Exercise and mental health: problems and possibilities

Despite a sound evidence base, the consideration of exercise as a therapeutic adjunct remains rare in mental health settings. This research project reports a series of studies examining the consideration of exercise as a strategy for promoting mental health in clinical settings. A broad, multi-level and multi-method analysis of exercise and mental health was adopted by focusing on trainers (key stakeholders responsible for treatment dissemination), providers (individuals at the forefront of treatment) and service users (individuals with clinical depression). First, the perceptions of exercise as an adjunctive therapy is qualitatively explored through interviews with Course Directors of UK training programmes in clinical psychology and mental health nurses working in acute, inpatient settings. A range of conceptual barriers are revealed such as the perceived `simplicity' of exercise interventions and the incompatibility of exercise with traditional models of understanding and treating clinical conditions. Second, the nature and extent of exercise promotion are identified within one NHS Mental Health Trust. A lack of training and protocols are the most significant barriers. The Theory of Planned Behaviour variables of attitude, subjective norms, perceived behavioral control, and intention predict stage of change of physical activity promotion in a health care setting. However, the past promotion of physical activity overrides much of these effects. Third, the role of exercise in the lives of individuals with depression is explored in a case study analysis of four participants of an exercise referral scheme. The context of each person's life is instrumental in understanding adherence and the experiences associated with participation in exercise and/or physical activity. These studies offer insight to some of the conceptual and structural barriers inhibiting the promotion of exercise as well as factors that may contribute to the success of such promotion within mental health settings. Recommendations are offered to enhance the development of comprehensive physical activity provision for people with mental health problems

A qualitative perspective on multiple health behaviour change: views of smoking cessation advisors who promote physical activity

There are mixed views on whether smoking cessation advisors should focus only on quitting smoking or also promote simultaneous health behaviour changes (e.g. diet, physical activity), but no studies have qualitatively examined the views and vicarious experiences of such health professionals. Semi-structured interviews were conducted with 11 trained smoking cessation advisors who promote physical activity to their clients. The data were categorised into themes using thematic analysis supported by qualitative data analysis software. We report themes that were related to why advisors promote multiple health behaviour change and issues in timing. Physical activity could be promoted as a cessation aid and also as part of a holistic lifestyle change consistent with a non-smoker identity, thereby increasing feelings of control and addressing fear of weight gain. Multiple changes were promoted pre-quit, simultaneously and post-quit, and advisors asserted that it is important to focus on the needs and capabilities of individual clients when deciding how to time multiple changes. Also, suggesting that PA was a useful and easily performed cessation aid rather than a new behaviour (i.e. structured exercise that may seem irrelevant) may help some clients to avoid a sense of overload

Exercise interventions for smoking cessation

Background: Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. Objectives: To determine whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone. Search strategy: In July 2008, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL. Selection criteria: We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more. Data collection and analysis: We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis. Main results: We identified 13 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow up and a benefit for exercise of borderline significance (P = 0.05) at the 12-month follow up. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow up but not at the end of treatment or 12-month follow up. The other studies showed no significant effect for exercise on abstinence. Authors' conclusions: Only one of the 13 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to exclude reliably an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, measures of exercise adherence and change in physical activity in both exercise and comparison groups

Exercise interventions for smoking cessation

Background: Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain.  Objectives: To determine whether exercise-based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone.  Search methods: We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2014, and searched MEDLINE, EMBASE, PsycINFO, and CINAHL Plus in May 2014.  Selection criteria: We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme (which we considered the control in this review). Studies were required to recruit smokers or recent quitters and have a follow-up of six months or more. Studies that did not meet the full inclusion criteria because they only assessed the acute effects of exercise on smoking behaviour, or because the outcome was smoking reduction, are summarised but not formally included.  Data collection and analysis: We extracted data on study characteristics and smoking outcomes. Because of differences between studies in the characteristics of the interventions used we summarized the results narratively, making no attempt at meta-analysis. We assessed risk of selection and attrition bias using standard methodological procedures expected by The Cochrane Collaboration.  Main results: We identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow-up and a benefit for exercise of borderline significance (p = 0.05) at the 12-month follow-up. Another study reported significantly higher abstinence rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow-up but not at the end of treatment or 12-month follow-up. The other studies showed no significant effect for exercise on abstinence.  Authors' conclusion: Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups

Correlates of Active School Transport Immediately Before and After the Transition from Primary to Secondary School: A Pilot-Study

The transition from primary to secondary school is a major life event associated with large decreases in physical activity levels. Cross-sectional studies also suggest that secondary school students are less likely to engage in active school transport (AST; e.g. walking and cycling to/from school). To our knowledge, no longitudinal study has previously examined the correlates of AST immediately before and after the school transition. This pilot-study assessed: 1) the concordance between child- and parent-perceived barriers to AST (with Spearman correlations); 2) the associations of AST with child- and parent-perceived barriers to AST, parental neighborhood selection factors and socio-demographic characteristics (using Fisher’s exact test). Participants were recruited in four K-6 schools (where children are required to change school after grade 6) located in census tracts with varying population density in Ottawa (Canada). All assessments were done at baseline and follow-up with respectively 49 and 29 participants. Substantial concordance was found between child- and parent-perceived barriers to AST at baseline, but not at follow-up; this might reflect the novelty of the route and the secondary school environment. Distance between home and school was the strongest barrier to AST while road safety concerns and the perception of having too much stuff to carry were also important barriers to AST. Children were more likely to engage in AST when their parents reported that they chose their neighborhood so that their children could easily walk or bike to school; thus future studies should take parental neighborhood selection into account. These findings should contribute to inform future research informing the development of policies and interventions to promote AST

Nonspecialist, Preservice Primary-School Teachers: Predicting Intentions to Teach Physical Education

The purpose of this study was to establish the utility of the theory of planned behavior in predicting nonspecialist, preservice primary-school teachers' intentions to teach physical education for 2 hr per week. A questionnaire was developed according to the recommended procedures and was administered to 128 final-year teacher trainees in two primary-teacher training courses in England. A variety of predictors were identified including: beliefs of significant others, such as parents; a positive assessment of control over difficult barriers; and experiences of past (teaching) behavior. The most significant predictor in discriminating between intenders and nonintenders, however, was personal exercise behavior. Helping preservice primary-school teachers become more physically active themselves might positively influence their intentions to teach physical education 2 hr per week more than alleviating barriers to teaching physical education

Effectiveness of active school transport interventions : a systematic review and update

Background: Active school transport (AST) is a promising strategy to increase children's physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. Methods: Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen's d as a measure of effect size. Results: Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen's d ranged from -0.61 to 0.75, with most studies reporting "trivial-to-small" positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. Conclusions: Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. Trial registration: Registered in PROSPERO: CRD4201603325

An investigation of ribonucleoprotein processing in amphibian oocytes

Two forms of ribonucleoprotein complex from oocytes of Triturus cristatus carnifex are investigated, heterogeneous nuclear ribonucleoprotein (hnRNP) and a free 40S cytoplasmic RNP particle that stores 5SRNA and transfer RNA in pre-vitellogenic oocytes. HnRNP, isolated from homogenates of Triturus ovaries, has been characterized by sucrose gradient centrifugation, isopycnic centrifugation, electron microscopy and treatment with non-ionic detergent. The results largely confirm previous observations by Malcolm and Sommerville (1974) although electron microscopy of thin-sectioned hnRNP material revealed a considerable degree of cytoplasmic contamination of the preparation. This finding was confirmed by characterization of the polypeptide components of the hnRNP fraction and by comparison with the polypeptide spectrum of manually isolated oocyte nuclei. These studies further revealed that not only were there very few major polypeptides common to both the hnRNP preparation and isolated oocyte nuclei but that the majority of the "hnRNP" polypeptides could be isolated from the oocyte cytoplasm. Comparison of the polypeptide spectra of hnRNP, oocyte nuclei and rat-liver hnRNP "core particles" suggest that a "core protein" homologue may be present in oocyte nuclei though not in the "hnRNP" preparation. Immunostaining of SDS/polyacrylamide gel transfers with an antiserum to rat-liver hnRNP "core protein" revealed the presence of antigenically related polypeptides in the "hnRNP".- It is suggested that a large proportion of the so-called hnRNP preparation from Triturus oocytes could represent partially processed messenger RNP in association with membranous supramolecular structures. The 40S cytoplasmic RNP accumulated in previtellogenic Triturus oocytes contains 5S RNA and transfer RNA with two proteins of molecular mass 45,000 and 39,000 (P45 and P39). The particle has a buoyant density of 1.53 g cm-3 and consists of four identical subunits as shown by salt dissociation and isopycnic centrifugation experiments. Treatment with SDS completely dissociates the RNP complex into its separate components. These can be reassociated into subunits and even intact 40S RNP particles upon removal of the SDS by dialysis. The stable RNA/protein interactions can be demonstrated by analysis of reformed RNP complexes using isopycnic centrifugation and are found to be: 5S RNA/P45, 3(tRNA)/P45, 5S RNA/P39 and 58 RNA/P45/ P39. Indirect immunostaining of frozen oocyte sections with antisera to P45 and P39 suggest a purely cytoplasmic location for P39 whilst P45 is also found in the nucleus. The relationship between the 40S RNP particle proteins with transcription of 5S RNA and transfer RNA is discussed and the possibility that P39 is related to 5S RNA associated ribosomal proteins is also considered. A scheme for the formation and breakdown of 40S RNP storage particles is presented