The new issue of *Archives of Internal Medicine* (Vol. 170, No. 4,
February 22) includes an article: “The Effect of Exercise Training on
Anxiety Symptoms Among Patients: A Systematic Review.”

The authors are Matthew P. Herring, MS, MEd, Patrick J. O’Connor, PhD, & Rodney K. Dishman, PhD.

Here’s how the article starts:

[begin excerpt]

Anxiety, an unpleasant mood characterized by thoughts of worry, is an
adaptive response to perceived threats that can develop into a
maladaptive anxiety disorder if it becomes severe and chronic.1

Anxiety symptoms and disorders are common among individuals with a
chronic illness,2-8  yet health care providers often fail to recognize
or treat anxiety and may consider it to be an unimportant response to a
chronic illness.9

Anxiety symptoms can have a negative impact on treatment outcomes in
part because anxious patients can be less likely to adhere to prescribed
medical treatments.10-11

Personal costs of anxiety among patients include reduced health-related
quality of life12 and increased disability, role impairment,13 and
health care visits.14
(more…)

The journal *Medicine & Science in Sports & Exercise* (vol. 41, #2)
includes the American College of Sports Medicine’s new revised
guidelines for “Appropriate Physical Activity Intervention Strategies
for Weight Loss and Prevention of Weight Regain for Adults.”  This
updates their previous 2001 ACSM recommendations.

Here are their specific clinical recommendations and ratings of the
level of scientific evidence supporting each recommendation:

[begin excerpt]

*    For prevention of weight gain in most adults, physical activity of 150 to 250 minutes
per week
, with an energy equivalent of 1200 to 2000 kcal/week, will
prevent weight gain of more than 3% (level of evidence, A).

*There is a dose-response effect of physical activity on weight loss, with physical activity of less
than 150 minutes per week resulting in minimal weight loss, physical activity of more
than 150 minutes per week in modest weight loss of approximately 2 to 3
kg
, and physical activity of more than 225 to 420 minutes per week leading to weight
loss of 5 to 7.5 kg (level of evidence, B).

*To maintain weight after weight loss, some studies suggest that physical activity of
approximately 200 to 300 minutes per week
will help minimize weight
regain, although “more is better.” To date, no well-designed,
sufficiently powered, energy-balance studies provide evidence concerning
the amount of physical activity needed to prevent weight regain after weight loss
(level of evidence, B).

*Lifestyle physical activity, which is an ambiguous term that should be better defined
to assess available evidence in the literature, may help counteract the
small energy imbalance ultimately leading to obesity in most adults
(level of evidence, B).

*If diet restriction is modest but not if diet restriction is severe, physical activity
will increase weight loss
(level of evidence, A).

*Resistance training is ineffective for weight loss with or without diet
restriction, according to limited research evidence. However, some
limited data suggest that resistance training enhances gain or
maintenance of lean mass and loss of body fat during energy restriction.
Furthermore, resistance training may also ameliorate risk factors for
chronic disease, such as low high-density lipoprotein cholesterol
levels, high low-density lipoprotein cholesterol levels, insulin
sensitivity, and blood pressure (level of evidence, B).

[end excerpt]

The article notes that the new ACSM Guidelines are consistent with the
U.S. Dephysical activityrtment of Health & Human Services Physical Activity Guidelines
for Americans.

Here’s the abstract: “Overweight and obesity affects more than 66% of
the adult population and is associated with a variety of chronic
diseases. Weight reduction reduces health risks associated with chronic
diseases and is therefore encouraged by major health agencies.
Guidelines of the National Heart, Lung, and Blood Institute (NHLBI)
encourage a 10% reduction in weight, although considerable literature
indicates reduction in health risk with 3% to 5% reduction in weight.
Physical activity (physical activity) is recommended as a component of weight
management for prevention of weight gain, for weight loss, and for
prevention of weight regain after weight loss. In 2001, the American
College of Sports Medicine (ACSM) published a Position Stand that
recommended a minimum of 150 min·wk-1 of moderate-intensity physical activity for
overweight and obese adults to improve health; however, 200-300 min·wk-1
was recommended for long-term weight loss. More recent evidence has
supported this recommendation and has indicated more physical activity may be necessary
to prevent weight regain after weight loss. To this end, we have
reexamined the evidence from 1999 to determine whether there is a level
at which physical activity is effective for prevention of weight gain, for weight loss,
and prevention of weight regain. Evidence supports moderate-intensity physical activity
between 150 and 250 min·wk-1 to be effective to prevent weight gain.
Moderate-intensity physical activity between 150 and 250 min·wk-1 will provide only
modest weight loss. Greater amounts of physical activity (>250 min·wk-1) have been
associated with clinically significant weight loss. Moderate-intensity
physical activity between 150 and 250 min·wk-1 will improve weight loss in studies that
use moderate diet restriction but not severe diet restriction. Cross-
sectional and prospective studies indicate that after weight loss,
weight maintenance is improved with physical activity >250 min·wk-1. However, no
evidence from well-designed randomized controlled trials exists to judge
the effectiveness of physical activity for prevention of weight regain after weight
loss. Resistance training does not enhance weight loss but may increase
fat-free mass and increase loss of fat mass and is associated with
reductions in health risk. Existing evidence indicates that endurance physical activity
or resistance training without weight loss improves health risk. There
is inadequate evidence to determine whether physical activity prevents or attenuates
detrimental changes in chronic disease risk during weight gain.”

The article is online — but requires a subscription — at:
<http://tinyurl.com/bvycn4&gt;.

Here’s how the Discussion section starts: “In this population-based
trial, participants were assigned to and taught about diets that
emphasized different contents of carbohydrates, fat, and protein and
were given reinforcement for 2 years through group and individual
sessions. The principal finding is that the diets were equally
successful in promoting clinically meaningful weight loss and the
maintenance of weight loss over the course of 2 years
. Satiety, hunger,
satisfaction with the diet, and attendance at group sessions were
similar for all diets. The diets improved lipid risk factors and fasting
insulin levels in the directions that would be expected on the basis of
macronutrient content. The study had a large sample, a high rate of
retention, and the sensitivity to detect small changes in weight. The
population was diverse with respect to age, income, and geography and
included a large percentage of men. The participants were eager to lose
weight and to attempt whatever type of diet they were assigned, and they
did well in screening interviews and questionnaires that evaluated their
motivation. Thus, the findings should be directly applicable to both
clinicians’ recommendations for weight loss in individual patients and
the development of population-wide recommendations by public health
officials.”

Here’s another excerpt: “Study participants who attended two thirds of
the sessions over the course of 2 years lost about 9 kg of weight
.
Regain after 6 to 12 months was about 20% of the regain reported in
earlier trials.28 Several recent trials have also shown that continued
contact with participants after weight loss is associated with less
regain.12,24,37,38 These findings together point to behavioral factors
rather than macronutrient metabolism as the main influences on weight loss
.”

The article is online at:
http://content.nejm.org/cgi/content/full/360/9/859&gt;

The new issue of the American Psychiatric Association’s *Psychiatric
News* (Volume 44, Number 1) includes an article: “Link Grows Stronger
That Exercise Can Avert Depression; Exercise seems to be capable of
preventing depression in both men and women. But when it comes to high-
intensity exercise, men seem to benefit more” by Joan Arehart-Treichel.

PLEASE NOTE: Immediately below are excerpts from the *Psychiatry News*
article; beneath those excerpts I’ve included the abstract of the
original *Journal of Psychiatric Research* study and along with contact
info for the senior author.

Here are some excerpts from the *Psychiatric News* article:

[begin excerpts]

[A] new study, with a large number of subjects and a prospective design,
has also linked exercise with less depression.

<snip>

Its results bolster the argument that exercise can prevent depression,
Xuemei Sui, M.D., a research associate at the University of South
Carolina and the lead investigator, believes. “Improving one’s fitness
can not only lower many disease risks such as cardiovascular disease and
certain types of cancer,… but also benefit one’s mental well-being,”
she asserted.

Ronald Kamm, M.D., a sport psychiatrist in Oakhurst, N.J., and a past
president of the International Society for Sport Psychiatry, concurs
with Sui. “This is a good study,” he said. “It adds to the literature
showing a preventive effect of exercise regarding depression.”

The study, which started in 1970, involved more than 14,000 men and
women enrolled in the Aerobics Center Longitudinal Study in Dallas.

<snip>

Their cardiorespiratory fitness was measured at the start of the study
with a maximum treadmill exercise test. They were evaluated for
depression one or two times during the follow-up period, which ranged
from one to 15 years, with the average being 12 years. At the end of
that time, 1,022 subjects reported having had depressive symptoms at the
time of either or both assessments.

The researchers found that subjects who had been more fit at the start
of the study were significantly less likely to experience depression
during the follow-up period than were subjects who had been less fit at
that time.

Further, the results held even when a number of possibly confounding
factors–baseline physical examination year, depression survey year,
smoking status, alcohol consumption, body mass index, high blood
pressure, and diabetes–were considered.

And perhaps most strikingly, there appeared to be a dose-response
relationship between fitness and the prevention of depression.

“I’m also glad that the researchers talked about the obesity-depression
link [in their report], as psychiatrists need to be aware of that,” Kamm said.

Indeed, Sui and her colleagues found that obese subjects had a
significantly higher risk of depressive symptoms than nonobese subjects,
and in a previous study, that overweight or obese postmenopausal women
could improve their physical fitness with as little as 72 minutes of
moderately intense physical exercise a week.

An abstract of “Prospective Study of Cardiorespiratory Fitness and
Depressive Symptoms in Women and Men” can be accessed at
<www.sciencedirect.com> by clicking on “J” under “Browse by Title,” then
“Journal of Psychiatric Research,” then “Articles in Press.”

[end excerpts]

The article is online at:
<http://pn.psychiatryonline.org/cgi/content/full/44/1/12-a&gt;.

Here’s the abstract of the original study (“Prospective Study of
Cardiorespiratory Fitness and Depressive Symptoms in Women and Men”)
appearing in *Journal of Psychiatric Research*: “Most studies of the
relationship between cardiorespiratory fitness (CRF) and depression have
been limited to cross-sectional designs. The objective of this study was
to follow individuals over time to examine whether those with higher
levels of CRF have lower risk of developing depressive symptoms.
Participants were 11,258 men and 3085 women enrolled in the Aerobics
Center Longitudinal Study in Dallas, TX. All participants completed a
maximal treadmill exercise test at baseline (1970-1995) and a follow-up
health survey in 1990 and/or 1995. Individuals with a history of a
mental disorder, cardiovascular disease, or cancer were excluded. CRF
was quantified by exercise test duration, and categorized into age and
sex-stratified groups as low (lowest 20%), moderate (middle 40%), or
high (upper 40%). Depressive symptoms were assessed using the 20-item
Center for Epidemiologic Studies Depression Scale (CES-D). Those who
scored 16 or more on the CES-D were considered to have depressive
symptoms. After an average of 12 years of follow-up, 282 women and 740
men reported depressive symptoms. After adjusting for age, baseline
examination year, and survey response year, the odds of reporting
depressive symptoms were 31% lower for men with moderate CRF (odds
ratio, OR 0.69; 95% confidence interval, CI 0.56-0.85) and 51% lower for
men with high CRF (OR 0.49, CI 0.39-0.60), compared to men with low CRF.
Corresponding ORs for women were 0.56 (CI 0.40-0.80) and 0.46 (CI 0.32-
0.65). Higher CRF is associated with lower risk of incident depressive
symptoms independent of other clinical risk predictors.”

The author note of the *Journal of Psychiatric Research* article states
that correspondence about the article may be sent to <msui@gwm.sc.edu>.

The new issue of the American Medical Association’s *American Medical
News* includes an article: “Steps to a nimble mind: Physical and mental
exercise help keep the brain fit; Neuroscience is uncovering techniques
to prevent cognitive decline” by Kathleen Phalen Tomaselli.

Some key points: life-long learning, trying new things, a healthy diet, social interactions, sleep and physical activity keep the brain fit

Here are some excerpts:

[begin excerpts]

The brain — containing 100 billion neurons, 900 billion glial cells,
100 trillion branches and 1,000 trillion receptors — reacts to stimuli
in a series of electrical bursts, spanning a complex map of
connections. Whether calculating an algorithmic equation or learning
the tango, our brain continuously changes in response to our ideas,
actions and activities.

Each time a dance step is learned, for instance, new pathways are
formed. “Dancing is excellent for the brain and body,” says Vincent
Fortanasce, MD, clinical professor of neurology at the University of
Southern California in Los Angeles. He wrote the Anti-Alzheimer’s
Prescription. “Not only are you moving around more, your brain is in
constant motion as it recalls steps and movements.”

It’s an example that highlights a wave of new thinking about the
importance of brain fitness.

(more…)

BBC News released the following article:
“Exercise aids depression, say GPs”
Doctors are increasingly prescribing exercise for people with depression, mental health campaigners have found.
In a survey of 200 English GPs, the Mental Health Foundation found 22% suggest exercise to help people with milder forms of the condition.
This compares with just 5% in a similar survey three years ago.
The foundation said it was important that doctors did not just prescribe antidepressants for patients, and looked for other options.
Tackling isolation
Research has shown that exercise can help people with mild forms of depression by improving self-esteem – through better body image or achieving goals, and by relieving feelings of isolation which can fuel their depression.
It also releases feel-good brain chemicals such as endorphins.
Celia Richardson, campaigns director for the Mental Health Foundation, said: “It can help people physically, socially and biologically.
“They often meet others who have been in the same situation as them, but are now further down the line and feeling better.”
The survey found there is now a wider belief by GPs that exercise therapy can be beneficial.
Three years ago, 41% thought it was “effective or very effective”, rising to 61% now.
But half of the GPs questioned did not have access to an exercise referral scheme. Two thirds of these doctors said they wished they had.
More patients are also interested in how exercise can help them – one in six GPs say they have noticed an increase in the number of people asking whether exercise could help them.
Choice
Exercise programmes run by the Mental Health Foundation, partly funded by the Department of Health, are now available in Bedfordshire, Cambridgeshire, London, Northamptonshire, Redcar and Cleveland, and the Wirral.
People referred under the schemes are given a personal trainer who can devise a suitable exercise regime for them.
Results from the six areas will be published next year.
Andrew McCulloch, chief executive of the foundation, said: “There is a real need for increased availability of exercise on prescription so that it is accessible alongside antidepressant medication and psychological therapies.
“Depression is a complex illness – it is important that GPs have a range of treatments to offer and that people with depression have a choice.”
Professor Steve Field, chairman of the Royal College of GPs, said GPs did recognise the benefits of exercise in treating mental illness.
“There is now more awareness and increasing evidence that it works, and the overarching feedback from patients is incredibly positive.”

REGULAR exercise could help lift the cloud of major depression as
effectively as an antidepressant, new research shows.

“A lot of people know from their own experience that when they exercise,
they feel better,” says James A. Blumenthal, a professor of psychology
at Duke University and lead author of the study. But such anecdotes and
gut feelings don’t amount to clinical proof. So Blumenthal conducted a
placebo-controlled clinical trial, the first time the gold standard of
research has been used to compare exercise with antidepressants for
treatment of major depression.

He sorted 202 patients into four groups. After 16 weeks, 47% of the
people who took the antidepressant Zoloft improved. But some 45% of
those who exercised in supervised groups improved, and 40% of those who
exercised on their own improved, a statistically insignificant
difference from the drug group result. About 30% of those in the placebo
group improved, a finding consistent with the placebo effect.

Exercise, Blumenthal speculates, may increase endorphin or serotonin
levels, so-called feel-good brain chemicals. The study was published in
the September 2007 issue of the journal Psychosomatic Medicine.