“You can't take a pill to exercise” – Qualitative findings from the Toward Exercise as Medicine for Adolescents with bipolar disorder (TEAM-BD) study

•Less than 20% of adolescent girls meet physical activity guidelines.•Few interventions have incorporated wearable activity trackers among youth.•Feasibility and preliminary efficacy of the INSPIRE program were examined.•Results indicated good program attendance and satisfaction.•Participants increased their physical activity and reduced their resting heart rate. IntroductionThis pilot study evaluated the feasibility and preliminary effectiveness of the Intervention to Support Physical Activity Independence and Routine Everyday program.MethodThis quasi-experimental single-group pretest/posttest study included adolescent girls (n = 15) who received a Fitbit Inspire 2 wearable activity tracker and participated in the seven-week Intervention to Support Physical Activity Independence and Routine Everyday program on a college campus in the Midwest. Feasibility outcomes included intervention participation, fidelity, and satisfaction. Preliminary effectiveness outcomes included moderate-to-vigorous physical activity, cardiorespiratory fitness, and resting heart rate.ResultsFor intervention sessions, the mean attendance rate was 83.42%, the mean minutes of moderate-to-vigorous physical activity was 62.03, and the mean satisfaction score was 28.90. Moderate-to-vigorous physical activity and resting heart rate improved significantly from baseline to postintervention, but cardiorespiratory fitness did not.DiscussionResults suggest the need for a pilot randomized controlled trial to improve cardiorespiratory fitness and incorporating an objective measure of moderate-to-vigorous physical activity. 

Feasibility and Preliminary Effectiveness of the INSPIRE Pilot Study for Adolescent Girls.

Appropriate physical activities and a biodiversity-rich environment are conducive to the relief of psychological stress, and pro-nature physical activities are a combination of the two, which has good application potential in antagonizing psychological stress, but the intervention mechanism is still unclear. The microbiota-gut-brain axis is cyclically associated with psychological stress, and psychological stress can affect the microbiota through the gut-brain pathway, and conversely, the microbiota can also affect the psychological stress-induced symptoms. It is suggested that the microbe-gut-brain axis may provide a new perspective and target for the treatment of psychological stress-related diseases. Pro-nature physical activity can improve the number of Firmicutes, short-chain fatty acids, Akkermansia bacteria, and the gut-brain barrier and further affect the HPA axis, BDNF, and serotonin pathways of gut-brain two-way communication, thereby maintaining the body's homeostasis and reducing antagonistic psychological stress. According to the comprehensive influence of physical activities on the microbiota-gut-brain axis, a "green + exercise prescription hypothesis" in line with the holistic medical concept is revealed, which is expected to be effective in the prevention, alleviation, and treatment of irritable bowel syndrome and neurodegenerative diseases. It provides new means for treating psychological stress-related diseases such as mental disorders and mood disorders. In addition, it enlightens the construction of green infrastructure that is conducive to the diversified contact of microorganisms in outdoor physical activities venues and induces healthy interaction between the human body and the microbial population in the natural ecology. However, the current research is still in its early stages, and the intervention effect and mechanism of pro-nature physical activities need further demonstration in the future. 

Mechanism and implications of pro-nature physical activity in antagonizing psychological stress: the key role of microbial-gut-brain axis

Abstract Background Physical exercise (PE) is a recommended lifestyle intervention for different mental disorders and has shown specific positive therapeutic effects in unipolar depressive disorder. Considering the similar symptomatology of the depressive phase in patients with bipolar disorder (BD) and unipolar depressive disorder, it is reasonable to suggest that PE may also be beneficial for bipolar depression. However, there is an absence of studies evaluating the antidepressant effect of a structured PE intervention in BD. Methods This is an open-label, single-arm study trial. Fifteen patients with a diagnosis of BD Type I or Type II, presenting a depressive episode were included in the study. After physical and functional evaluation, patients participated in supervised training sessions with aerobics followed by strength exercises, three times per week, for 12 weeks (36 training sessions). Depressive and manic symptoms were assessed at baseline and 2, 4, 8, and 12 weeks. Additionally, quality of Life and functioning were assessed at baseline and 4, 8, and 12 weeks). Finally, we tested cardiorespiratory fitness, muscle strength and body composition at baseline and week-12. Results The mean (± SD) Montgomery Asberg Depression Rating Scale (MADRS) score at baseline was 23.6 ± 8.3 points and after 12 weeks of PE the mean score was 10.2 ± 4.8 points. Nine patients (82%) presented an antidepressant response defined as a reduction of more than 50% of depressive symptoms at week 12 with five of those patients (45%) presenting criteria for full remission. A large and significant Cohen’s D Effect Size (pre-post) was verified for MADRS reduction [1.98 (95% Confidence interval = 0.88 to 3.08)]. We did not detect a significant change in manic symptoms, functioning, and quality of life during the 12-week follow-up. At week-12, all patients increased their muscular strength (one repetition maximal test − 1RM) and reduced the percentage of body fat (spectral bioelectrical impedance analysis). Conclusions This study, using rigorous criteria and a structured intervention, provides valid pilot data, showing the feasibility of a structured PE intervention for the treatment of depressive symptoms in BD, and suggesting a potential adjunctive antidepressant effect. Moreover, PE showed a positive impact on muscle strength and body composition. This should be further verified by randomized controlled studies. 

/pdf/structured-physical-exercise-for-bipolar-depression-an-open-31hoog13.pdf

Structured physical exercise for bipolar depression: an open-label, proof-of concept study

Introduction: Mental health is a condition in which individuals realize their potential, are able to contribute, prosper, work productively, and can contribute to the environment. Physical activity is any body movement capable of producing energy. The purpose of this study was to figure out the description of mental health and physical activity in adolescents. Methods: The study used a quantitative descriptive research method with a cross-sectional approach. The population was 780 youths, and a sample of 265 people was calculated using the Slovin formula. The sampling method used stratified random sampling. The measuring tool for mental health variables used the SRQ-29 and physical activity used the IPAQ.Results: The results of the study showed that 46.4% of the respondents had symptoms of mental-emotional disorders, none of the respondents used psychoactive substances, 4.9% of the respondents had psychotic symptoms/psychosis, and 7.5% of the respondents had symptoms of PTSD. In the physical activity variable, the majority of the respondents had moderate physical activity, 39.6%.Conclusion: The mental health problems experienced by the respondents and the physical activity undertaken can be influenced by characteristics such as age, sex, relationships with colleagues, stress, and bullying. Respondents are expected to pay attention to their mental health conditions and continue to perform physical activities in their daily lives. 

A Descriptive Study of Mental Health and Physical Activity in Adolescents

Toward exercise as medicine for adolescents with bipolar disorder (TEAM-BD): A feasibility study

Background: The DOC screen was developed to identify Depression, Obstructive sleep apnea, and Cognitive impairment ("DOC" comorbidities) after stroke. Each component has its own score, but additional information may be gained from the time to complete the screen. Cognitive screening completion time is rarely used as an outcome measure. We assessed the added value of using DOC screen completion time as a predictor of impairment on detailed cognitive assessments.Methods: Consecutive English-speaking new referrals to the stroke prevention clinic were consented to participate in detailed neuropsychological testing (n=437). DOC screen scores and times were compared to cognitive test scores using multiple linear regression and receiver operating characteristic (ROC) analysis. All linear regression analyses controlled for age, sex, years of education, and functional outcome as assessed by the modified Rankin score.Results: Average completion time for the DOC screen was 3.8 {plus minus} 1.3 minutes. After accounting for age, sex and cognitive screen score, completion time was a significant independent predictor, of speed of processing (p = .002, 95% CI: -0.016 to -0.004), verbal fluency (p < .001, CI: -0.012 to -0.006) and executive (p = .004, CI: -0.006 to -0.001), but not memory, function. Completion time above 5.5 minutes (332.5 seconds) was associated with a high likelihood of impairment on gold standard executive (likelihood ratios 3.9-5.2) and speed of processing (likelihood ratio = 5.2) tasks.Conclusions: DOC screen completion time is easy to collect in routine care and is independently associated with speed of processing, language and executive dysfunctions after stroke. People who take more than 5.5 minutes to complete the DOC screen are likely to have deficits in executive functioning and speed of processing. These domains can be challenging to screen for in stroke survivors, and this measure provides a simple, clinically feasible method to screen for these under-appreciated concerns.

/pdf/doc-screen-completion-time-reflects-executive-function-speed-55jcnu70.pdf

DOC screen completion time reflects executive function, speed of processing and fluency in an observational cohort study

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Toward exercise as medicine for adolescents with bipolar disorder (TEAM-BD): A feasibility study

“You can't take a pill to exercise” – Qualitative findings from the Toward Exercise as Medicine for Adolescents with bipolar disorder (TEAM-BD) study

DOC screen completion time reflects executive function, speed of processing and fluency in an observational cohort study