運動可能無法降低焦慮或是憂鬱


  August 8, 2008 — 新研究顯示,對某些病患來說,運動對於精神健康預後,例如憂鬱或是焦慮,並沒有正面的影響;然而,研究者表示,其對於身體健康的好處並沒有爭議,病患應該被鼓勵持續運動。
  
  根據荷蘭阿姆斯特丹大學的研究人員們表示,該研究發現顯示個人對於運動的精神反應,至少部份來說,可以透過基因來預測。
  
  一項大型、縱向、針對雙胞胎進行的研究結果顯示,運動較多的人發生焦慮或是憂鬱的症狀並沒有比運動較少的人少。
  
  除此之外,縱向分析顯示,運動參與度的增加並不能預測焦慮與憂鬱症狀的減少。
  
  來自阿姆斯特丹大學的第一作者Marleen H. M. De Moor向Medscape精神學表示,這些研究結果並不代表運動對於焦慮與憂鬱是沒有效果的,但是我們認為這個效應可能不適用於每一個人;某些人可能對於運動有正面的反應,然而,運動可能對於某些人的情緒穩定沒有太大幫助。
  
  這項研究結果發表於8月號的一般精神學誌上。
  
  【傳統智慧】
  流行病學研究結果一致地報導,缺乏規律地運動與憂鬱症狀及焦慮有關;部份隨機分派臨床研究證實運動訓練有降低憂鬱效果,且其作用與抗憂鬱藥物差不多。
  
  研究者表示,以運動降低與焦慮症狀的傳統智慧來支持這樣的闡釋是有些冒險的,實驗性研究結果並非總可以外推到一般大眾。
  
  根據這項研究,基因因素可能扮演部分角色,因為他們大概佔了50~60%的運動行為變異,且大約40~50%是焦慮與憂鬱症狀變異。
  
  將這些基因影響因子列入考慮後,研究人員們檢驗一大群群眾,看自願性運動的改變是否會影響焦慮與憂鬱的症狀。
  
  他們分析來自一項進行中研究的數據,這項研究是針對自願登錄到荷蘭雙胞胎註冊試驗的雙胞胎成人所進行。
  
  他們收集1991年到2002年、年齡介於18到50歲個體的資訊,參與者中包括5952對雙胞胎、1,357位家族成員與1,249位父母;在試驗前、2、4、7、9與11年後,取得自行通報回覆有關於運動行為,包括形式、頻率與時間長度以及焦慮與憂鬱症狀問卷的資料。
  
  研究者特別專注在休閒時間的運動,非休閒運動,例如散步或是騎車上班,這在荷蘭是非常普遍的,則沒有列入運動當中;Moor博士表示,我們真的對人們自己選擇的運動感到興趣。
  
  焦慮與憂鬱症狀,以憂鬱症、焦慮與體憂慮感及神經過敏症連續性指標評估。
  
  【運動仍有好處】
  以橫向及縱向測試確定運動與焦慮及憂鬱之間是否存在因果關係;分析發現運動能減少焦慮及憂鬱症狀,然而,研究者注意到,比起運動本身,基因的影響更能減少這些焦慮憂鬱的狀況。
  
  舉例來說,一對同卵雙胞胎,一個熱愛運動,一個都不活動,研究員發現兩人對於焦慮與憂鬱狀況並無不同,這與異卵雙生不同。
  
  斷面研究資料顯示,個體在11年的觀察期間,增加其運動量並不能減輕焦慮或憂鬱症狀。
  
  在此同時,受試者停止運動也不會使他們更焦慮或憂鬱。
  
  研究者注意到,此項發現並不會減損規律運動對於心血管健康的好處,但他們表示斷面研究顯示出應該謹慎闡釋運動與精神健康之間的關係。
  
  根據De Moor的研究,比較重要的是複製這樣的結果,以及關注運動是否能改善精神健康,且決定何種運動是比較有益的。
  
  她指出,運動可能有助於精神健康,但是運動無法幫助所有人,而且特定運動可能會是較佳的選擇。
  
  此研究沒有資金方面的報告,是由史坦利醫學研究院與澳洲國家健康醫學研究會贊助。

Exercise May Not Lower Anxiety, Depression in Everyone

By Marlene Busko
Medscape Medical News

August 8, 2008 — New research shows that in some individuals exercise does not have a positive effect on mental health outcomes such as depression or anxiety. Nevertheless, researchers say its beneficial effect on physical health is not in dispute, and patients should be encouraged to stay physically active.

According to investigators at the University of Amsterdam, in the Netherlands, the study's findings suggest an individual's psychological response to exercise may, at least in part, be predicted by genetics.

A large, longitudinal population-based study in identical twins found the twin who exercised more did not display fewer anxious or depressive symptoms than the twin who exercised less.

Further, longitudinal analyses showed that increase in exercise participation did not predict decreases in anxious and depressive symptoms.

"The findings do not mean that exercise has no effect on anxiety and depression, but we think that this effect may not be the same for everyone; some people may respond positively toward exercise, while in others it may not improve their mood much," first author Marleen H.M. De Moor, from the University of Amsterdam, told Medscape Psychiatry.

The study is published in the August issue of the Archives of General Psychiatry.

Conventional Wisdom

Epidemiological studies have consistently reported that lack of regular exercise is associated with depressive symptoms and anxiety. Some randomized controlled clinical investigations have suggested that exercise training causes a depression-lowering effect that is comparable to antidepressant use.

While it may be tempting to interpret these findings as supporting the conventional wisdom that exercise decreases depression and anxiety symptoms, the researchers note that results from experimental studies cannot always be extrapolated to the general population.

According to the study, genetic factors may play a role, since they account for about 50% to 60% of variations in exercise behavior and about 40% to 50% of variations in symptoms of anxiety and depression.

Taking this potential genetic confounding into account, the investigators examined a large population to see whether changes in voluntary exercise led to changes in symptoms of anxiety and depression.

They analyzed data from an ongoing study in adult twins who voluntarily registered with the Netherlands Twin Register.

This included information on individuals aged 18 to 50 years from 1991 to 2002. The participants included 5952 twins, 1357 siblings, and 1249 parents. Data from self-reported replies to questionnaires about exercise behavior, including the type, frequency, and duration, and symptoms of anxiety and depression were available at baseline and 2, 4, 7, 9, and 11 years later.

The researchers focused specifically on leisure-time exercise. Non–leisure-time activities such as walking or biking to work, which are very common in the Netherlands, were not counted as exercise. "We were really interested in physical activity that people choose themselves," said De Moor.

Anxious and depressive symptoms were measured using continuous scales for depression, anxiety, somatic anxiety, and neuroticism.

Exercise Still Beneficial

Cross-sectional and longitudinal tests were conducted to determine whether there was a causal relationship between exercise and symptoms of anxiety and depression.

The analysis showed that exercise behavior was associated with decreased anxious and depressive symptoms.

However, rather than an effect of the exercise itself, the researchers note the reduction in these conditions is more likely due to common genetic factors.

For instance, although in the case of identical twins where, when 1 was physically active and 1 was sedentary, the researchers saw no difference in anxiety and depression, this was not the case with fraternal twins.

Longitudinal data showed that individuals who increased their exercise levels during the 11-year follow-up period did not become less anxious or depressed.

Over the same time period, participants who stopped exercising did not become more anxious and depressed.

The findings do not detract from beneficial effects of regular exercise on cardiovascular health, but they suggest that cross-sectional studies showing exercise and mental health correlations should be interpreted cautiously, the researchers note.

According to Ms. De Moor, it is important to replicate these findings and obtain more insight into when exercise does and does not work to improve mental health outcomes and to determine the types of exercise that might be most beneficial.

"Exercise may help [mental health], but exercise may not help everyone, and certain types of exercise may be better than others," she said.

No financial disclosure was reported. This study was supported by the Stanley Medical Research Institute and the National Health and Medical Research Council of Australia.

Arch Gen Psychiatry. 2008;65:955-960.Abstract

    
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