health Survey

Chronic obstructive pulmonary disease (COPD) is expected to be the third leading cause of premature death and disability in Canada and around the world by the year 2020. The study aims to compare objective physical activity (PA) and sedentary time in a population-based sample of adults with chronic obstructive pulmonary disease (COPD) and comparison a group, and to investigate whether these behaviors differ according to COPD severity. Methods From the 2007-2013 Canadian Health Measures Survey dataset, accelerometer and pre-bronchodilator spirometry data were available for 6441 participants, aged 35 to 79. Two weighted analyses of covariance were performed with adjustments for age, sex, body mass index, accelerometer wearing time and season, work, smoking (cotinine), education level and income. A set of sensitivity analyses were carried out to examine the possible effect of COPD, and type of control group. Results A cross-sectional weighted analysis indicated that 14,6% of study participants had a measured airflow obstruction consistent with COPD. Time in PA (moderate-vigorous and light PA), number of steps and sedentary duration were not significantly different in participants with COPD, taken together, compared to controls. However, moderate to severe COPD participants (stages ≥2) had a significantly lower daily time spent in PA of moderate and vigorous intensity level compared to controls. Conclusions Canadian adults with COPD with all disease severity levels combined did not perform lower daily duration of light, moderate and vigorous PA, number of steps and higher daily sedentary time than those without airflow obstruction. Both groups are extremely sedentary and have low PA duration. Thus, “move more and sit less” public health strategy could equally target adults with or without COPD.

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Cognitive Behavioral Therapy combined with physical exercise for depression, anxiety, fatigue and pain in adults with chronic diseases: systematic review and meta-analysis

Objective. The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise). Methods. Relevant randomized clinical trials, published before July 2017, were identified through database searches in Pubmed, PsycArticles, CINAHL, SportDiscus and the Cochrane Central Register for Controlled Trials. Results. A total of 30 studies were identified. CBTEx interventions yielded small-to-large effect sizes for depression (SMC = -0.34, 95% CI [-0.53; -0.14]), anxiety (SMC = -0.18, 95% CI [-0.34; -0.03]) and fatigue (SMC = -0.96, 95% CI [-1.43; -0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes. Conclusion. The current literature suggests that CBTEx interventions are effective for decreasing depression, anxiety, and fatigue symptoms, but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the four outcomes compared to each condition alone.

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A commentary on the importance of controlling for medication use within trials on the effects of exercise on depression and anxiety

Antidepressant and anxiolytics drugs may confound our understanding of the effects of exercise on anxiety and depression which may occur through biological pathways (some may act synergistically while others may be antagonistic), behavioural pathways (with indications of poorer exercise adherence for drug users), and indirect pathways (driven by deteriorated health status affecting the exercise capabilities of medication users). Therefore, the use of antidepressant or anxiolytic medications needs to be carefully considered in future studies assessing the effects of exercise on anxiety or depression.

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Differences in daily objective physical activity and sedentary time between women with self-reported fibromyalgia and controls: results from the Canadian Health Measures Survey

Introduction Physical activity and sedentary behaviors are important modifiable factors that influence health and quality of life in women with fibromyalgia. The purpose of this study was to compare objectively assessed physical activity and sedentary time in women self-reporting fibromyalgia with a control group. Method Data were drawn from the Canadian Health Measures Survey cycle 1, 2 and 3 conducted by Statistics Canada. We included women aged 18 to 79 years with complete accelerometer data. We performed one-way analyses of covariance (adjusted-for socio-demographic and health factors) to determine mean differences in physical activity and sedentary variables (minutes per day of moderate and vigorous physical activity, light physical activity, sedentary and daily steps) between women with and without fibromyalgia. Results In total, 4132 participants were included. A cross-sectional weighted analysis indicated that 3,1% of participants self-reported a diagnosis of fibromyalgia. Participants with fibromyalgia spent less time than controls engaged in moderate and vigorous physical activity (M = 19.2 min/d (SE=0.7) vs M = 9.1 min/d (SE=1.2), p = 0.03, η2= 0.01). No significant differences were found for daily time spent in light physical activity, sedentary activities and number of steps. Conclusion Women participants with self-reported fibromyalgia spent significantly less time in moderate and vigorous physical activity than control. Physical activity promotion interventions for women with self-reported fibromyalgia should, as a priority, target physical activities with moderate to vigorous intensity.

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