EXERCISE, STRESS AND STRESS-RELATED HEALTH PROBLEMS
Symposium Overview:
In today’s industrialized society, pressures to produce results in the workplace and in school are
becoming a normalized part of daily life for adults and adolescents. However, research has shown that
this increased pressure has permeated the psychological well-being to a level of burden. One way to
combat the stress-related outcomes of societal pressures is through physical activity and exercise.
Hence, over the last several decades, empirical studies have amassed conclusive evidence which
posit that exercise reduces psychopathological symptoms such as stress, depression, burnout, etc.
The proposed symposium elucidates upon the relationships between exercise and several stressrelated health problems, namely post-traumatic stress disorder (PTSD), depression, stress, burnout
and a multitude of psychiatric diseases. Results from the symposium are encouraging in the realm of
physical activity. First, resistance training and a pedometer-facilitated walking program showed both a
reduction in PTSD and depressive symptoms, as well as improved body composition and decreased
sedentary behavior among PTSD patients. Second, group-based exercise programs improved
motivational attitudes among people with mental health problems during a short intervention. Third,
girls with high self-control exercised longer on non-stressful days, whereas girls with low self-control
more often exercised on stressful days. Fourth, vigorous physical activity buffered emotional
exhaustion at school when assessing the School Burnout Inventory among adolescents. Collectively,
these results suggest that physical activity is an effective way to lessen and even prevent several
psychological disturbances affecting both adults and adolescents.
EXERCISE AUGMENTATION COMPARED TO USUAL CARE FOR
PTSD: RESULTS FROM THE REAP RANDOMISED CONTROLLED
TRIAL
Simon ROSENBAUM 1,2
Anne Tiedemann 1
Hidde van der Ploeg 3
Catherine Sherrington 1
1. Musculoskeletal Division, The George University for Global Health, University of Sydney,
Australia
2. St John of God Healthcare, Richmond Hospital
3. EMGO Institute for Health and Care Research, The Netherlands
People with posttraumatic stress disorder (PTSD) are more likely to suffer from poor physical health
(Boscarino, 2004) and are less likely to be physically active (de Assis et al., 2008). Exercise can
potentially improve both the primary psychiatric diagnosis and physical health simultaneously. To date
no randomised controlled trials have evaluated the impact of exercise on PTSD symptoms. This study
aimed to investigate the impact of a 12-week exercise program as an augmentation to usual care for
PTSD patients. An assessor-blinded RCT was conducted among participants with a DSM-IV diagnosis
of PTSD recruited from St John of God Hospital (Australia) (n=81; mean age 47.9 (12.1), 84% male).
Participants were randomized to receive usual care (n=42) or exercise augmentation in addition to
usual care (n=39). The intervention compromised resistance training and a pedometer-facilitated
walking program. Participants were assessed at baseline and immediately post-intervention. The
primary outcome was PTSD symptoms obtained through the PTSD Check List –Civilian version (PCLC), a 17-item self-report measure. Scores range from 17- 85, with at least a 5-point change considered
significant. Secondary outcomes included depression, waist circumference, as well as self-reported
physical activity. Fifty-eight participants (72%) completed the follow-up assessments. Linear
regression analysis revealed that the intervention group reported significantly lower PTSD symptoms
compared to the control group (mean difference (MD)= 5.39, 95% CI 0.26 - 10.52, p=0.04). Further,
compared to the controls, intervention recipients reported a significant reduction in sedentary behavior
(mins/day) (MD= 261, p =0.001), levels of depression (DASS) (MD= 17.44, p<0.01) and waist
circumference (cm) (MD= 3.56, p=0.04). This study provides preliminary evidence that exercise may
be effective in reducing both PTSD and depressive symptoms, as well as improving body composition
and decreasing sedentary behavior in PTSD patients. This trial has important clinical implications and
supports the inclusion of exercise programs within PTSD treatment facilities.
Boscarino, J. A. (2004). Ann NY Acad Sci, 1032, 141-153.
de Assis et al (2008). Clinics (Brazil), 63(4), 473-478.
Simon Rosenbaum – srosenbaum@georgeinstitute.org.au
MOTIVATING PEOPLE WITH PSYCHIATRIC DISEASES TO BE
PHYSICALLY ACTIVE
Attilio CARRARO1
1. Dept. of Biomedical Sciences, University of Padua, Italy
Background
Physical activity (PA) is a fundamental means of improving mental health. PA reduces the risks of
many psychiatric diseases and benefits individuals by increasing physical and psychological health,
wellness and social interaction (Probst & Carraro, 2013; USDHHS, 2008). Unfortunately, a large part
of people with mental health problems is not active enough to meet health recommendations.
Motivating this population to be regularly physically active represents a challenge for health
professionals.
The purpose of this study was to investigate the effects of a group-based exercise program on
motivation, enjoyment of exercise and decisional balance in a sample of psychiatric inpatients.
Method
Participants were 28 men and 40 women (mean age = 42.9 ±10.4, min/max 20-64 years) with a DSMIV-TR psychiatric diagnosis admitted to a multidimensional residential treatment. At the begging and at
the end of their hospitalization participants filled in a package of questionnaires included the
Situational Motivation Scale (SIMS), the Physical Activity Enjoyment Scale (PACES) and the
Decisional Balance Questionnaire (DBQ). Moreover, a battery of fitness test (6-MWT, seat & reach
and handgrip test) was performed pre- post-treatment, and PA habits were recorded using the
International Physical Activity Questionnaire (IPAQ) and a set of Actigraph units.
Results
The majority of participants (54.4%) reported a low level of physical activity before the admission to
the hospital, 25% a moderate level, 20.6% a high level. Compared to general population their fitness
was lower. Significant improvements (p < .01) in the SIMS subscales, PACES, DBQ, 6-MWT and PA
quantity during free time were recorded. No significant changes in seat & reach and handgrip tests
were noted.
Discussion
Results suggest that it is possible to improve motivational attitudes among people with mental health
problems also with a short-time intervention. Further research is necessary to assess the effectiveness
of intervention in the long term.
References
Probst M., Carraro A. (2013) (Eds.). Physical activity and mental health, a practice oriented approach.
Milano, New York: EdiErmes.
Physical Activity Guidelines Advisory Committee (2008). Physical activity guidelines Advisory
Committee report. Washington DC: Department of Health and Human Services.
Attilio Carraro – attilio.carraro@unipd.it
DISPOSITIONAL SELF-CONTROL AS A MODERATOR OF THE
RELATIONSHIP BETWEEN DAILY STRESS AND DAILY EXERCISE:
A NATURALISTIC DIARY STUDY WITH ADOLESCENT GIRLS
Markus GERBER 1
1. University of Basel, Institute of Exercise and Health Sciences
Background: Self-control is a key antecedent in many theories of health-related behaviour (Hagger,
Wood, Stiff, & Chatzisarantis, 2009), and researchers have argued that self-control is needed to
adhere to regular exercise participation (Martin Ginis & Bray, 2010). In the present study, we
investigate with survey and diary data whether dispositional self-control moderates the assumed
negative relationship between stress and exercise behaviour.
Methods: 104 female students (M = 17.21 years, SD = 1.44) completed an online survey. 76 students
agreed to participate in a 7-day diary study, and reported their daily stress and exercise behaviour.
Regression analyses and ANOVAs were calculated to examine the two-way interactions.
Results: The survey data showed that higher self-control is associated with increased physical
activity. Stress was not significantly associated with self-control and physical activity, and no
significant interaction existed between stress and self-control. The diary data demonstrated that girls
with low self-control report the highest number of stress days. Although not significant, higher selfcontrol was associated with elevated daily exercise. A significant interaction revealed that girls with
high self-control spend more exercise time on non-stress days, whereas girls with low self-control
more often exercise on stress days.
Conclusion: Self-control has an impact on physical activity patterns of adolescent girls. The potential
of prevention programs to improve health behaviors in adolescents may be improved if more specific
attention is placed on self-control processes.
References:
Hagger, M.S., Wood, C., Stiff, C., & Chatzisarantis, N.L.D. (2009). The strength model of selfregulation failure and health-related behavior. Health Psychology Review, 3, 208-238.
Martin Ginis, K. A., & Bray, S. (2010). Application of the limited strength model of self-regulation to
understanding exercise effort, planning, and adherence. Psychology & Health, 25, 1146-1160.
Markus Gerber: markus.gerber@unibas.ch
PHYSICAL ACTIVITY AND SCHOOL BURNOUT AMONG SWISS
VOCATIONAL STUDENTS: A DOSE RESPONSE RELATIONSHIP
Catherine ELLIOT 1
Christin Lang 1
Serge Brand 2
Edith Holsboer-Trachsler 2
Uwe Pühse 1
Markus Gerber 1
1. University of Basel, Institute of Exercise and Health Sciences
2. Psychiatric Hospital of the University of Basel, Depression and Sleep Research Unit
Abstract:
Introduction/Aim: Adult burnout has been shown to reduce productivity and hinder mental health.
Adolescent school burnout is now on the radar of developmental psychopathologists. This
investigation examined dose-response relationships between vigorous physical activity and adolescent
burnout.
Methods: 145 Swiss vocational school students (M=16.22 years, SD=1.12) were recruited from four
physical education classes. The School Burnout Inventory measured exhaustion, cynicism and sense
of inadequacy within the school context. The SMBM subscale measured physical fatigue, emotional
exhaustion, and cognitive weariness, yielding a single burnout score. Vigorous physical activity was
assessed using the International Physical Activity Questionnaire (IPAQ) short form (Metabolic
Equivalents MET per week). The IPAQ scores were grouped into four physical activity levels, low
(n=25), moderate (n=47), high (n=51) and very high (n=22). Factor structure of the SBI was tested via
confirmatory factor analysis (CFA), providing a good fit for the burnout measures. ANOVAs were used
to compare the four groups.
Findings: Significant differences existed in several burnout dimensions; however, similar trends
existed across all subscales. Specifically, low physical activity yielded higher burnout-related
subscores than high physical activity in all subscales. With the exception of inadequacy at school, low
MET scores indicated poorer mental health than all other levels of physical activity. This trend
suggests that at just 500-1499 MET of physical activity, cynicism towards the meaning of school,
exhaustion at school, physical fatigue, cognitive weariness and emotional exhaustion are all reduced.
A linear trend was exhibited in exhaustion at school, physical fatigue, and the sum scores of the
SMBM scale, suggesting a dose-response.
Relevance: On the SBI scale, vigorous physical activity buffered exhaustion the most at school.
Notably, physical activity seemed to decrease physical fatigue as the MET level increased on the
IPAQ scale. Implications for future adolescent burnout research of physical activity are strongly
supported with this exploratory research.
Lundgren-Nilsson, A., Jonsdottir, I. H., Pallant, J., & Jr., G. A. (2012). Internal construct validity of the
Shirom-Melamed Burnout Questionnaire (SMBQ). BMC Public Health, 12.
Salmela-Aro, K., Kiuru, N., Leskinen, E., & Nurmi, J. E. (2009). School Burnout Inventory (SBI)
Reliability and Validity. European Journal of Psychological Assessment, 25(1), 48-57.
Salmela-Aro, K., Savolainen, H., & Holopainen, L. (2009). Depressive symptoms and school burnout
during adolescence: evidence from two cross-lagged longitudinal studies. Journal of Youth &
Adolescence, 38(10), 1316-1327.
Salmela-Aro, K., Kiuru, N., & Nurmi, J. E. (2008). The role of educational track in adolescents' school
burnout: a longitudinal study. Br J Educ Psychol, 78(Pt 4), 663-689.
Catherine Elliot: catherine.elliot@unibas.ch