Children and adolescents with depression can benefit from physical activity | get informed

Mental health, understood from a global perspective as the absence of mental disorders together with an optimal state of well-being, is a critical component for health and development in adolescence. However, between 10 and 20% of all children in the world experience a problem related to mental health and almost half of them develop them before the age of 14. In our country the figures are very alarming; Spain is the European country with the highest prevalence of mental health problems among children and adolescents, according to Unicef. One in five children between the ages of 10 and 19 have some type of diagnosed mental health problem. Depression is the second most prevalent mental disorder among children and adolescents (6.2% globally). In addition, we have to take into account that the incidence of depressive symptoms at an early age is a strong predictor of mental problems in the future; it has been shown that more than 67% of young people with depressive symptoms are at risk of developing a full-blown depressive syndrome or anxiety in adulthood.

Clinical practice guidelines suggest the use of psychological and pharmacological therapy to reduce depressive symptoms in children and adolescents. In addition to the limitations that may reduce adherence to treatment, recent survey data is worrying, since a large percentage of children and adolescents (80% in the US) who need mental health treatment do not receive appropriate medical care. That is why it is urgent to explore new treatments that are safe and easy to implement in the daily life of children and adolescents with depression. Interventions with physical activity have been shown to be effective in reducing depressive symptoms in adults and have been included in international guidelines as an official treatment at these ages.

Faced with this social challenge to improve depressive symptoms in the youngest, science forcefully proposes intervention with physical activity. The results are very resounding: exercise interventions can markedly reduce depressive symptoms in children and adolescents. Additionally, physical activity is generally safer and more accessible than other clinical treatments for depression.

Very recently it has been published in JAMA Pediatrics a rigorous meta-analysis work that included more than 2,400 children and young people who participated in more than 20 randomized clinical trials. The work includes data from research carried out in the United States, China, Chile, Germany, Iran, Brazil, Thailand and the United Kingdom; most of the last 10 years. The authors found a moderate to large association between decreased depressive symptoms and physical activity interventions for adolescents and youth with diagnosed depression. The results of this meta-analysis are even more conclusive when the interventions were carried out for participants with high depressive symptoms. In addition, it is also noteworthy that the benefits were greater for participants aged 13 and over than for younger ones.

These findings reinforce the role of physical activity in the treatment of depressive symptoms and highlight the potential of physical education in primary and secondary education to improve mental health in children and adolescents. The authors, while stating that various physical activity programs (swimming, running, dancing, sports activities, physical education class…) can reduce the symptoms of depression, also acknowledge that further research is needed to define the dose well. of necessary exercise (duration, frequency, intensity, mode) and to know the underlying mechanisms behind the antidepressant properties of physical exercise.

In relation to the dose of exercise, the interventions of three weekly sessions and a duration of less than 12 weeks were those that produced the greatest benefits in the reduction of depressive symptoms compared with other frequencies and durations. More research is needed to explain these findings and to establish optimal parameters of physical activity for the treatment of depressive symptoms, as there is controversy as to whether more physical activity does not necessarily translate into greater improvements. In the same way, it is pointed out that low doses of physical activity may not reach a minimum stimulus to achieve the desired benefits.

It seems that a combination of biological, psychological and psychosocial factors could well explain the relationship between physical activity and depression. Biological factors include activation of the endocannabinoid system to stimulate the release of endorphins, increased bioavailability of neurotransmitters (serotonin, dopamine, or norepinephrine) that are reduced with depression, and changes in brain plasticity that occur over the long term. Psychosocial and behavioral hypotheses have also been formulated, according to which physical activity can lead to improvements in self-perception, social interactions and self-confidence.

Approximately 65% ​​of the child and youth population in Spain do not reach the minimum WHO recommendations of 60 minutes a day of moderate aerobic physical activity; this percentage is even more alarming in girls, as it rises to 70% according to the study Steps of the Gasol Foundation that included almost 4,000 schoolchildren. In this situation at the national level, it is difficult for us to think that children and adolescents with depressive symptoms or with diagnosed depression are currently benefiting from physical activity, since they have numerous barriers to participate in physical activity programs.

The promises of physical activity for the promotion of mental health will not be achieved by making physical activity more antidepressant, but by promoting physical activity and getting children and young people with mental health problems to access it. The evidence that indicates that physical activity is an effective medicine for mental health is strong and robust, but now the time has come to find the way so that children and young people can easily access it.

GET INFORMED is the space of EL PAIS SALUD where we will talk about those aspects related to physical activity, sport and physical and mental health. From the Sciences of Physical Activity and Sports, attempts have been made to advance scientific knowledge about the importance of movement and physical exercise on the body, as well as the processes that explain why certain adaptations, modifications, or changes occur at different times. levels (physiological, anatomical, motor, emotional or cognitive). This space seeks to find scientific explanations that support and justify the very beneficial reasons for physical activity and sport. Likewise, it will try to discuss and refute certain myths or false beliefs existing in society on specific issues of physical exercise and health.

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