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Why is physical activity important for girls? What can help?

Why is physical activity important for girls? What can help?

Angela Crawford has a unique role at Union Middle School. She’s a middle school health and physical education teacher who specializes not in basketball or volleyball, but in strength and conditioning.

She’s noticed a discouraging pattern. She’s repeatedly seen fewer girls than boys in her classrooms. This year, only about 1 in 5 students in her strength and conditioning class is female. While it’s an uptick from her high school days, when she was one of five girls total in a strength and conditioning class, it’s still a noticeable deficit and highlights a gap between men and women in the school gymnasium.

In fact, only 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of Utah girls meet the recommended physical activity levels of 60 minutes or more of moderate-to-vigorous exercise set by the state, compared to 28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of boys. Recent research by Utah State University’s Utah Women & Leadership Project digs into why, combining three studies to illuminate why this deficit exists.

One obstacle that stands in the way of getting girls interested in physical fitness is the lack of options. While some girls prefer team sports or competitive activities, women of all age groups showed preferences for noncompetitive sports like yoga, biking and dancing. Traditional sports in gym class, like soccer, basketball and flag football, are usually taught more than any sort of noncompetitive activity, and girls are given no input on how they’d like to be taught.

“A lot of people are concerned about physical activity in general, especially for young kids,” said Rachel Myrer, an assistant professor at Utah State University and an author on the study. “But there is a difference between activities that young boys and girls enjoy, and because of that, we see disparities reflected in how many participate. Those are reflected further as they go from youths to adults.”

When girls and young women are offered different options for physical activity, studies show that they experience more autonomy, self-determination and participation in their chosen activity.

That’s why teachers in Granite School District survey junior high students on what activities they’d like to do in high school physical education classes. Based on those survey results, Chris Shipman, the physical education and athletics specialist for the district, meets with the high school physical education teachers and determines what activities to provide.

“If it’s something that we don’t have equipment for, we help secure the equipment to introduce new activities,” said Shipman. “When you go into our P.E. classes, there isn’t a lot of sitting out, because we’re doing what the kids want to be doing.”

Junior and high school teachers have control over their physical education curriculum, with the exception of one required year of “Fitness for Life” curriculum in either ninth or 10th grade. This requirement actually supports the results of the study, giving students the opportunity to build skills that lead to a lifelong healthy lifestyle. These skills can be learned in many forms, including sports, dance and outdoor recreation, giving schools the chance to include activities favored by women.

Breanna Villegas, left, and Sarah Cowdell compete in a doubles tennis match at Jordan High School in Sandy on Wednesday, Aug. 11, 2021.

Breanna Villegas, left, and Sarah Cowdell compete in a doubles tennis match at Jordan High School in Sandy on Wednesday, Aug. 11, 2021.
Spenser Heaps, Deseret News

So why aren’t all schools adaptive?

One issue presented by Tim Brusseau, an associate professor at the University of Utah’s Department of Health and Kinesiology and a peer reviewer for the study, is that schools don’t have the resources to accommodate a variety of activities.

“Especially in our middle and elementary schools, we may only have one or two physical education teachers,” said Brusseau, who has been studying school-based physical activity programming for over 15 years. “So it’s harder to split up students into multiple activities and provide opportunities for choice.”

Brusseau says that budgets for physical education programs sometimes don’t accommodate requests for new equipment, so children may not have the option to pick next year’s program. Even if no one wants to play basketball or flag football, the equipment is already there.

Elementary school physical education teachers may also not have specialty training in that field. Elementary schools usually hire paraprofessionals or part-time support staff to teach physical education, and those teachers often only teach once a week for about 45 minutes, drastically undershooting the recommended activity time for students.

The myth of ‘shaping a body’

Another barrier faced by girls and women is social pressure on body image. According to the study, Utah women have low rates of body acceptance, which correlates to low rates of physical activity. One study cited showed that the physical and mental benefits of physical activity were lost entirely “if the motivating factor for exercise was weight loss or body toning.”

Not only is this emphasis on centering workouts on body shape harmful to women, it’s factually inaccurate, according to Angela Crawford, a strength and conditioning trainer working at Union Middle School.

“You can’t spot reduce,” says Crawford. “You can’t do situps to lose belly fat. You can build muscle, but you can’t choose where you’ll lose fat from. It’s not actually possible to do.”

Even with this knowledge, Crawford sees social media pressure aimed at women’s bodies everywhere. She remarked that her previous employer, 24 Hour Fitness, sold shirts that displayed the slogan “Look Better Naked.” Research has found that conforming to societal ideas of attractiveness is young women’s primary motivator to participating in physical activity.

“Women face a lot of pressure to meet a certain standard of beauty,” said Kim Buesser, a graduate student at Utah State University and author for the study. “That can reduce self-confidence, self-worth and reduce her capacity to what her body looks like. I think that reveals, as a result, that young women have less self-confidence or ability to understand their worth and their ability beyond what their body looks like.”

Sarah Cowdell and Breanna Villegas talk to a coach during their doubles tennis match at Jordan High School in Sandy on Wednesday, Aug. 11, 2021.

Sarah Cowdell and Breanna Villegas talk to a coach during their doubles tennis match at Jordan High School in Sandy on Wednesday, Aug. 11, 2021.
Spenser Heaps, Deseret News

How to bridge the gap

With such low numbers of girls meeting physical fitness recommendations, teachers and district supervisors show concern. But the solution is simple: listen.

“One of the things that’s a high-yielding strategy that’s based solidly in data: relationships are really important, definitely,” says Sally Williams, Canyons School District curriculum specialist. “If you have a good relationship with your students and are approachable, then they’re more likely to participate by far.”

Canyons School District offers yoga, aerobics, biking, dance and a girls-only weight training class. Through learning what children like to do in classes, teachers can make requests for different materials and adapt their curriculum.

The girls-only weight class appeals to high school-aged girls in particular. A study in Journal of Sports, Science & Medicine states that young women experience negative social feedback if they’re not able to shower or change clothes after working out because of how they appear to others, especially around boys.

A weight class where girls are unafraid to let loose and get sweaty helps eliminate that social perception and create a safe environment to work out.

By learning from this research, study author Madsen hopes that schools can begin tailoring lessons to addressing body insecurity and expanding out the typical repertoire of gym class activities.

“For girls to become leaders, they have to feel like leaders,” Madsen says. “Self-confidence and mental health comes from that. This is one of those foundational elements of really being able to contribute to your home, your school, your workplace, and your community at large.”

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American Heart Association says Physical Activity even more Critical as Students return to Classroom

American Heart Association says Physical Activity even more Critical as Students return to Classroom

American Heart AssociationNashville, TN – The American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, the National Football League (NFL) and the Tennessee Titans are doubling down on kids physically active through NFL PLAY 60 as students return to the classroom following remote, distant and hybrid learning due to COVID-19 Coronavirus.

Now in its 15th year, the NFL PLAY 60 program establishes healthy habits and reduces sedentary behaviors in kids, which is key to immediate and long-term health benefits that can play a role in the classroom experience.

“Now that school is back in session, moving more is even more important following more than a year at home away from physical education classes, team sports, and daily recess,” Annie Thornhill, Executive Director of the Middle Tennessee American Heart Association. “Research has shown healthy behaviors are important in the classroom as active kids learn better. When kids are active, they focus more, think more clearly, react to stress more calmly, and perform and behave better in the classroom.”

In a recent scientific statement released by the American Heart Association, data continues to show poor cardiorespiratory fitness in youth, which includes cognitive and academic functions. As children return to the classroom, it is important for parents and educators to prioritize physical activity for immediate and long-term health.

Rooted in science, NFL PLAY 60, helps children to develop healthy physical and mental health habits for a better chance of a healthy adulthood. The program encourages kids to get a minimum of 60 minutes of vigorous physical activity each day to meet the U.S. Department of Health and Human Services’ 2018 Physical Activity Guidelines for Americans (Department of Health and Human Services, Physical Activity Guidelines, page 14. Available for download here).

The American Heart Association and the NFL will continue to provide free resources to support parents and educators in making physical activity fun and engaging.

Resources available now:

  • Powered by GoNoodle, a landing page of videos and activities to help kids get 60 minutes of movement each day along side fun animated characters.
  • NFL PLAY 60 App– The free NFL PLAY 60 app helps kids get more movement throughout the day. The PLAY 60 app allows users to control personalized avatars onscreen with their own physical movement. The app is available for iOS and Android devices.
  • NFL PLAY 60 Exercise Library– In collaboration with the 32 NFL clubs, the first-ever NFL PLAY 60 library features kid-friendly exercises to help kids to get their recommended 60-minutes of daily physical activity.


The NFL and the American Heart Association have teamed up since 2006 to inspire kids through a fun and engaging way to get physically active. The impact of physical activity on overall mental and physical wellness is essential to help children grow to reach their full potential.

Additional NFL PLAY 60 resources can be found online at heart.org/nflplay60.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century.

Connect with us on heart.org, Facebook, Twitter or by calling 1.800.AHA.USA1.  

About NFL PLAY 60

NFL PLAY 60 is the League’s national youth health and wellness campaign to encourage kids to get physically active for at least 60 minutes a day. Since PLAY 60 launched in 2007, the NFL has committed more than $352 million to youth health and fitness through PLAY 60 programming, grants, and media time for public service announcements. Over the past decade, the NFL has partnered with leading academic, scientific, and nonprofit organizations to help children of all abilities lead healthier, active lives.

The NFL and its clubs have supported programs in over 73,000 schools and constructed more than 265 youth fitness zones nationwide—giving more than 38 million children an opportunity to boost their physical activity levels. NFL PLAY 60 is also implemented locally, as part of the NFL’s in-school, after-school and team-based programs.

For more information, visit www.NFL.com/PLAY60

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Physical activity promoting policies in the era of COVID-19: is Europe on the right track?

Physical activity promoting policies in the era of COVID-19: is Europe on the right track?

European Union (EU) countries have been making gains in the development of policy on physical activity promotion since 2015, but during the COVID-19 pandemic progress has slowed down, shows a recent WHO publication. The new report, “2021 physical activity factsheets for the European Union Member States of the WHO European Region”, is based on data from all 27 EU Member States and presents an overview of policies and actions that have been implemented in the countries to promote health-enhancing physical activity (HEPA).

Regular physical activity provides health benefits to everyone, regardless of age or fitness level. Among adults, physical activity contributes to the prevention and control of chronic diseases, such as cardiovascular diseases, cancer, diabetes, anxiety, depression, dementia and obesity, and reduces overall mortality and premature deaths.

Physical inactivity: a serious risk factor for the Region

The report provides an overview summarizing the overall situation across the EU, as well as detailed country factsheets for each EU Member State. Indicators in the report signify what kind of WHO-recommended HEPA policies have been implemented in each country.

According to the report, an overall improvement in policy indicators can be observed between 2015 and 2021. Across the Region, the average proportion of the 23 indicators accomplished by Member States increased from 2015 to 2021, although the pace of progress slowed down after 2018.

“In the WHO European Region, around a third of adults are physically inactive. Lack of physical activity is closely connected to overweight and obesity, and consequently to many noncommunicable diseases and health risks,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “It is time for us to remember that healthy habits – from balanced diets to physical activity – are key factors that protect our health much more than we tend to think.”

EU policies implementation: what’s new?

As the report data shows, in 2021 countries of the EU had made progress implementing the following measures:

  • supporting interventions to promote physical activity in older adults (74{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of countries);
  • promoting physical activity in the workplace (74{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of countries);
  • training of physical education teachers (89{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of countries);
  • granting wider access to exercise facilities for socially disadvantaged groups (78{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of countries);
  • producing national recommendations on physical activity for health (85{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of countries).

WHO and the European Commission: commitment to promoting healthy lifestyles for all

To increase physical activity levels, WHO has been collaborating closely with the European Commission and EU Member States to increase health-enhancing physical activity across the region. This collaboration has helped to enhance policy and practice in line with the WHO European Programme of Work 2020–2025 – “United Action for Better Health in Europe”.

The launch of the new report marked the start of an initiative called Healthy Lifestyles 4 All (HL4A) led by WHO/Europe and the European Commission. The 2-year campaign will showcase efforts and support countries in the EU to promote healthy lifestyles across generations and social groups, and to promote a global approach across policies and sectors – linking food, health, well-being and sport.

As an open and collaborative project, HL4A invites sports organizations, civil society, and international, national, regional and local authorities to join and create projects that bring together sports, physical activity and healthy diets. All participating organizations can submit a commitment for concrete actions in the online Pledge Board. WHO/Europe has submitted its contributions.

Looking forward, this important collaboration between WHO/Europe and the European Commission can play a role in supporting the societal and economic recovery from COVID-19, with a sustained and coordinated focus on attainment of a 15{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} reduction in physical inactivity by 2030 and achievement of the Sustainable Development Goals.

Impact of COVID-19 on physical activity

Physical activity can take place in various settings, during leisure-time activities, at school, at the workplace and at home during daily activities. However, maintaining sufficient levels of physical activity is becoming more difficult as most daily environments have become more sedentary.

According to the new WHO report, the ongoing COVID-19 pandemic has highlighted the importance of our environments and our access to opportunities to be physically active as part of daily life.

“Lockdowns and limited access to public and indoor spaces had a negative impact on levels of physical activity that were already at very low levels before the pandemic. Some countries of the WHO European Region still feel this impact. Now is a good time to bring physical activity levels up again. There are various health-enhancing policies to choose from, and they work best when combined,” said Dr Kremlin Wickramasinghe, Acting Head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases.

By implementing HEPA policies, countries of the WHO European Region can provide long-term benefits for people’s health and health systems.

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Are You Interested in Increasing Your Physical Activity? Join Walk Across Northwest Arkansas

Are You Interested in Increasing Your Physical Activity? Join Walk Across Northwest Arkansas

Do you feel stressed? Has your fitness routine lagged due to COVID-19 or for other reasons? You might need a new challenge to get back on track. Walk Across NWA can help you! 

It’s not too late. Register for the Fall 2021 Program and gain access to Health and Wellness resources from the U of A Division of Agriculture and make a difference in the environment. Participation is free. Registration is open now and the program lasts through Nov. 7. 

Online registration is available at walk.uada.edu.  More details are located on the following sites: uaex.uada.edu/nwa-wellness along with on the Facebook Page @NWALivingWell and our NWA Living Well Facebook Group to receive additional support with stress management, nutrition tips, healthy recipes and more.

Earlier this year, 890 Arkansans statewide participated in the Spring 2021 Walk Across Arkansas, logging 1,469,867 minutes, with 217 teams from counties walking across the state. Many of those participants reported they had more energy, slept better, controlled stress, strengthened relationships, lost weight or inches and improved their blood panels and blood pressure.

Physical activity can lower the risk of early death, coronary heart disease, stroke, high blood pressure, high cholesterol, Type 2 diabetes, metabolic syndrome and some cancers, according to the Centers for Disease Control and Prevention. Exercise also helps with weight loss and can improve mood and energy level and help us stress less.

National physical activity guidelines recommend that adults achieve at least 150 minutes of aerobic physical activity and two strength training sessions per week, and youth need at least 60 minutes of exercise daily.

To participate, find a few friends, classmates, family members or co-workers to form a team and register online. If you do not know others who are interested, make up a team name and be a team of one. Joining a team provides support to help you reach your goals, but team members do not have to be physically active together. Then, through Nov. 7, just record the number of minutes you spend walking, jogging, gardening or getting any other form of exercise. You can do any type of physical activity to increase your heart rate or break a sweat.

Minutes can be logged online daily or entered weekly, or you can contact your local County Extension Agents for paper forms. Team captains can log in minutes for team members. Even if you do not have an email address, this program is still for you. 

For more information about Walk Across NWA, contact the Washington County Family and Consumer Sciences Extension Agent Anna Goff by email at [email protected], or you can call or text 479-841-1212 or office 479-444-1755. In Benton County, contact Family and Consumer Sciences Agent Trudy McManus at [email protected] or 479-271-1060.

Have some fun this fall with friends and family — physically distancing of course — and make a difference as you get healthy with Walk Across NWA.

Special thanks to Jamie Baum at the U of A Center for Human Nutrition for support in promotion of this program.

The University of Arkansas System Division of Agriculture offers all its Extension and Research programs and services without regard to race, color, sex, gender identity, sexual orientation, national origin, religion, age, disability, marital or veteran status, genetic information, or any other legally protected status, and is an Affirmative Action/Equal Opportunity Employer.

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Physical activity in children can be improved through ‘exergames’

Physical activity in children can be improved through ‘exergames’
physical activity
Credit: CC0 Public Domain

Physical activity among young people can be improved by well-designed and delivered online interventions such as ‘exergames’ and smartphone apps, new research shows.

According to a review study carried out at the University of Birmingham, children and young people reacted positively in PE lessons to the use of exergames, which deliver physical activity lessons via games or personalized activities. Changes included increases in physical activity levels, but also improved emotions, attitudes and motivations towards physical activity.

The study, published in Physical Education and Sport Pedagogy is one of the first to examine not only the impact of online interventions on physical behaviors in non-clinical groups of young people but the effects of digital mediums on physical activity knowledge, social development and improving mental health.

The evidence can be used to inform guidance for health and education organizations on how they can design online interventions to reach and engage young people in physical activity.

The authors analyzed 26 studies of online interventions for physical activity. They found three main mechanisms at work: gamification, in which participants progress through different levels of achievement; personalization, in which participants received tailored feedback and rewards based on progress; and information, in which participants received educational material or guidance to encourage behavioral change.

Most of the interventions were focused on gamification or personalisation and the researchers found the majority of studies (70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) reported an increase and/or improvement in outcomes related to physical activity for children and young people who participated in online interventions. Primary school age pupils in particular who participated during PE lessons benefited.  

Lead author Dr. Victoria Goodyear, in the University of Birmingham’s School of Sport, Exercise and Rehabilitation Science, said: “We find convincing evidence that PE teachers can use online learning to boost attitudes and participation in physical activity among young people, particularly at primary school age. There’s a real opportunity here for the PE profession to lead the way in designing meaningful and effective online exercise opportunities, as well as an opportunity to embed positive approaches to exercise and online games and apps at an early stage.”

Girls ‘least likely’ to enjoy fitness tests, finds study

More information:
Students’ perceptions of fitness testing in physical education across primary, secondary, and pre-university school levels: a motivational profiles perspective, DOI: 10.1080/17408989.2021.1953458

Provided by
University of Birmingham


Citation:
Physical activity in children can be improved through ‘exergames’ (2021, August 26)
retrieved 28 November 2021
from https://phys.org/news/2021-08-physical-children-exergames.html

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Role of physical activity and self-compassion in depression

Role of physical activity and self-compassion in depression

Introduction

Depression symptoms among youths capture considerable attention from researchers and practitioners. Numerous studies have indicated the high prevalence of depression symptoms among youths. For instance, a meta-analysis covering 45 studies including 50,825 participants revealed that the prevalence of depression symptoms among Chinese college students was about 30.39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}.1 Depression is a psychosomatic phenomenon showing both physical and psychological symptoms (eg, emotional and physical retarded activity),2 and it associates with an array of detrimental health outcomes among young adults, including impaired cognitive processes, a variety of somatic diseases, and even frequent suicidal ideation and suicide attempts.3 Given the prevalence and adverse influence of depression symptoms, it is essential to reveal factors that could provide more targeted and efficient interventions. The present research focuses on two important factors, namely physical activity (PA) and self-compassion (SC).

The role of lifestyle factors (eg, physical activity [PA]) in the intervention of psychopathology (eg, depression) has been gaining increasing attention among researchers (eg, lifestyle psychiatry framework4,5). Many studies have established a consistent association between PA and mental health outcomes in young people, including depression symptoms.6,7 For instance, research suggests that insufficient PA associates with the risk of depression symptoms.8,9 From the perspective of the stress-vulnerability model of depression, low-level PA (LPA) may increase the vulnerability towards depression biologically by dysregulating the generation of some hormones10 and psychologically by increasing negative emotion.11 According to self-determination theory (SDT),12 human behaviors are driven by three basic psychological needs, namely, autonomy, competence, and relatedness. Physical activity is conducive to promote self-efficacy,13 and further help individuals to meet the essential need of autonomy and competence. In addition, exercise and sports, forms of physical activity, might involve social interaction with others, cultivating the sense of relatedness.

Self-compassion (SC) is another factor that emerges as an effective intervention approach for mental health and well-being.14 SC emphasizes the autonomy and competence of “self” to be kind towards oneself in suffering, and it views sufferings as shared human experiences with a sense of relatedness. Thus, SC is also closely linked to human psychological needs proposed by SDT. SC can intervene with the vicious cognitive-emotional cycle and alleviate depression symptoms.15 Research suggests that SC is a strong predictor of depression,14 suggesting that it is effective for mental health and stress management. For instance, low-level self-compassion (LSC) has been shown to be linked to multiple kinds of mental illness indicators15,16 and may predispose people to be vulnerable to depression symptoms.17,18

The above information suggest that SC and PA are tightly associated with people’s mental health. Specifically, the present study proposed that LPA (Hypothesis 1a) and LSC (Hypothesis 1b) were positively associated with depression symptoms among Chinese college students, respectively.

In the field of health care, instead of solely relying on external resources, researchers and practitioners focus more on the importance of self-care and the value of individuals’ sense of agency. SC and PA are constructive ways for self-help. While most studies focus on the independent role of PA and SC in the intervention of depression symptoms, their combined effect is rarely studied. Notably, as proposed by the cumulative risk model, instead of examining a single risk factor, the accumulation of risk factors may better explain an individual’s developmental outcomes.19,20 Moreover, there is a reciprocal relationship between PA and SC, suggesting that combining PA and SC may produce an additive effect on mental health. On the one side, individuals with high-level self-compassion (HSC) are likely to have a better sense of autonomy for health.21 Therefore, individuals with HSC may have more intrinsic motivation (eg, for their physical and mental health) to engage in PA and maintain PA habits.26,27 SC is also associated with more adaptive self-regulation, conducive to rational goal-setting of PA. This may facilitate PA by increasing the individual’s sense of competence or self-efficacy with appropriate exercise goals.22,23 On the other side, participating in PA is beneficial for regulating emotion and reducing the risk of psychopathology (eg, depression).24,25 Individuals may experience less rumination while exercising, which further promotes mindfulness and increase self-compassion.26 Indeed, a recent meta-analysis covering 25 studies have concluded that higher levels of PA were associated with higher levels of SC.26 Considering the known separate role of LPA and LSC in depression symptoms, along with the mutually reinforcing relationship between PA and SC, it is thus reasonable to speculate that concurrent exposures to LPA and LSC would generate an additional risk in depression symptoms. Specifically, we proposed that a combination of LPA and LSC was associated with a higher risk of depression symptoms (Hypothesis 2), and there was an additive interaction between LPA and LSC (Hypothesis 3).

Therefore, the purpose of this study was threefold: (1) to examine the independent roles of LPA and LSC on depression symptoms; (2) to investigate the joint roles of LPA and LSC on depression symptoms; (3) and to test whether LPA and LSC had an additive interaction in increasing the odds of depression symptoms. Although the independent associations between PA and SC with depression symptoms have been well established, existing studies rarely considered the potential interaction between PA and SC. Besides, studies on the roles of SC in Chinese samples are still limited. Findings from this study would add evidence to the knowledge base of the role of modifiable self-determined factors (SC and PA) on depression symptoms in Chinese samples, and thus may provide theoretical and practical implications for future intervention.

Method

Participants and Procedure

The cross-sectional study was conducted via an online survey in August (21–31st) 2020, when the pandemic was under control in China, and college students were about to back to school for the fall semester. A convenient sampling method was adopted in recruiting college students as our participants via social media platforms (ie, WeChat and QQ). The inclusion criteria for participants were: (a) Chinese college students; (b) willing to participate in the study, (c) able to communicate in Chinese, and (d) no major mental health problems at present. Students who had completed all questionnaires (approximately 15 minutes) were given ten RMB (Chinese currency, equivalent to 1.5 USD) via online payment. In total, 1942 participants from 30 provinces and autonomous regions were recruited and 1846 participants (response rate = 95.1{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) provided valid answers in this study. Participants were asked to provide online consent before filling out the survey. Based on existing studies on depression symptoms during the COVID-19 pandemic,28–31 the sample was computed using G*Power 3.1 based on the following assumptions: an expected prevalence (25.0{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of symptoms (PHQ-9 scores ≥10 as the cut-off), 1.5 odds ratio (OR) of symptoms among LPA or LSC, margin of error of 5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} and power of 90{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, two-tailed examination, and binomial distribution of independent variables. This gives a total sample size of 1435. The finally recruited sample (n = 1846) exceeds this, indicating the sufficiency for statistical analysis. The confidence level was set at 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}. The research obtained ethics approval from the local Human Research Ethics Committee (blinded for review). All participants were informed about the purpose of the study, and that it was conducted in accordance with the Declaration of Helsinki.

Instruments

Socio-Demographic Variables

Socio-demographic variables were collected, including gender (male/female), age (years), body mass index (BMI, calculated by the formula weight [kg]/height2 [m]), family structure (full/divorced/other), number of siblings (none/one or more), number of friends (none/1–2/3–5/6 or more), and residence (rural/urban).

Physical Activity (PA)

PA was self-reported using the International Physical Activity Questionnaire Short Form (IPAQ-SF).32,33 Respondents were asked to report the frequency and duration of participating PA of different intensities (high-intensity PA, moderate-intensity PA, and low-intensity PA) in the past week. PA refers to activities that involve the contraction of large skeletal muscles, including exercise, sports, walking, activities done at work or in spare time, etc. Example question: “During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, or fast bicycling?” The Chinese version of the IPAQ has been confirmed adequately reliable and valid for measuring total PA in a Chinese population.33 Following the scoring rule of IPAQ-SF, participants were classified as low-level PA (less than 600 metabolic equivalents of task (METs) min/week) and high-level PA (no less than 600 METs min/week) according to their amount of PA.

Self-Compassion (SC)

The Self-compassion Scale-Short Form (SCS-SF) was used to measure the level of SC.34 It consisted of 12 items, with each item is rated on a 5-point scale (1 = almost never to 5 = almost always). SCS-SF consisted of six subscales: three compassionate self-responding dimensions (CS; ie, self-kindness, mindfulness, and common humanity), and three uncompassionate self-responding dimensions (UCS; ie, self-judgment, isolation, and over-identification). The negative dimensions were reverse coded, given self-compassion involves concomitantly engaging in CS and disengaging in UCS. The mean of six subscales was averaged and created an index of self-compassion. An example item for SCS-SF is “When I’m going through a very hard time, I give myself the caring and tenderness I need.” SCS-SF was validated in Chinese college students, with good psychometric properties.35 In the represent study, SCS-SF shows high internal consistency reliability (Cronbach’s α = 0.86). The confirmatory factor analysis (CFA) indicated acceptable model fits, χ2 = 634.18, df = 39, p < 0.001, CFI = 0.95, TLI = 0.91, RMSEA = 0.09, and SRMR = 0.06, suggesting adequate structural validity. According to a recommended cutoff point (3.5) for the scale,36 participants were classified into low-level SC (LSC) and high-level SC (HSC), respectively.

Depression Symptoms

The severity of depression symptoms was measured by the Chinese version of the 9-item Patient Health Questionnaire (PHQ-9).37 Each item is reported on a 4-point Likert scale (0 = “Not at all” to 3 = “Nearly every day”). An example item is “Feeling down, depressed, or hopeless.” Higher scores indicated more severe depression symptoms. Existed study showed that individuals with a total score of 10 or above were indicated as having probable major depression,38 and thus participants were classified into two categories: with depression symptoms (PHQ-9 score ≥ 10) and without depression symptoms (PHQ-9 score < 10). PHQ-9 is validated in Chinese college students with good psychometric properties.39 The Cronbach’s α coefficient of PHQ-9 in the study is 0.90. The CFA showed good model fits, χ2 = 407.57, df = 25, p < 0.001, CFI = 0.96, TLI = 0.94, RMSEA = 0.91, and SRMR = 0.03, indicating good structural validity.

Statistical Analyses

We analyzed data in 4 steps. First, descriptive statistical analyses were conducted. Given the data was collected based on self-reported measures, the Harman single-factor method was performed to test common method biases.40 Second, logistic regression models were used to examine the separate association of LPA and LSC with depression symptoms. With HPA and HSC as referent, odds of depression symptoms for LPA and LSC were presented by odds ratios (ORs) and 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} confidence intervals (CIs). We mutually adjusted exposures (LPA and LSC) for each other (ie, when LPA was modeled as the main exposure, the analysis was adjusted for LSC, and when LSC was modeled as the main exposure, the analysis was adjusted for LPA).

Third, we examined if the joint association of LPA and LSC with depression symptoms was larger than the sum of the separate associations of LPA and LSC with depression symptoms. Study samples were divided into 4 (2 × 2) groups (ie, Group I: HPA + HSC; Group II: LPA + HSC; Group III: HPA + LSC; Group IV: LPA + LSC). If LPA was present, then i = 1; otherwise i = 0. If LSC was present, then j = 1; otherwise j = 0. Next, a logistic regression model was conducted to computed the estimates and 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI of ORij to represent the odds of depression symptoms in each category (ie, OR00 [reference category], OR10, OR01, OR11).

Fourth, the potential additive interaction association between LPA and LSC with depression symptoms was explored. Measures regarding relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated.41,42 A growing body of studies showed that the additive scale instead of the multiplicative scale is more important in public health assessment, given it allows people to distinguish whether the effects are different in specific subgroups.43,44 Therefore, for disease prevention and health promotion among the vulnerable populations, the additive interaction is more suitable than the multiplicative scale.41 Therefore, we assessed the presence of interaction between LPA and LSC on the additive scale using the algorithm developed by Anderson et al.42 If the 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CIs of RERI and AP did not contain 0 and the 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI of S did not contain 1, it can be considered that there is an additive interaction between LPA and LSC. The 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CIs were calculated based on 20,000 bootstrap samples.

In all models, the following variables were controlled: age, gender, BMI, number of siblings, residence, family structure, and number of friends. Statistical analyses were performed using SPSS software (IBM SPSS 23.0, SPSS Inc). Significance was set as p < 0.05.

Results

Among the 1846 participants (mean age: 20.67 ± 1.61, 64.0{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} females), 51.5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} and 73.0{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} were classified to LPA and LSC, respectively. In total, 23.6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of participants were screened positive for depression symptoms in this study. More details of participants are listed in Table 1. The results of Harman single-factor analysis showed that the variance interpretation rate of the first common factor was 25.92{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, less than the critical standard of 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, indicating no serious common method bias in this study.40

Table 1 The Characteristics of Participants

Table 2 presents the independent association of LPA and LSC with depression symptoms. Compared with those with HPA, participants with LPA were more likely to report depression symptoms (OR = 1.47, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI = 1.16–1.86) after adjusting for socio-demographic variables and SC (confirmation of Hypothesis 1a). Likewise, compared with those with HSC, LSC was associated with higher odds for depression symptoms (OR = 5.74, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI = 3.89–8.45) after adjustment for socio-demographic variables and PA (confirmed Hypothesis 1b).

Table 2 Independent Association of Physical Activity and Self-Compassion with Depression Symptoms

Table 3 shows the joint association of LPA and LSC with depression symptoms after adjusting for socio-demographic variables. With Group I (HPA + HSC) as the referent, the OR of Group IV (LPA + LSC) reached 9.62 (95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI = 5.28–17.22), which indicated that, for individuals with concurrent LPA and LSC, the risk for depression symptoms was nearly ten times as those with both HPA and HSC (confirmation of Hypothesis 2).

Table 3 Logistic Regression Results of Joint Association Between Physical Activity and Self-Compassion with Depression Symptoms

Table 4 displays the presence of the additive association of LPA and LSC with depression symptoms. Specifically, both RERI and S were significant, indicating the LPA and LSC had a synergic effect on the occurrence of depression symptoms in this sample (confirmation of Hypothesis 3). AP was 0.25 (95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI: 0.05–0.44), suggesting that 25{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of depression symptoms may be due to the interaction of LPA and LSC.

Table 4 Index of Additive Interaction Between Physical Activity and Self-Compassion on Depression Symptoms

Discussion

Main Findings

This study examined the independent, joint, and additive interaction associations between LPA and LSC with depression symptoms among Chinese college students. Our findings showed that LPA and LSC were independently associated with depression symptoms. Furthermore, those who engaged in both LPA and LSC had a higher risk of depression symptoms than those who had none or one of these two behaviors. We also found that LPA and LSC synergistically increased the odds of depression symptoms (additive interaction), suggesting that the joint association was more significant than the sum of the separate association. Interpretation of these results is as follows.

Interpretations of Findings

The study found that LPA was associated with an increased risk of depression symptoms, which supported previous studies on young adults in the context of China and other countries.45,46 Similar findings across the world suggest that PA is a globally applicable relevant factor in depression symptoms. The antidepressant effects of PA can be explained from two aspects: biological and psychological mechanisms.47 Regarding the biological mechanism, it is suggested that PA elicits a wide range of structural and functional changes in the brain, which suggests that PA may produce its effect through multiple pathways, such as balancing neurotransmitters related to mood-regulation or stress response (eg, cortisol).48,49 PA was also associated with the decrease in basal pro-inflammatory markers and the increase in anti-inflammatory markers.50 Thus, PA can moderate the relationship between inflammation and depression symptoms.51 In terms of the psychological mechanism, PA improves self-esteem and self-efficacy, for example, by improving physical self-perceptions and transferable sense of coping with challenges.52,53 PA also makes it more accessible for individuals to get more social support by more interaction and emotional disclosure during exercises with companions.54,55 Besides, physically active individuals are prone to have other healthy behaviors in their daily life, such as recommended eating and sleep habits, which are also associated with better mental health.56–59 Therefore, compared to the participants with HPA who could obtain the benefits of PA above, it is not surprising to find those with LPA had a greater risk for depression symptoms in this study.

We also found that LSC significantly increased the risk of depression symptoms, which supported previous studies.16,60 Studies across age and populations showed that SC could strongly affect overall well-being.61,62 The potential effect of SC may also be explained from physiological and psychological perspectives. SC is associated with the mammalian caring systems.63 The activation of this system may generate oxytocin, which can down-regulate one’s stress response and alleviate mood disorders (eg, depression).64 Besides, SC indicated a competence to treat oneself with kindness when suffering pain.65 Conversely, individuals with LSC may manifest a high level of self-criticism.66 Many studies showed that excessive self-criticism might lead to depression symptoms.67 One possible reason is that self-criticism, similar to external criticism, may diminish one’s self-esteem and generate a sense of failure, leading to depression symptoms.68 In addition, individuals with LSC tend to ruminate on the sufferings and setbacks they experienced, which also explain the development of depression symptoms.69

Notably, a substantial increase in the odds of depression symptoms was observed in combination with both LPA and LSC in this study. Our findings partially support previous research demonstrating that the increase in the number of unhealthy behaviors increased the odds for depression symptoms.70–72 Our findings are also in line with the cumulative risk model, suggesting that cumulative risk predicts cumulative outcome.19 As expected, both LPA and LSC were risk factors for depression symptoms, and thus their co-occurrence could significantly increase the risk of the symptoms.

Moreover, the combination of LPA and LSC presented a synergy effect on the association with depression symptoms after adjusting for covariates in this study. In other words, the coexistence of LPA and LSC may make an additive risk on depression symptoms. Although underlying mechanisms of this finding can hardly be fully classified based on our data, some empirical evidence may be helpful in explaining the additive interaction. Research suggests that individuals with LPA are more prone to have rumination and self-coldness, which may negatively impact their capacity of SC,73,74 and trigger psychological problems such as depression.75 Individuals with LSC may have symptoms of self-isolation that may affect their sense of relatedness, and LSC may also reduce individuals’ autonomous health behaviors both psychologically and physiologically. These, subsequently, may lead to emotional dysregulation76 and learned helplessness,77 which may further undermine self-efficacy and increase the likelihood of experiencing depression symptoms. Taken together, these findings may partly explain why additive interaction between LPA and LSC act synergistically to increase the odds of depression symptoms. Nevertheless, literature concerning the additive association between LPA and LSC on depression symptoms is rare, more research is called in the area to clarify the mechanisms.

Limitations and Strengths

This study has several limitations. First, the cross-sectional design did not allow us to infer causality. Second, this study collected data from university students, mainly from Guangdong province. The results may not be generalizable to other populations. Third, the assessments of PA, SC, and depression symptoms in this study were self-reported, leading to potential recall bias. Fourth, after adjusting for socio-demographic factors, even though the indexes of additive interaction of physical activity and self-compassion were still significant, the lower confidence intervals of AP and S are close to the statistical rejection area. This suggested that the significance may be marginal. Nevertheless, we still find 25{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of depression symptoms attributed to the interaction of LPA and LSC. Future studies are needed to validate or refute our findings. Finally, it is worth to be noted that PA is the superordinate concept of exercise. Exercise refers to several kinds of PA that are planned, structured for purposes of fitness.78 More purposed and moderate-to-high intensity exercise, relative to incidental PA, may pose a distinct influence on depression symptoms and differently interact with SC, whereas it is not precisely measured in this study. But generally, college students accompanied with LPA and LSC were prone to have more depression symptoms. Future studies can further improve the study design with more precision.

Despite these limitations, the present study investigates the relationship between PA and SC with depression among Chinese college students based on large sample size. One of the significant strengths of this study was its novelty in examining the additive association between PA and SC. The current study results highlight the potential interplay between PA and SC in the prevention or intervention of depression symptoms among college students. The finding provides some practical implications. Specifically, concurrently increasing participation in PA and SC may provide more effective prevention and intervention for depression symptoms. A growing body of evidence has indicated that adding psychological components (eg, mindfulness) to exercise-based interventions could contribute to better effects.79–81 For example, Kratz et al82 found that the exercise-based intervention combined with psychological treatment may be more effective for individuals with depression symptoms than simple exercise intervention. Likewise, Li et al83 found that mindful exercise was more beneficial to reduce psychiatric symptoms than pure aerobic exercise. According to recent meta-analyses,84,85 body-mind exercises were of great benefit to treating depression symptoms. Therefore, clinical measures integrating PA and SC can also be designed and taken to help prevent or reduce depression symptoms in young adults. For instance, when we design the interventions for depressive symptoms, we could add some SC components to PA-based interventions or some PA components to SC-based interventions. The effect of these interventions may be better than the interventions involving only PA or SC.

Conclusions

LPA and LSC could independently increase the odds of depression symptoms among college students and act synergistically to increase the odds of depression symptoms with an additive interaction. To find a better way to resist the risk of depression symptoms, future research and clinical intervention could integrate PA and SC.

Abbreviations

PA, physical activity; SC, self-compassion; LPA, low-level physical activity; LSC, low-level self-compassion; RERI, relative excess risk due to interaction; AP, attributable proportion; S, synergy index; OR, odds ratio.

Data Sharing Statement

Available upon request to the first author.

Ethics Approval and Informed Consent

The Human Research Ethics Committee of Shenzhen university granted ethics approval (Approval Number: 2020005), and that it was conducted in accordance with the Declaration of Helsinki.

Consent for Publication

All authors consent for publication.

Acknowledgment

We are very grateful to our colleagues for their diligent work, the participants who took the time to participate in this study, and their teachers and parents to promote their participation.

Funding

XC was supported by the Guangdong Basic and Applied Basic Research Foundation (Grant No.2021A1515011330). YZ was funded by the Shenzhen Science and Technology Research and Development Funds of the Shenzhen Science and Technology Innovation Committee (Grant No.20200814102701001).

Disclosure

The authors report no conflicts of interest in this work.

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