Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials

IntroductionSleep problems are common in post-traumatic stress disorder (PTSD). Exercise can improve sleep quality, but whether this occurs among those with PTSD is unclear. We conducted a systematic review and meta-analysis to estimate the magnitude of the effect of exercise training on overall sleep quality in patients with PTSD. Secondarily, the impact of exercise training on symptoms of PTSD, anxiety, and depression were evaluated.MethodsArticles published before April 1, 2020, were located through PubMed, Web of Science, PsycINFO, and Google Scholar. Exercise training interventions that measured sleep quality in patients with PTSD were evaluated for inclusion. In total, 1,948 articles were screened, 40 were further appraised, and four were analyzed. Hedges’ d effect sizes were calculated for sleep quality. Due to the relationship between poor sleep and symptoms of PTSD, anxiety, and depression, symptom changes with exercise training were analyzed.ResultsThe four studies involved a total of 149 participants (61% males) with a mean (SD) age of 44.7 (16.3) years. The exercise intervention duration ranged from 3 to 12 weeks. All 5 effect sizes for overall sleep quality supported a favorable effect of exercise training; the mean Hedges'd (95% CI) was −0.47 (−0.18, −0.75), p < 0.05. Exercise training was consistently associated with small or moderate improvements in PTSD, anxiety, and depression symptoms.ConclusionsThe small body of evidence suggests that exercise training has promise for improving overall sleep quality and PTSD, anxiety, and depression symptoms among those with PTSD.     

Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder

ObjectiveThis study compared the benefits of cognitive–behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life (QoL) in a sample of women veterans with and without probable post-traumatic stress disorder (PTSD) comorbid with insomnia disorder.MethodsSeventy-three women veterans (30 with probable PTSD) received a manual-based 5-week cognitive–behavioral therapy for insomnia treatment as part of a behavioral sleep intervention study. Measures were completed at baseline, post-treatment, and 3-month follow-up. Sleep measures included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, sleep efficiency measured by actigraphy, and sleep efficiency and total sleep time measured by sleep diary. Mental health measures included the PTSD Checklist-5, nightmares per week, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scale. QoL was measured with the Short Form-12. Linear mixed models compared changes over time across groups. Independent t tests examined PTSD symptom changes in women veterans with probable PTSD.ResultsBoth groups demonstrated improvements across sleep (ps < .001–.040), mental health symptoms (ps < .001), and QoL measures (ps < .001). The probable PTSD group reported greater improvements in diary sleep efficiency (p = .046) and nightmares per week (p = .001) at post-treatment and in total sleep time (p = .029) and nightmares per week (p = .006) at follow-up. Most participants with probable PTSD experienced clinically significant reductions in PTSD symptoms at post-treatment (66.7%) and follow-up (60.0%). Significant reductions in intrusive and arousal/reactivity symptoms were maintained at follow-up.ConclusionsCognitive–behavioral therapy for insomnia improves insomnia, mental health symptoms, and QoL among women veterans, with greater improvement in those with probable PTSD.     

Physical activity counseling promotes physical and psychological resilience in older veterans with posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD.MethodsOlder (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months.ResultsPrimary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 min/week to 161 min/week among participants in the intervention arm (p = 0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p < 0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p < 0.05).ConclusionsGiven the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.     

Telephone-based cognitive behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study

ObjectiveAlthough bariatric surgery is a durable treatment for patients with severe obesity, it does not directly address behavioural and psychological factors that potentially contribute to weight regain post-surgery. Psychological interventions, such as cognitive behavioural therapy (CBT), can be challenging to access due to physical limitations and practical barriers. Telephone-based CBT (Tele-CBT) can improve eating psychopathology and psychological distress before and after surgery. Given the frequent occurrence/recurrence of problematic eating-related and psychological issues many patients face 1-year post-surgery, this open-trial pilot study aimed to evaluate the effectiveness of Tele-CBT delivered 1-year post-surgery as an adjunctive treatment to the usual standard of bariatric care.MethodsPatients (n = 43) received six 1-h Tele-CBT sessions delivered weekly beginning at 1-year post-surgery. Patients completed questionnaire packages before and after the intervention to assess changes in binge eating (BES), emotional eating (EES), depression (PHQ-9), and anxiety (GAD-7).ResultsThirty-two patients completed Tele-CBT yielding a 74.4% completion rate. Participants reported significant improvements on the Binge Eating Scale (t(31) = 3.794, p = 0.001), Emotional Eating Scale (t(31) = 3.508, p = 0.001), Patient Health Questionnaire-9 Item Scale (z = ?2.371, p = 0.018), and Generalised Anxiety Disorder-7 Item Scale (z = ?3.546, p < 0.001) immediately following Tele-CBT.DiscussionThe results demonstrate that Tele-CBT delivered 1-year post-surgery may improve binge eating, emotional eating, depression, and anxiety. Additional research is warranted to examine whether these changes translate into long-term improvements in bariatric surgery outcomes.     

Psychological outcomes amongst family medicine healthcare professionals during COVID-19 outbreak: A cross-sectional study in Croatia

BackgroundHealthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown.ObjectivesTo assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes.MethodsA cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM.ResultsHCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact.ConclusionFamily physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.     

A pilot study to assess the feasibility and acceptability of a community based physical activity intervention (involving internet,telephone, and pedometer support), integrated with medication and mood management for depressed patients

ObjectiveTo assess the feasibility and acceptability of a multi-component intervention to treat depression in primary care.MethodsA single group prospective design was used to examine the feasibility and acceptability of a 12-week intervention combining antidepressant medication, brief behavioral counseling and physical activity (PA) promotion, and also associated changes in depression and various self-reported measures. A sample of adults with mild-to-moderate major depression and willingness to take antidepressant medication were recruited through local primary care clinics. A Research Nurse Practitioner (RNP) prescribed the selective serotonin reuptake inhibitor, escitalopram (10–20 mg), and provided brief weekly counseling. In addition participants received a pedometer, printed materials, and weekly emails addressing behavioral skills to increase their physical activity. Participants' depressive symptoms, quality of life and PA attitudes were surveyed at baseline, 6 and 12 weeks. At week 12 they also reported their satisfaction with the study components.ResultsOf the 36 participants recruited, 64% of participants completed measures at week 12, 30% completed all 12 counseling sessions and 60% responded to half the emails. By week 12, participants reduced their depressive symptom scores (by 4.7; p < .001), improved their quality of life scores (by 9.7; p < .001) and increased their daily step counts (by 2449.2; p < .03). Of the 23 who responded, over 70% thought the pedometer, calls and print materials helped improve their mood. Those who completed more counseling were more likely to reduce their depressive symptoms at week 12 (r = −.46; p < .05).ConclusionThis pilot study demonstrated the feasibility and acceptability of a multi-component intervention to reduce depressive symptoms in a sample of mild-to-moderately depressed adults.     

Effects of exercise on sleep among young women with Generalized Anxiety Disorder

Statement of the problemGeneralized Anxiety Disorder (GAD) and disturbed sleep are prevalent, debilitating, and frequently comorbid problems for which successful treatment remains limited. Exercise can promote sleep but whether it does among GAD patients is unknown.MethodsThirty sedentary women (18−37 y) with a primary DSM-IV diagnosis of GAD were randomized to six weeks of resistance (RET) or aerobic exercise training (AET), or waitlist (WL). RET and AET involved twice-weekly sessions of either lower-body weightlifting or leg cycling matched on multiple features of exercise. Outcomes included total sleep time (TST), lights out time, awakening out of bed time, time in bed (TIB), sleep onset latency (SOL), wakefulness after sleep onset, and sleep efficiency. Hedges' d effect sizes and 95% confidence intervals were calculated for each exercise condition compared to WL. Regression examined baseline associations between anxiety and sleep and associated change.ResultsTwenty-two of 26 participants reported poor baseline sleep (Pittsburgh Sleep Quality Index > 5). RET significantly decreased weekend TIB (d = −1.79; [−2.89,−0.70]) and SOL (d = −1.30; [−2.32,−0.28]), and significantly increased weekend sleep efficiency (d = 1.30; [0.29,2.32]). AET significantly reduced weekend TIB (d = −1.13; [−2.16,−0.11]) and SOL (d = −1.08; [−2.09,−0.06]). Reduced GAD clinical severity rating was significantly associated with improved weekend sleep efficiency among RET (t₆ = −3.48, p ≤ 0.013).ConclusionsShort-term exercise training improves sleep outcomes among GAD patients, especially for RET and weekend sleep. Findings suggest improved sleep may be associated with reduced clinical severity among GAD patients.     

Promoting psychological health in women with SCI: Development of an online self-esteem intervention

BackgroundThere are no known interventions addressing self-esteem in women following spinal cord injury (SCI).ObjectivesTo test the feasibility of an online self-esteem intervention for women with disabilities, as modified for women with SCI.MethodWe conducted a randomized, controlled feasibility test of a self-esteem intervention (N = 21). Participants were randomly assigned to the intervention or control group that received intervention materials at the end of the study. Intervention participants met as avatars for 7 weekly real-time group sessions in Second Life (SL), a free online virtual world. Feasibility indicators were study engagement, acceptability of SL and the intervention, and improvements on measures of psychological health promoting behaviors, social support, self-efficacy, self-esteem, and depression.ResultsIntervention participants (n = 10) were highly engaged, and most described the SL program as more enjoyable and more convenient than in-person programs. All rated the intervention as “good” (n = 4) or “very good” (n = 6), and all 10 rated themselves has having made positive life changes as a result of the program. Intervention participants experienced significantly greater change than controls on two measures of health-promoting behavior (Health Promoting Lifestyle Profile-II Spiritual Growth/Self-actualization; Interpersonal Relations). Examining change in the intervention group using regression analyses, we found medium-to-large effects of the intervention on these behaviors and measures of depression (CESD-10, PHQ-9). The intervention had small effects on remaining measures.ConclusionWe found preliminary support for the feasibility of this modified self-esteem intervention offered in SL. Such programming may help circumvent barriers to community-based psychological services and may improve psychological health.     

Feasibility of Group-Based Multiple Virtual Reality Sessions to Reduce Behavioral and Psychological Symptoms in Persons Living in Residential Aged Care

ObjectivesTo assess the feasibility of using group-based fully immersive virtual reality (VR) across multiple sessions to reduce behavioral and psychological symptoms (BPSs), including depression, anxiety, and agitated behaviors, in cognitively diverse aged care residents.DesignA 6-session feasibility trial was conducted within a residential aged care facility using convenience sampling to recruit N = 25 residents of varying cognitive capacity. Groups of 5 residents viewed 360-degree videos on a wireless head-mounted display to provide fully immersive VR experiences.Setting and participantsHalf of the participants recruited from the 160-bed facility had a diagnosis of dementia (48%), whereas assessment with the Psychogeriatric Assessment Scale for cognitive impairment revealed that 64% experienced cognitive impairment (mild 20%, moderate 16%, and severe 28%). Additionally, 32% of participants had an existing anxiety or depression diagnosis.MeasuresThe Cornell Scale for Depression in Dementia, Generalized Anxiety Disorder 7-item, and Cohen Mansfield Agitation Inventory–Short were used to assess changes in persisting BPS pre- to postintervention period. The Person-Environment Apathy Rating apathy subscale, Observed Emotions Rating Scale, and a visual analog scale (Smileometer) were used to assess immediate mood responses from residents at every VR session. VR tolerability and resident feedback was also recorded.ResultsPleasure (z = ?5.892, P < .001) and general alertness (z = ?2.455, P = .014) of participants improved at VR sessions, whereas apathy diminished (z = ?5.275, P < .001). Compared to baseline, post-intervention depression was significantly lowered (z = ?2.60, P = .009), whereas agitation increased (z = ?2.98, P = .003). No significant changes in anxiety were observed. The quality of 360-degree videos and the device used did not induce any major VR-related negative side effects.Conclusions and implicationsOverall group-based VR reduced depressive symptoms and apathy, and induced a positive emotional response in most residents, with few observed side effects. Results indicate feasibility of group-based VR technological innovation within RAC.     

Correlates of sleep disturbance in Veterans with traumatic brain injury and chronic pain: A cross-sectional study

BackgroundFew studies have investigated sleep in Veterans with comorbid traumatic brain injury (TBI) and chronic pain.ObjectiveTo describe mood and cognitive correlates with sleep disturbance in a sample of Veterans with both TBI and chronic pain.Research methodCross-sectional, correlational analyses were completed using baseline data from a randomized controlled trial comparing psychosocial treatments for pain in Veterans with TBI. Enrollment occurred between July 2015 and January 2017. Self-report measures of hours slept, insomnia severity, depression and PTSD symptoms were collected along with a brief neuropsychological assessment.ResultsParticipants (n = 221) were an average age of 37.2 years (SD = 8.2) and mostly male (89%). Participants reported sleeping an average of 4.9 h a night (SD = 1.4) with an average Insomnia Severity Index (ISI) score of 17.4 (SD = 5.4) suggesting moderate insomnia symptoms. Fewer hours slept was associated with higher depression scores (r = ?0.28, p < 0.001) and slower processing speed (r = 0.23, p < 0.001). Increasing insomnia severity was associated with greater depression (r = 0.57, p < 0.001) and PTSD symptoms (r = 0.44, p < 0.001), and slower processing speed (r = ?0.22, p < 0.001).ConclusionsThe average ISI score was above the clinical cut off for insomnia diagnosis. Results suggest that those with more severe insomnia symptoms report higher depression and PTSD symptoms as well as exhibit slower processing speed. Improving sleep in this population may be important for improving outcome following TBI.     

Effects of Acupressure on Sleep Quality and Psychological Distress in Nursing Home Residents: A Randomized Controlled Trial

ObjectiveTo compare the efficacy of acupressure with sham acupressure in older-adult nursing home residents presenting with poor sleep quality and psychological distress.DesignProspective, randomized, double-blind, sham-controlled trial.Setting and participantsSixty-two nursing home residents with poor sleep quality and psychological distress participated in this study. Participants were randomly assigned to an experimental group (n = 31) receiving acupressure at true acupoints (Baihui, Juque, Neiguan, Tianzhu, and Yongchung) or control group (n = 31) receiving acupressure at sham points. All participants received 20 minutes of acupressure before sleeping 3 times a week for 8 weeks. All participants were blinded to group allocation.MeasuresSleep quality and psychological distress were measured using the Pittsburgh Sleep Quality Index and the Kessler Psychological Distress scale, respectively. Both groups' outcomes were assessed by assessors blinded to group allocation at the baseline, the end of the intervention, and 1 month after the intervention.ResultsThe experimental group demonstrated significantly more improvement in sleep quality than did the control group at the end of the intervention (10.5 vs 13.3) and 1 month after the intervention (8.3 vs 14.2; both P ≤ .001). Moreover, the experimental group had lower psychological distress levels than did the control group at 1 month after the intervention (14.6 vs 17.9, P = .05). Furthermore, significant differences in mean sleep quality (F = 60.8, P < .001) and psychological distress (F = 24.6, P < .001) were observed in the experimental group between the measurements at baseline and after the intervention.ConclusionsAcupressure at true acupoints improves sleep quality, reduces psychological distress, and provides more clinically beneficial effects compared with that at sham points. Future studies should examine whether these effects are maintained in the long term.     

Perinatal Depression and Anxiety in Women with and without Human Immunodeficiency Virus Infection

BackgroundUntreated depression and anxiety during the perinatal period have significant consequences on maternal and infant health; however, few studies have examined perinatal depression and perinatal anxiety in women with human immunodeficiency virus (HIV) infection. The current study prospectively examined the prevalence of prenatal and postpartum depression and anxiety, and emotional support from family and friends, as well as childhood sexual abuse in women with and without HIV infection.MethodsBetween July 2009 and January 2013, 258 pregnant women receiving care in a Philadelphia hospital were enrolled, with 162 completing both the prenatal and postpartum portions of the study. The Center for Epidemiological Studies–Depression Scale (CES-D), and the State-Trait Anxiety Inventory for Adults were used to measure depression and anxiety symptoms, respectively. An independent samples t test and multiple linear regressions were used to determine associations among depression, anxiety, and pregnancy-related variables.ResultsForty-nine participants (30%) were living with HIV; 113 (70%) were HIV negative. CES-D scores did not differ prenatally (p = .131) or postpartum (p = .156) between women with and without HIV. Prenatal state anxiety scores were higher in women with HIV (p = .02) but there were no differences postpartum (p = .432). In a multiple linear regression, trait anxiety predicted postpartum anxiety in the full sample (p < .001) and childhood sexual abuse predicted postpartum depression among women with HIV (p = .021).ConclusionsThese findings highlight the importance of identifying and treating perinatal depression and anxiety early in the prenatal period. Results also emphasize the need for providers to be aware of childhood sexual abuse as a potential correlate for depression in women with HIV.     

Gender Differences in Service Utilization among OEF/OIF Veterans with Posttraumatic Stress Disorder after a Brief Cognitive–Behavioral Intervention to Increase Treatment Engagement: A Mixed Methods Study

PurposeWomen veterans who served in Iraq and Afghanistan (Operation Enduring Freedom and Operation Iraqi Freedom [OEF/OIF]) have a moderately higher risk of developing posttraumatic stress disorder (PTSD) than male veterans. However, gender disparities in treatment engagement may prevent women veterans from initiating the care they need. Understanding gender differences in predictors of and barriers to treatment is essential to improving engagement and mental health outcomes. The purpose of this study was to examine gender differences in treatment utilization after a brief, cognitive–behavioral therapy (CBT) intervention among male and female OEF/OIF veterans.MethodsParticipants were assigned randomly to either the intervention or control conditions. Intervention participants received the telephone-based CBT intervention. Participants were 35 female and 238 male OEF/OIF veterans who screened positive for PTSD and had never initiated PTSD treatment. Participants were asked about treatment utilization, beliefs about PTSD treatment, and symptoms at months 1, 3, and 6 months subsequent to the baseline telephone assessment. The PTSD Checklist—Military Version was used to assess PTSD and the Patient's Health Questionnaire was used to assess symptoms of depression.FindingsFemale veterans who received an intervention were significantly more likely to have attended treatment over the 6-month follow-up period than male veterans who received an intervention (χ² = 7.91; df = 3; odds ratio, 3.93; p = .04).ConclusionsThe CBT intervention may be a critical mechanism to engage female veterans in treatment. Further research is needed to understand how to engage male veterans with PTSD in treatment.     

Comprehensive Behavioral-Motivational Nutrition Education Improves Depressive Symptoms Following Bariatric Surgery: A Randomized,Controlled Trial of Obese Hispanic Americans

ObjectiveTo evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity.Design/SettingProspective randomized, controlled trial conducted in a laparoscopic institution.Participants/InterventionsDuring the Phase 1 clinical trial (from preoperative evaluation to 6 months after surgery), all participants received standard care. During Phase 2 (6–12 months after surgery), participants were randomly assigned to receive either standard care (n = 72) or comprehensive support (n = 72). Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling.Main Outcome MeasuresDepression scores and weight change over time.AnalysisIndependent samples t tests and regression analysis assessed relationships among depression scores and excess weight loss.ResultsParticipants receiving behavioral-motivational intervention scored significantly lower on Beck's Depression Inventory questionnaire scores than those receiving standard care. For those with depressive symptoms at randomization, 24% of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery, compared with 6% of those who received standard care (P < .001). Patients' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions (P < .001).Conclusions and ImplicationsFindings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss.     

A School-Based Cardiovascular Exercise and Nutrition Program With Parent Participation: An Evaluation Study

This study asks which siblings of children with cancer (SCC) benefit most from a group intervention specifically designed for them. One hundred and eleven SCC (aged 8–17) participated in eight weekly, two-hour, manualized group sessions. Changes in anxiety and depression symptoms were used as outcome measures. Anxiety and depression scores improved more for siblings who were initially most depressed and, thus, considered “less resilient” (p < 0.0001). Within this group, males improved more than females, and siblings of children with brain tumors improved less than SCC with other cancers, (p = 0.05), with female siblings of children with brain tumors improving the least (p = 0.0397).     

Naturalistic Sleep Patterns are Linked to Global Structural Brain Aging in Adolescence

PurposeWe examined whether interindividual differences in naturalistic sleep patterns correlate with any deviations from typical brain aging.MethodsOur sample consisted of 251 participants without current psychiatric diagnoses (9–25 years; mean [standard deviation] = 17.4 ± 4.52 yr; 58% female) drawn from the Neuroimaging and Pediatric Sleep Databank. Participants completed a T1-weighted structural magnetic resonance imaging scan and 5–7 days of wrist actigraphy to assess naturalistic sleep patterns (duration, timing, continuity, and regularity). We estimated brain age from extracted structural magnetic resonance imaging indices and calculated brain age gap (estimated brain age–chronological age). Robust regressions tested cross-sectional associations between brain age gap and sleep patterns. Exploratory models investigated moderating effects of age and biological gender and, in a subset of the sample, links between sleep, brain age gap, and depression severity (Patient-Reported Outcomes Measurement Information System Depression).ResultsLater sleep timing (midsleep) was associated with more advanced brain aging (larger brain age gap), β = 0.1575, p_uncorr = .0042, p_fdr = .0167. Exploratory models suggested that this effect may be driven by males, although the interaction of gender and brain age gap did not survive multiple comparison correction (β = 0.2459, p_uncorr = .0336, p_fdr = .1061). Sleep duration, continuity, and regularity were not significantly associated with brain age gap. Age did not moderate any brain age gap–sleep relationships. In this psychiatrically healthy sample, depression severity was also not associated with brain age gap or sleep.DiscussionLater midsleep may be one behavioral cause or correlate of more advanced brain aging, particularly among males. Future studies should examine whether advanced brain aging and individual differences in sleep precede the onset of suboptimal cognitive-emotional outcomes in adolescents.     

Effects of Integrating Pedometers,Parental Materials,and E-mail Support Within an Extracurricular School Sport Intervention

PurposeThe objective of this study was to evaluate the impact of a school-based intervention (Program X) incorporating pedometers and e-mail support on physical activity, sedentary behavior, and healthy eating in adolescents.MethodsA randomized control trial was used to evaluate the impact of the Program X intervention. Six schools (N = 124 participants; mean age 14.1 ± .8 years) were randomized to intervention or control conditions for the 6-month study period. Objectively recorded physical activity (mean steps/day), self-reported sedentary behavior, and dietary habits were measured at baseline and at 6-month follow-up and intervention effects were assessed using repeated-measures analysis of variance and χ² tests.ResultsParticipants in the intervention group increased their step counts by 956 ± 4107 steps/day (boys) and 999 ± 1999 (girls). Repeated-measures analysis of variance revealed significant group-by-time interactions for boys (F = 7.4, p = .01, d = .80) and girls (F = 29.6, p <.001, d = 1.27) for mean steps/day. The intervention significantly decreased the number of energy-dense/low-nutrient snacks consumed by boys (χ² = 4.0, p = .043) and increased the number of fruit serves among girls (χ² = 4.8, p = .028). The intervention did not have a statistically significant effect on sedentary behavior.ConclusionA school-based intervention incorporating physical activity monitoring using pedometers and e-mail support was successful in promoting physical activity and selected healthy eating behaviors in adolescent boys and girls.     

Regional differences in movement behaviours of children and youth during the second wave of the COVID-19 pandemic in Canada: follow-up from a national study

ObjectivesPublic health restrictions varied by region during the COVID-19 pandemic and reduced opportunities for children to be physically active. The purpose of this study was to assess regional differences in movement behaviours of Canadian children and youth during the second wave of the COVID-19 pandemic.MethodsA national sample of Canadian parents (n=1568; 58% women) of children and youth (5–17 years of age) completed an online survey. Participants were classified based on region of residence (British Columbia, Prairies, Ontario, Quebec, or Atlantic Canada). Differences in movement and play behaviours (physical activity, outdoor play, sleep, screen time) between children and youth living in different regions were examined.ResultsCompared to children and youth in Quebec (the region with the highest COVID-19 prevalence), children and youth in the Prairies (F_(1,1563)=9.0, p=0.01) and Atlantic Canada (F_(1,1563)=17.1, p<0.001) participated in more moderate-to-vigorous physical activity (MVPA). Compared to Quebec, living in Atlantic Canada increased the odds of meeting the MVPA guideline (odds ratio (OR)=2.1, p=0.02), living in Ontario decreased the odds of meeting the sleep guideline (OR=0.6, p=0.01), and living in Ontario (OR=0.7, p=0.04) or Atlantic Canada (OR=0.6, p=0.049) decreased the odds of meeting the screen time guideline. Children and youth in Atlantic Canada demonstrated smaller declines in outdoor play than their counterparts in Quebec.ConclusionMovement and play behaviours varied between regions of Canada where the highest COVID-19 prevalence corresponded to lower odds of meeting the physical activity guidelines. Low compliance with 24-hour movement guidelines suggests that regional pandemic recovery plans need to prioritize opportunities for healthy movement.     

Benefits of Adding an Aquatic Resistance Interval Training to a Nutritional Education on Body Composition,Body Image Perception and Adherence to the Mediterranean Diet in Older Women

The human population is increasing due to lengthening life expectancy, but the quality of life and health of people is moving in the opposite direction. The purpose of this study is to evaluate how aquatic resistance interval training can influence body composition, body image perception and adherence to the Mediterranean diet (MD) in older women participants in a nutrition education program and to study the relation between these variables. Thirty-four participants aged 69 ± 4 years were randomly assigned into two groups: experimental (aquatic resistance interval training plus nutritional intervention) and control (nutritional intervention). The intervention consisted of resistance training in an aquatic environment carried out for 14 weeks (three sessions per week; 60 min each). Body composition, body image perception and adherence to MD diet were evaluated at baseline and 14 weeks. No significant differences were found between groups regarding body image perception and adherence to the MD. There was a significant increase in muscle mass (kg) (p < 0.001) and a significant decrease in fat mass (kg) (p < 0.001) in the intervention group when compared to the control group. The addition of aquatic resistance interval training to a nutritional intervention was not sufficient to change body image perception and adherence to MD but produced improvement in body composition (through an increase in muscle mass and decrease on fat mass) in older women.     

The effects of 60 minutes of supervised weekly walking (in a single vs. 3–5 session format) on depressive symptoms among older women: Findings from a pilot randomized trial

ObjectiveTo investigate the effects of training frequency on psychological benefits resulting from a walking program among older women with subsyndromal depression.MethodsAll participants were randomly assigned to a 4-week-long self-paced walking program including one (G₁) or three to five (G_3–5) weekly training sessions. They completed the Geriatric Depression Scale (GDS) as a measure of depressive symptoms during the intervention and one month later.ResultsUsing statistics for small-n designs, it appeared that, at the end of the program, a significantly greater proportion of women in G_3–5 reported GDS values below the cutoff score of 10 (i.e., indicative of the absence of any depressive symptoms) compared to women in G₁ (5 of 6 vs. 1 of 6; Φ² = 0.48; p < .05). The GDS scores after treatment were significantly lower than baseline scores in both groups (Z = 2.20; p < .03, and Z = 1.99; p < .05 respectively), but the mean decrease of depressive symptoms was significantly larger in G_3-5 (48.9%) than in G₁ (22.7%).ConclusionBreaking 60 min of weekly walking into shorter periods on 3–5 days a week appears to be more effective to alleviate depressive symptoms in older women with subsyndromal depression.