Relationship between Physical Activity and Symptoms of Depression and Anxiety in Childhood and Adolescence - Coursework Example

Relationship between Physical Activity and Symptoms of Depression and Anxiety in Childhood and Adolescence Affiliation Relationship between Physical Activity and Symptoms of Depression and Anxiety in Childhood and Adolescence Depression is a mental disorder that affects the emotions and behaviours of a person. Anxiety is a psychological issue that affects nearly every individual at one or more times in their lives. Depression and anxiety impact negatively on a person’s health and are regarded as precursors of stress related illnesses. Depression mainly begins in childhood years and continues in adolescent years. Adolescence is a time whereby an individual is faced with numerous changes in their lives as they develop and transit from childhood into adulthood. This period requires that an individual adjusts psychologically to the changes he or she is going through. Failure to adapt to these changes results in anxiety, stress, fears and depression. Depression affects many people globally. Depression and anxiety present big challenges to researchers and health professionals. The big challenge has been the lack of an efficient and effective treatment. Up to now, no effective treatment has been developed to deal with the effects of depression. It is approximated that out of four clients who are treated for depression associated symptoms, only one or less of the treatment is successful. In adolescents, who are the main focus of this paper, it is approximated that the likelihood of depression related illnesses is nearly twelve percent. Among adolescents who are under depression related illnesses, only half of them ever receive treatments. The possible causes of the other half not getting treatment include disclosure failure, ignorance and fear. This is not an admirable trend nor one to appreciate as it is the right of every individual to receive treatment. The main focus of this paper is how physical activity is associated with symptoms of depression and anxiety in childhood and adolescence (Meyer & Gullota, 2012). The National Research Council and Institute of Medicine (2009) reports that between the start of the first depression symptom and depression related disease, there is usually a two to four year period. It is during this window period that a prevention step can be undertaken. What is characteristic about depression is that there are high chances of its development during life stages when a person is considered as vulnerable. These stages include childhood and adolescence. Anxiety is also another major aspect that affects a person during these vulnerable periods. It may be said that anxiety occurs due to the lack of knowing. When a person is in a period whereby so many aspects occurring in their life are new, then the person is bound to get anxious about them. Many questions go through their mind like why is this happening to me? What is wrong with my body? These questions result into anxiety. It has been stated that the standard age at which the first depression symptoms express themselves is fourteen years. However, eleven years is the age at which the initial symptoms emerge. This emergence of depression symptoms is influenced biologically. Biological influencers include hormonal changes and brain changes resulting from development. These changes are usually associated with adolescence. To mitigate the anxiety and depression effects, prevention is vital. The main point of focus of prevention strategies should be focused during childhood and adolescence years when anxiety and depression episodes are likely to occur. In fact, the National Research Council and Institute of Medicine (2009) notes that prevention of the initial symptoms is vital as it may have lifetime effects. This is mostly when there is lack of effective and efficient treatments to deal with anxiety and depression effects as is the case. It is always said that prevention is better than cure. This statement holds true for anxiety and depression related illnesses. Prevention enables the enhancement of techniques which can be acquired during childhood and adolescence years and carried on into adult age. The above discussion on prevention of anxiety and depression leads to the following question, what preventive measure can be undertaken to mitigate anxiety and depression in life? The answer to this question lies in the main focus of this paper which is the relationship between physical activity and symptoms of anxiety and depression particularly in childhood and adolescence. Research conducted is of the view that physical activity avails an efficient and effective technique to prevent anxiety and depression symptoms. The main aim of physical activity in dealing with anxiety and depression symptoms is to counter depression related illnesses. This ensures that anxiety and depression symptoms are controlled and dealt with. Therefore the relationship between physical activity and symptoms of depression and anxiety is the use of physical activity in countering and dealing with them. What physical activity does to children and adolescents is that it avails necessary techniques to deal with anxiety and depression symptoms. If for instance a child is identified as one who has a higher chance of been affected by depression than others due to life experiences such as divorce of his or her parents, then physical activity can be used to provide him or her with the necessary flexibility techniques to cope with anxiety and depression symptoms (Meyer & Gullota, 2012). Numerous research studies have been conducted on the relationship between physical activity and symptoms of depression and anxiety. The evidence provided by these studies has been exemplary and all point towards the benefits accrued by the use of physical activity. Many of the research studies have focused on childhood and adolescence because of the onset of anxiety and depression during these years. Years when development can be affected by anxiety and depression but physical activity can easily be used in prevention and control of their symptoms. It is also the stages when it is easy and appropriate to impart life time habits associated with physical activity (Meyer & Gullota, 2012). Justifications for Stating the Relationship between Physical Activity and Symptoms of Depression and Anxiety is Prevention As stated, physical activity is associated with symptoms of depression and anxiety through its provision of preventive techniques. Hence, this has to be justified. To justify it, it is good to note of the availability of numerous means through which physical activity has been and can be used to prevent the start of anxiety and depression and also prevent their symptoms as presented in research studies. Physical activities are vital in regulation of various biological processes such as hormonal synthesis. They are also important in social aspects of the lives of children and adolescents whereby they foster social structures which provide adolescents and children with support. They also help in improving the physical features of children and adolescents which are essential in determining whether their anxiety levels. This is because they are faced with fears over their new developmental and growth features occurring in their bodies. Physical activities also aids in control of psychological aspects of adolescence and childhood. During these two stages, an individual is faced with numerous processes that are psychological. An example of these psychological processes is emotions and how to deal with them. They are filled with anxiety on how to deal with the new emotions that they are experiencing. Such psychological processes are related with anxiety and depression (Meyer & Gullota, 2012). Research studies have shown that physical activity can enhance anxiety and depression symptoms. These symptoms include irregular sleep patterns, feelings associated with lack of worth and low self esteem. As a result, physical activities hinder anxiety and depression related illnesses. In many studies as will be shown, physical activity has shown to be effective. This efficacy justifies the relationship between physical activity and symptoms of anxiety and depression in childhood and adolescence (Meyer & Gullota, 2012). Physical Activity in Prevention of Anxiety and Depression in Childhood and Adolescence Research studies have used various methods to test how physical activity is associated with anxiety and depression symptoms. In many of these studies, it is the methods that have differed. Studies that have been used include prospective and cross sectional epidemiology studies. The common features about these types of studies are that they normally are composed of a survey. Participants are asked to undertake the survey by detailing their past, present physical activities or how frequently they undertake physical activities. Participants also indicate their present level of anxiety and depression symptoms. In many cases, participants are not able to indicate their levels of anxiety and depression symptoms. The failure to specifically measure the levels of anxiety and depression symptoms presents a weakness in prospective and cross sectional epidemiology studies. This is because they cannot effectively indicate how physical activity associates with symptoms of anxiety and depression (Meyer & Gullota, 2012). This weakness calls for improved studies which can effectively measure anxiety and depression levels of participants as they undergo physical activities. Improved studies have made use of approved scales that are utilised in measurement. Thereafter evaluation includes computation. In computation, mean values of anxiety and depression are compared with various physical activity levels by use of ANOVA techniques. Correlation coefficients can also be computed or ratio odds. Other studies have made use of regression analyses while others have made use of standard Chi – square techniques to calculate chances of attaining a particular point in anxiety and depression points at certain physical activity levels. This way, these studies are able to bring out the relationship between physical activity and symptoms of anxiety and depression. Clinically, it is rare to have a definite evaluation of this relationship. However, if a definite relationship is obtained, then it is inferred that physical activity prevents anxiety and depression symptoms (Meyer & Gullota, 2012). Evidence from Studies Showing the Relationship between physical Activity and Symptoms of Depression and Anxiety in Childhood and Adolescence The relationship that exists between physical activity and symptoms of anxiety and depression in children and adolescents is subject to a lot of research. In adults, it has been clearly illustrated. However, the question is what about in children and adolescents? Studies illustrating this relationship are not many. Nevertheless, those that do study this relationship have indicated in general that a relationship does exist. Children and adolescents who have taken part in these studies have expressed reduction of depressive and anxiety symptoms as they take part in physical activity. Children and adolescents who are physically active experience have shown minimal depressive moments in their life if any. Equally, decreased levels of physical activity have been shown to be related with symptoms of depression. As stated above, studies employ different methods of analysis. Kremer at al., (2014) undertook a study on the relationship between physical activity and symptoms of depression in children and adolescents in Australia. The study utilised logistic regression analysis. It found that the chances for depressive symptoms were greater in girls. Further, it found that the chances for symptoms of depression were reduced significantly in participants who had more occasions in physical activity such as physical education classes. Kremer et al., (2014) goes on to explain that the reason for these findings is based on biological and psychological reasons. Reduced rates of depressive symptoms have a relationship with taking up of healthy activities like physical exercises. Low rates of depressive symptoms may also be related with the increased positive social pressure associated with taking part in group or class physical exercises with other children or adolescents. Biologically, physical activities may promote levels of monoamine by enhancing neurotransmitter activity. It may also enhance endorphin levels (Kremer, et al., 2014). Physical activity can also reduce the amount of cortisol that is secreted in children and adolescents. These biological effects in turn function to reduce and control symptoms of anxiety and depression. Kremer et al., (2014) continues to indicate that, children and adolescents who chose not to take part in physical activities and instead watched television had more depressive symptoms. Reason being, the children and adolescents were somewhat susceptible to socio – cognitive results that were negative due to television use rather than taking part in physical activity. Negative socio – cognitive outcomes include reduced social time and association with other children and adolescents. What physical activity does is that it increases the outcomes of positive socio – cognitive outcomes, which in turn has a positive impact that reduces depressive symptoms and reduces anxiety symptoms. After physical exercise Kremer et al., (2014) states that, children and adolescents experience physiological responses from an aroused and active nervous system. If a child or an adolescent spends more time on the television, he or she is not physically active. The time spent watching television negatively impacts on their sleep regime when he or she has a high rate of watching television programs. It is outright that watching television is associated with low levels of physical activity. This results in what is termed as psychological distress. When the adolescent or child takes part in physical activity Kremer et al., (2014) notes that, it affects their psycho – physiological reactions to watching television. This in turn decreases the chances of developing depressive symptoms. According to Kremer et al., (2014), adolescents and children who had higher incidences of depressive symptoms may have chosen to undertake minimal physical activity and more time in activities which demanded less physical activity such as television viewing. Such activities are indicated as isolated activities. This is because more time is spent alone than with other children or adolescents. On this basis, Kremer et al., (2014) argues that reduced physical activity may act to raise the chances of depressive symptoms. However, the study was not thorough as it did not study bi – directional effects such as cases where children and adolescents spent a lot of their time in both physical activities and activities that did not involve physical exercise such as television viewing. Other studies have used this bidirectional approach and found that there were increased levels of depressive symptoms among children and adolescents. The study did not also look at cases whereby participants undertook low levels of physical activity and had more time in activities that did not need physical activity. The study used a cross – sectional design which limited its directionality. The response of the study was average. Nevertheless, all genders were adequately represented in the study. It was also limited to Australians. However, this study indicated strongly, the relationship between physical activity and symptoms of depression and anxiety through its use of a big sample size and strong designs methods. In support of Kremer’s study, Veitch et al., (n.d.) conducted a study on mental health and physical activity among adolescents. This study looked at the occurrence of symptoms of depression among adolescents. It also examined the relationship between physical activity, television watching, and depressive symptoms. Its findings showed a high occurrence of depressive symptoms among adolescent females as compared to that of adolescent males. The findings did not show any relationship between changes in physical activity and depressive symptoms. Nevertheless, females who spent more time watching television and engaged less in physical activities showed depressive symptoms. Reason being that they withdrew from physical activities that included more social participation and spent more time alone watching television. Goldfield, et al., (2011) undertook a study on the relationship between intensity and volume of physical activity and symptoms of depression among adolescents in Ottawa. According to this study, adolescents who took part in increased physical activity showed improved psychological adaptations than those who took part in minimal physical activity. Gender was decisive in these findings as increased physical activity was related to decrease in depressive symptoms in males but did not impact on their anxiety symptoms. However, females experienced decreased anxiety symptoms but there was no impact on their depressive symptoms. This relationship between increased physical activity and psychological body functions was not considerable when gender was regarded other than for decrease in anxiety in females. The findings of this study did indicate that a difference does exist between volume and intensity of physical activity. Goldfield et al., (2011) indicates that increased intensity of physical activity had a more close relationship in reducing depressive symptoms than total volume of physical activity. This is to say that even short episodes of physical activity involving high intensity provided greater effects in reducing depressive symptoms than low intensity physical activities that took a long time. A study on the relationship between leisure time vigorous physical activity and symptoms of depression in adolescents conducted by Moksenes, Lillefjell & Espnes (2013), indicated that adolescents who showed greater stress levels also indicated greater scores on symptoms of depression. Physical activity was not considerably related with symptoms of anxiety and depression in both girls and boys. Nevertheless, the study did indicate a vital role of high physical activity levels in preventing stress factors which lead to anxiety and depression symptoms. Stress factors in the study included peer pressure and performance for boys, while for girls; they included pressure at home and peer pressure. This study was very considerate of the differences in physical abilities between boys and girls. A variation in symptoms of anxiety and depression was due to differences in stress factor of boys and girls. The study showed that physical activity in boys increased with age while for girls it was relatively stable across all age groups. As expected, the physical activities mean scores for boys were relatively higher than girls. This result was in agreement with other studies that showed boys are more involved in physical activities than girls. However, it was in disagreement with other studies regarding physical activity increase with advancing age in adolescent boys and girls. Other studies indicate that physical activity decreases with advancing age. What was the relationship between physical activity and symptoms of depression? The study, based on the cross sectional design utilised showed that, due to considerable relations, adolescents who took part in physical activities were minimally affected by stress factors that lead to anxiety and depression disorders. In other words as stated in the study, adolescents who did not show anxiety and depression symptoms were those who took part in physical activities. The study by Moksenes, Lillefjell & Espnes (2013), has its strength and weaknesses. Its main strength was the use of a large group of participants and their high rate of response. Its limitations are its use of a cross – sectional design. It would also be asked whether the freedom of participants to report measures themselves contributed to a legitimate evaluation of physical exercise participation. This is because participants may have been enforcers of bias in reporting. The main cause of bias may have been due to lack of understanding of the main question which was largely associated with the younger age groups. Rothon, et al., (2010), states that minimal research has been conducted on the relationship between depressive symptoms and physical activity in adolescents. This is especially from longitudinal studies. The study Rothon, et al., (2010) conducted was a cohort study with participants been between the ages of eleven and fourteen. A survey was conducted and it had a response rate of eighty four percent. Short Moods and Feelings Questionnaire was utilised in measurement of symptoms of depression. Also, as stated in the types of methods studies utilise, this study made use of the logistic regression analysis was used to evaluate the relationship between physical activity and symptoms of depression. This was done both longitudinally and cross – sectionally. The findings of this study found a relationship between physical activity and depression symptoms. This was stated as a cross – sectional relationship for both boys and girls. Depression symptoms reduced by eight percent for each additional hour of physical activity undertaken per week. Also, the study did show that from the logistic regression analysis, there was no considerable relationship between physical activity and symptoms of depression in longitudinal analysis. The study took into consideration differences in ethnicity. It also examined the eligibility of the participants before enrolling them for the study. Its response rate was rational and provided a good basis to evaluate the data that was obtained. Its use of Short Moods and Feelings Questionnaire was accepted. This is because the technique has been described as an appropriate assessment tool for depression especially in epidemiological research studies. However, this study used data obtained from self reporting by participants. Self reporting has been questioned by researchers especially on its credibility. As stated, adolescents under depression symptoms may not remember their physical activity facts as compared to those who are not under depression symptoms, reason being that these adolescents tend to underrate their physical activity levels. Also, age advancement may lead to reduced physical activity among adolescents resulting in underrating physical activity in follow – up cases. Longitudinal relationship may thus not be found between physical activity and symptoms of depression. Tarakci, et al., (2011), also undertook a study to show “the relationship between physical activity level, anxiety, depression and functional ability in children and adolescents with juvenile idiopathic arthritis.” The design of the study was a cross sectional one. Patient ages were between eight and seventeen years. As indicated, the study utilised healthy controls. The study also made use of the questionnaire commonly referred to as “The Screen for Child Anxiety Related Emotional Disorders.” Symptoms of depression were evaluated using the “Children’s Depression Inventory.” (Tarakci, et al., 2011). As the participants were patients suffering from juvenile idiopathic arthritis, a “Child Health Assessment Questionnare” (Tarakci, et al., 2011), was used to assess the childrens’ functional capability. As the condition leads to pain, a “visual analog scale” (Tarakci, et al., 2011), was used to measure pain. This study found that depression was associated to functional ability, anxiety and health in adolescents and children with juvenile idiopathic arthritis. What does this indicate? This indicates that health is paramount in defining the relationship between physical activity and symptoms of anxiety and depression. If a child or an adolescent has poor health, then that relationship may not be showed. This is because it negatively impacts on his or her functional ability. Clark et al., (2007) undertook a prospective study. The participants of the study were all adolescents. The study period was two years. This study was also based on self reporting of physical activity of the participants. The study found that there was no relationship between the chances of symptoms of depression and physical activity. Another study by Sagatun et al., (2007) found minute prospective results of physical activity on anxiety and depression symptoms. This study was done on participants of the ages between fifteen and sixteen. Later on, the study studied eighteen to nineteen year olds which indicated that the results remained considerably similar especially for adolescent boys. Gender is one of the key determinants in defining what relationship exists. It has been found that when human beings indulge in a lifestyle which lacks exercise, in this case, physical activity, they are most likely to suffer from emotional and mental disorders along with physical illnesses. As evidenced above, a relationship exists between physical activity and symptoms of depression and anxiety in children and adolescents. Studies have shown that physical activity levels are greatest at childhood. They then go on to decrease as the child grows into adolescence. In fact, Johnson, et al., (2008) notes that only a little as a third of adolescents in middle age school attain the suggested levels of physical activity. This is also the same case when it comes to taking part in physical activity programs. In support of the above discussions, it has been shown that nearly half of all mental illnesses, depression is classified as a mental illness, begin at the age of fourteen, however, the symptoms of mental illnesses show earlier in childhood years. It is important to note that adolescence is the period that follows childhood. It is also a time of development, a time when with advancing age, physical activity levels are on a downward momentum and symptoms of depression are on the rise. This statement precisely indicates the relationship between symptoms of depression and anxiety with physical activity. Gender plays a big role in this relationship. Females are shown to express higher chances of symptoms of depression. Girls in adolescence show twice the probability of developing depressive symptoms than adolescent boys (Johnson, et al., 2008). As the studies described above have shown, not all are in agreement that a relationship exists. However, for longitudinal and cross – sectionally designed studies, they have shown that a relationship exists between symptoms of depression and anxiety with physical activity. In support of these studies, Johnson, et al., (2008) indicates on studying that children who took part in physical education classes, it was shown that there was an inverse relationship between sadness feelings and physical activity. What does this mean? This means that when children took part in physical activity, depressive symptoms reduced. However, when they failed to take part in physical activity, depressive symptoms increased. Hence, physical activity is said to prevent and control symptoms of depression. Sallis et al., (2000), reassessed fifty four studies touching on adolescents. The findings of this reassessment indicate that many of the studies found an inverse relationship between physical activity and symptoms of depression and anxiety. Another reassessment of studies looking at physical activity in the adolescence stage, done by Calfas & Taylor (1994) says that positive developments in symptoms of depression were related to physical activity. Johnson et al., (2008) notes that, physical activity levels are considerably higher in adolescent males than in adolescent females which supports the gender differences that are indicated when it comes to physical activity. Larun et al., (2006) looks at a review done by Cochrane that described the relationship between symptoms of depression and anxiety and physical activity in children and adolescents. The review analysed evidence by use of samples from the total population of children. In the review, studies reviewed were undertaken in the years between 1980 and 1999. The findings of the review indicated that two of the studies showed no considerable relationship in groups that undertook low intensity exercises. Five of the studies showed that physical activity had a considerable relationship with symptoms of anxiety and depression in children. Physical Impacts of Physical Activity One of the most important concerns of children and adolescents is their physical appearance. Adolescents especially show great concern on how they look. How is their body appearance? Physiological effects that are brought about by physical activity create a relationship between physical activity and symptoms of depression and anxiety. Such physiological effects in adolescents include capability to control their body weight, figure and shape, and also capability to control sleep. Al Mamun et al., (2007) notes that, if an adolescent thinks that he or she is overweight, that is enough reason to trigger depressive symptoms. What physical activity does is that it enables children and adolescents to control their body weight. When they are able to do so, then they perceive themselves as individuals with a better body. This thought works to prevent depressive symptoms. By controlling their body weight, adolescents and children attain a regime of body weight management. Body weight management has several merits that include improvement of the overall body image. An improved body image for an adolescent means raised self esteem levels which as stated above function to reduce depressive symptoms. On sleep patterns, irregular sleep pattern is one of the symptoms of depression. According to Meyer & Gullota (2012), when children and adolescents take part in physical activities they express improved sleep patterns where the sleep regularity improved. As they explain, physical activity raises sleep quality. How does it do this? Physical activity reduces energy in the body. It also raises the overall temperature of the body while functioning to break down tissue in the body. Socio Cognitive Impacts of Exercise Physical activity has various socio cognitive effects that can explain its relationship with symptoms of depression and anxiety. One of the most important things about physical activity is that it leads to an enhancement in self esteem in children and adolescents. A high level of self esteem is considered to lower anxiety and depressive symptoms while low levels raise the chances of expressing anxiety and depressive symptoms. What is self esteem? Self esteem is defined as how an individual views him or herself. Another beneficial socio cognitive effect of physical activity is that it also leads to enhancement in self efficiency just as it leads to an improvement in self esteem. Taking these two socio cognitive effects into consideration, it can be seen that physical activity raises the moods of children and adolescents. This creates a relationship between physical activity and symptoms of anxiety and depression. A raise in self efficiency and esteem means that a child is relaxed in any set of environment regardless of the negative factors that may be associated with that environment. Children and adolescents are also able to adapt and cope better when their self efficacy and esteem levels are high. This functions to hinder depressive symptoms that may otherwise be harmful to the child or adolescent. It is for this reason that the relationship between physical activity and depressive symptoms is meaningful and important. Children and adolescents who fail to take part in physical activity are more susceptible to depressive symptoms (Schumacher, 2010). Internalizing Behaviour Problems The relationship between physical activity and symptoms of depression and anxiety may result from its help in helping children and adolescents learn and internalize their behaviour problems. What does this mean? This means that when children and adolescents take part in physical activity, they learn how to interact with others. They learn what behaviour is socially acceptable and what is not socially acceptable. This learning is not from someone telling or instructing them, it results from what they observe and do during the physical activity they are taking part in. To put it in the right context, it is a self internalized thing (Meyer & Gullota, 2012). In regard to behaviour, physical activity functions as behavioural trigger. It triggers certain behaviours that are therapeutically connected to reduction of depressive and anxiety symptoms. Such triggered behaviours include enhanced problem solving skills and mastering abilities. Such acquired behaviours resulting from physical activities are a boost to a child’s or an adolescent’s ability. This improvement positively impacts on their moods and feelings. As a result, negative depressive symptoms are prevented. It is true that behaviour is connected with individual feelings. Negative feelings increase depressive symptoms, while positive feelings prevent depressive symptoms. Adolescents and children who take part in physical activities are exposed to rewarding experiences which raise their positive feelings (Meyer & Gullota, 2012). Social Impacts of Physical Activity When children and adolescents are involved in physical activity, they experienced amplified social relations with their peers. This social impact functions as an enhancement that enhances the relationship between physical activity and symptoms of depression and anxiety. As Sallis & Patrick (1994) state, social associations developed during physical activities work to avail moral and mental support to children and adolescents. It is extremely vital that adolescents develop social networks during their late childhood and early adolescent years. This is because it is the period when the chances to do so are high. These social networks are improved by taking part in physical activities. This way anxiety and depressive symptoms are repressed. Meyer & Gullota (2012), note that children and adolescents who are involved in team games during physical education classes are beneficiaries. They benefit in that team games which are an example of physical activity in school work like antidepressants. So, if an adolescent or a child is lonely, he or she will experience a reduction in depressive symptoms. Conclusion This paper has touched on various issues that describe the relationship between physical activity and symptoms of depression and anxiety in children and adolescents. It has also looked at studies that have been conducted to illustrate what relationship exists. However, various questions concerning this relationship are still not answered. Questions such as at what age during a child’s and an adolescent’s life is this relationship maximally expressed. Some studies, though few did not find any relationship due to various factors unique to each of them. Prevention of depressive and anxiety symptoms is the main aspect which illustrates this relationship. While there are suggested levels of physical activity, minimal physical activity can be vital in preventing depressive symptoms. A physical activity that involves team or group work is important when it comes to internalizing behaviours, improving self esteem and efficiency which raises the moods of children and adolescents. References Al Mamun, A., Cramb, S., McDermott, B. M., et al. (2007). Adolescents’ perceived weight associated with depression in young adulthood: a longitudinal study. Obesity, 15(12), 3097 – 3015. Calfas, K. J., & Taylor, W. C. (1994). Effects of physical activity on psychological variables in adolescents. Paediatrics Exercise Science, 6(4), 406 – 423. Goldfield, G. S., Henderson, K., Buchholz, A., et al. (2011). Physical Activity and Psychological Adjustment in Adolescents. Journal of Physical Activity and Health, 8, 157 – 163. Jerstad, S. J., Boutelle, K. N., Ness, K. K., & Stice, E. (2011). Prospective Reciprocal Relations between Physical Activity and Depression in Adolescent Females. Journal of Consultative Clinical Psychology, 78(2), 268 – 272. doi:  10.1037/a0018793 Johnson, C. C., Murray, D. M., Elder, J. P. et al. (2008). Depressive Symptoms and Physical Activity in Adolescent Girls. Medicine & Science in Sports and Exercise, 40(5), 818 – 826. Kremer, P., Elshaug, C., Leslie, E., et al. (2013). Physical activity, leisure – time screen use and depression among children and young adults. Journal of Science and Medicine in Sport, 17, 183 – 187. Larun, L., Nordheim, L. V., Ekeland, E., et al. (2006). Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews, 3, n.p. Mangerud, W. L., Bjerkeset, O., Lydersen, S., & Indredavik, S. (2014). Child and Adolescent Psychiatry and Mental Health, 8(2), n.p. doi:10.1186/1753-2000-8-2 Meyer, A. l., & Gullota, T. P. (2012). Physical Activity Across the Lifespan: Prevention and Treatment for Health and Well-Being. Springer. Moksnes, U. K., Lillefjell, M., & Espnes, G. A. (2013). The Relationship between Stress, Leisure Time Vigorous Physical Activity and Depressive Symptoms in Adolescents. Journal of Child and Adolescent Behavior, 2(120), n.p. doi: 10.4172/jcalb.1000120 National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioural disorders among young people: Progress and Possibilities. Washington, DC: The National Academic Press. Rothon, C., Edwards, P., Bhui, K., et al. (2010). Physical activity and depressive symptoms in adolescents: a prospective study. BMC Medicine, 8(32), n.p. doi:10.1186/1741- 7015-8-32 Sagatun, A. (2009). Physical activity and mental health in adolescence – a longitudinal study in a multiethnic cohort. Centre for Child and Adolescent Mental Health. Norwegian Institute of Public Health. Sallis, J. F., & Patrick, K. (1994). Physical Activity guidelines for adolescents: Consensus Statement. Pediatric Exercise Science, 6, 302 – 314. Sallis, J. F., Prochaska, J. J., & Taylor, W. (2000). A review of correlates of physical activity of children and adolescents. Medicine & Science in Sports & Exercise, 32(5), 963 – 975. Schumacher, A.,& Seiler, R. (2010). The Association between Extra – Curricular Sport Participation and Social Anxiety Symptoms in Children. Journal of Clinical Sport Psychology, 4, 191 – 203. Tarakci, E., Yeldan, I., Kaya Mutlu, E., et al. (2011). The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis. Clinical Rheumatology, 30(11), 1415 – 20. doi: 10.1007/s10067-011-1832-0. Read More