Physical fitness and risk of mental disorders in children and adolescents

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2818132

by pseudolus • 2 years ago

68 69 2 years ago

delichon2• 2 years ago

The role of brain health in mental illness is commonly discounted, but so consistently found in studies. I got roasted here for recommending psychiatrist Mary Edes' book on improving mental health with dietary changes, but the benefits of the approach are clear.

https://www.npr.org/sections/health-shots/2024/01/27/1227062...

I've resolved most of my diabetes type 2 with diet, and nobody should be surprised that this came with improved mental clarity and emotional stability.

hanniabu• 2 years ago

Your gut microbiome plays a huge part in brain health and mental illness. That's likely why improving your diet improved your mental clarity and emotional stability.

tomcar2882• 2 years ago

This! Absolutely. It's as if people think the brain isn't even an organ in the body and that it's completely disconnected from the rest of the body. After doing a ton of research and listening to many talks on metabolic syndrome and all the diseases caused by our modern diets, I've realized just how impactful diet can be on the body, the brain and the many modern diseases caused by our modern diets and lifestyle.

lambdaba3• 2 years ago

Yes. For those wanting to research this further look up keywords like "metabolic psychiatry" and "brain energy".

AlexandrB• 2 years ago

It's as if people think the brain isn't even an organ in the body and that it's completely disconnected from the rest of the body.

This happens a lot in a different context when people talk about AI and try to reduce human intelligence and creativity to just brain function.

Attummm• 2 years ago

The individual parts of diabetes, blood glucose, nutrition, cell energy systems are really well documented.

But yet putting those facts together leads significant resistance.

lambdaba3• 2 years ago

I'm convinced brain health *is* mental health. With more nuance, mental health is brain health accreted through time. Healing the brain is possible, mainstream medicine and psychiatry is entirely ignorant of this, and once the brain is healed, the learned behavior oftentimes also needs some unlearning. For this, psychedelics are the most powerful tools. I think they can also be healing to the brain, particularly psilocybin, but the ideal order in my opinion is getting the brain to homeostasis first.

The main intervention there is ketogenic dieting. Ketosis is required for brain healing, as a sick brain is an overexcited brain, to the point of toxicity.

Of course, optimal nutrient intake, particularly brain related nutrients (which is most of them, really, but omega-3 fatty acids, and, yes, cholesterol are particularly important).

delichon2• 2 years ago

Oops, that's nutritional psychiatrist Georgia Ede. I confused her with another low carb physician and author, Mary Eades.

thefz• 2 years ago

I got roasted here for recommending psychiatrist Mary Edes' book on improving mental health with dietary changes,

This is because sadly diet, fitness and weight loss are some of the topics this otherwise very lucid website literally loses its mind over. Another is natality.

diob• 2 years ago

Only want to chime in here for folks to not feel bad about also getting help beyond physical fitness and diet.

I've been a health junky my whole life, very in shape, and I eat well.

Of course that helps my mental health a lot.

However, I still get depressed. I suffer from chronic sleep apnea (it's related to my anatomy, so I can't exercise out of it, it's around 79 AHI). I take zoloft for anxiety and it has helped me to calm down and enjoy my life more.

And finally, I recently got diagnosed with ADHD. I'm fairly high functioning without meds, but with meds I can finally do all the things I've wanted to. My todo list, those things I used to forget or put off, I just do them now.

So yes, take care of yourself, but don't feel bad if it doesn't solve everything. Some of us need extra help, and it's nothing to be ashamed of. I understand you weren't shaming folks, but I really want to share this in case folks think they're broken for needing medication.

And sometimes you need the help from medication to kick-start being more healthy physically, don't be ashamed! We are all different.

sn9• 2 years ago

I think most people are on board with diet plausibly being a significant lever for improving mental health, and keto can be a way to do that, but the meat-heavy way most people implement keto massively increases risk of cardiovascular disease.

We have an overwhelming mountain of evidence that saturated fat intake from animal sources above a certain threshold percent of one's caloric intake causally increases risk of heart disease through well-characterized mechanisms and that reducing one's intake below that threshold causally improves health.

https://www.barbellmedicine.com/blog/a-basic-guide-to-choles...

Likewise the benefits of a high fiber diet are also overwhelmingly documented, and it's a rare person for whom it isn't beneficial. Your doctor can tell you if you're one of these unlucky people.

You can eat a keto diet that's low in saturated fats from animals and high in fiber, but that's rarely done and most of the health benefits from keto is from the increased rate of adherence to a diet that makes it easier to stay in a caloric deficit.

DangitBobby2• 2 years ago

For those of you with better understanding, did they establish causality? Does exercise fend of mental disorders, or do people with mental disorders find it harder to exercise consistently? The first could be a novel finding, but the latter seems obvious. Forcing yourself to exercise routinely requires discipline, and many mental disorders carry along with them executive dysfunction that make discipline harder to come by.

tomcar2882• 2 years ago

Experientally, my brother with ADHD and severe depression, has told me many times, that he notices a huge difference in the severity of his depression based on how much he exercises.

DangitBobby2• 2 years ago

I certainly notice a relationship between the two in myself, but I couldn't tell you which one is in control.

loeg• 2 years ago

This is a cohort study. They show association, not causality.

zzzeek4• 2 years ago

less anxious / depressed kids get to do more sports in the first place. kids without "the right attitude" or a lack of innate ability are routinely excluded from sports, as im sure many of us here have experienced.

recursive• 2 years ago

I've also experienced that I feel better when I exercise more, when I get passed the initial "barrier to entry".

hollywood_court• 2 years ago

Perhaps that can be resolved by getting the children started in sports while they are very young?

But you may be right because I have experienced this while watching the other kids in my son's sports classes.

My son started going to a gym called "Kidstrong" when he was 3.5 years old. It was basically a bunch of kids following instructions and performing basic calisthenic exercises and beginner gymnastics moves.

However, we had to stop going because there was a kid in the class who simply couldn't get his act together. Maybe he was special needs or maybe that's just the way he was allowed to behave at home. But the coaches spent so much time trying to get that one kid to follow basic instructions that it ended up detracting from the time that my child and the other kids got with the coaches. It came to the point where my wife and I (along with a number of other parents) realized that we were paying $25 per 45 minute session for our children to sit and watch the coaches spend 20 minutes trying to corral this one kid who couldn't behave.

So we put my son into BJJ instead. And we're experiencing something very similar. There are two other kids in his class that simply can't follow instructions or chose not too. Fortunately this is a locally owned gym so we spoke to the owner about our concerns and he spoke to the kids' parents. The kids have been behaving better lately, but they still serve as a huge distraction.

SamoyedFurFluff• 2 years ago

The risk isn’t anxious kids with involved parents that can gently push them into activity. It’s kids with not enough food at home and no one at home to give a shit bout them.

NickC252• 2 years ago

I was routinely picked last if not at all in sports all throughout my childhood.

As a result, I picked up sports I could do on my own, such as lifting weights, biking, swimming, and running. Individual sports such as golf and tennis followed naturally.

I would have otherwise been a complete shut-in. Although I do have a lack of executive function, I make sure to get exercise as often as I can. Classes at the local gym are a godsend - I don't need to prep, plan ahead, or anything. I just need to show up at the right time and the thinking has been done for me.

I'm thankful I got the opportunity to do all the physical activities I did. Helped that my siblings were all big athletes and most kids in my neighborhood were too.

Kids today don't have that, and I feel for them.

wintermutestwin• 2 years ago

I was routinely picked last if not at all in sports all throughout my childhood. As a result, I picked up sports I could do on my own

I suspect many kids are so disheartened by these early experiences that they are much less likely to make the transition as you did. Personally, it took many years of adulthood before I figured out that physical activity was actually super beneficial and not just the games that bullies play. By high school, I refused to participate in PE and just took Fs.

Maybe schools should start kids out with individual activities instead of team sports?

zzzeek4• 2 years ago

As a result, I picked up sports I could do on my own, such as lifting weights, biking, swimming, and running. Individual sports such as golf and tennis followed naturally.

good for you but yes, you had people in your family who were athletes and apparently did not dissuade you further. lots of kids are not really that lucky.

jimbob45• 2 years ago

kids without "the right attitude" or a lack of innate ability are routinely excluded from sports, as im sure many of us here have experienced.

You're projecting. Most coaches just want kids to work hard and have fun. They really couldn't care less about winning. If you need absolute proof, there are many sports such as swimming and track where every additional kid adds points to your team total such that having more kids is always more advantageous to the coach(es).

miriam_catira• 2 years ago

No, I don't think they're projecting, I think you've been highly fortunate.

Track is not a good example, at least in my case. Our coaches spent ZERO time with those of us who weren't obviously going to be breaking any records, and whenever we lost a match, made us do so much extra work it was almost impossible to climb stairs the next day. I couldn't get any support from any of them, which I still consider highly unfair, since if I had support maybe I could have figured out a method to improve, but on my own... I just quit.

From my experience in multiple sports, most coaches just want to win. Finding one who cares more about the kids than the score is an absolute blessing, they're so rare.

zzzeek4• 2 years ago

i watched a basketball coach literally pass over my child twice in a basketball-skills display for the parents, as he is mildly autistic and was not lining up with the other kids (not at lot of kids, about 15 kids) cleanly enough for the coach to notice him. He had practiced every move, he was able to do every skill. We had to yell at the coach "HEY YOU FORGOT <our son>!" when it was time for him to demonstrate dribbling in a curved line, pass back and then shoot for the basket; the coach apologized "Oh I forgot!" and our son did the display PERFECTLY, then literally 5 minutes later when all the kids lined up to shoot for a full height basket, HE SKIPPED OVER HIM AGAIN - we didnt have the nerve to yell out again that our child was passed over, they had moved onto a new exercise by then. My child came over to us and curled up into a ball on the floor for the rest of the display as all the parents around us ignored us. The coach DID NOT NOTICE or care. Because our child is mildly autistic and does not display the usual "sporting attitude", he was literally ignored by his coach in front of our faces, and as he continued to not look very "sporting", this grown adult coach simply could not see that our child even existed even as we were RIGHT THERE (nor did any parents). I had many similar experiences 45 years ago. A lot has changed in sports but dumb coaches who can only see what they want to see have apparently not, and this most CERTAINLY has an enormous impression on neurodivergent kids as to how athletic they're going to be.

so no I'm not projecting. Kids who don't "look/act right" are ignored and discarded by sports and in my direct experience as a parent this has hardly changed at all.

krunck• 2 years ago

I wasn't the most well balanced kid. I'm sure I would be "diagnosed" if I were an adolescent today. I was in the outsider caste in high school. I hated sports. But I loved doing physical activities outside: hiking, swimming, camping, cross-country skiing. I credit this activity with my failure to develop any severe mental illness. That and the fact that the portable 24x7 entertainment and self-loathing generators had not been invented yet.

eYrKEC2• 2 years ago

I coach multiple rec-level soccer teams in my kids ages. I am ruthlessly fair about play time on the field. You may not get to play center midfielder, but you will get the same amount of time.

Some of my children are naturally good at soccer and some aren't. Doesn't matter. I don't play favorites with them or any other kids on my soccer team.

I started coaching soccer for my kids, because one of my more naturally-gifted children had a horrible coach. Even though she played my kid more, I hated her favoritism and I hated her lack of sportsmanship.

That's it -- I started coaching.

My team is probably never going to win the league, because the best players _still_ get sub'd out on my teams. I don't care.

Be the change you wish to see.

zzzeek4• 2 years ago

Some of my children are naturally good at soccer and some aren't. Doesn't matter. I don't play favorites with them or any other kids on my soccer team.

in our town we've met some coaches like you and a lot of others who are not like you. sports are still 90% a popularity contest in my current observation (read my comment later in this thread)

ambicapter• 2 years ago

You don't have to do sports to do physical activity.

billconan• 2 years ago

shouldn't the title be "Physical weakness/unhealthiness and the risk of mental disorders"?

based on the abstract, Physical weakness/unhealthiness is positively correlate to mental disorders. not the opposite.

Firaxus• 2 years ago

The title is matching the title of the linked article (if you’re referring to the title here on HN, and not the title the author chose to use for their article).

From a pedantic perspective, the title doesn’t imply the positivity/negativity of the correlation, just that there is a relationship to be elaborated upon in the article.

surfpel6• 2 years ago

Not doubting the importance of physical activity, but poor mental health makes it significantly harder to maintain fitness as a child.

Often, school sports have minimum GPA requirements. A poor home life increases chances of mental illness and decreases chances that someone will drive you to practice. Will you even maintain the team sport if your teammates never accept you, given whatever mental condition that gives you anxiety or quirks? When can you even consider being active when much of the rest of your life is in shambles? You’re also less likely to have the ability to pay for it, given the correlations between low household income and poor mental health.

Poor mental health just makes everything harder to do, and you see that impact every aspect of life in aggregate.

The paper isn’t public so “controlling for confounders” is all you get, but I doubt they went through all the effort to have deep, revealing conversations about the home life or other nuanced cofounders of each participant.

itsoktocry• 2 years ago

but I doubt they went through all the effort to have deep, revealing conversations about the home life or other nuanced cofounders of each participant.

Why is it that nearly every paper linked on HN, someone is in the comments saying the research didn't go far enough? In this case without even reading the paper?

Nothing in your critique is relevant to the fact that the authors found physical fitness and mental health linked. No, not everyone has equal access to sports. Yes mental health is complicated.

surfpel6• 2 years ago

This is such a bad, overly-cynical take.

Why is it that nearly every paper linked on HN, someone is in the comments saying the research didn't go far enough?

Because they usually don't.

And for those who are actually curious, look up "reproducibility crisis" and "publish or perish" to learn more about issues in academia, and ask ChatGPT about why systemic skepticism of scientific research is critical to the process of science.

In this case without even reading the paper? Nothing in your critique is relevant to the fact that the authors found physical fitness and mental health linked. Nothing in your critique is relevant to the fact that the authors found physical fitness and mental health linked.

Such irony, that you didn't read any part of the preview yourself. If you did, you'd see:

"This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents."

The viability of this correlation, given controls for confounders, changes the significance of the results dramatically. Perhaps you think the point of research is to publish pointless correlations and suggest wild ideas for journalists to turn into clickbait?

For those actually curious: the authors are proposing a causation, and given the absence of any counter, it's a biased conclusion that attempts to increase the significance of the findings for the sake of publishing, at the cost of coming uncomfortably close to declaring a causal relationship. Not a criticism of the authors necessarily, but of the poor incentives plaguing academia. For studies like this to be of higher quality, they become very expensive, so given the lack of discussion regarding confounders in the preview, one should have strong skepticism regarding the actual practical significance of the strength of the causal relationship. Though if the research is of low quality, then it really all was pointless and probably only serves to keep the authors employed. At that point, the paper is only an unsubstantiated suggestion to study something else, so why even bother with the rest of the paper. That being said, having been an athlete for most of my life, I'm a huge proponent of children being given access to sports.

No, not everyone has equal access to sports. Yes mental health is complicated.

Do you talk to people in real life like this? That's quite upsetting.

knallfrosch• 2 years ago

Instead of looking for excuses, find a way. You don't have to play tennis, climbing a tree will do.

somenameforme2• 2 years ago

Or even just buying a few fun and dirt cheap physical toys - hula hoop, jump rope, etc. Staying in minimally decent physical shape is super easy and cheap - even more so for a child.

surfpel6• 2 years ago

Instead of looking for excuses, find a way. You don't have to play tennis, climbing a tree will do.

Please tell me this is a shitpost?

noah917343• 2 years ago

A poor home life increases chances of mental illness and decreases chances that someone will drive you to practice.

That you need to be driven at all to exercise is a huge part of the reason why exercise and fitness rates are so low in our youth. Our grandparents and great grandparents walked miles to go to school five days a week, and we've built our cities such that this is impossible or dangerous. We now live in towns that sprawl endlessly, and most of us forbid our kids to go outside unsupervised, so kids never find each other and play amongst themselves.

And for what? What exactly are we gaining by building our cities and our towns like this? It makes us all unhealthier because we are forced to drive everywhere. It isolates us and our children, who are now lonely on top of being merely physically inactive. We are poorer because we spend so much money on car loans, car insurance, gas, and parking. We are just as likely to die a violent death in the suburbs due to the increase risk of car crashes. We are isolated, poor, unhealthy, and unhappy, and in exchange we get... what exactly?

The paper isn’t public so “controlling for confounders” is all you get, but I doubt they went through all the effort to have deep, revealing conversations about the home life or other nuanced cofounders of each participant.

The study was conducted in Taiwan which does not suffer from US-style car extremism. "Children cannot go out to play because their parents cannot afford to drive them" is a statement they would consider unthinkably psychotic. Can they not use public transit, or at worst, walk to where all the other neighborhood children are playing unorganized?

slothtrop7• 2 years ago

Intramurals are one option, often favored by immigrant parents who place more importance on academics, to exercise at school and by extension (usually) fairly close to home (see: volleyball, basketball, wrestling). Aside from some sports that require lots of travel around the city (like hockey, soccer) there are normally quite a few that tend to stay fixed, except for tournaments.

storf45• 2 years ago

Doesn't 'home life' depend on the parent's emphasis on physical activity, sports, or general fitness? I.e. if the parents put a higher value on other things, it seems likely that the children will follow their lead.

surfpel6• 2 years ago

The study was conducted in Taiwan which does not suffer from US-style car extremism

This is true and a fair criticism of driving specifically. I noticed the location and do agree the 'driving' remark isn't as applicable to this specific study, but I still put forward the general sentiment regarding both a family's overall ability to support, where needed, and a childs ability to travel to travel if needed. Some kids won't need it, but in the cases where it is needed & they don't have it, it would lower the chances of keeping up with sports. Just one of many possible pathways that would make athletics hard to maintain.

But more generally to your point, while some sports won't require extra effort, it really does depend on the situation, which is why a study like this is so hard to carry out well. In my youth, it would have been more convenient to do lacrosse or soccer on-site, but those didn't work for with me so I picked different sports that had more of a demand for travel.

slothtrop7• 2 years ago

Obesity is an epidemic, broken or abusive households are not. It doesn't make sense to be skeptical of fitness on the conceit that it might not handle issues in the margins (except, they do -- sports can improve self-esteem in kids who otherwise struggle).

Will you even maintain the team sport if your teammates never accept you

Kids are generally pretty accepting, and in a sports setting they spend nearly all of their time focused on playing, as they should be. It would require egregious behavior for an entire team not to "accept" you.

given whatever mental condition that gives you anxiety or quirks?

No one cares about quirks. They care if you're a dick, or waste everyone's time in the field.

quesera3• 2 years ago

This is so completely not true -- but if you're on the right side of ordinary, you do have the privilege of believing it.

surfpel6• 2 years ago

Kids are generally pretty accepting

No one cares about quirks

Haha

TacticalCoder• 2 years ago

... A poor home life increases chances of mental illness and decreases chances that someone will drive you to practice. Will you even maintain the team sport if your teammates never accept you...

I've never been and shall never be a team player. I go my own way. Never did any team sport (I hate them and I hate watching them). My parents never drove me to any practice (OK, OK, one year of judo but that's it).

A crappy skateboard, a used BMX clone, and self-assembled rollerskates go a long way (and in the not so long run cost less money than the fuel to drive to sport).

I'm still fit at 51 and I attribute that to me moving my arse off when I was a kid (and then teenager) and going out to play in the streets and parks every single day with my skate/roller/bicycle.

People should stop looking for excuses. And they should especially stop looking to excuse others.

Others don't like you? Grow a pair. Build a carapace. Learn to wheelie and learn to do kickflips. You'll get the girls.

Team sports are totally overrated (nowadays I still play some tennis).

deodar• 2 years ago

Others don't like you? Grow a pair.

Stop being depressed.

mattmaroon3• 2 years ago

This seems like a very easy one to point out that they may be getting the cause and effect backward.

canucker20162• 2 years ago

They've done the analysis: meta-analysis of random controlled trials , see https://www.bmj.com/content/384/bmj-2023-075847

"Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression."

mattmaroon3• 2 years ago

That’s a meta analysis (which is always a solid indicator of pseudoscience) of studies that are not really controlled because

A.) you have to actually do the exercise, which means the people who don’t may simply not do so because their mental illness is worse or at least different than the ones who do.

2. If you’ve ever read the attempts to quantify various mental illnesses, they’re extremely unscientific and borderline laughable if you’ve ever known a few people who suffer from them. What we call “depression” affects so many people in so many ways that in the future, it’s likely it will become a category of diseases with many different individual names. One of my exes medicated her depression by working, one by calling off work, for example. One would have (and did) do lots of exercise, one did not, and there’d be no way to quantify either on any simple scale.

3.) It’s obviously neither double nor single blind. You can’t not know if you’re exercising, and the researcher can likely tell which are which to a decent degree just by looking at them.

All a meta analysis of a bunch of non-controlled studies really tells you is the prevailing pre-sentiment among the researchers of a topic. Which, really, isn’t nothing (they’re more likely to guess correctly than a random person) but it’s far from an actual controlled study.

And I still stand by that there’s no way you could realistically say this study indicates causation with any certainty. Though that never stops people in the social sciences I guess.

localhost• 2 years ago

I wonder if enhanced operation of the lymphatic system might be causal to better mental health outcomes? The lymphatic system doesn't have a "pump", so it relies on muscle contraction to drive circulation. So more movement/exercise drives more lymphatic activity which may lead to better outcomes in people, especially if mental disorders are correlated with buildup of waste materials in the brain.

lambdaba3• 2 years ago

Well, the brain is a heavily vascularized organ. Proper sleep and exercise are both crucial for cleaning up waste products, and supplying nutrients and good blood flow.

mrinterweb• 2 years ago

I am trying to learn how to interpret clinical study results. It seems that the confidence intervals and p-values suggest there is high degree of certainty in the results. Still, the odds ratio seems to have marginal improvements over the control, 4-8% depending on what was being measured. If I'm interpreting this study correctly, exercise has a marginal impact on adolescents mental health. I kind of hope I misread that study, and that exercise plays a larger role.

If I read a study that tells me I may see a 4% chance of improvement if I make significant changes to my lifestyle, the chances that I ignore that study are about 96%.

Guess, when viewed on aggregate a 4-8% improvement would be a valuable improvement.

jasonpeacock• 2 years ago

Spark[1] is a good book about the connection between exercise and brain performance, especially in school children. From 2008, this is nothing new.

[1] https://a.co/d/9jqlU9z

mensetmanusman• 2 years ago

Its kind of obvious kids should be sweating 30 minutes a day at school.

Physical fitness and risk of mental disorders in children and adolescents

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