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Paeds MH – Symptoms of depression are often in lower in children and adolescents who are more physically active

Evidence Summary
1.1 40 studies were identified, which explored the association between physical activity levels, sport or inactivity and symptoms of depression, typically acquired through depression screening questionnaires.

1.2 The majority of studies were longitudinal in design with follow-up periods up to 10 years in one study(1). This longer study found that whilst there is an inverse relationship between levels of PA and symptoms of depression in adolescence, baseline levels of PA do not predict later changes in depressed mood. Also, baseline depressed mood does not predict future levels of physical activity. In other words, it suggests that adolescents who are exercising might expect to see an improvement in mood, but the fact that you have been active as a child does not protect against future depression. Similarly, a higher depression score as a teenager does not impact on future activity levels. This is in keeping with much of what we know regarding the benefits of exercise, it must be sustained to have continuing positive effects.

1.3 A common theme in these longitudinal studies was a tendency for depression symptoms (measured using validated depression tools such as ‘profile of mood states’, to give one example) to rise as the child ages. It appears however, that those undertaking higher levels of physical activity see an attenuation in this rise(2).

1.4 One study found of 31 children (9-13yo) who swam competitively had higher self-esteem and lower depression scores but higher state anxiety levels than 30 non-athlete controls(3). It was proposed that the stress associated with competition may account for the higher anxiety levels.

1.5 A positive association between low mood and higher physical activity levels is reported by numerous studies(1,5,6,7)). A 4 year longitudinal study by Flotnes et al (2011) found that boys and girls reporting less than one day per week of physical activity had a relative risk of low mood roughly twice that of those who more active(5). A study comparing mood and measures of sleep quality in paediatric athletes and non-athletes found that the athletic group had significantly lower depression scores and improved sleep quality (6). Langguth et al (2016) found ‘more than usual’ PA significantly predicted improved mood the following day, with 60minutes of MVPA resulting in a 50% reduction in depression scores compared to days without previous exercise(7). A large longitudinal study of over 4500 7th grade children found naturally occurring changes in physical activity were inversely related to depressive symptoms(8). The change in depression scores with activity levels, although small were statistically significant.

A small longitudinal study did not find an association between teenage boys and girls playing organised sport and symptoms of depression (9).

A 2017 Meta-analysis asked the pertinent question ‘Should we recommend exercise to adolescents with depressive symptoms?’. They concluded that there was overall a moderate significant effect of exercise in the reduction of depressive symptoms, but this was not a dose-dependent response. This latter point should be borne in mind when recommending exercise to treat symptoms of depression (10). It has been recognized that self-directed activity levels facilitate engagement in exercise, and this should be prioritized over the quantity or intensity of activity recommended.


Quality of Evidence
High
Strength of Recommendation
Strong
Conclusion
Children and Adolescents who take part in regular physical activity are likely to reduce their symptoms of depression. Exercise should be sustained to have continuing positive effects.


References

  1. Birkeland MS, Torsheim T, Wold B. A longitudinal study of the relationship between leisure-time physical activity and depressed mood among adolescents. Psychology of Sport and Exercise. 2009 Jan 1;10(1):25-34.
  2. Nagamatsu T, Suzukawa K, Kai Y, Suyama Y, Matsubara I, Ueki T, Osanai H, Ochi E, Wakamatsu K, Aoyama K. Influence of organized sport activity on stress response and mental health in adolescents: a 15-month cohort study in high school students. Bulletin of the Physical Fitness Research Institute. 2010 Apr(108):1-7.
  3. Karakaya I, Çoşkun A, Ağaoğlu B. Evaluation of depression, anxiety and self-esteem levels in swimmers. Anatolian Journal of Psychiatry. 2006;7(3):162-6.
  4. Crews DJ, Lochbaum MR, Landers DM. Aerobic physical activity effects on psychological well-being in low-income Hispanic children. Perceptual and motor skills. 2004 Feb;98(1):319-24.
  5. Fløtnes IS, Nilsen TI, Augestad LB. Norwegian adolescents, physical activity and mental health: The Young-HUNT study. Norsk epidemiologi. 2011 Aug 3;20(2).
  6. Brand S, Gerber M, Beck J, Hatzinger M, Pühse U, Holsboer-Trachsler E. High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls. Journal of Adolescent Health. 2010 Feb 1;46(2):133-41.
  7. Langguth N, Schmid J, Gawrilow C, Stadler G. Within‐person link between depressed affect and moderate‐to‐vigorous physical activity in adolescence: An intensive longitudinal approach. Applied Psychology: Health and Well‐Being. 2016 Mar;8(1):44-63.
  8. Motl RW, Birnbaum AS, Kubik MY, Dishman RK. Naturally occurring changes in physical activity are inversely related to depressive symptoms during early adolescence. Psychosomatic medicine. 2004 May 1;66(3):336-42.
  9. Hume C, Timperio A, Veitch J, Salmon J, Crawford D, Ball K. Physical activity, sedentary behavior, and depressive symptoms among adolescents. Journal of Physical Activity and Health. 2011 Feb 1;8(2):152-6.
  10. Radovic S, Gordon MS, Melvin GA. Should we recommend exercise to adolescents with depressive symptoms? A meta‐analysis. Journal of paediatrics and child health. 2017 Mar;53(3):214-20.

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