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Kids room - 49420 backup

Available at Prezzip.com. Step in this kids room, play with some toys or clean up the mess.
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Transcript of Kids room - 49420 backup

SEPARATE ELEMENTS
Exercise and Mental Health in Children
ZOOM into detail.
There are placeholders enough to tell your story
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Introduction
Development
Parenting...
Discipline...
Excercise...
Excercise for ODD/ADHD...
Excercise for mental health



Mental Health Impact and Adult
Therapy
Dilly DALY: The Mental Health Problem...
Global Burden of Diseases study, 2010: Let's define some terms

DALY: Disabilty adjusted life years: A measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
YLL: Years of life lost to premature mortality
YLD: Years LIVED with disability


Dilly DALY: The Mental Health Problem...
Mental and substance use disorders:
7.4% of all DALY worldwide (183.9 million). Of this, depression accounts for 40%.

Years lost?: 8.6 million (0.5% of all YLL)

YLD: 175.3 million years of life lost. The leading cause of YLD worldwide at 22.9%.
L
Lancet: Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Whiteford et al. Volume 382, No. 9904, p1575–1586, 9 November 2013.
Exercise as treatment
How? Multiple theories.
Mayo has a fun summary

Exercise as treatment in Adults
Background on the Data
Most studies are observational. There seems to be a link, but causation is in question.
The APA and NIH described using exercise as monotherapy or asjuntive therapy in guidelines on treating depression in adults.
Exercise as treatment in Adults
The evidence is better than for children, but not overwhelming.

Mostly based on smal studies.

Cochrane review of 39 trials in 2010: Exercise moderately more effective than control.
Exercise in Children's Mental Health
Do happy people run or does running make happy people?
In this discussion I hope to examine prospective trials to evaluate the evidence.
Exercise and Depression
Depression and Exercise
Depression and Exercise:
Basic Science Fast Facts
Don't Go There:
Scope of the
discussion
Exercise and...
physical Health
treatment of substance abuse
eating disorders
school performance
cognition
Deep inside the brain...
Neurotranmitters
"Wiring"

Exercise...
and physical Health
treatment of substance abuse
and eating disorders

Long term: Increased brain derived neurotrophic factor, IGF-1, VEGF.
Increase in gray matter volume especially in prefrontal cortex and hippocamus.
Affects reward processing.
Caveats
Most of these are associations
and
Most studies are on adults or animals.
Depression and Exercise:
Basic Science Fast Facts
Short term:
As a physical stressor, exercise briefly increases cortisol.
Recent exercise associated with improved stress coping behaviors
Depression and Exercise:
Basic Science Fast Facts
Increases
Beta-phenylethylamine (mood enhancement).
Beta-Endorphin (improved mood and pain relief)
Increases anandamide which binds cannabinoid receptors (improved mood).
Also, NE and dopamine incrased.

SHould you talk about?
Proc Natl Acad Sci U S A. 2015 Oct 20;112(42):13105-8. doi: 10.1073/pnas.1514996112. Epub 2015 Oct 5.
A runner's high depends on cannabinoid receptors in mice.
Fuss J1, Steinle J2, Bindila L3, Auer MK4, Kirchherr H5, Lutz B3, Gass P2.
Depression: Show me the data
Cochrane review (Laurun 2005)
The Cohrane review regarding exercise
for treatment of depression in
adults
35 Studies
Moderate effect
One study: Performed at psychiatric facility.
Intervention: Thrice weekly exercise
Both recieved regular physical activity classes.
General population (of children)--NOT depressed
Moderate difference
That's it? 5 studies from the 80's and 90's?
Depression: My own search
Exercise Therapy as a Treatment for Psychopathologic Conditions in Obese and Morbidly Obese Adolescents: A Randomized, Controlled Trial (Pediatrics 2006). Daley et al.
The Title is deceptive--this is a "proof of concept trial". These were obese otherwise healthy children.
81 participants, from 11-16 yo.
Randomized to 3 groups:
aerobic exercise with exercise counseling 30 minutes thrice weekly x 8 weeks WITH exercise counseling
"exercise placebo"--light stretching 30 minutes thrice weekly x 8 weeks WITH exercise counseling
usual care which was no intervention.
Results
27% had reported suicidal thoughts at baseline.
No major changes to depression score. Mild improvement in self-perception scores.
Exercise Effects on Depressive Symptoms and Self-Worth in Overweight Children: A Randomized Controlled Trial. (J Pediatr Psychology 2009)
207 obese 7-11 yo. 59% Black.
Randomized to
low dose exercise (20 min daily)
high dose exercise (40 min daily)
control (nothing)
Exercise was at gym after school.
There was a dose-response improvment detected for depressive symptoms.
Post-intervention depression scores not significantly different, but the trend of improvement with increased exercise was significant.
Self worlth outcome seemed to be dose and race-related.
And that's it.
No other RCT's I could find
Difference in social climate?
Or did we just catch a fluke?
Depression: One other bit of data
Cochrane review (Laurun 2005)
Only 2 studies compared to psychosocial therapy (group therapy and "leisure skill" therapy.
None compared to medications or counseling.
But there are adult studies
From: Cochrane review "Exercise for depression". Cooney et al. 2013.
From: Cochrane review "Exercise for depression". Cooney et al. 2013.
Depression: One other bit of data
Cochrane review (Laurun 2005)
Only 2 studies compared to psychosocial therapy (group therapy and "leisure skill" therapy.
None compared to medications or counseling.
But there are adult studies
From: Cochrane review "Exercise for depression". Cooney et al. 2013.
From: Cochrane review "Exercise for depression". Cooney et al. 2013.
Depression and Exercise: Conclusion
Exercise seems to at least mildly improve mood in the general pediatric population, but this is based on a few, small, heterogenous studies.

We simply have little data regarding exercise as therapy in children.

However, in adults exercise as therapy seems to be mildly or moderately effective and may be as good as some other common modalities.
Exercise
and
Self-Worth
The worth of self-worth

However, more recently some have questioned the benefit of high self-esteem. For instance, elevated self esteem...
May be associated with lower grades
May be associated with more violent people including bullies
Has not been proven to be associated with many benefits
Self esteem not so great?
Lowers grades
Baumeister, Roy F.; Jennifer D. Campbell, Joachim I. Krueger and Kathleen D. Vohs; Krueger, Joachim I.; Vohs, Kathleen D. (January 2005). "Exploding the Self-Esteem Myth" (PDF). Scientific American 292 (1): 84–91.Bibcode:2005SciAm.292a..84B. doi:10.1038/scientificamerican0105-84.PMID 15724343. Retrieved 20 February 2011.
Baumeister, Roy (23 December 2009). "Self-Esteem". Education.com. Retrieved 8 January2015.
From Nuture Shock
Dweck, Carol S., “Caution—Praise Can Be Dangerous,” American Educator , vol. 23, no. 1, pp. 4–9 (1999). Children less likely to try hard things if praised.
Bullies
Cardemil, Alisha R.; Cardemil, Esteban V.; O'Donnell, Ellen H. (August 2010). "Self-Esteem in Pure Bullies and Bully/Victims: A Longitudinal Analysis". Journal of Interpersonal Violence (Sage Publications) 25 (8): 1489–1502.doi:10.1177/0886260509354579. PMID 20040706. Retrieved 2013-10-29. Girls who bully had higher self-esteem.

This is a bit tricky...
Self-esteem has been well esteemed generally in western culture for decades and influenced public policy in the USA and elsewhere. Maslow considered self-esteem a human need, just as many other important thinkers. There have been national efforts in the US to encourage the development of high self-esteem, especially in children. The WHO in a 2000 publication "Preventing Suicide" recommended strengthening student self-esteem to help prevent mental illness.
Having said all that...
The association between self-esteem and exercise has been studied.
Certain aspects of self-esteem or self-concept may be important or even vital to alleviation of mental illness. We just don't know.
So lets look at the data.
Cochrane Review 2002 by Ekeland
Cohen offered the following guidelines for interpreting the magnitude of the SMD in the social sciences: small, SMD = 0.2; medium, SMD = 0.5; and large, SMD = 0.8.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.

Cochrane Database Syst Rev. 2004;(1):CD003683. Exercise to improve self-esteem in children and young people. Ekeland E1, Heian F, Hagen KB, Abbott J, Nordheim L.
Since that review, Ekeland performed another review in 2005. No new studies and similar findings.

I found a few new reports since that review...
Exercise Therapy as a Treatment for Psychopathologic Conditions in Obese and Morbidly Obese Adolescents: A Randomized, Controlled Trial (Pediatrics 2006). Daley et al.
The Title is deceptive--this is a "proof of concept trial". These were obese otherwise healthy children.
81 participants, from 11-16 yo.
Randomized to 3 groups:
aerobic exercise with exercise counseling 30 minutes thrice weekly x 8 weeks WITH exercise counseling
"exercise placebo"--light stretching 30 minutes thrice weekly x 8 weeks WITH exercise counseling
usual care which was no intervention.
Results
27% had reported suicidal thoughts at baseline.
No major changes to depression score. Mild improvement in self-perception scores.
Exercise Effects on Depressive Symptoms and Self-Worth in Overweight Children: A Randomized Controlled Trial. (Petty et al. J Pediatr Psychology. 2009)
207 obese 7-11 yo. 59% Black.
Randomized to
low dose exercise (20 min daily)
high dose exercise (40 min daily)
control (nothing)
Exercise was at gym after school.
There was a dose-response improvment detected for depressive symptoms.
Post-intervention depression scores not significantly different, but the trend of improvement with increased exercise was significant.
Self worth outcome seemed to be dose and race-related.
Difference in social climate?
Or did we just catch a fluke?
Remember this? Daley, et al. 2006:
Physical Self-Worth
Children and Youth Physical Self-Perception Profile
Self-Perception Profile for Adolescents
Global Self Worth
GSW as a subcategory of physical self-perception not explained
And remember this one?
Three other less informative trials...
Randomized 74 African-American children from 15-19. Twenty dropped out. Randomized to competitive exergaming (Wii active), cooperative exergaming, or control (usual daily activities). Assessed at baseline, 10 weeks, and 20 weeks. Averaged 1.3 sessions weekly.

While there were no significant differences in self-esteem, students in the cooperative group did lose the most weight.

There was an increase in self-efficacy that was reportedly significant (p = 0.005) in the cooperative condition compared to the control.
Adolescent exergame play for weight loss and psychosocial improvement: a controlled physical activity intervention.
Staiano AE1, Abraham AA, Calvert SL. Obesity (Silver Spring). 2013 Mar;21(3):598-601.
Randomized thirty 12-17 year old children to either cycling to music vs interactive video game cycling. Performed twice weekly x 10 weeks. No control. No difference between groups.

Results included mild overall improvements in self-perception.
The effects of aerobic exercise on psychosocial functioning of adolescents who are overweight or obese.

Goldfield GS1, Adamo KB, Rutherford J, Murray M. J Pediatr Psychol. 2012 Nov-Dec;37(10):1136-47.
Recruited 25 adolescents. Randomized to either natural or built scenes observed while exercising. Each participant completed all three exercise conditions with assessment of self-esteem immediately following the test.

A randomised control trial of physical activity in a perceived environment on self-esteem and mood in UK adolescents.
Wood C, Angus C, Pretty J, Sandercock G, Barton J. Int J Environ Health Res. 2013;23(4):311-20.
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