Richard Dopp - University of Michigan Depression Center

Physical Activity,
Sleep, and Depression
Richard Dopp, MD
University of Michigan
Child and Adolescent Psychiatry

Disclosures
• None
• Research funding:
Klingenstein Third Generation Foundation
Michigan Institute of Clinical Health Research
Rachel Upjohn Clinical Scholars Award
Center for Research on Learning and Teaching
Gilmore Fund for Sleep Research and Education
Office of the Vice President for Research (Univ. of Michigan)

“Eat right, sleep right, and get
your exercise!”

Physical Educators

Physical Education Classes

Physical Activity in Adolescence

Depression in Adolescence
• Prevalence up to 8.3% in
early adolescence.
• By age 18, one in four
adolescents will experience
at least one depressive
episode.
• Females outnumber males
2 to 1 by late adolescence
(Wichstrom, 1999; Kessler
et al., 1996).

Evidence-Based Treatments
• Cognitive Behavioral
• Interpersonal
• Dialectical Behavioral
• Medications

Physical Activity and Depression
in Adolescence
• Actigraphy studies in
children and adolescents
with depression show they
are less active than their
healthy peers.
Roseanne Armitage PhD., Robert Hoffmann PhD, Graham
Emslie MD, Jeanne Rintelman BS, Jarrette Moore MA. Kelly
Lewis BS (JAACAP 2004)

Neurobiological Theory
• Increase in opiate
receptor occupancy in rat
brain (Pert et al., 1979).
• Increase in steady-state
levels of brain NE in
physically active rats
(Brown, 1973).
• Increase in BDNF in rats
following physical
activity (Oliff et al.,
1998).

Wheel Running

Blumenthal et al., 1999
Exercise and SSRIs

Exercise treatment for depression:
efficacy and dose response
Dunn, Trivedi et al., 2005

READY
• Research on Exercise And Depression in Youth
• Pilot, feasibility study.
• Can you get a teenager with depression to
participate in an exercise intervention?

READY
Study Protocol
This protocol required participants to:
• spend 4 nights in the Sleep and Chronophysiology Lab,
• complete 12 weeks of intervention including exercise 3
times each week,
• wear an actigraph watch 24/7 for several weeks,
• participate in 2 clinical interviews, and
• fill out surveys and self-report questionnaires.

READY
Participants
13 Adolescents
Ages 13 – 17 years, M = 15.2, SD = 1.4
Females = 9 Males = 4
Racial/Ethnic Background:
Caucasian = 7 (54%) African American = 3 (23%)
Hispanic = 1 (8%) Bi-racial/Multi-ethnic = 2 (15%)

READY
Participants
• Medical Diagnoses:
Major Depressive Disorder = 11 (85%)
Depressive Disorder NOS = 2 (15%)
• Co-morbid diagnoses:
1 with ADHD
1 with Anxiety Disorder NOS
2 with both ADHD and Anxiety Disorder NOS

READY
Medications
• 7 participants were taking no meds.
• 5 participants were taking SSRIs
throughout the intervention:
fluoxetine (4), and sertraline (1).
• 3 of these 5 were also on
stimulants.
• 1 participant initiated sertraline in
the 2 nd week of the intervention.

READY
Motivation:
Reasons for Participation
• for the structured exercise (5),
• to lose weight (5),
• for incentive money (5),
• to fight their depression (4),
• to be involved in research (2),
• to help other people (1).

READY
Adverse Events
Adverse events experienced by the adolescent
participants during the intervention phase:
parental separation (2)
temporary homelessness (1)
suicide attempt (1)
orthopedic injury (2)
arrest by police (1)

READY
Feasibility
100% of participants who initiated the physical
activity intervention completed the study.
Dopp, Mooney, Armitage, King (Manuscript submitted)

READY
• Total 15.
Supervised Sessions
• Took on average 14.25 weeks to complete.
• Heart rate measured every 10 minutes.
• Average heart rate ranged from 124 to 181.

READY
Independent Sessions
• Actigraphy watches:
• worn 24/7 at weeks 3 and 11.
• Used to verify self-reported independent
physical exercise sessions.
• 81% of reported exercise was verified via
actigraphy.

PAQ-A Scores
READY
PAQ-A
3.5
Physical Activity
3
2.5
2
1.5
1
Baseline Post-intervention 6 Months
Timeline

C D R S -R Scores
READY
CDRS-R
80
Depression Severity
70
60
50
40
30
20
10
Baseline Post-intervention 6 Months
Timeline

Mean CASAFS Scores
READY
CASAFS
Adaptive Functioning
70
69
68
67
66
65
64
63
62
Baseline Post-intervention 6 Months

READY
Adaptive Functioning
CASAFS
• In females, peer relationships showed significant
improvement [t (12)=-2.67, p

READY
Correlations
• Average heart rate was not correlated with
change in depression severity between baseline
and post-intervention.
• Average heart rate was correlated with a greater
reduction in BMI (r=0.75, p

READY
Participants
• Centers for Disease Control
BMI Weight Category:
Healthy = 3 (23%)
Overweight = 5 (38.5%)
Obese = 5 (38.5%)

Prevalence Rates of BMIs Greater Than the 95th
Percentile and 85th Percentile
National Longitudinal Survey of Youth
1986-1998
Strauss, R. S. et al. JAMA 2001;286:2845-2848.
Strauss, R. S. et al. JAMA 2001;286:2845-2848.
Copyright restrictions may apply.

Obesity and Depression
• Depression and conduct problems in childhood
predict later development of obesity (Duarte et
al., 2009)
• Chronic obesity in childhood increases risk for
depression (Mustillo et al., 2003)

Obesity and Sleep in Children
• Shorter sleep duration in 3rd grade was
associated with overweight in 6th grade,
independent of the child's weight status in 3rd
grade.
• Shorter sleep duration in 6th grade was
associated with overweight in 6th grade.
• Depression was associated with overweight in
6th grade.
Lumeng et al., 2007; PEDIATRICS

Sleep and BMI in Depression
Higher BMI associated with decreased sleep efficiency.

Sleep and Depression
TADS
Kennard et al., 2006

Physical Activity and Sleep
Among healthy adults:
• Increase in total sleep time.
• Increase in amount of slow-wave sleep.
• Prolonged REM latency.
• Moderators of this effect include body
temperature, exercise duration, and exercise
timing.
Youngstedt et al., 1997

READY
Randomized Controlled Trial
• Goal: Recruit adolescents with depressive
disorders who are inactive, and have a sleep
complaint.
• Participants are randomly assigned to 12 weeks
of exercise or treatment-as-usual (TAU).

READY
Demographics
12 Adolescents
Ages 13 – 19 years, M = 15.3, SD = 1.8
Females = 9 Males = 4
Racial/Ethnic Background:
Caucasian = 7 (54%) African American = 3 (23%)
Hispanic = 1 (8%) Bi-racial/Multi-ethnic = 2 (15%)

READY
Exercise or TAU
• Exercise condition (n=6)
3 dropped out (week 2, 5, and 10)
• Treatment-As-Usual (n=6)

Change in Depression
Treatment-As-Usual vs. Exercise
t (20)= -2.59; p

Depression Among University
Students
• The prevalence of positive screens for
depression was 13.8% for undergraduates and
11.3% for graduate students.
• Suicidal thoughts in the last 4 weeks were
reported by 2.3% of undergraduates and 1.6% of
graduate students.
Eisenberg et al., 2007

Women’s College Physical
Activity and Future Depression
• Women who are physically active during college
have significantly less physician-diagnosed
depression in their middle and older ages.
Wyshak, 2001

Physical Activity Benefits
• Academic performance
• Productivity and salary increases
• Decreases in cardiovascular disease
• Decreases in diabetes mellitus
• Mortality rates are significantly lower among
college graduates who are physically active
(Paffenbarger et al., 1986).

Obesity Increase
•The time of greatest increase of
overweight and obesity occurs
between the ages of 18 and 29.
Gordon-Larsen et al., 2004; Mokdad et al., 1999

College Students’ Barriers to
Healthful Weight Management
• Intrapersonal (temptation, lack of discipline)
• Interpersonal (social situation)
• Environmental (time constraints, ready access to
unhealthful food)
Greaney et al., 2009

College Students’ Enablers for
Healthful Weight Management
• Intrapersonal (regulating food intake, being
physically active)
• Interpersonal (social support)
• Environmental (university’s environment as
supportive of physical activity)
Greaney et al., 2009

College Student Physical Activity
• What do you see as barriers to
engagement in physical activity in
college students?
• What can be done to reduce those
barriers and encourage more physical
activity?

Take Home Points
• Aerobic exercise is proven to
have a significant impact on
adults with depression.
• Research investigating this
relationship in adolescents is
encouraging.
• Individually focused and
environmental-level
interventions are needed to
facilitate behavior change.

Mental Health Resources
• Campus Mind Works:
www.campusmindworks.org/downloads/
• Provides information about managing your
mental health while in college. Find a free
exercise log to track your physical activity and
mood, along with helpful tips.

Exercise Resources
• Department of Recreational Sports:
http://www.recsports.umich.edu/
• FREE access to the Department of Recreational Sports facilities
– Central Campus Recreation Building (CCRB), North Campus
Recreation Building (NCRB), and Intramural Sports Building
(IMSB) – is granted to students who are enrolled in classes for
the current term or semester and have paid tuition and student
fees.
• Department Hotline: (734) 763-0050
• Rec sports also has information intramural and club sports,
outdoor adventures, and challenge programs.
• Campus Running Maps:
http://www.recsports.umich.edu/facilities/RunnersMap.pdf

Exercise Resources
• MHealthy Exercise and Relaxation Classes: (734) 647-7888
• http://hr.umich.edu/mhealthy/programs/activity/classes/index
.html
• http://hr.umich.edu/mhealthy/programs/activity/personaltraini
ng.html
• U-Move Fitness:
http://hr.umich.edu/mhealthy/programs/activity/classes/index
.html
• U-Move Fitness offers a wide variety of group exercise and
wellness classes on campus. Phone: (734) 764-1342

Exercise Resources
• Ann Arbor Community Education and Recreation (Rec&Ed):
http://www.aareced.com/reced.home/rec___ed_home
• Offers league and team sports for youth and adults.
• Phone: (734) 994-2300, ext. 0
• Ann Arbor Parks and Recreation:
http://www.a2gov.org/government/communityservices/parksa
ndrecreation/Pages/default.aspx
• Provides information about recreation activities in the area,
including parks, golf courses, and pools.
• Phone: (734) 794-6230

• Participants and families
• Roseanne Armitage, PhD
• Cheryl King, PhD
• Sheila Marcus, MD
• John Greden, MD
• Ann Mooney, MSW
• Karan Patel, ME
• Zach Ciullo
• Samarth Bhandari
• Jenish Patel
• Keri James
• Barbara Berman, PhD
• Deborah Berman, MD
Acknowledgements

Questions

Running group in young females
with depression
A = 21
B = 28
Nabkasorn et al., 2005; European Journal of Public Health

Treatment Options