Insomnia, Psychosocial Well-Being, and Weight Control Behaviors Among Healthy-Weight Adolescent Females: Brief Report.

BACKGROUND: Weight control behaviors (WCBs) typically involve appearance- or health-driven behaviors that may be influenced by physiological, psychological, or social factors. Sleep disturbances like insomnia are an important area of research for adolescent populations, as early intervention may result in improvements in other physical and mental health domains. The purpose of this study was to investigate the relationship of insomnia, psychosocial well-being, and current WCBs in healthy-weight female adolescents. METHOD: Female adolescents (N = 323; Mage = 12.33 ± .04) who had healthy body mass index (BMI) levels completed self-report items on insomnia, depression, self-esteem, and physical self-concept. Multivariate analysis of covariance (MANCOVA), controlling for age, was conducted to further examine differences in insomnia and psychosocial variables among the WCB groups. RESULTS: Compared to those who were trying to stay the same weight or not trying to do anything about their weight, the girls who were trying to lose weight had significantly greater insomnia and depression symptoms, and lower self-esteem, with small to medium effect sizes. CONCLUSIONS: Clinicians working with adolescent girls should include assessments of WCBs in addition to measures of insomnia symptoms, even for adolescent girls within a normal BMI range, as these are common and frequently co-occurring phenomena. Additional research is needed to further disentangle these complicated relationships.

Association of Midlife Cardiorespiratory Fitness With Incident Depression and Cardiovascular Death After Depression in Later Life.

Importance: Cardiorespiratory fitness (hereinafter referred to as fitness) as estimated by exercise testing is a modifiable risk factor independently associated with chronic diseases, cardiovascular disease (CVD) events, and mortality, but the association of fitness at midlife with incidence of later-life depression and the risk of CVD mortality after a depression diagnosis is unknown. Objective: To determine whether fitness measured in midlife would be inversely associated with later-life CVD mortality with antecedent depression. Design, Setting, and Participants: This retrospective cohort study at a single-center, community-based preventive medicine clinic was performed as part of the Cooper Center Longitudinal Study. Data were collected from January 13, 1971, through December 31, 2009, and analyzed from October 6, 2015, through August 14, 2017. Participants included generally healthy men and women who presented for preventive medicine examinations at midlife and who were eligible for Medicare from 1999 to 2010. Those with a self-reported history of depression, myocardial infarction, or stroke at examination were excluded. Exposures: Objective midlife fitness estimated from results of treadmill exercise testing. Main Outcomes and Measures: Depression diagnosis from Medicare claims files using established algorithms and CVD mortality from National Death Index records. Results: A total of 17 989 participants (80.2% men) with a mean (SD) age of 50.0 (8.7) years were included. After 117 218 person-years of Medicare follow-up, 2701 depression diagnoses, 610 deaths due to CVD without prior depression, and 231 deaths due to CVD after depression were observed. A high level of fitness in midlife was associated with a 16% lower risk of depression (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95) compared with a low level of fitness. A high fitness level was also associated with a 61% lower risk of death due to CVD without depression (HR, 0.39; 95% CI, 0.31-0.48) compared with a low level of fitness. After a diagnosis of depression, a high fitness level was associated with a 56% lower risk of death due to CVD (HR, 0.44; 95% CI, 0.31-0.64) compared with a low fitness level. Conclusions and Relevance: Midlife fitness is associated with a lower risk of later-life depression, CVD mortality, and CVD mortality after incident later-life depression. These findings suggest the importance of midlife fitness in primary prevention of depression and subsequent CVD mortality in older age and should encourage physicians to consider fitness and physical activity in promoting healthy aging.

Meeting USDHHS Physical Activity Guidelines and Health Outcomes.

Current public health physical activity (PA) guidelines suggest ≥500 METmin/week of PA, with additional benefits beyond 1000 METmin/week (i.e., a dose response). Revised U.S. PA guidelines are scheduled for 2018. The purpose was to relate health markers (blood pressure, percent fat, BMI, blood glucose, cholesterol, and cardiorespiratory fitness) to verify the dose response for PA guidelines revision. 505 non-smoking participants self-reported PA behaviors and completed medical screening. MANCOVA controlling for age and gender determined the relation between health markers and PA. MANCOVA indicated significantly (P<.001) different health markers of percent fat, BMI, glucose, and treadmill time as a function of PA. Post-hoc Helmert contrasts (1] <500 METmin/week vs. ≥500 METmin/week and 2] 500 to <1000 METmin/week vs. ≥1000 METmin/week) indicated that meeting the PA guidelines was associated with better health markers and higher cardiorespiratory fitness. Effect sizes were greater for contrast 1 than for contrast 2, suggesting a plateauing effect. Revised public health guidelines should consider achievement of ≥500 METmin/week to be most important, with additional modest gain thereafter. Revised PA guidelines should stress the importance of achieving 500-1000 METmin/week.

Better Health-Related Fitness in Youth: Implications for Public Health Guidelines.

Public health guidelines for physical activity (PA) behaviors are being updated with 2018 as a proposed release date. Currently, ≥60 minutes of daily PA are recommended for youth. Thus, the purpose of this study was to investigate the association between reported days of aerobic PA and health-related fitness (HRF). Participants included 4448 students in grades 6-8. Self-reported days of ≥60 minutes of aerobic PA was obtained. HRF was assessed with FitnessGram. Discriminant analysis indicated that weekly days of aerobic PA related to HRF. Adolescents who participated in ≥5 days of weekly aerobic PA generally had better fitness results than those with ≤4 days. Chi-square analyses indicated the highest percentages of adolescents in the FitnessGram Healthy Fitness Zone™ (HFZ) for each test item were those with ≥5 days of aerobic PA. These findings provided initial support that the impact of aerobic PA on HRF plateaus at 5 days per week. Thus, adolescents may be able to improve HRF even if they do not meet the currently recommended guidelines for daily PA.

Athletes' Expectations About Sport-Injury Rehabilitation: A Cross-Cultural Study.

CONTEXT: Athletes enter injury rehabilitation with certain expectations about the recovery process, outcomes, and the professional providing treatment. Their expectations influence the effectiveness of the assistance received and affect the overall rehabilitation process. Expectations may vary depending on numerous factors such as sport experience, gender, sport type, and cultural background. Unfortunately, limited information is available on athletes' expectations about sport-injury rehabilitation. OBJECTIVE: To examine possible differences in athletes' expectations about sport-injury rehabilitation based on their country of residence and type of sport (contact vs noncontact). DESIGN: Cross-sectional. SETTING: Recreational, college, and professional athletes from the US, UK, and Finland were surveyed. PARTICIPANTS: Of the 1209 athletes ranging from 12 to 80 y of age (mean 23.46 ± 7.91), 529 US [80%], 253 UK [86%], and 199 Finnish [82%] athletes provided details of their geographical location and were included in the final analyses. MAIN OUTCOME MEASURES: The Expectations About Athletic Training (EAAT) questionnaire was used to determine athletes' expectations about personal commitment, facilitative conditions, and the expertise of the sports-medicine professional (SMP). RESULTS: A 3 × 2 MANCOVA revealed significant main effects for country (P = .0001, ηp2 = .055) and sport type (P = .0001, ηp2 = .023). Specifically, US athletes were found to have higher expectations of personal commitment and facilitative conditions than their UK and Finnish counterparts. Athletes participating in contact sports had higher expectations of facilitative conditions and the expertise of the SMP than did athletes participating in noncontact sports. CONCLUSIONS: SMPs, especially those in the US, should consider the sport and environment when providing services. In addition, SMPs need to highlight and demonstrate their expertise during the rehabilitation process, especially for those who compete in contact sports.

Moving Beyond Univariate Post-Hoc Testing in Exercise Science: A Primer on Descriptive Discriminate Analysis.

There has been a recent call to improve data reporting in kinesiology journals, including the appropriate use of univariate and multivariate analysis techniques. For example, a multivariate analysis of variance (MANOVA) with univariate post hocs and a Bonferroni correction is frequently used to investigate group differences on multiple dependent variables. However, this univariate approach decreases power, increases the risk for Type 1 error, and contradicts the rationale for conducting multivariate tests in the first place. PURPOSE: The purpose of this study was to provide a user-friendly primer on conducting descriptive discriminant analysis (DDA), which is a post-hoc strategy to MANOVA that takes into account the complex relationships among multiple dependent variables. METHOD: A real-world example using the Statistical Package for the Social Sciences syntax and data from 1,095 middle school students on their body composition and body image are provided to explain and interpret the results from DDA. RESULTS: While univariate post hocs increased the risk for Type 1 error to 76%, the DDA identified which dependent variables contributed to group differences and which groups were different from each other. For example, students in the very lean and Healthy Fitness Zone categories for body mass index experienced less pressure to lose weight, more satisfaction with their body, and higher physical self-concept than the Needs Improvement Zone groups. However, perceived pressure to gain weight did not contribute to group differences because it was a suppressor variable. CONCLUSION: Researchers are encouraged to use DDA when investigating group differences on multiple correlated dependent variables to determine which variables contributed to group differences.

Weight Control Behavior as an Indicator of Adolescent Psychological Well-Being.

BACKGROUND: Adolescence is a critical time for the development of psychological well-being. Weight gain and the emergence of body image concerns during this period can lead to the development of negative psychological states. To explore this issue, we examined the relationship between weight control behavior (WCB; ie, trying to lose, gain, stay the same, or do nothing about weight) and levels of depression and self-esteem. METHODS: Adolescents (508 boys, 502 girls; Mage = 12.32 ± .88 years) completed a survey that assessed WCB, depression, and self-esteem. Descriptive discriminant analysis was used to analyze WCB group differences on psychological well-being. Multivariate post hoc analysis further examined group differences. Structure coefficients indicated the relative importance of each dependent variable in boys and girls. RESULTS: Results indicated that, among both sexes, WCB was significantly related to depression and self-esteem. Individuals trying to lose weight had lower levels of psychological well-being than the other groups. CONCLUSIONS: Adolescents trying to lose weight reported the lowest psychological well-being scores whereas those not doing anything to control weight reported the highest levels of psychological well-being. These findings have important implications for screening and education programs designed to monitor and support adolescent psychological well-being.

National Collegiate Athletic Association Division I Certified Athletic Trainers' Perceptions of the Benefits of Sport Psychology Services.

CONTEXT: Certified athletic trainers (ATs) are responsible for integrating relevant professionals into the rehabilitation team to assist with the holistic care of injured athletes. OBJECTIVE: To explore National Collegiate Athletic Association Division I (DI) ATs' experience with sport psychology consultants (SPCs), willingness to encourage athletes to use SPCs for injury rehabilitation, and perceptions of the benefits of sport psychology services. DESIGN: Quantitative study. SETTING: A Web-based survey was administered to a national sample of DI ATs. PATIENTS OR OTHER PARTICIPANTS: A total of 659 (341 men, 318 women) ATs completed the survey. MAIN OUTCOME MEASURE(S): Athletic trainers' experience with SPCs, willingness to encourage athletes to seek sport psychology services, and perceptions of the benefits of those services in injury-rehabilitation settings were self-reported using a rating scale that ranged from 1 (never or not at all) to 5 (definitely or extremely). RESULTS: Logistic regression revealed that the availability of SPCs, previous encouragement to athletes to seek sport psychology services, and previous positive interactions with SPCs predicted the ATs' willingness to encourage athletes to use these services (P < .0001). The services ATs rated the highest for injury rehabilitation were managing anxiety and emotion, improving coping techniques, and building confidence (ie, confidence in returning to sport and building confidence). Chi-square analyses indicated that female ATs' ratings of perceived benefits were higher (P ≤ .001) than those of male ATs, and the ratings of ATs who were likely to encourage the use of SPCs were higher (P ≤ .001) than those who were unlikely to encourage SPC service use. CONCLUSIONS: Athletic trainers in our study who had previous positive SPC experiences were most likely to use SPCs and their services during the injury-rehabilitation process. Possible implications are offered for how ATs interested in sport psychology services might call on SPCs to complement their work with injured athletes.

Implementing Policies to Enhance Physical Education and Physical Activity in Schools.

The purpose of this commentary is to provide an overview of national physical activity recommendations and policies (e.g., from the Institute of Medicine, National Physical Activity Plan, and Centers for Disease Control and Prevention) and to discuss how these important initiatives can be implemented in local schools. Successful policies are illustrated. Specific strategies and ideas are shared regarding how physical educators can assert themselves and impart their knowledge in an effort to build support for policy implementations that enhance the delivery of physical education and physical activity in their schools and communities.

Biopsychosocial correlates of dietary intent in middle school girls.

Adolescent girls commonly engage in weight management and dietary restriction with the hopes of changing their bodies to more closely approximate social body ideals. The purpose of this study was to examine biopsychosocial factors that predict dietary restraint. Participants (n=774, Mage=12.38) completed measures of dietary intent, pubertal status, sociocultural pressures, body comparison, internalization, body dissatisfaction, social support, and general self-esteem. Height, weight, and cardiorespiratory fitness were objectively measured. Pressures to lose weight and gain muscle mass, internalization of social body ideals, and friend support predicted higher levels of dietary intent; cardiorespiratory fitness predicted lower levels of dietary intent. Girls who experience pressure, adopt social body ideals as their own, and experience social support from friends may be at increased risk for disturbed eating attitudes and behaviors. Fitness may offer a protective effect against psychological and social risk factors. Additional research is needed to establish the causal nature of these relationships and determine effective methods for reducing disordered eating risk among adolescent girls.

Athletes' use of mental skills during sport injury rehabilitation.

CONTEXT: Existing theoretical frameworks and empirical research support the applicability and usefulness of integrating mental skills throughout sport injury rehabilitation. OBJECTIVE: To determine what, if any, mental skills athletes use during injury rehabilitation, and by who these skills were taught. Cross-cultural differences were also examined. DESIGN: Cross-sectional design. SETTING: College athletes from 5 universities in the United States and a mixture of collegiate, professional, and recreational club athletes from the United Kingdom and Finland were recruited for this study. PARTICIPANTS: A total of 1283 athletes from the United States, United Kingdom, and Finland, who participated in diverse sports at varying competitive levels took part in this study. MAIN OUTCOME MEASURES: As part of a larger study on athletes' expectations of injury rehabilitation, participants were asked a series of open-ended and closed-ended questions concerning their use of mental skills during injury rehabilitation. RESULTS: Over half (64.0%) of the sample reported previous experience with athletic training, while 27.0% indicated that they used mental skills during injury rehabilitation. The top 3 mental skills reported were goal setting, positive self-talk/positive thoughts, and imagery. Of those athletes that used mental skills, 71.6% indicated that they felt mental skills helped them to rehabilitate faster. A greater proportion of athletes from the United States (33.4%) reported that they used mental skills during rehabilitation compared with athletes from the United Kingdom (23.4%) and Finland (20.3%). A small portion (27.6%) of the participants indicated that their sports medicine professional had taught them how to use mental skills; only 3% were taught mental skills by a sport psychologist. CONCLUSIONS: The low number of athletes who reported using mental skills during rehabilitation is discouraging, but not surprising given research findings that mental skills are underutilized by injured athletes in the 3 countries examined. More effort should be focused on educating and training athletes, coaches, and sports medicine professionals on the effectiveness of mental training in the injury rehabilitation context.

Relationship of weight-based teasing and adolescents' psychological well-being and physical health.

BACKGROUND: To date, research has focused primarily on psychological correlates of weight-based teasing. In this study, we extended previous work by also examining physical health-related variables (eg, physical self-concept and physical fitness [PF]). METHODS: Participants included 1419 middle school students (637 boys and 782 girls). Of these, 245 (17.3%) reported being teased about being overweight. Participants completed measures of self-esteem, depression, physical self-concept, physical activity (PA) self-efficacy, and self-report physical and sedentary activities. Participants also completed PF testing. RESULTS: After controlling for demographic characteristics, participants who were teased about being overweight had higher scores on depression and lower scores on self-esteem, physical self-concept, PA self-efficacy, and health-related measures of PF in comparison to participants who were not teased. CONCLUSIONS: The results of this study support previous research indicating relationships between teasing and low levels of psychological well-being, physical self-concept, and PA self-efficacy, and establishes one between weight-based teasing and different types of PF. Research is needed to determine the potential causal nature of the relationships between teasing and fitness and evidence-based interventions are needed to reduce weight-based teasing and its potential effects on health and well-being.

Meeting physical activity guidelines and health-related fitness in youth.

BACKGROUND: National physical activity guidelines have been developed for Americans. Interest lies in the relationship between meeting the national physical activity guidelines and physical fitness outcomes in youth. Theoretically, those who meet the physical activity guidelines are more physically fit, which translates to better health and reduced risk. PURPOSE: To examine the relationship between youth self-reported physical activity behaviors sufficient to meet DHHS Physical Activity Guidelines for Americans and an external health criterion: achievement of the FITNESSGRAM(®) Healthy Fitness Zone™ (HFZ). METHODS: Logistic regression was used to examine achievement of the HFZ for three physical fitness measures (i.e., aerobic capacity, BMI, and muscle fitness) separately, and for all three combined, based on self-reported physical activity of 7 days per week for aerobic activity and ≥3 days per week of muscle-strengthening activity. One model examined the direct relationship between physical activity and fitness measures, and a second model assessed the same relationship while controlling for gender, age, ethnicity, economic status, and school. Data were collected during the 2009-2010 academic year and analyzed in 2012. RESULTS: Adolescents failing to meet national aerobic and muscle-strengthening physical activity guidelines have higher odds of not achieving healthy physical fitness levels of aerobic capacity, BMI, muscle fitness, and the combination of all three. An increase in the number of days of aerobic activity was related to decreased odds of being in the Needs Improvement Fitness Zone. CONCLUSIONS: The findings provide further support that meeting the national physical activity guidelines produces health benefits for youth.

Health-related fitness, body mass index, and risk of depression among adolescents.

PURPOSE: The Centers for Disease Control and Prevention indicates that depression is a serious issue for teenagers, with 10% to 15% reporting some symptoms and 15% having considered attempting suicide in 2009. PURPOSE: The objective of this study is to determine the relations between cardiorespiratory fitness and body mass index (BMI) and depressive symptoms among young adolescents. METHODS: The sample included 531 females and 455 males in grades 6 to 8. The FITNESSGRAM physical fitness test battery was administered to the participants as part of required school activities. Two results from the test battery, cardiorespiratory fitness and BMI, were used to classify the students into meeting or not meeting the healthy fitness zones established for each test. The Center for Epidemiological Studies-Depression Scale for Children (CES-DC) was administered in the schools to assess behavioral and cognitive aspects of depression. Participants were classified as elevated depression (CES-DC ≥16, n = 295) or normal (<16, n = 691). RESULTS: Logistic regression was used to assess the relations of Health Fitness Zone status for cardiorespiratory fitness and BMI with depression while controlling for age, ethnicity, sex, economic status (school lunch support), and other fitness factors (cardiorespiratory fitness or BMI). Children classified as not in the Health Fitness Zone for cardiorespiratory fitness had significantly higher odds of elevated depression (odds ratio = 1.71 (95% CI = 1.03-2.84)). BMI was not significantly related to depression. CONCLUSION: These findings indicate that a healthy level of cardiorespiratory fitness was associated with a lower level of depression as measured by the CES-DC. Because of the cross-sectional nature of this study, no cause and effect relations can be assumed.

Moderators of the internalization-body dissatisfaction relationship in middle school girls.

The purpose of the present study was to replicate and extend previous research by examining the moderating effects of self-esteem, physical self-concept, physical appearance comparisons, BMI, pubertal status, and cardiorespiratory fitness, on the internalization-body dissatisfaction relationship in middle school girls. Hierarchical multiple regression (HMR) was used to examine direct and moderating effects of these variables. Internalization was related directly and significantly to body dissatisfaction, as were the proposed moderators (i.e., self-esteem, physical self-concept, physical appearance comparisons, BMI, pubertal status, and cardiorespiratory fitness); however, these variables failed to significantly influence the internalization-body dissatisfaction relationship. Possible explanations for the lack of moderating effects and directions for future research are discussed.

Survey results of the training, nutrition, and mental preparation of triathletes: practical implications of findings.

Although triathlon is growing in popularity at a remarkable rate, it has not been extensively studied. The aims of this research were to identify preparation strategies used by triathletes and to categorize these strategies according to gender and consultation with triathlon coaches. Survey data collected from 401 triathletes (207 males, 194 females) revealed training, nutritional, and mental preparation habits. Most participants engaged in strength training, consumed food and/or fluids during and after training, set training and competition goals, and applied mental preparation strategies during training and the hour before racing. Water was the most commonly consumed fluid; positive self-talk was the most used mental strategy. Participants were more likely to consult with a triathlon coach than a nutrition or sport psychology professional. Athletes with more years of experience in triathlon and those competing in longer distances were more likely to consult a triathlon coach. Female triathletes were more likely than male triathletes to train with others, use mental preparation strategies, and report feeling anxious before competitions. More male triathletes reported using nutritional supplements during training than their female counterparts. These findings add to the limited research base on triathletes' training habits, and hopefully will help guide practitioners who work with this group. The results provide guidance for collaborative efforts among training, nutrition, and mental health professionals to best support triathletes.

Weight control beliefs, body shape attitudes, and physical activity among adolescents.

BACKGROUND: Relatively little is known about how perceived weight controllability influences important psychological health factors among adolescents. Thus, the purpose of this study is to explore adolescents' weight controllability beliefs and how those beliefs influence weight-related attitudes and behaviors. METHODS: Adolescents (N = 369, mean age = 13.14, SD = 0.95) enrolled in physical education completed a survey packet, which included demographic questions and items targeting obesity, body shape, and weight controllability beliefs. RESULTS: Participants believed that fat children have weight problems because they consume too many calories, are lazy, have access to junk food, and lack self-control. Those who endorsed high weight controllability beliefs were more likely to indicate that a thin person, as compared to a fat person, would enjoy physical activity and be coordinated, have higher levels of personal weight and body shape satisfaction, and engage in vigorous physical activity more days per week. CONCLUSIONS: Perceived weight controllability may be an important construct to study further, particularly in relationship to health- and weight-related attitudes and behaviors.

Overview of the Texas Youth Fitness Study.

This paper summarizes the historical and legislative backgrounds leading to statewide testing of health-related physical fitness in Texas children grades 3-12 as mandated by Texas Senate Bill 530. The rationale and goals for an associated research project (the Texas Youth Fitness Study, funded by the Robert Wood Johnson Foundation) to evaluate data collected from the statewide initiative are provided. The study investigated the relations between health-related physical fitness and educational variables, including academic achievement, absenteeism, and negative school incidents. It also provides unique insights into the quality (both reliability and validity) of collected data and implications of large-scale school-based physical fitness testing. Teacher commentary and experiences add to the description of the data collection processes. Last, the relations between psychosocial variables and health-related fitness in middle school students are described.

Reliability and validity of the FITNESSGRAM: quality of teacher-collected health-related fitness surveillance data.

The purpose of this study was to investigate the quality (reliability and validity) of large-scale fitness testing in Texas and determine if reliabilities and validities were related to potential confounding variables. Four test administration scenarios were conducted to investigate the quality of data collected statewide as part of the Texas Youth Evaluation Project. Teachers and/or expert test administrators tested individual students (N=1010) on two occasions. Criterion-referenced reliabilities were very good to generally acceptable for all FITNESSGRAM test items, with musculosheletal items having the lowest reliabilities. The validity of teacher-administered tests was good. Reliability and validity of teacher-obtained health-related fitness measures were generally unrelated to potentially confounding student or school characteristics. Administrators, teachers, parents, and students can feel comfortable with the reliability and validity of the statewide health-related fitness testing in Texas.

Statewide physical fitness testing: perspectives from the gym.

This paper provides observations of physical fitness testing in Texas schools and physical education teachers' insights about large-scale testing using the FITNESSGRAM assessment (Cooper Institute, 2007) as mandated by Texas Senate Bill 530. In the first study, undergraduate and graduate students who were trained to observe and assess student fitness testing in grades 3 through 12 provided observations. In the second study, physical education teachers responded to selected interview questions during a focus group discussion. From the observations and responses, specific themes emerged related to teachers' knowledge and training about conducting fitness testing and managing data, students' knowledge and motivation, support and resources for conducting fitness assessments, and complexity of the fitness situation.