Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis.

BACKGROUND: A review of the safety profile of exercise training in multiple sclerosis (MS) has not been conducted since 2013. OBJECTIVE: We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) of exercise training published since 2013 and quantified estimated population risks of clinical relapse, adverse events (AE) and serious adverse event (SAE). METHODS: Articles reporting safety outcomes from comparisons of exercise training with non-exercise among persons with MS were identified. The risk of bias was established from study's internal validity assessed using Physiotherapy Evidence Database (PEDro). Rates and estimated mean population relative risks (RRs; 95% confidence interval (CI)) of safety outcomes were calculated, and random-effects meta-analysis estimated the mean RR. RESULTS: Forty-six interventions from 40 RCTs (N = 1780) yielded 46, 40 and 39 effects for relapse, AE, adverse effects and SAE, respectively. The mean population RRs ((95% CI), p-value) for relapse, AE and SAE were 0.95 ((0.61, 1.48), p = 0.82), 1.40 ((0.90, 2.19), p = 0.14) and 1.05 ((0.62, 1.80), p = 0.85), respectively. No significant heterogeneity is observed for any outcome. CONCLUSION: In studies that reported safety outcomes, there was no higher risk of relapse, AE, adverse effects or SAE for exercise training than the comparator. Exercise training may be promoted as safe and beneficial to persons with MS.

The Interplay Between Expected Psychological Responses to Exercise and Physical Activity in Analogue Generalized Anxiety Disorder: a Cross-sectional Study.

BACKGROUND: Expectations for psychological responses to exercise are not well characterized, particularly in people at risk for anxiety-related illnesses. Given the substantial evidence for salutary effects of exercise on anxiety symptoms and emerging recognition for expectations as a critical mechanism of placebo/nocebo effects, this study explored the interplay between expectations and physical activity in young adults with and without analogue generalized anxiety disorder. METHODS: Participants (N=470, 23.2±4.8 years, 63% female) completed a physical activity and mood survey, including a 7-day physical activity recall questionnaire, and a 20-item questionnaire designed to measure positive and negative expectations for psychological and perceptual responses to exercise, particularly expectations for symptoms in the generalized anxiety disorder symptom profile. Analogue generalized anxiety disorder status was determined using the Generalized Anxiety Disorder subscale of the Psychiatric Diagnostic Screening Questionnaire. RESULTS: For select outcomes, expected exercise-induced changes significantly differed according to analogue generalized anxiety disorder (whole-body pain, sleep quality, psychological well-being, stress, relaxation) and active versus inactive (anxious mood, depressed mood, concentration, physical function, psychological well-being, relaxation) status. However, these findings did not survive corrections for multiple comparisons and the magnitude of these differences was small, approximating 0.25 standard deviations. Expectations for anxious (Spearman's ρ=-0.14, p≤0.002) and depressed mood (ρ=-0.15, p≤0.002), and psychological well-being (ρ=0.15, p≤0.001) were significantly associated with higher physical activity levels. Exercise expectations for anxious mood explained a significant, but small (+1.5%, p≤0.03), amount of variance in physical activity. CONCLUSIONS: Expectations for exercise-induced improvements did not significantly differ between young adults based on analogue generalized anxiety disorder or physical activity status.

Differential Associations of Total and Context-Specific Sedentary Time with Depressive Symptoms Among Adolescents: Results from Ireland's CSPPA Study.

BACKGROUND: Higher levels of sedentary behaviour (SB) and screen-time are associated with greater symptoms of depression in adolescents, but the effect of the type and context of SB and screen-time remains underexplored. As part of a nationally-representative observational study, the current cross-sectional study examined associations between SB, screen-time and depressive symptoms among 422 adolescents (13.5 ± 0.92 years; 125 female) in the Republic of Ireland. METHOD: Participants completed the Quick Inventory of Depressive Symptomatology and self-reported weekly SB, categorised into mentally-active screen-time (e.g., computer use for fun), mentally-passive screen-time (e.g., television viewing) and mentally-active non-screen-based SB (e.g., reading). Mann-Whitney U tests and Kruskal-Wallis H tests examined differences in screen-time and depressive symptoms by relevant covariates. Linear regression quantified crude and adjusted associations between total SB and mentally-active and mentally-passive screen-time and SB, and depressive symptoms. RESULTS: Crude and adjusted linear regressions showed total SB was significantly, positively associated with depressive symptoms (unadjusted: ß = 0.27, p = 0.002, adjusted: ß = 0.27, p = 0.002). When type and context were examined in the same model, only mentally-active screen-time was positively associated with depressive symptoms (unadjusted: ß = 0.37, p = 0.009, adjusted: ß = 0.39, p = 0.007). CONCLUSION: Differential associations between total SB and mentally-active screen-time and SB, versus mentally-passive screen-time, and depressive symptoms among Irish adolescents were observed. Findings highlight the importance of investigating the context and type of SB and screen-time in adolescents.

Associations between screen-time, physical activity and depressive symptoms differ based on gender and screen-time mode.

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 (ß = 0.106, p ≤ 0.000) and phone use (ß = 0.138, p ≤ 0.000) showed the strongest associations with depressive symptoms. PA level was inversely associated with depressive symptoms (ß = - 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.

A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention.

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.

Perspectives of youth in Ireland on school-based mental health and suicide prevention: the MYSTORY study.

Anxiety, depression, and suicide are leading causes of disability and death among young people, globally. Schools are an ideal setting to target young people's mental health, yet young people's beliefs about and experiences with school mental health and suicide prevention are not well understood. This gap in knowledge contradicts both national and international youth mental health recommendations and the United Nations Convention on the Rights of the Child, which collectively advocate for understanding young people's perspectives on matters concerning them, including school mental health. Therefore, the Mental Health of Youth Story (MYSTORY) study explored young people's perspectives on school mental health and suicide prevention using a participatory-based approach incorporating photovoice. MYSTORY consisted of a community/university partnership involving young people as participants (n = 14) and advisors (n = 6). Experiential, reflexive thematic analysis (TA) within a critical approach generated three themes relating to young people's experiences with and beliefs about school mental health promotion and suicide prevention. Findings highlight the critical role of schools in impacting young people's mental health, with the need to amplify youth voice and involvement in school mental health evident. Our study addresses an important gap by employing participatory-based approaches to explore young people's perspectives on school mental health and suicide prevention. This is the first known study to explore young people's perspectives on their voice and involvement in school mental health. Findings have important implications for youth and school mental health and suicide prevention research, policy, and practice.

Comparison of fibula strut and calcium phosphate cement augmentation of the medial buttress in 2-part proximal humerus fractures reconstruction: a biomechanical study.

PURPOSE: Augmentation strategies for surgical fixation of proximal humerus fractures (PHF) are available to address their relatively high failure rate. The purpose of this study was to compare two medial-buttress augmentation strategies for PHF fixation. METHODS: A two-part PHF model with loss of medial buttress was created in 16 synthetic bones. The PHFs were fixed with locking plates and either calcium phosphate cement (CPC) or fibula strut (FS) augmentation. After cadaveric validations, the fixation constructs were subjected to nondestructive axial compression tests, followed by a cyclic test. Construct stiffness and angular displacement of the humerus head were recorded. RESULTS: Humeral head angular displacement was statistically greater in the CPC group than in the FS group at the applied force of 300 N and higher (p < 0.05). Axial stiffness was statistically greater in the FS fixation group than in the CPC group at initial and final phases of cyclic loading protocol (p < 0.05). CONCLUSIONS: In an osteoporotic cadaveric model of a 2-part PHF with loss of a medial buttress, locked plate constructs augmented with FS have a higher resistance to varus collapse compared to those augmented with CPC.

Research Review: The effect of school-based suicide prevention on suicidal ideation and suicide attempts and the role of intervention and contextual factors among adolescents: a meta-analysis and meta-regression.

BACKGROUND: Globally, suicide is the fourth highest cause of adolescent mortality (Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide). The effects of post-primary school-based suicide prevention (PSSP) on adolescent suicidal thoughts and behaviours (STBs) have not been comprehensively synthesised. We aim to estimate the population effect for PSSP interventions on adolescent STBs and explore how intervention effects vary based on intervention and contextual moderators. METHODS: Searches of PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials identified cluster randomised trials examining the effectiveness of PSSP on adolescent STBs. The Cochrane Risk of Bias tool assessed bias. Crude and adjusted back-transformed odds ratios (ORs) were calculated. Multilevel random-effects models accounted for dependencies of effects. Univariate meta-regression explored variability of intervention and contextual moderators on pooled effects. RESULTS: There were 19 and 12 effects for suicidal ideation (SI) and suicide attempts (SA). Compared with controls, interventions were associated with 13% (OR = 0.87, 95%CI [0.78, 0.96]) and 34% (OR = 0.66, 95%CI [0.47, 0.91]) lower crude odds reductions for SI and SA, respectively. Effects were similar for adjusted SI (OR = 0.85, 95%CI [0.75, 0.95]) and SA (OR = 0.72, 95%CI [0.59, 0.87]) models. Within-study (0.20-9.10%) and between-study (0-51.20%) heterogeneity ranged for crude and adjusted SA models and SI heterogeneity was 0%. Moderator analyses did not vary SA effects (ps > .05). CONCLUSIONS: This meta-analysis contributes to the PSSP evidence-base by demonstrating that PSSP targeting STBs as both primary intervention outcomes and with other health and well-being outcomes reduced SI and SA among 33,155 adolescents attending 329 schools, compared to controls. The number needed to treat estimates suggests the potential of reducing the incidence of SA and SI in one adolescent by implementing PSSP in 1-2 classrooms, supporting PSSP as a clinically relevant suicide prevention strategy. Although moderator analyses were nonsignificant and contained a small number of trials, larger SA effect sizes support particular effectiveness for interventions of a duration of ≤1 week, involving multiple stakeholders and with a 12-month follow-up.

Home-based Pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis: An 8-week randomized controlled trial.

BACKGROUND: Symptoms of anxiety, depression and fatigue are common comorbidities among persons with multiple sclerosis (PwMS). A previous pilot study supported Pilates as a feasible exercise modality that may improve these outcomes among PwMS. OBJECTIVE: To quantify the effects of 8 weeks of home-based Pilates on symptoms of anxiety, depression and fatigue among PwMS. METHODS: A total of 80 PwMS (69 female) were randomized to twice-weekly home-based Pilates guided by a DVD) or wait-list control. Validated questionnaires assessed anxiety, depressive and fatigue symptoms at baseline, weeks 2, 4, 6 and 8. Using intention to treat, repeated measures analysis of covariance (RM-ANCOVA) adjusted for baseline physical activity examined between-group differences across time. Hedges' d quantified the magnitude of differences in outcome change. Sensitivity analyses examined female-only samples. RESULTS: Group × time interactions were statistically significant for all outcomes (all p ⩽ 0.005). Pilates significantly reduced (all p ⩽ 0.03) depressive symptoms (Quick Inventory of Depressive Symptomatology, d = 0.70; Hospital Anxiety and Depression Scale-Depression, d = 0.74), anxiety (State-Trait Anxiety Inventory, d = 0.30; Hospital Anxiety and Depression Scale-Anxiety, d = 0.49), cognitive (d = 0.44), physical (d = 0.78), psychosocial (d = 0.56) and total fatigue (d = 0.76). Female-only results were materially the same. CONCLUSION: Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms among PwMS with minimal-to-mild mobility disability, including moderate-to-large, clinically meaningful improvements in depressive and fatigue symptoms.Trial Registration: ClinicalTrials.gov (NCT04120207).

Effect of Acute Aerobic Exercise on Ocular Measures of Attention to Emotionally Expressive Faces.

BACKGROUND: Mechanisms underlying exercise-induced mood enhancement are not well understood, but it is plausible that adaptive changes in attention to emotional stimuli underlie this effect. Thus, this study examined the effects of acute aerobic exercise on eye-tracking metrics while participants viewed emotionally expressive faces. METHODS: Thirty-four adults (18 women) aged 21.1 ± 1.4 years completed two counterbalanced 30-min conditions: vigorous running or seated rest. Eye tracking occurred pre- and 20-min post-condition. Participants viewed positive (n = 15), negative (n = 15), and neutral (n = 15) emotional facial expressions from the NimStim repository. Fixation duration, longest fixation, number of fixations, and scan path length were analyzed using repeated measures ANOVAs. RESULTS: Exercise improved mood, but had no effect on the dependent measures (all 3-way interactions p > 0.66). However, a main effect of emotionally expressive content for fixation duration (p = 0.04, η = 0.10) and a marginally significant effect for longest fixation (p = 0.06, ηp2 = 0.09) were detected, such that fixation duration and longest fixation were greatest for faces expressing positive emotions. CONCLUSION: These preliminary findings indicated that acute exercise did not alter the processing of expressive faces as indexed by eye-tracking metrics of attention. However, eye tracking effectively detected processing patterns indicative of a pleasure bias while viewing emotional facial expressions.

Customary physical activity and odds of depression: a systematic review and meta-analysis of 111 prospective cohort studies.

OBJECTIVE: To explore whether physical activity is inversely associated with the onset of depression, we quantified the cumulative association of customary physical activity with incident depression and with an increase in subclinical depressive symptoms over time as reported from prospective observational studies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, PsycINFO, PsycARTICLES and CINAHL Complete databases, supplemented by Google Scholar. ELIGIBILITY CRITERIA: Prospective cohort studies in adults, published prior to January 2020, reporting associations between physical activity and depression. STUDY APPRAISAL AND SYNTHESIS: Multilevel random-effects meta-analysis was performed adjusting for study and cohort or region. Mixed-model meta-regression of putative modifiers. RESULTS: Searches yielded 111 reports including over 3 million adults sampled from 11 nations in five continents. Odds of incident cases of depression or an increase in subclinical depressive symptoms were reduced after exposure to physical activity (OR, 95% CI) in crude (0.69, 0.63 to 0.75; I2=93.7) and adjusted (0.79, 0.75 to 0.82; I2=87.6) analyses. Results were materially the same for incident depression and subclinical symptoms. Odds were lower after moderate or vigorous physical activity that met public health guidelines than after light physical activity. These odds were also lower when exposure to physical activity increased over time during a study period compared with the odds when physical activity was captured as a single baseline measure of exposure. CONCLUSION: Customary and increasing levels of moderate-to-vigorous physical activity in observational studies are inversely associated with incident depression and the onset of subclinical depressive symptoms among adults regardless of global region, gender, age or follow-up period.

Associations of self-reported physical activity and anxiety symptoms and status among 7,874 Irish adults across harmonised datasets: a DEDIPAC-study.

BACKGROUND: Anxiety is an adaptive response to an objective or perceived threat; however, when symptoms become severe and chronic it that can become a maladaptive anxiety disorder. Limited evidence suggests that physical activity may be associated with prevention against anxiety. This study uses data from The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study to investigate cross-sectional associations between physical activity and anxiety symptoms and status among Irish adults. METHODS: Both datasets were harmonized (n = 7874). The short form International Physical Activity Questionnaire measured physical activity. Participants were classified as meeting World Health Organization physical activity guidelines (≥150 min weekly of moderate intensity physical activity, ≥75 min weekly of vigorous intensity physical activity, or ≥ 600 MET-minutes) or not. They were also divided into three groups based on weekly MET-minutes of moderate-to-vigorous physical activity (Low: 0-599; Moderate: 600-1199; High: ≥1200), and three groups based on weekly minutes of walking (Low: 0-209; Moderate: 210-419; High: 420+). Anxiety symptoms were measured by the Hospital Anxiety and Depression Scale with a score of ≥8 indicating anxiety. Binomial logistic regression, adjusted for relevant confounders examined physical activity-anxiety associations. RESULTS: Females had higher rates of anxiety than males (28.0% vs 20.0%; p < 0.001). Following adjustment for relevant covariates, meeting physical activity guidelines was associated with 13.5% (95% CI: 2.0-23.7; p = 0.023) lower odds of anxiety. Moderate and High physical activity were associated with 13.5% (- 11.0-32.6; p = 0.254) and 13.6% (1.4-4.2; p = 0.030) lower odds of anxiety compared to Low physical activity, respectively. Moderate and High walking were associated with 2.1% (- 14.5-16.3; p = 0.789) and 5.1% (- 9.3-17.6; p = 0.467) lower odds of anxiety compared to Low walking, respectively. CONCLUSION: Meeting physical activity guidelines is associated with lower odds of anxiety, but the strength of associations did not increase considerably with increased physical activity levels.

The effects of exercise interventions on health and fitness of firefighters: A meta-analysis.

OBJECTIVE: The present review synthesized the available empirical evidence to provide support of the effectiveness and feasibility of exercise interventions for improving health and fitness of firefighters. METHODS: Nine randomized controlled trials (RCTs) published before May 2018 were located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. RCTs involved 462 (18 Females) active-duty firefighters, an exercise intervention, and reported changes in health and/or fitness. Hedges' d effect sizes quantified the magnitude of the effects of exercise compared to control conditions. Aggregated mean effects for differential modes of exercise (aerobic exercise training (AET), resistance exercise training (RET), or combined (AET + RET)) were also calculated. Random effects models were used for all analyses. RESULTS: Exercise significantly improved body fat percentage (Δ = 0.52, [95% CI: 0.16-0.88] z = 2.81, P = 0.005, k = 4), aerobic capacity (Δ = 1.20, [0.52-1.87] z = 3.48, P = 0.000, k = 8), endurance (Δ = 1.74, [0.94-2.53] z = 4.03, P = 0.000, k = 10), strength (Δ = 1.27, [0.42-2.11] z = 2.93, P = 0.003, k = 9), and power (Δ = 1.02, [0.52-1.52] z = 4.00, P = 0.000, k = 2). Specifically, RET improved body fat percentage (Δ = 0.87, [0.38-1.36] z = 3.47, P = 0.000, k = 2), aerobic capacity (Δ = 3.06, [2.37-3.75] z = 8.65, P = 0.000, k = 2), endurance (Δ = 2.79, [1.48-4.09] z = 4.19, P = 0.000, k = 6), strength (Δ = 1.44, [0.49-2.39] z = 2.97, P = 0.002, k = 8), and power (Δ = 1.02, [0.52-1.52] z = 3.99, P = 0.000, k = 2), while AET improved aerobic capacity (Δ = 0.69, [0.24-1.15] z = 3.01, P = 0.000, k = 3), and AET + RET improved aerobic capacity (Δ = 0.52, [0.15-0.89] z = 2.78, P = 0.005, k = 3) and endurance (Δ = 0.44, [0.19-0.70] z = 3.41, P = 0.000, k = 3). CONCLUSIONS: The present results provide evidence of the positive effects of exercise interventions, particularly RET, to improve outcomes of health and fitness associated with superior job performance and reduced risk of injury and CVD.

Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety.

PURPOSE OF REVIEW: The purpose of this paper was to provide a comprehensive narrative review of the relationship between physical activity (PA) and anxiety and the rationale for including it as a treatment option for anxiety disorders. Several gaps in the literature are highlighted alongside recommendations for future research. RECENT FINDINGS: PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing. Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders. In addition, evidence from systematic reviews of randomised control trials suggests that exercise training, a subset of PA, can reduce symptoms in anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder. Anxiety disorders are common, burdensome and costly to individuals and wider society. In addition to the profound negative impact on individuals' wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality. Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease. Given the combined anxiolytic and physical health benefits of increased activity, PA presents a promising additional treatment option for people with anxiety disorders. However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness. These must be addressed for PA to be successfully implemented in mental health services.

Associations of self-reported physical activity and depression in 10,000 Irish adults across harmonised datasets: a DEDIPAC-study.

BACKGROUND: Depression is a prevalent, debilitating, and often recurrent mood disorder for which successful first-line treatments remains limited. The purpose of this study was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status among Irish adults, using two existing datasets, The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study. METHODS: The two selected databases were pooled (n = 10,122), and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms. Data collection were conducted in 2010-2011. RESULTS: Significantly higher depressive symptoms were reported by females (7.11 ± 7.87) than males (5.74 ± 6.86; p < 0.001). Following adjustment for age, sex, BMI, and dataset, meeting the PA guidelines was associated with 44.7% (95%CI: 35.0 to 52.9; p < 0.001) lower odds of elevated depressive symptoms. Compared to the low PA tertile, the middle and high PA tertiles were associated with 25.2% (95%CI: 8.7 to 38.6; p < 0.01) and 50.8% (95%CI: 40.7 to 59.2; p < 0.001) lower odds of elevated depressive symptoms, respectively. CONCLUSION: Meeting the PA guidelines is associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.

Sources of Variability in Physical Activity Among Inactive People with Multiple Sclerosis.

PURPOSE: Evidence supports that physical activity (PA) improves symptoms of multiple sclerosis (MS). Although application of principles from Social Cognitive Theory (SCT) may facilitate positive changes in PA behaviour among people with multiple sclerosis (pwMS), the constructs often explain limited variance in PA. This study investigated the extent to which MS symptoms, including fatigue, depression, and walking limitations combined with the SCT constructs, explained more variance in PA than SCT constructs alone among pwMS. METHOD: Baseline data, including objectively assessed PA, exercise self-efficacy, goal setting, outcome expectations, 6-min walk test, fatigue and depression, from 65 participants of the Step It Up randomized controlled trial completed in Ireland (2016), were included. Multiple regression models quantified variance explained in PA and independent associations of (1) SCT constructs, (2) symptoms and (3) SCT constructs and symptoms. RESULTS: Model 1 included exercise self-efficacy, exercise goal setting and multidimensional outcomes expectations for exercise and explained ~14% of the variance in PA (R 2=0.144, p < 0.05). Model 2 included walking limitations, fatigue and depression and explained 20% of the variance in PA (R 2=0.196, p < 0.01). Model 3 combined models 1 and 2 and explained variance increased to ~29% (R 2=0.288; p<0.01). In Model 3, exercise self-efficacy (ß=0.30, p < 0.05), walking limitations (ß=0.32, p < 0.01), fatigue (ß = -0.41, p < 0.01) and depression (ß = 0.34, p < 0.05) were significantly and independently associated with PA. CONCLUSION: Findings suggest that relevant MS symptoms improved by PA, including fatigue, depression and walking limitations, and SCT constructs together explained more variance in PA than SCT constructs alone, providing support for targeting both SCT constructs and these symptoms in the multifactorial promotion of PA among pwMS.

Sleep quality moderates the association between physical activity frequency and feelings of energy and fatigue in adolescents.

Physical activity (PA) can improve sleep quality, low energy, and fatigue. Though poor sleep quality may induce feelings of low energy and fatigue, the potential moderating effect of sleep quality on associations between PA and feelings of energy and fatigue among adolescents is unknown. Thus, this study examined the moderating effect of sleep quality on associations between PA frequency and feelings of energy and fatigue among adolescents in Ireland. Adolescents (N = 481; 281 males, 200 females) aged 15.1 ± 1.7 years self-reported PA frequency, feelings of energy and fatigue, and sleep quality (September to December 2015). Two-way ANCOVAs examined variation in feelings of energy and fatigue according to the interaction of PA and sleep quality. Standardized mean difference (d) quantified the magnitude of differences. Poor sleepers with low PA reported greater feelings of fatigue compared to normal sleepers with low PA (d = 1.02; 95% CI 0.60, 1.44), and poor sleepers with moderate PA reported greater feelings of fatigue compared to normal sleepers with moderate PA (d = 0.50; 0.17, 0.82). Poor sleepers with low PA reported greater feelings of fatigue compared to both poor sleepers with moderate PA (d = 0.44; 0.05, 0.83) and poor sleepers with high PA (d = 0.87; 0.46, 1.28). Poor sleepers with moderate PA reported greater feelings of fatigue compared to poor sleepers with high PA (d = 0.52; 0.14, 0.91). Poor sleep did not moderate the association between PA and feelings of energy. Sleep quality moderates the association between PA frequency and feelings of fatigue. Fatigue symptoms improve as PA frequency increases among adolescents with poor sleep quality.

Effect of exercising at minimum recommendations of the multiple sclerosis exercise guideline combined with structured education or attention control education - secondary results of the step it up randomised controlled trial.

BACKGROUND: Recent exercise guidelines for people with multiple sclerosis (MS) recommend a minimum of 30 min moderate intensity aerobic exercise and resistance exercise twice per week. This trial compared the secondary outcomes of a combined 10-week guideline based intervention and a Social Cognitive Theory (SCT) education programme with the same exercise intervention involving an attention control education. METHODS: Physically inactive people with MS, scoring 0-3 on Patient Determined Disease Steps Scale, with no MS relapse or change in MS medication, were randomised to 10-week exercise plus SCT education or exercise plus attention control education conditions. Outcomes included fatigue, depression, anxiety, strength, physical activity, SCT constructs and impact of MS and were measured by a blinded assessor pre and post-intervention and 3 and 6 month follow up. RESULTS: One hundred and seventy-four expressed interest, 92 were eligible and 65 enrolled. Using linear mixed effects models, the differences between groups on all secondary measures post-intervention and at follow-up were not significant. Post-hoc, exploratory, within group analysis identified improvements in both groups post intervention in fatigue (mean ∆(95% CI) SCT -4.99(-9.87, -0.21), p = 0.04, Control -7.68(-12.13, -3.23), p = 0.00), strength (SCT -1.51(-2.41, -0.60), p < 0.01, Control -1.55(-2.30, -0.79), p < 0.01), physical activity (SCT 9.85(5.45, 14.23), p < 0.01, Control 12.92(4.69, 20.89), goal setting (SCT 7.30(4.19, 10.4), p < 0.01, Control 5.96(2.92, 9.01), p < 0.01) and exercise planning (SCT 5.88(3.37, 8.39), p < 0.01, Control 3.76(1.27, 6.25), p < 0.01) that were maintained above baseline at 3 and 6 month follow up (all p < 0.05). Only the SCT group improved at 3 and 6 month follow up in physical impact of MS(-4.45(-8.68, -0.22), -4.12(-8.25, 0.01), anxiety(-1.76(-3.20, -0.31), -1.99(-3.28, -0.71), depression(-1.51(-2.89, -0.13), -1.02(-2.05, 0.01)) and cognition(5.04(2.51, 7.57), 3.05(0.81, 5.28), with a medium effect for cognition and fitness (Hedges' g 0.75(0.24, 1.25), 0.51(0.01, 1.00) at 3 month follow up. CONCLUSIONS: There were no statistically significant differences between groups for the secondary outcomes once age, gender, time since diagnosis and type of MS were accounted for. However, within the SCT group only there were improvements in anxiety, depression, cognition and physical impact of MS. Exercising at the minimum guideline amount has a positive effect on fatigue, strength and PA that is sustained at 3 and 6 months following the cessation of the program. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02301442 , retrospectively registered on November 13th 2014.

Brief report: Associations of physical activity with anxiety and depression symptoms and status among adolescents.

The purpose of this study is to investigate associations between physical activity (PA), depression, and anxiety among adolescents in Ireland. Adolescents (N = 481; 281 male, 200 female) aged 15.1 ± 1.7y self-reported PA level, depression, and anxiety. Approximately 21% of adolescents were high trait anxious, and ∼37% reported scores indicating probable depression. Anxiety and depressive symptoms were higher for low PA (60 min/d, 0-2 d/wk) compared to moderate (60 min/d, 3-4 d/wk) and high (60 min/d, 5-7 d/wk) PA. After adjustment for relevant covariates, reduced odds of depression were 30% and 56% for moderate and high PA, respectively; reduced odds of high trait anxiety were 46% and 47% for moderate and high PA, respectively. These findings support the need for adolescents to engage in moderate PA, with potential for increased benefits with increased PA. To conclude, moderate and high PA are inversely associated with anxiety and depressive symptoms, and risk of depression and high trait anxiety in adolescents.