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      Mechanisms Linking Physical Activity with Psychiatric Symptoms Across the Lifespan: A Systematic Review

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          Abstract

          Background

          Physical activity has been suggested as a protective factor against psychiatric symptoms. While numerous studies have focused on the magnitude of physical activity’s effect on psychiatric symptoms, few have examined the potential mechanisms.

          Objective

          The current review aimed to synthesize scientific evidence of the mechanisms through which physical activity might reduce psychiatric symptoms across the lifespan.

          Methods

          We included articles that were published before March 2022 from five electronic databases (MEDLINE, Web of Science, PsycINFO, Embase, and Cochrane). A qualitative synthesis of studies was conducted. The risk of bias assessment was performed using The Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Studies were included if they explored the possible mechanisms through which physical activity influences psychiatric symptoms (i.e., internalizing and externalizing symptoms) across the lifespan.

          Results

          A total of 22 articles were included (three randomized controlled trials, four non-randomized controlled trials, three prospective longitudinal studies, and 12 cross-sectional studies). Overall, most of the studies focused on children, adolescents, and young adults. Our findings showed that self-esteem, self-concept, and self-efficacy were the only consistent paths through which physical activity influences psychiatric symptoms (specifically depressive and anxiety symptoms) across the lifespan. There were insufficient studies to determine the role of neurobiological mechanisms.

          Conclusions

          Overall, future physical activity interventions with the purpose of improving mental health should consider these mechanisms (self-esteem, self-concept, self-efficacy) to develop more effective interventions.

          Clinical Trial Registration: The protocol of this study was registered in the PROSPERO database (registration number CRD42021239440) and published in April 2022.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40279-023-01895-0.

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2024)
          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            World Health Organization 2020 guidelines on physical activity and sedentary behaviour

            Fiona Bull, Salih Al-Ansari, Stuart Biddle … (2020)
            Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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              Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

              Marco Solmi, Joaquim Radua, Miriam Olivola … (2021)
              Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11–34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7–16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9–25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14–29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15–23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17–48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20–41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20–34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20–33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21–46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.
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                Author and article information

                Contributors
                María Rodriguez-Ayllon:
                ORCID: http://orcid.org/0000-0002-8267-0440
                m.rodriguez@erasmusmc.nl
                Journal
                Journal ID (nlm-ta): Sports Med
                Journal ID (iso-abbrev): Sports Med
                Title: Sports Medicine (Auckland, N.z.)
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0112-1642
                ISSN (Electronic): 1179-2035
                Publication date (Electronic): 19 August 2023
                Publication date PMC-release: 19 August 2023
                Publication date (Print): 2023
                Volume: 53
                Issue: 11
                Pages: 2171-2190
                Affiliations
                [1 ]Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, ( https://ror.org/018906e22) Rotterdam, The Netherlands
                [2 ]VN-UK Institute for Research and Executive Education, The University of Danang, ( https://ror.org/03ecpp171) Da Nang, Vietnam
                [3 ]Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, ( https://ror.org/057w15z03) Rotterdam, The Netherlands
                [4 ]Medical Library, Erasmus MC University Medical Center, ( https://ror.org/018906e22) Rotterdam, The Netherlands
                [5 ]Department of Epidemiology, Erasmus MC University Medical Center, ( https://ror.org/018906e22) Rotterdam, The Netherlands
                [6 ]Centre for Active Living and Learning, University of Newcastle, ( https://ror.org/00eae9z71) Newcastle, NSW Australia
                [7 ]Faculty of Sport and Health Sciences, University of Jyväskylä, ( https://ror.org/05n3dz165) Jyväskylä, Finland
                Author information
                http://orcid.org/0000-0003-3082-9285
                http://orcid.org/0000-0002-1106-6094
                http://orcid.org/0000-0003-2681-9180
                http://orcid.org/0000-0003-0571-3774
                http://orcid.org/0000-0002-0204-8257
                http://orcid.org/0000-0003-4658-2176
                http://orcid.org/0000-0002-8267-0440
                Article
                Publisher ID: 1895
                DOI: 10.1007/s40279-023-01895-0
                PMC ID: 10587276
                PubMed ID: 37597100
                SO-VID: 55970d82-b0b7-4abb-b703-1e72e4b8d743
                Copyright © © The Author(s) 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date accepted : 13 July 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100008062, Fundación Alicia Koplowitz;
                Categories
                Subject: Systematic Review
                Custom metadata
                issue-copyright-statement © Springer Nature Switzerland AG 2023

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