Combined physical training associated with multidisciplinary intervention in the treatment of alcohol use disorder: a study with n of 1 / O treinamento físico combinado associado à intervenção multiprofissional no tratamento do transtorno por uso de álcool: um estudo com n de 1

ABSTRACT Objective: Substance misuse can lead to several consequences for physical and mental health. Physical exercise is an important ally to pharmacological and psychotherapeutic treatment for substance use. However, the literature is still scarce regarding long-term interventions. Thus, this study aims to describe the acceptability and effects of combined physical training intervention (aerobic and strength). Methods: This study comprises an n-of-1 clinical trial that was performed with a 64-year-old male individual with alcohol use disorder. The treatment lasted 12 weeks and evaluated the association of multidisciplinary interventions on quality of life, depressive symptoms, cognitive impairment, and anxiety. Results: The participant improved general quality of life (12.5%), no alterations were found for depressive symptoms, there was an improvement in cognition (20%), as well a reduction in the trait (16.2%) and state (14.7%) anxiety symptoms of the participant. Conclusions: These findings allude to the importance of non-drug therapeutic resources such as structured physical exercise, associated with other offers in the treatment of alcohol use disorder.

RESUMO Objetivo: O uso de substâncias psicoativas pode levar a diversas consequências à saúde física e mental. O exercício físico é um importante aliado ao tratamento farmacológico e psicoterápico para o uso de substâncias. No entanto, a literatura ainda é escassa em relação às intervenções de longa duração. Dessa forma, este estudo objetiva descrever a aceitabilidade e os efeitos de uma intervenção de treinamento físico combinado (aeróbico e força). Métodos: Este estudo compreende um n-of-1 clinical trial que foi realizado com um indivíduo do sexo masculino, de 64 anos de idade, com transtorno por uso de álcool. O tratamento teve a duração de 12 semanas e avaliou a associação de intervenções multiprofissionais sobre a qualidade de vida, sintomas depressivos, comprometimento cognitivo e ansiedade. Resultados: O participante melhorou a qualidade de vida geral (12,5%), não foram encontradas alterações para sintomas depressivos, houve melhora na cognição (20%), bem como redução nos sintomas de ansiedade traço (16,2%) e estado (14,7%) do participante. Conclusões: Esses achados aludem à importância de recursos terapêuticos não medicamentosos como o exercício físico estruturado, associados às demais ofertas no tratamento para o transtorno por uso de álcool.

Sedentary behavior and physical activity: barriers and facilitators for active behavior during the COVID-19 pandemic / Comportamento sedentário e atividade física: barreiras e facilitadores para o comportamento ativo durante a pandemia de COVID-19

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period.

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social.

Alcohol use in self-isolation during the COVID-19 pandemic: a cross-sectional survey in Brazil

Abstract Objectives To assess alcohol use and perceived change in alcohol consumption (before and during the pandemic) in Brazilians during the COVID-19 pandemic, their correlates, and their associations with depressive, anxiety and co-occurring depressive and anxiety symptoms (D&A). Methods This is a cross-sectional study comprising 992 individuals in self-isolation. A self-report questionnaire was used to assess whether participants were drinking during self-isolation and whether they changed their drinking behavior (drinking less, more, or no change) from before to during the pandemic. D&A symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI). Results A total of 68.5% of participants reported alcohol consumption during the pandemic, and 22.7% of these reported increased alcohol use. Smoking was positively associated with alcohol consumption during the pandemic. Alcohol consumption was associated with anxiety (OR = 1.40, 95%CI 1.06-1.85, p < 0.01) and D&A (OR = 1.38, 95%CI 1.02-1.87, p = 0.033) symptoms. Conclusions Drinking during self-isolation was prevalent and was associated with risk factors for alcohol use disorders. The long-term effects of high drinking rates and increased consumption should be proactively monitored and assessed.

Inflammatory cytokines and alcohol use disorder: systematic review and meta-analysis

Objective: To assess differences in blood inflammatory cytokines between people with alcohol use disorder (AUD) and healthy controls (HC). Methods: Searches were performed from inception through April 14, 2021. Meta-analyses with random-effects models were used to calculate the standardized mean difference ([SMD], 95%CI), and potential sources of heterogeneity were explored trough meta-regressions and subgroup analysis. Results: The meta-analysis included 23 studies on the following 14 cytokines: tumor necrosis factor (TNF)-α, IL-1, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-13, IL15, interferon (IFN)-γ and sCD14. There were significantly higher concentrations of IL-6 (n=462 AUD and 408 HC; SMD = 0.523; 95%CI 0.136-0.909; p = 0.008) in AUD than HC. No significant differences were found in the other 13 cytokines. Conclusion: We found that IL-6 levels were significantly higher in individuals with AUD than HC and that other cytokines were not altered. This can be explained by the small number of studies, their methodological heterogeneity, and confounding factors (active use, abstinence, quantity, and physical or psychiatric illnesses, for example). Despite a great deal of evidence about alcohol and inflammatory diseases, studies assessing the role of neuroimmune signaling in the development and severity of AUD are still lacking.

Anger and substance abuse: a systematic review and meta-analysis

Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

Measurement of physical activity and sedentary behavior in national health surveys, South America / Medición de la actividad física y del sedentarismo en encuestas nacionales de salud en América del Sur / Mensuração de atividade física e comportamento sedentário em pesquisas nacionais de saúde, América do Sul

ABSTRACT Objectives. To characterize how physical activity and sedentary behavior have been measured in national health surveys in South American countries. Methods. An extensive search was made for national health surveys from all 12 South American countries through health websites, national statistical offices, and contact with researchers and policy-makers. The following eligibility criteria were used to select surveys: conducted in a South American country; used a nationally representative sample ≥ 18 years; coordinated by the public, private or mixed private-public sector; and assessed physical activity and/or sedentary behavior. Data were extracted on general information about the surveys, specific details about the physical activity and sedentary behavior assessment, and additional questions related to activity behavior. Results. In total, 36 surveys were included, two of which were multicountry surveys; all surveys assessed physical activity and 27 assessed sedentary behavior. Most surveys (23/36; 64%) were based on previously validated international questionnaires, but 13 (57%) of these deviated from the reference tools, introducing changes and adaptations. Sedentary behavior was assessed mostly through questions on screen time and/or daily sitting time in the same physical activity questionnaires. No survey used device-based measures to generate data on these behaviors. Conclusions. Differences between instruments used and modifications limit the comparability of data across countries. This highlights the importance of standardizing assessment within South America for physical activity and sedentary behavior sections in national surveys, with the broader aim of contributing to establishing a standardized strategy for the surveillance of physical activity and sedentary behavior in South America.

RESUMEN Objetivos. Describir cómo se han medido la actividad física y el sedentarismo en las encuestas nacionales de salud en los países de América del Sur. Métodos. Se llevó a cabo una extensa búsqueda de encuestas nacionales de salud de los doce países sudamericanos en sitios web de salud, oficinas nacionales de estadística y mediante el contacto con investigadores y responsables de formular políticas. Para escoger las encuestas se emplearon los siguientes criterios de selección: realizada en un país sudamericano; muestra representativa a nivel nacional de ≥ 18 años; coordinada por el sector público, el sector privado o mixto público-privado; y evaluación de la actividad física o el sedentarismo. Se extrajeron datos como información general de las encuestas, detalles específicos de la evaluación de la actividad física y el sedentarismo, y otras preguntas relacionadas con la actividad física. Resultados. En total, se incluyeron 36 encuestas, dos de las cuales se realizaron en varios países. Todas las encuestas evaluaron la actividad física; 27, el sedentarismo. La mayoría de las encuestas (23/36; 64%) se basaron en cuestionarios internacionales anteriormente validados, de los cuales 13 (57%) se desviaron de las herramientas de referencia al tener cambios y adaptaciones. El sedentarismo se evaluó principalmente en los mismos cuestionarios de actividad física mediante preguntas sobre el tiempo invertido delante de pantallas o el tiempo diario sentado. Ninguna encuesta aplicó medidas basadas en dispositivos para obtener datos sobre estos comportamientos. Conclusiones. Las diferencias entre los instrumentos empleados y las modificaciones limitan la comparabilidad de los datos en todos los países. Esto pone de relieve la importancia de estandarizar la evaluación en América del Sur de las secciones dedicadas a la actividad física y al sedentarismo en las encuestas nacionales, con el objetivo general de contribuir a la creación de una estrategia estandarizada para la vigilancia de la actividad física y el sedentarismo en América del Sur.

RESUMO Objetivos. Caracterizar como a atividade física e o comportamento sedentário têm sido medidos em pesquisas nacionais de saúde em países sul-americanos. Métodos. Foi realizada uma busca extensa de pesquisas nacionais de saúde de todos os 12 países sul-americanos em sites de saúde e órgãos nacionais de estatística, e pelo contato com pesquisadores e formuladores de políticas. Foram usados os seguintes critérios de elegibilidade para selecionar as pesquisas: conduzida em um país sul-americano; que tenha usado uma amostra nacionalmente representativa ≥ 18 anos; coordenada pelo setor público, privado ou público-privado; e que tenha avaliado a atividade física e/ou o comportamento sedentário. Os dados extraídos eram sobre informações gerais das pesquisas, detalhes específicos sobre a avaliação da atividade física e do comportamento sedentário e questões adicionais relacionadas ao comportamento na atividade. Resultados. Ao todo, 36 pesquisas foram incluídas, duas das quais foram conduzidas em vários países. Todas as pesquisas avaliaram a atividade física e 27 avaliaram o comportamento sedentário. A maioria das pesquisas (23/36; 64%) baseou-se em questionários internacionais previamente validados e 13 (57%) delas se desviaram das ferramentas de referência, introduzindo mudanças e adaptações. O comportamento sedentário foi avaliado principalmente por meio de perguntas sobre tempo de tela e/ou tempo diário sentado nos mesmos questionários sobre atividade física. Nenhuma pesquisa utilizou medições realizadas por dispositivos para gerar dados sobre esses comportamentos. Conclusões. As diferenças entre os instrumentos usados e as modificações limitam a comparabilidade dos dados entre os países, o que destaca a importância de padronizar a avaliação na América do Sul para as seções de atividade física e comportamento sedentário em pesquisas nacionais, com o objetivo mais amplo de contribuir para o estabelecimento de uma estratégia padronizada para a vigilância da atividade física e do comportamento sedentário na América do Sul.

Physical activity, exercise, and mental disorders: it is time to move on

Abstract Introduction Physical activity, conceptualized as any bodily movement that results in energy expenditure, and its structured form, exercise, play an important role in public health, preventing and treating a wide range of physical conditions, including metabolic and cardiovascular diseases and obesity. Objective This article aims to provide a brief overview and summary of the evidence on: 1) the preventive effects of physical activity on a wide range of mental disorders; 2) the role of physical activity in promoting the physical health of people with mental disorders; 3) the role of exercise as a strategy to manage mental health symptoms in a range of mental disorders; and 4) the challenges and barriers faced when implementing exercise in clinical practice. Methods This was a narrative review. Results Compelling evidence has demonstrated that physical activity and exercise can also prevent common mental disorders, such as depression and anxiety disorders, and have multiple beneficial effects on the physical and mental health of people with a wide range of mental disorders. This body of evidence has been incorporated in national and international guidelines over the last decades, which have recommended the inclusion of physical activity and exercise as therapeutic approaches for mental disorders, mainly for depression and schizophrenia. Nonetheless, implementation into clinical practice has been slow, probably due to barriers associated both with patients and mental health professionals. Conclusion Increases in physical activity levels in populations are likely to reduce the mental health burden. Exercise interventions should be incorporated to the routine care of people with mental disorders due its multiple benefits on physical and mental health outcomes. A multidisciplinary approach is needed to overcome patients barriers and enhance adherence and benefits.

Factors associated with adherence to sports and exercise among outpatients with major depressive disorder

Abstract Introduction Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. Methods In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. Results MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. Conclusion Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients.

Atividade física e saúde mental durante a pandemia da COVID-19: uma revisão rápida de estudos epidemiológicos brasileiros / Physical activity and mental health during the covid-19 pandemic: a rapid review of Brazilian epidemiological studies

O distanciamento social, uma das principais estratégias para minimizar a transmissão e o contágio pelo novo coronavírus, provoca um rompimento brusco e substancial nos comportamentos da vida diária, levando a diminuição dos níveis de atividade física e piora dos sintomas de depressão e ansiedade. O objetivo do estudo foi realizar uma revisão rápida de estudos epidemiológicos brasileiros que avaliaram a associação entre atividade física e saúde mental durante a pandemia de COVID-19. A busca pelos estudos foi realizada nas bases Scielo, Scielo Preprints e PubMed até o dia 27 de janeiro de 2021. Foram incluídos seis estudos que avaliaram um total de 64.473 brasileiros, com idades acima dos 18, de todas as regiões do país. Dos estudos analisados, quatro demonstraram que há uma associação entre atividade física e sintomas de depressão e ansiedade, um demonstrou que há associação entre atividade física e depressão e um que há associação entre atividade física e sintomas de ansiedade. Ser fisicamente inativo durante a pandemia da COVID-19 está associado a um risco 152% maior de apresentar depressão e 118% maior de ansiedade. Realizar 30 minutos ou mais de atividade física moderada a vigorosa por dia está associado a redução de 29% no risco de sintomas depressivos, 28% de ansiedade e 29% na co-ocorrência de sintomas de depressão e ansiedade. A prática de atividade física é uma estratégia importante de saúde pública para mitigar o impacto da pandemia e das medidas de isolamento social na saúde mental da população Brasileira.(AU)

Social distancing, the main strategy to minimize transmission and contagion by the coronavirus, causes a sudden and substantial disruption in daily life behavior, leading to decreased levels of physical activity and worsening symptoms of depression and anxiety. The aim of the study was to conduct a rapid review of Brazilian epidemiological studies that evaluated the association between physical activity and mental health during the COVID-19 pandemic. The search for the studies was carried out on the Scielo, Scielo Preprints and PubMed databases until January 27, 2021. Six studies were included that evaluated a total of 64,473 Brazilians, over 18, from all regions of the country. Of the studies analyzed, four demonstrated an association between physical activity and symptoms of depression and anxiety, one demonstrated that there is an association between physical activity and depressive symptoms and one that there is an association between physical activity and symptoms of anxiety. Being physically inactive during the COVID-19 pandemic is associated with a 152% higher risk of depression and 118% greater anxiety. Performing 30 minutes of moderate to vigorous physical activity per day is associated with a 29% reduction in the risk of depressive symptoms, 28% anxiety and 29% in the co-occurrence of symptoms of depression and anxiety. The practice of physical activity is an important public health strategy to mitigate the impact of the pandemic and social isolation measures on the mental health of the Brazilian population.(AU)

El distanciamiento social, una de las principales estrategias para minimizar la transmisión y contagio por el nuevo coronavirus, provoca una alteración repentina y sustancial en el comportamiento y la vida diaria, lo que lleva a una disminución de los niveles de actividad física y al empeoramiento de los síntomas de depresión y ansiedad. El objetivo del estudio fue realizar una revisión rápida de los estudios epidemiológicos brasileños que evaluaron la asociación entre la actividad física y la salud mental durante la pandemia de COVID-19. La búsqueda de los estudios se realizó en las bases de datos Scielo, Scielo Preprints y PubMed hasta el 27 de enero de 2021. Se incluyeron seis estudios que evaluaron a un total de 64.473 brasileños, mayores de 18 años, de todas las regiones del país. De los estudios analizados, cuatro demostraron que existe asociación entre actividad física y síntomas de depresión y ansiedad, uno demostró que existe asociación entre actividad física y depresión y uno que existe asociación entre actividad física y ansiedad. Estar físicamente inactivo durante la pandemia de COVID-19 se asocia con un 152% más de riesgo de depresión y un 118% más de ansiedad. Realizar 30 minutos o más de actividad física de moderada a vigorosa por día se asocia con una reducción del 29% en el riesgo de síntomas depresivos, 28% de ansiedad y 29% en la co-ocurrencia de síntomas de depresión y ansiedad. La práctica de actividad física es una importante estrategia de salud pública para mitigar el impacto de la pandemia y las medidas de aislamiento social en la salud mental de la población brasileña.(AU)

Pre-Exercise Screening Questionnaire: tradução do instrumento de triagem relacionado à COVID-19 / Pre-Exercise Screening Questionnaire: translation of the screening instrument related to COVID-19

A pandemia causada pela doença do coronavírus 2019 (COVID-19) e as medidas de distanciamento social provocaram reduções nos níveis de atividade física das pessoas. A atividade física está associada a uma melhor saúde física e mental, e manter a população ativa durante a pandemia é essencial. No entanto, ainda não se sabe se exercícios podem, em pessoas infectadas, causar uma potencial exacerbação de sintomas da COVID-19. O presente estudo objetivou traduzir o Pre-exercise screening questionnaire (PESQ) para o Português Brasileiro e de Portugal, para facilitar a sua utilização por profissionais ligados ao exercício físico não fluentes na língua inglesa. O PESQ contém sete perguntas diretas sobre os sintomas mais comuns de COVID-19 mais comumente encontrado em adultos e idosos, para orientação segura para prática de exercício físico. A tradução foi feita em 5 etapas: Tradução inicial, tradução cega, revisão da tradução, adequação da língua Portuguesa e ajustes e finalização. As etapas foram realizadas por pesquisadores experientes, com fluência em língua inglesa e nativos em português Brasileiro e de Portugal. No processo de tradução não houve divergências importantes entre os tradutores. A adaptação transcultural foi importante, pois, o português de Portugal difere-se do brasileiro. O instrumento foi devidamente traduzido e pode ser utilizado como ferramenta de screening para os sintomas da COVID-19 por profissionais do exercício durante a pandemia. No momento, o PESQ é a principal ferramenta disponível para prevenir danos relacionados à COVID-19 e a prática de exercícios

The 2019 pandemic caused by coronavirus disease (COVID-19) and measures of social detachment caused reductions in people's physical activity levels. Physical activity is associated with better physical and mental health, and keeping the population active during the pandemic is essential. However, it remains to be determined whether exercise can potentially exacerbate symptoms of COVID-19 in infected people. This study aimed to translate the Pre-exercise screening questionnaire (PESQ) into Brazilian Portuguese and Portugal, to facilitate its use by professionals linked to physical exercise who are not fluent in the English language. The PESQ has seven questions about the most common symptoms of COVID-19 seen in adults and older adults, providing safety to perform exercise. The translation was done in 5 steps: initial translation, blind translation, revision of the translation, adequacy of the Portuguese language and adjustments and finalization. The stages were carried out by experienced researchers, fluent in English and native speakers in Brazilian and Portuguese. There was no relevant disagreement within assessor in the translating procedure. The transcultural adaptation was crucial because Portuguese language varies across Brazil and Portugal. The instrument has been properly translated and can be used as a screening tool for the symptoms of COVID-19 by exercise professionals during the pandemic. Nowadays, the PESQ is the main available tool to prevent burden regarding COVID-19 and exercise practice

Exercise prescription for people with mental illness: an evaluation of mental health professionals knowledge, beliefs, barriers, and behaviors

Objective: The aim of this study was to understand the knowledge, beliefs, barriers, and behaviors of mental health professionals about physical activity and exercise for people with mental illness. Methods: The Portuguese version of The Exercise in Mental Illness Questionnaire was used to assess knowledge, beliefs, barriers, and behaviors about exercise prescription for people with mental illness in a sample of 73 mental health professionals (68.5% women, mean age = 37.0 years) from 10 Psychosocial Care Units (Centros de Atenção Psicossocial) in Porto Alegre and Canoas, state of Rio Grande do Sul, Brazil. Results: Most of respondents had received no formal training in exercise prescription. Exercise ranked fifth as the most important treatment, and most of the sample never or occasionally prescribed exercise. The most frequently reported barriers were lack of training in physical activity and exercise prescription and social stigma related to mental illness. Professionals who themselves met recommended physical activity levels found fewer barriers to prescribing physical activity and did so with greater frequency. Conclusion: Exercise is underrated and underused as a treatment. It is necessary to include physical activity and exercise training in mental health curricula. Physically active professionals are more likely to prescribe exercise and are less likely to encounter barriers to doing so. Interventions to increase physical activity levels among mental health professionals are necessary to decrease barriers to and increase the prescription of physical activity and exercise for mental health patients.

Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis / O exercício físico pode modular os níveis de cortisol em indivíduos com depressão? Uma revisão sistemática e metanálise

Abstract Introduction: Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD. Objective: To review evidence of cortisol changes after exercise training in individuals with MDD. Methods: We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software. Results: At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = −0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them. Conclusion: Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.

Resumo Introdução: A depressão maior (DM) é uma doença associada ao estresse crônico que pode apresentar um desequilíbrio nos níveis de cortisol, podendo ser recuperado com a remissão dos sintomas. O exercício tem sido utilizado como uma ferramenta para promover mudanças nos níveis de cortisol em indivíduos saudáveis. No entanto, não se sabe se o exercício produz os mesmos resultados em indivíduos com DM. Objetivo: Revisar evidências de alterações dos níveis de cortisol após o exercício em indivíduos com DM. Métodos: Foi realizada busca nas bases de dados PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus e PsycInfo. Procedeu-se a metanálise com o cálculo do tamanho do efeito da diferença de média padronizada. Foi utilizado o software Stata v.11.0. Resultados: Foram obtidos na busca 463 estudos. Após o procedimento de seleção, cinco artigos com sete análises foram incluídos. O tipo de exercício, frequência de treinamento, tipo de medida do cortisol e tipo de grupo controle foram analisados como subgrupos. Houve uma redução dos níveis de cortisol no grupo de exercício. Além disso, a análise de sensibilidade e análises de subgrupos revelaram um efeito do tipo (exercício aeróbico) e da frequência (cinco vezes por semana) de exercício na redução dos níveis de cortisol. No entanto, esses resultados devem ser interpretados com cautela, devido ao pequeno número de estudos e uma heterogeneidade substancial entre eles. Conclusão: O exercício promove redução dos níveis de cortisol em indivíduos com DM. No entanto, esse achado pode ser influenciado pelo tipo de exercício, medida do cortisol e frequência semanal.

Psychometric properties of the modified Yale Food Addiction Scale 2 0 in a large Brazilian sample

Objective: The field of food addiction has attracted growing research attention. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a screening tool based on DSM-5 criteria for substance use disorders. However, there is no validated instrument to assess food addiction. Methods: The mYFAS 2.0 has been transculturally adapted to Brazilian Portuguese. The data for this study was obtained through an anonymous web-based research platform: participants provided sociodemographic data and answered Brazilian versions of the the mYFAS 2.0 and the Barratt Impulsivity Scale (BIS-11). Analysis included an assessment of the Brazilian mYFAS 2.0's internal consistency reliability, factor structure, and convergent validity in relation to BIS-11 scores. Results: Overall, 7,639 participants were included (71.3% females; age: 27.2±7.9 years). The Brazilian mYFAS 2.0 had adequate internal consistency reliability (Cronbach's alpha = 0.89). A single factor solution yielded the best goodness-of-fit parameters for both the continuous and categorical version of the mYFAS 2.0 in confirmatory factor analysis. In addition, mYFAS 2.0 correlated with BIS-11 total scores (Spearman's rho = 0.26, p < 0.001) and subscores. Conclusion: The Brazilian mYFAS 2.0 demonstrated adequate psychometric properties in our sample; however, future studies should further evaluate its discriminant validity.

Portuguese and Brazilian guidelines for the treatment of depression: exercise as medicine

Depression is a psychiatric disorder and major contributor to the burden of disease worldwide. The strength of evidence of the benefits of exercise as a therapeutic intervention for patients with depression has expanded in the last 30 years. In fact, the available evidence indicates exercise can not only help manage depressive symptoms, but also effect significant improvements in other health outcomes. Clinical guidelines including such recommendations have been issued by different agencies, namely the UK National Institute for Health and Clinical Excellence (NICE), the American Psychiatric Association (APA), and the Royal Australian and New Zealand College of Psychiatrists (RANZCP). With increasing recognition of the benefits of exercise and shortcomings of healthcare systems, other countries, such as Sweden and Canada, have included exercise in their national guidelines for treating depression. Unfortunately, progress in incorporating exercise guidelines into clinical practice has been slow, and Portugal and Brazil reflect this reality. In this update, we reemphasize the importance of bridging this gap and integrating exercise into clinical practice guidelines as an essential component of depression treatment.

Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias

Objective: To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data. Methods: We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted. Results: Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities. Conclusion: Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.

Treinamento de força diminui os sintomas depressivos e melhora a qualidade de vida relacionada a saúde em idosas / Strength training decreases the depressive symptoms and improves the health-related quality of life in older women

O objetivo do presente estudo foi de avaliar os efeitos do treinamento de força, com prescrição baseada na percepção de esforço, nos sintomas depressivos e na Qualidade de Vida Relacionada à Saúde (QVRS) de idosas. Participaram do estudo 24 idosas (idade de 65,6 ± 4,5 anos), submetidas a um treinamento de força duas vezes por semana, durante 12 semanas com intensidade prescrita através da escala de percepção de esforço de BORG. Utilizou-se a escala de depressão geriátrica (EDG) de para rastreio de depressão e avaliação dos sintomas depressivos. Para avaliação da QVRS, utilizou-se o Questionário de Qualidade de Vida Short Form-36 (SF-36). Para comparação das variáveis pré e pós-treinamento foi utilizado o teste de Wilcoxon. Foi encontrada uma redução dos sintomas depressivos, bem como da frequência de idosas com pontuação indicativa de episódio depressivo atual, após o treinamento de força. Para a QVRS, foram encontradas melhoras nas subescalas de capacidade funcional, estado geral da saúde, vitalidade e saúde mental. O treinamento de força, baseado na percepção de esforço, foi um método efetivo para uma redução nos sintomas de depressivos das participantes bem como para melhora da QVRS relacionada à saúde nas seguintes subescalas do SF-36: vitalidade, capacidade funcional, estado geral da saúde e saúde mental em idosas

The objective of this study was to evaluate the effects of strength training, based on the perceived effort, on depressive symptoms and Health-Related Quality of Life (HRQoL) of elderly women. Twenty four older women (65.6 ± 4.5 years), performed training exercise two times per week during 12 weeks. The intensity was prescribed using the BORG perceived effort scale. The Geriatric Depression Scale (EDG) was used to evaluate the depressive symptoms intensity. The HRQoL, was evaluated thought the Short Form-36 (SF-36). A significant decrease of depressive symptoms was found. The HRQoL improved in some, but not all subscales. Improvements were found at functional capacity, general heath, vitality and mental health subscales. The strength training, based on perceived effort, was an effective method to decrease the depressive symptoms and improve HRQoL on the functional capacity, general heath, vitality and mental health subscales of SF-36 on older women

Efeitos de três programas de treinamento de força na qualidade de vida de idosas / Effects of three different strength training programs on quality life of enderly women

Estudos revelam a importância da força na realização de tarefas diárias, na diminuição de quedas e na capacidade funcional de idosas. O presente estudo tem como objetivo verificar os efeitos de três programas de treinamento de força na capacidade funcional, tempo de reação e força máxima e por conseguinte observar se estas modificações tiveram algum efeito nos padrões de qualidade de vida das idosas. A amostra foi composta por 45 indivíduos do sexo feminino com idades entre 60 e 75 anos, recrutadas voluntariamente e separadas em grupo controle (GC), treinamento de potência (TP), treinamento de força reativa (TR) e treinamento de força máxima (TF). A qualidade de vida foi avaliada pelo questionário validado, WHOQOL-BREF. A potência, força reativa e força máxima foram avaliadas respectivamente através do teste de sentar /levantar em 30 segundos, do tempo de reação e do teste de 1 RM (uma repetição máxima). Os resultados indicaram um aumento significativo dos valores médios das variáveis comparativamente ao GC (p<0,05). Além disso, houve uma melhora significativa das variáveis funcionais associadas a especificidade de cada treinamento. No entanto, não foram encontradas diferenças estatisticamente significativas entre os valores médios dos domínios da qualidade de vida e entre os três grupos de treinamento e o GC. Nesta perspectiva, os resultados sugerem uma melhora da capacidade funcional de idosas submetidas a três programas de treinamento comparativamente ao GC.

Studies have shown the importance of strength to carry out daily tasks, on the reduction of falls and on functional capacity of elderly women. The present study has as objective to verify the effects of three strength training programs on functional capacity, reaction time and maximum strength and therefore see if these changes have any effect on different standards of quality of life of elderly women. The sample consisted of 45 females aged between 60 and 75 years, voluntarily recruited and separated into control group (CG), power training (PT), reactive strength training (TR) and maximum strength training (TF). Quality of life was assessed using the validated questionnaire WHOQOL-BREF. The power, reactive power and maximum strength were respectively evaluated by testing for sit / stand in 30 seconds, reaction time and the 1 RM (one repetition maximum). The results indicates a significant increase in mean values of variables compared to the control group (p <0.05). In addition, there was a significant improvement of the variables associated with functional specificity of each training, however, found no statistically significant differences between mean values of the domains of quality of life and among the three training groups and the GC. In this perspective, the results suggest an improvement in functional capacity of elderly women undergoing three training programs compared to GC.