# Exercise as it relates to Disease/Does physical activity improve mental wellbeing and reduced symptoms of mental disorders in adolescents?

This Wikibook is an evidence-based critique on the research article “The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study” by Sarah Louise Bell, Suzanne Audrey, David Gunnell, Ashley Cooper & Rona Campbell Published 2019 in the International Journal of Behavioral Nutrition and Physical Activity.

## What is the background to this research?

Mental illness is considered a health condition which alters an individual’s thoughts, feelings, or behaviour (can be a combination of all three), this causes the person to become distressed and leads to difficulty in functioning whether that may be socially, occupationally or completing normal day to day tasks. The research article by Bell at el., attempts to investigate whether there is a relationship between physical activity, mental wellbeing, and symptoms of mental illness in adolescents (aged 12-13 years) in the UK. It is important to understand this relationship as the occurrence of mental illness and poor mental wellbeing in adolescence in the UK is high and continues to increase A survey conducted concluded that mental disorders among adolescence aged between 11–15-year-olds in the UK, increased from 11.4% in 1999 to 13.6% in 2017. With even more recent data collected in suggesting adolescence’s mental health is continuing to decrease.
There has been many studies that have examined the relationship between physical activity, mental wellbeing, and symptoms of mental health. However, many of these studies are cross sectional whereas this research article by Bell at el is unique as it is a longitudinal study where participants where followed over an extended period of time and is believed to the only study that has used an objective measure of physical activity using accelerometers combined with participants completing both mental wellbeing measures using the ‘Warwick Edinburgh Mental Wellbeing Scale’ (WEMWBS) and symptoms of mental health illness measures using the ‘Strengths and Difficulties Questionnaire’ (SDQ) in order to understand the relationship.

## Where is the research from?

This research paper was published by the International Journal of Behavioural Nutrition and Physical Activity in 2019. The researchers conducted the study in the UK where data was collected from six different secondary schools located in the south west region of the UK.
A total of 6 authors completed this research. 5 of the authors having extensive knowledge in the field of population health sciences having done previous work relating either physical activity or mental health wellness in the adolescence population. One of the six authors’ focus is Exercise, Nutrition and Health Sciences and has also previously completed serval
publications relating to the relationship between physical activity and mental health benefits.

## What kind of research was this?

Research was conducted using a prospective cohort study (longitudinal study), which has been shown to have a higher accuracy and higher efficiency than other study methods such as case-control studies that have been done to understand the relationship between physical activity and mental wellness. It included 928 participants that where adolescence aged between 12-13 years old from secondary schools in the UK. These participants where then followed up 3 years later aged between 15- 16 rears old.

## What did the research involve?

The research involved 928 participants that had previously participated in the AHEAD trial (Activity and Healthy Eating in Adolescence). Baseline Physical activity was measured when participants were aged between 12-13 years of age using accelerometers. After a period of three years these participants were then followed up and their mental wellbeing and symptoms of mental health disorder was measured when aged between 15-16 years old. The base line measures as well as the follow up data were collected by researchers in the schools.
Physical activity measure
* Accelerometers were utilised to measure physical activity of participants. Participants had to wear the accelerometers during school and were also informed to have it on for seven days during waking hours, excluding water-based activities such as showering and swimming.
Mental wellbeing and symptoms of mental health disorder measures
* The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) is a measure of mental well-being which has a scale of 14 positively worded items and concentrates on positive aspects of mental health. Each item has a score between 1-5 where 1 represents ‘none of the time’ and 5 represents “all of the time”. This scale was used to measure participant’s mental wellbeing. A high score assumes better mental wellbeing of the participants.
* Strengths and Difficulties Questionnaire’ (SDQ) is a 25-item questionnaire which is separated across five scales which measure emotional and behavioural symptoms as well as, social problems, hyperactivity-inattention conduct problems. The SDQ is specifically designed for younger individuals and adolescence ranging from 3-16 years of age. This questionnaire was used to identify which participants presented with symptoms of mental disorders therefore could be at risk of developing mental disorders.
Limitation.
* The study showed to have a reduction in the number of participants which led to a loss for some data.
* Accelerometers have their limitations can be inaccurate or participants would wear them incorrectly. Also, they are not waterproof meaning any water-based activities or sport where not accounted for.

## What were the basic results?

Of the 928 participants 794 (84%) had valid physical activity data from the accelerometers these participants then were followed up three years later to undertake a mental wellbeing and symptoms of mental health illness measures. Of the 794 participants, 673 (73%) completed the SDQ and 668 (72%) completed the WEMWBS during the follow up.
The following results from the study where found. No evidence of a relationship between physical activity and mental wellbeing (WEMWBS overall score) or overall symptoms of mental disorder (SDQ). However, a link was found between physical activity volume and the emotional problems sub-scale of the SDQ. This finding suggests if adolescents participate in physical activity at an increased volume it may it is likely to reduce their risk of developing emotional problems this sub-scale includes includes worrying a lot; being easily scared, and easily losing confidence; often feeling unhappy, downhearted or tearful. Therefore adolescents engaging in more daily physical activity minutes may have more beneficial effects.

## What conclusions can we take from this research?

* Relationship between physical activity and the emotional problems sub-scale of the SDQ was found, implying physical activity may be associated with minimising symptoms of depression and anxiety in adolescents.
* Engaging in physical activity may not necessarily be linked to mental wellbeing based on the overall WEMWBS scores or overall symptoms of mental health disorder from the SDQ.
* Future studies need to be conducted in order to allow for a more clear-cut understanding of the role that physical has in impacting adolescence’s mental wellbeing.

## Practical advice

The study has given an important insight which shows, higher levels of physical activity were associated with lower scores on the emotional problems sub-scale of the SDQ. This finding is important as it suggests that increasing physical activity volume in adolescents may have the potential to reduce their risk of emotional problems such as worrying a lot, low confidence, having fears and being unhappy therefore potentially decreasing the prevalence of mental health problems in the adolescent population.

## Further information/resources

Further information regarding the relationship between mental health and physical activity have been listed below.
* Physical inactivity and mental wellbeing is there a relationship? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774736/
* Physical activity and general mental health: https://www.sciencedirect.com/science/article/pii/S0091743512003945
* Association of physical activity and mental health disorders in adults: https://www.sciencedirect.com/science/article/pii/S0091743503000422

## References

* 1 2 3 4 Bell SL, Audrey S, Gunnell D, Cooper A, Campbell R. The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study. International Journal of Behavioral Nutrition and Physical 16(1).
* ↑ National Institutes of Health (US, Biological Sciences Curriculum Study. Information about Mental Illness and the Brain [Internet]. Nih.gov. National Institutes of Health (US); 2018
* ↑ Ford T, Vizard T, Sadler K, McManus S, Goodman A, Merad S, et al. Data Resource Profile: Mental Health of Children and Young People (MHCYP) Surveys. International Journal of Epidemiology 2020
* ↑ Euser AM, Zoccali C, Jager KJ, Dekker FW. Cohort Studies: Prospective versus Retrospective. Nephron Clinical Practice. 2009;113(3):c214–7.
* ↑ Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes. 2007
* ↑ Hall CL, Guo B, Valentine AZ, Groom MJ, Daley D, Sayal K, et al. The validity of the Strengths and Difficulties Questionnaire (SDQ) for children with ADHD symptoms. Ferrer M, editor. PLOS ONE. 2019;14(6):e0218518.