An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial

doi:10.1016/j.ypmed.2004.02.007

Preventive Medicine

Volume 39, Issue 2, August 2004, Pages 424-434

https://doi.org/10.1016/j.ypmed.2004.02.007 Get rights and content

Abstract

Objectives. This study investigates the effectiveness of 24-week aerobic and weight-training exercise plus behavior modification for mental health and quality of life (QOL) outcomes.

Methods. Mental health and QOL data was collected using the Depression Anxiety and Stress Scales and SF-36 Health Status Survey, respectively. Employees from a single work-site were randomized into either treatment or wait-list control groups.

Results: Mental Health (P = 0.005), Vitality (P < 0.001), General Health (P = 0.009), Bodily Pain (P = 0.005), Physical Functioning (P = 0.004), Depression (P = 0.048), and Stress (P = 0.036) scales significantly improved for the treatment group compared to wait-list controls after 24 weeks.

Conclusions. Multimodal exercise is as effective as other single-modality exercise treatments for depressive symptoms and, in contrast to other studies, does improve stress symptoms and QOL outcomes.

Introduction

In Australia in 1996, mental disorders accounted for nearly 30% of all nonfatal disease burden among which depression (8%) was the leading cause, in both men and women [1]. Prevalence estimates for mental disorders were obtained from self-administered questionnaires (surveys). General population mental health screening instruments have been demonstrated to be valid tools that can identify associated negative outcomes. For example, the StayWell HealthPath® health-risk appraisal contains 78 questions including two on stress and one on depression, has demonstrated predictive validity for higher health care expenditure [2], [3], absenteeism [4], and cardiovascular-disease-related mortality [5] in high-risk employees vs. low-risk employees according to stress and depression scores. Interventions that reduce self-reported psychological distress have the potential to increase employee productivity in the workplace. The Australian National Health Survey used the self-administered SF-36 Health Status Survey to measure and develop normative quality of life (QOL) values for the Australian population using over 17,000 observations [6]. Those with self-reported serious physical and medical conditions including cancer, heart disease, stroke, hypertension, and diabetes had lower Mental Health scores by approximately 7 points compared to those without these conditions [6]. Improving mental health scores (SF-36) may have clinically meaningful implications in terms of reducing the communities' health care burden as reported by Ware [7].

Therapeutic options available to health care specialists in the mental health domain include antidepressant medication, psychotherapy, or combination therapy (antidepressant medication and psychotherapy, i.e., “standard care”) [8]. Mental disorders often coexist with each other (e.g., depression and anxiety) and with physical conditions and disabilities (e.g., depression and obesity). These comorbid conditions may contribute to or result from mental disorders [8], which may translate into poorer physical health, and QOL. Therefore, additional interventions beyond “standard care” are needed, which specifically address depressive symptoms and generally has no efficacy in improving additional variables that may act as causal or complicating factors. Exercise is one such intervention, as it has been shown to address both psychological and physiological factors associated with reduced QOL as well as many risk factors for loss of healthy life years [i.e., disability-adjusted life years (DALYs)] [1], [9]. Some evidence suggests exercise interventions may have a preventive as well as therapeutic role for mental health disorders; however, optimal dose in terms of frequency, duration, and intensity needed for treatment and prevention efficacy is not fully defined.

The work-site offers extensive opportunities for testing the effectiveness of interventions to improve mental health and QOL in large populations. Features that enhance feasibility include a cohesive cohort with similar characteristics, geographical localization, access to facilities, potential for social and behavioral reinforcement, and benefits to both the employee and employer. Previous work-site interventions have not reported significant improvements in the mental health domain [10], [11]. This may have been due to methodological shortcomings. Well-designed randomized controlled trials are still needed to establish the efficacy of exercise-based interventions for the treatment of self-reported psychological distress in the workplace.

This study investigates the effectiveness of a 24-week combined aerobic and weight-training exercise plus behavior modification intervention for improving mental health and QOL outcomes. We hypothesized that this multimodal intervention would improve QOL, depressive, anxiety, and stress symptoms relative to wait-list controls over a 24-week period.

Section snippets

Participants and study design

Star City casino employees (approximately 3,800) were invited to participate. The recruitment process consisted of orientation seminars, posters, and a research team member (EA) setting up a stall in the lunchroom to promote the project. The orientation seminar involved a detailed description of the project including subject requirements, timetable, costs, location of testing and training facilities, and to answer any questions regarding the project mentioned herein. The promotional material

Results

A summary of participant flow and retention is presented in Fig. 1. Of the 3,800 employees invited to participate, 244 attended an orientation seminar where informed consent was obtained (Phase 1). These employees were instructed to obtain a doctor's clearance and then attend the local (to the work-site) designated fitness center for anthropometrical and physiological data collection, before random group assignment (Phase 2). Of the 244 employees that entered Phase 1, 167 did not attend the

Discussion

This 24-week exercise-based intervention significantly improved QOL, depression, and stress outcome measures within a heterogeneous employee population. Mental health constructs that improved included the Vitality and Mental Health (SF-36), Depression and Stress (DASS) scales. Similar trends were observed for both Role-Emotional and Social Functioning constructs, with Role-Emotional mean changes over the 24-week period almost reaching statistical significance (P = 0.06). Based on the ES of 0.35

Acknowledgements

We are grateful to the management and staff of Star City casino, Sydney Australia, for supporting this trial. We thank the numerous undergraduate students from the School of Exercise and Sport Science at the University of Sydney who assisted in data collection. Finally, we thank management and staff from UTS union gym for allowing free access to their facilities throughout this trial.

References (40)

C.J Murray et al.
Mortality by cause for eight regions of the world: global burden of disease study
Lancet
(1997)
P.F Lovibond et al.
The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories
Behav. Res. Ther.
(1995)
T.M DiLorenzo et al.
Long-term effects of aerobic exercise on psychological outcomes
Prev. Med.
(1999)
L Lalonde et al.
Comparing the benefits of diet and exercise in the treatment of dyslipidemia
Prev. Med.
(2002)
A Steptoe et al.
The effects of exercise training on mood and perceived coping ability in anxious adults from the general population
J. Psychosom. Res.
(1989)
L Lalonde et al.
The Canadian Collaborative Cardiac Assessment G. Health-related quality of life with coronary heart disease prevention and treatment
J. Clin. Epidemiol.
(2001)
Y Beniamini et al.
Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients
Am. J. Cardiol.
(1997)
C.M Yu et al.
Long-term changes in exercise capacity, quality of life, body anthropometry, and lipid profiles after a cardiac rehabilitation program in obese patients with coronary heart disease
Am. J. Cardiol.
(2003)
R.G Laforge et al.
Stage of regular exercise and health-related quality of life
Prev. Med.
(1999)
C.D Mathers et al.
The burden of disease and injury in Australia
Bull. W.H.O.
(2001)

D.R Anderson et al.

Health enhancement research organization research C. The relationship between modifiable health risks and group-level health care expenditures. Health enhancement research organization (HERO) research committee

Am. J. Health Promot.

(2000)

R.Z Goetzel et al.

The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. The Health Enhancement Research Organization (HERO) Research Committee

J. Occup. Environ. Med.

(1998)

S.A.P.M.P.H Serxner et al.

The impact of behavioral health risks on worker absenteeism

J. Occup. Environ. Med.

(2001 (April))

K.W Smith et al.

The validity of health risk appraisal instruments for assessing coronary heart disease risk

Am. J. Public Health

(1987)

ABS. National Health Survey: SF-36 Population Norms, Australia. Canberra: The Australian Bureau of...

J.E Ware et al.

Health status and the use of outpatient mental health services

Am. Psychol.

(1984)

AIHW. National Health Priority Areas Report. Mental Health: A Report Focusing On Depression. Canberra: Commonwealth...

T.E Dunnagan et al.

Mental health issues in the workplace: a case for a new managerial approach

J. Occup. Environ. Med.

(2001 (December))

H.R Eriksen et al.

Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme

Occup. Med. (London)

(2002)

S.H Lovibond et al.

Manual for the depression anxiety stress scales

(1993)

Cited by (159)

Weight change and mental health status in a behavioral weight loss trial
2023, Journal of Affective Disorders
Obesity, depression, and anxiety often co-occur, but research on weight change and mental health status is limited. This analysis examined how the mental component score (MCS-12) from the Short Form health survey changed over 24 months in weight loss trial participants with vs. without treatment seeking for affective symptoms (TxASx) and by weight change quintiles.
Participants with complete data (n = 1163) were analyzed from enrollees in a cluster-randomized, behavioral weight loss trial in rural U.S. Midwestern primary care practices. Participants received a lifestyle intervention with different delivery models, including in-clinic individual, in-clinic group, or telephone group counseling visits. Participants were stratified by baseline TxASx status and 24-month weight change quintiles. Mixed models were used to estimate MCS-12 scores.
There was a significant group-by-time interaction at the 24-month follow-up. The largest 0–24 month increase in MCS-12 scores (+5.3 points [12 %]) was observed in participants with TxASx who lost the most weight during the trial, while the largest decrease in MCS-12 scores (−1.8 points [−3 %]) was observed in participants without TxASx who gained the most weight (p < 0.001).
Notable limitations included self-reported mental health, the observational analytical design, and a largely homogenous source population, as well as the possibility of reverse causation biasing some findings.
Mental health status generally improved, particularly among participants with TxASx who experienced significant weight loss. Those without TxASx who gained weight, however, had a decline in mental health status over 24 months. Replication of these findings is warranted.
Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis
2023, Sleep Medicine Reviews
Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, −1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, −1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.
Bicycle ergometer exercise during hemodialysis and its impact on quality of life, aerobic fitness and dialysis adequacy: A pilot study
2022, Complementary Therapies in Clinical Practice
Chronic kidney disease patients on hemodialysis commonly have a worse quality of life (QoL) due to complications of the disease and dialysis procedure. Physical exercise has emerged as a strategy to improve this scenario. The objective of this study was to evaluate the effect of an intradialytic aerobic exercise program on QoL and aerobic fitness in hemodialysis patients.
These are a secondary analysis of clinical trial data previously published in which hemodialysis patients were randomized into “bike group” (using an adapted exercise bicycle) or “control group” (usual care). The exercise sessions lasted 45 min (5 min of warm-up, 35 min of moderate-intensity and 5 min of cool-down) three times/week for three months. The QoL domains were assessed using the SF-36 QoL questionnaire. Aerobic fitness was evaluated using the 6-min walk test (6MWT). Circulating cytokines, biochemical parameters and Kt/V were also assessed.
Nine patients completed three months of exercise (5 men, 44 ± 11 years), and nine were in the control group (6 men, 44 ± 14 years). In the bike group, there was a trend to improve the physical role domain (p = 0.06) regarding QoL, an improvement in the 6MWT (p = 0.02), and in the Kt/V (p = 0.03) after three months. There was a positive correlation between the general health domain and Kt/V (r = 0.691; p = 0.003) and an inverse correlation between the physical functioning domain and plasma TNF-α levels (r = −0.514; p = 0.04).
12 weeks of intradialytic aerobic exercise was enough to benefit hemodialysis patients' quality of life, aerobic fitness, and quality of dialysis.
Clinicaltrials.gov id: NCT04375553.
Worker wellbeing and productivity in advanced economies: Re-examining the link
2021, Ecological Economics
Citation Excerpt :
Increases in productivity as a result of engaging in workplace wellness programmes helps to support the case that wellbeing is a direct determinant of productivity levels. Indeed, many programmes have been shown to reap rewards in terms of enhanced organisational productivity (Atlantis et al., 2004; Burton et al., 2005; Halliwell, 2010), often gaining financial rewards that outweigh the cost of implementing the scheme (Henke et al., 2011; McDaid et al., 2008; PricewaterhouseCoopers, 2008). We have seen that various components of wellbeing have been positively associated with higher levels of productivity.
Labour productivity is a key concept for understanding the way modern economies use resources and features prominently in ecological economics. Ecological economists have questioned the desirability of labour productivity growth on both environmental and social grounds. In this paper we aim to contribute to ongoing debates by focusing on the link between labour productivity and worker wellbeing. First, we review the evidence for the happy-productive worker thesis, which suggests labour productivity could be improved by increasing worker wellbeing. Second, we review the evidence on ways that productivity growth may undermine worker wellbeing. We find there is experimental evidence demonstrating a causal effect of worker wellbeing on productivity, but that the relationship can also sometimes involve resource-intensive mediators. Taken together with the evidence of a negative impact on worker wellbeing from productivity growth, we conclude that a relentless pursuit of productivity growth is potentially counterproductive, not only in terms of worker wellbeing, but even in terms of long-term productivity.
Mental health in relation to changes in sleep, exercise, alcohol and diet during the COVID-19 pandemic: Examination of four UK cohort studies
2023, Psychological Medicine
Which factors can be used to persuade managers to start workplace physical activity programmes and what motivates employees to participate? A Hungarian study on goals, effects and motivations
2024, Sport, Business and Management: An International Journal

View all citing articles on Scopus

View full text

An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial

Abstract

Introduction

Section snippets

Participants and study design

Results

Discussion

Acknowledgements

Lancet

Behav. Res. Ther.

Prev. Med.

Prev. Med.

J. Psychosom. Res.

J. Clin. Epidemiol.

Am. J. Cardiol.

Am. J. Cardiol.

Prev. Med.

The burden of disease and injury in Australia

Bull. W.H.O.

Health enhancement research organization research C. The relationship between modifiable health risks and group-level health care expenditures. Health enhancement research organization (HERO) research committee

Am. J. Health Promot.

The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. The Health Enhancement Research Organization (HERO) Research Committee

J. Occup. Environ. Med.

The impact of behavioral health risks on worker absenteeism

J. Occup. Environ. Med.

The validity of health risk appraisal instruments for assessing coronary heart disease risk

Am. J. Public Health

Health status and the use of outpatient mental health services

Am. Psychol.

Mental health issues in the workplace: a case for a new managerial approach

J. Occup. Environ. Med.

Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme

Occup. Med. (London)

Manual for the depression anxiety stress scales