Physical Exercise for Mental Health

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1		Pasquale Caponnetto	+ 2596 word(s)	2596	2021-12-24 06:53:49	\|
2	format corrected.	Beatrix Zheng	+ 110 word(s)	2706	2021-12-29 03:03:50	\|

This entry is adapted from the peer-reviewed paper 10.3390/ijerph182413384

Regarding the benefits of physical exercise on cognitive functions, we can say that most of the considered sample have greater precision and speed of response in information processing tasks; children have an improvement in executive functions, selective attention, linguistic understanding, and a wider lexical network, syntactic and spelling skills, working memory, cognitive flexibility, inhibition control and school performance.

physical activity exercise addiction sport addiction cognitive functions executive functions

1. Insightful Analysis

1.1. Benefits of Physical Exercise on Cognitive Functions

The analysis of several research from scientific literature confirmed the positive influence of physical exercise on cognitive functions.

The phenomenon of positive influence of physical exercise on cognitive functions is evident in a randomized study conducted by Chiu et al. ^[1] in which the sample consisted in thirty-one participants recruited from National Central University, Taiwan. Twelve of these were in the exercise group, who regularly engaged in running or swimming, 11 were members of the university volleyball teams, and 8 were controls. For each, height, weight, and gender were recorded, and fitness was evaluated using a standard measure, the Progressive Aerobic Cardiovascular Endurance Run (PACER) test, a measure of maximal oxygen uptake (VO_2max) and an indicator of aerobic physical fitness. A between-subjects design was used with repeated measures of flanker task accuracy and response times (for each of three different time limits for making a response) as within-subject factors. The flanker task measures information processing skill in different time constraints. Response times were used in diffusion model analysis to allow assessment of further relevant within subject parameters. Each participant performed blocks of the flanker task with a fixed response time limit (of which they were informed) for each block, with block orders (and hence the order of presentation of the time limits) being randomized across participants. Results showed that sporting participation, and more specifically, playing volleyball, was associated with better performance on the flanker task, primarily in terms of accuracy on the task but also with a trend toward faster responding. Additionally, time pressure was associated with reduced accuracy on the task. Response times also showed the expected reduction with the shorter time limits. The pattern of the effects on accuracy for the sporting groups showed more accurate performance for the volleyball group for the shortest time limit compared to controls, with seemingly intermediate performance for the exercise group. The response time data pointed out a trend toward faster responding for the volleyball group for the 1000 ms (intermediate) and 3000 ms (longest time limit) conditions.

1.1.1. Effects of Physical Activity on Cognitive Functions in Relation to Age

Erickson et al. ^[2] also showed that physical activity (PA) improves cognitive functions in many age ranges. In their general review, they found out that both acute and chronic moderate-to-vigorous PA interventions improved brain structure and function, as well as cognition, and academic outcomes, in children from 6 to 13 years old. They refer to chronic PA behavior as PA that is repeated and lasts longer than a single session or episode. Thus, acute PA research reflects the immediate (transient) response to a single bout of PA, while chronic PA reflects a true change in an individual’s baseline (i.e., a prolonged/permanent shift in activity). In the case of chronic PA, the change is not as tightly coupled in time to the last bout of PA. Anyway, moderate evidence from randomized controlled trials (RCTs) indicated an association between moderate-to-vigorous intensity PA and improvements in cognition, including performance on academic achievement and neuropsychological tests, such as those measuring processing speed, memory, and executive function. Two systematic reviews reported by Erickson et al. have described differences in brain structure and function as a result of PA in RCTs, with additional support from cross-sectional comparisons of higher and lower fit groups of preadolescents. Briefly, findings have demonstrated differences in brain structure including greater integrity in specific white matter tracts following PA interventions. Functional brain changes resulting from PA interventions have also been noted in preadolescent children. Such studies have indicated PA intervention-induced benefits to the neuroelectric system as well as changes in functional magnetic resonance imaging (fMRI) signals. Collectively, there is moderate evidence that PA is beneficial to cognition and brain structure and function during preadolescence.

A systematic review by Bidzan-Bluma et al. ^[3] considered the effect of physical activity on children’s cognitive functions. The authors pointed out morphological modifications of cerebral structures and improvements of cognition abilities in children, after physical exercise, analyzing data from 58 articles. Positive influence on selective attention, development of better lexical accomplishment, effective linguistic comprehension and improved syntactical and orthographical skills were also observed. The domains in which the positive effect of physical exercise is more pronounced—in the period between childhood and preadolescence—are working memory, cognitive flexibility, and inhibition control, with consequent pursuit of objectives capability. Moreover, research suggested that physical activity positively influences verbal functions, which facilitates the learning of words in a new language, leading to richer networks of words and their meanings, and also improves spelling performance, language understanding, and the detection of syntactic errors.

Available data in literature suggest that physical exercise also positively affects cognitive domains of ADHD (attention deficit hyperactivity disorder) children ^[4]. Specifically, a meta-analysis conducted by Cerrillo-Urbina et al. ^[5] examinated five trials grouped according to the intervention program: aerobic and yoga exercise. The meta-analysis included a total of 249 children diagnosed with ADHD. Of these, 230 participated in aerobic exercises and 19 in yoga exercises. The average sample size of all groups was 31.13 subjects. The meta-analysis suggests that aerobic exercise had a moderate to large effect on core symptoms such as attention, hyperactivity and impulsivity and related symptoms such as anxiety, executive function, and social disorders in children with ADHD. Yoga exercise suggests an improvement in the core symptoms of ADHD. The main cumulative evidence indicates that short-term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD.

Regarding people over 50 years old, literature showed that acute and long-term PA improves brain structures, functions, and cognition, reducing risks connected to cognitive impairment and lowering the possibility of developing dementia ^[2]. In a meta-analysis of 39 randomized controlled trials conducted by Barha et al. ^[6], training showed to improve executive functions, episodic memory, visuo-spatial functions, words fluidity, speed processing and global cognitive functions. In specific, results suggest evidence that a larger amount of PA is associated to lower risks of cognitive decline and dementia, including Alzheimer’s disease. Another meta-analysis by Sofi et al. ^[7] concerning 15 prospective studies which lasted from 1 to 12 years, with a total of more than 33.000 participants, revealed that larger amounts of PA were associated to a 38% lower risk of cognitive decline. A meta-analysis conducted by Beckett et al. ^[8] involving 10 prospective studies—which included more than 20.000 participants—showed that larger amounts of PA were associated to a 40% lower risk of developing Alzheimer’s disease.

Furthermore, regarding the prevention of age-related cognitive decline in elderly with mild cognitive impairment (MCI), a randomized trial conducted by Bisbe et al. ^[9] explored cognitive effects of choreographic exercise and of a multimodal physical therapy program, with two elderly parallel groups from 65 to 85 years old with amnestic MCI, which are the subjects with highest risk of developing dementia. Participants were assigned to the choreography or physical therapy group and performed exercises twice a week, of which the duration was 60 min, for a period of 12 weeks. The 36 participants were assessed at baseline and after the 12 training weeks, through physical and neuropsychological standardized evaluations. The main result of the study was an improvement in verbal memory performance, measured with the word list learning test from the Wechsler Memory Scale—Third Edition (WMS-III). Changes in Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) visual memory subtest and other cognitive scores were considered as secondary results. The comparison between groups showed the following effects: the choreography group obtained more statistically significant benefits in verbal-recognition memory than physical therapy group (p = 0.003). Both groups showed better performance in retarded visual recall from RBANS (choreography group: p = 0.022; physical therapy group: p = 0.030). Eventually, there have been no statistically significant worsening of any neuropsychological aspect.

1.1.2. Effects of Physical Activity on Cognitive Functions in Patients with Mental Disorders

Concerning the psychiatric area, Aas et al. ^[10] demonstrated that physical activity leads to cognitive functions improvement in patients with severe mental disorders. This was demonstrated by dividing a sample composed of 306 participants with schizophrenia or bipolar disorder and considering two groups: patients that performed physical activity for ≥90 min a week and patients that performed physical activity for <90 min a week. Through neuropsychological evaluation, it emerged that the group which performed physical activity for ≥90 min a week had better global functioning (GAF scores; p < 0.001). This one group also obtained higher scores in working memory (p < 0.001), executive functioning (p < 0.001), verbal memory (p = 0.04) and general intellectual skills (p = 0.02). A multiple regression analysis was executed to investigate the relation between physical exercise (as continue variable) with cognitive function, considering age, sex, and psychiatric diagnosis. There was a positive association between physical exercise and working memory (p = 0.006) and executive functioning (p = 0.006). In addition, a significant association was observed between messenger ribonucleic acid (mRNA) of brain-derived neurotrophic factor (BDNF) levels, measured in plasma through standardized procedures, and general intellectual skills, measured by Wechsler Abbreviated Scale of Intelligence (WASI; p = 0.037), showing a higher mRNA of BDNF level in patients with better cognitive performance. Moreover, this study highlighted a significant association between physical exercise and mRNA of BDNF levels (p = 0.046).

Eventually, a meta-review by Chamberlain and Grant ^[11] confirmed that global cognition of subjects with schizophrenia can be improved through aerobic exercises. Particularly, a systematic review and meta-analysis by Firth et al. ^[12] focused on seven randomized controlled trials—which involved 292 subjects with schizophrenia—revealed that aerobic exercise improves global cognitive functioning more than control conditions, which included: only table soccer, occupational therapy and treatment as usual (p < 0.001).

We were able to note, therefore, how the performance of physical activity produces numerous benefits on cognitive functions on all types of analyzed samples (Table 1).

Table 1. Positive effects of physical activity on cognitive functions.

PARTICIPANTS	BENEFITS OF PHYSICAL ACTIVITY ON COGNITIVE FUNCTIONS
GENERAL POPULATION	Better precision and response speed in information processing tasks
CHILDREN	Improvement of executive functions Improvement selective attention Wider lexical network Improvement of linguistic understanding Improvement of syntactic ability Improvement of spelling skills Improved working memory Improvement of cognitive flexibility Improved inhibition control Improvement of school performance
CHILDREN WITH ADHD	Improvement of attention Less hyperactivity Less impulsiveness Improvement of executive functions
ADULTS OVER 50 YEARS OLD	Lower risk of cognitive decline and dementia Improvement of executive functions Improvement of visual-spatial functions Improvement of episodic memory Improved fluency of words Improvement of processing speed Improvement of global cognitive functions
PATIENTS WITH SCHIZOPHRENIC SPECTRUM DISORDER OR BIPOLAR DISORDER	Improvement of overall cognitive functioning Improvement of general intellectual skills Improvement of verbal memory Improved working memory

1.2. Risk Factors in the Development of Exercise Addiction

Exercise Addiction was conceptualized by Morgan ^[13] as a behavioral dysfunction and, therefore, as addiction that takes negative connotation. He assumed that excessive physical exercise could lead to physical damage and to neglect many everyday life contexts (e.g., family, job). There are two key-aspects of this condition: firstly, sport becomes a daily need; secondly, the presence of withdrawal symptoms in case of abstention from training.

Lukács et al. ^[14] explored exercise addiction in amateur runners through multidimensional approach, underlying some risk predictors of develop this addiction. The sample consisted in 257 runners with at least 2 consecutive years of practice. Risk prevalence of exercise addiction (EA) was 8.6%, while 53.6% of respondents was characterized as symptomatic non-addicted and 37.8% asymptomatic non-addicted. Likelihood ratio tests indicated that five factors have contributed in a significant way: time spent running weekly (p < 0.001); childhood activity p = 0.008); level of education (p = 0.006); anxiety (p = 0.023); loneliness (p = 0.004). It was observed that the risk group obtained a higher score in “lack of control” subscale; these runners were, in fact, less able to manage the urge of doing or to stop exercising. The results support the theory that assumes lonely athletes use sport activity as source of joy and happiness—to cope for anxiety and loneliness—increasing time or quantity of physical activities, because they need more and more of it to achieve these emotions.

A new and interesting discovery is that a lower level of education may predict the probability of exercise addiction. Studying at better universities or colleges may improve the capability to deal with emotional distress and develop coping strategies which, in their turn, can prevent behavioral disorders and presumably numerous other problems. In fact, the level of education seemed to be a protective factor, as resulted in Menczel’s research ^[15]: 65% of the sample—1743 subjects, 58.6% of which were female, the mean age was 31.7 (SD = 8.491), the youngest person was 18, and the oldest one was 61-year-old—had a university or college degree. The subjects were administered questionnaires consisted of different parts, namely, demographic questions, e.g., age, gender, residency, weight and height. In the second part, sporting habits were assessed, such as the frequency, the kind of sport they practiced. Menczel also measured the existence of eating disorders. As the final part of the survey, fitness users were asked to fill in two standardized questionnaires, the Exercise Addiction Inventory (EAI) and the Exercise Dependence Scale-21 (EDS). Additionally, to these scales—self-esteem, well-being and sensation seeking were also measured. Furthermore, body dissatisfaction was measured with the Eating Disorder Inventory and the SCOFF scale. In terms of education, the higher level of studies, the lower scores people obtained on exercise dependence (ED) (rs, 0.094, p ≤ 0.001; rs, 0.148, p ≤ 0.001). As Menczel suggests, addictive exercising may link to having worse coping mechanisms, poorer ways to deal with stress. One way to improve in it is to study in higher education.

1.2.1. Exercise Addiction, Behavioral Disorders and Psychological Distress

Exercise addiction can also be related to certain personality characteristics and/or psychological distress. In a cross-sectional survey by Guidi et al. ^[16], a total of 79 participants (recruited in five gyms) completed the following self-report questionnaires: Exercise Dependence Questionnaire (EDQ), Eating Disorder Inventory II (EDI-2), Temperament and Character Inventory (TCI), Attitude Toward Self Scale (ATS), Muscle Dysmorphia Questionnaire (MDQ) and Symptom Questionnaire (SQ). In the sample, exercise addicted subjects were 32, who were compared with control subjects (n = 47). From the results, it was observed significant differences between genres in EDI-2 total score, where women have obtained higher scores than men (p = 0.048). Participants with primary exercise addiction showed more dysfunctional eating patterns than control group; in fact, significant differences emerged in EDI-2 total score (p < 0.001). Other differences between these groups are associated to behavioral aspects: participants with primary exercise addiction reached higher scores than control group in these TCI subscales: damage avoidance (p = 0.038), persistence (p = 0.024), self-directivity (p = 0.002). In contrast, lower scores were reached in matureness character index (p = 0.033). In SQ total score (p = 0.002) and in anxiety (p = 0.001) and hostility subscales (p < 0.001), better scores were found in participants with primary exercise addiction. Considering the issue of body dysmorphia related to exercise addiction, significant differences in ATS dysmorphophobia subscale (p = 0.010) emerged, with higher scores in participants with primary exercise addiction. Primary exercise addiction resulted significantly associated with higher scores in muscular dysmorphia, evaluated by MDQ (p < 0.001). Data provided further support to the idea that exercise addiction could be a specific clinical condition associated with psychological symptoms and personality characteristics. These evidences report a relation between excessive physical activity and eating behavioral disorders. Regarding personality characteristics, these results are consistent with those of other studies, in which a negative association between self-esteem and excessive physical activity was highlighted. The results also indicate difficulty in assumption of responsibility and lack of objectives. Finally, the presence of primary exercise addiction is associated with significant higher scores in muscular and body dysmorphia, anxiety and hostility.

In Hausenblas e Giacobbi’s hypothesis ^[17], some people could start to perform physical activity as a coping strategy towards psychological distress. The researchers therefore examined the relationship between personality and exercise dependence symptoms; participants of the study were 390 university students who completed multidimensional assessments of personality, exercise dependence, and exercise behavior. To examine the predictive relationship of personality for exercise dependence symptoms hierarchical regressions with forced block entry were undertaken. In Block 1, exercise dependence was regressed on exercise behavior. In Block 2, the personality subscales (neuroticism, extraversion, conscientiousness, agreeableness, openness) were entered into the regression. Results showed that extraversion, neuroticism, and agreeableness predicted exercise dependence symptoms.

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Pasquale Caponnetto

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