Exercise for Student Mental Health

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Toronto

Disqualifiers: Physically active, Unsuccessful exercise clearance, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

Duration: 6 weeks

93 Participants Needed

Trial Summary

What is the purpose of this trial?

Post-secondary students report alarming rates of feeling overwhelmed, hopeless, anxious, and depressed. To better support student mental health, there is a well-documented need to improve the range and quality of mental health services available to students. Focussing on formalized treatment approaches and strategies supporting well-being in the campus community more generally are needed. Physical activity is an alternative therapeutic approach that could be implemented as an evidence-based lifestyle intervention for supporting mental health and well-being on post-secondary campuses. Despite the growing evidence supporting physical activity for student mental health, there are significant knowledge gaps in the literature. First, there is a paucity of research exploring the effects of different delivery styles (i.e., one-on-one (1:1) vs. group) on primary (i.e., mental health symptomology including anxiety symptoms, depression symptoms, psychological distress) and secondary (i.e., social support, social connectedness) outcomes. Secondly, the maintenance effects of a physical activity program on mental health or sustained physical activity behaviour change are largely unknown. Lastly, limited research has explored contextual implementation factors (e.g., intervention reach, adherence, and program satisfaction) that may influence the sustainability and scale-up of physical activity programs for student mental health. Examining contextual implementation factors is critical for optimizing physical activity intervention delivery and for facilitating wider dissemination of research findings into practice. The goal of this 3-arm parallel randomized controlled trial is to test the effectiveness of 1:1 physical activity intervention and group-based physical activity intervention compared to a wait-list control group in supporting post-secondary student mental health. The main questions include: * Are there group differences between 1:1, group-based delivery, and waitlist control in the immediate (post-intervention) and follow-up (1-month) maintenance effects on the primary and secondary outcomes? * Grounded in recommendations for process evaluation of complex interventions, what are contextual implementation factors that may be linked to variation in primary and secondary outcomes while offering insight for wider dissemination? Trial participants will be randomly assigned to one of the following groups: 1. 1:1 physical activity training; 2. Group-based physical activity training consisting of small 5-8 person groups; or 3. Waitlist control. Students will participate in the physical activity intervention after the intervention and follow-up period (10 weeks); however, their participation will not be monitored or evaluated. The physical activity training will involve a 6-week physical activity intervention consisting of weekly 1-hour sessions. Each session involves: (1) 30-minutes of behaviour change coaching (e.g., goal setting, action-planning, brainstorming strategies to overcome barriers to engaging in physical activity); and (2) 30-minutes of supervised and structured physical activity training. To address the aims of the study, participants will complete self-report questionnaires at baseline, post-intervention (following completion of the 6-week physical activity intervention), and 1-month following completion of the physical activity intervention. Questionnaires will assess demographic characteristics, primary outcomes (i.e., mental health symptomology including anxiety symptoms, depression symptoms, psychological distress), secondary outcomes (i.e., social support, social connectedness, physical activity behaviour) and contextual implementation factors (e.g., intervention reach, adherence, and program satisfaction) that may be linked to variation in primary and secondary outcomes while offering insight for wider dissemination. It is hypothesized that there will be no group differences between 1:1 delivery and group-based delivery on the primary outcomes. It is also hypothesized that group-based delivery, in comparison to 1:1 delivery will achieve greater improvements and more favourable maintenance effects in the secondary outcomes. Lastly, it is hypothesized that in comparison to the control group, 1:1 delivery and group-based delivery will be more effective in achieving change in the primary and secondary outcomes.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications. It seems focused on physical activity interventions, so it's likely you can continue your medications, but you should confirm with the trial organizers.

What data supports the effectiveness of the treatment Physical Activity Intervention for student mental health?

Research shows that physical activity interventions can help improve mental health in adolescents and university students by reducing symptoms of depression, anxiety, and stress, and enhancing overall well-being. Studies have found that regular exercise, including aerobic activities and yoga, can lead to better mood, increased self-confidence, and improved academic performance. ^{1 2 3 4 5}

Is exercise generally safe for improving mental health in students?

Research shows that exercise, like moderate-to-vigorous physical activity, is generally safe and can improve mental health in young people. It can reduce symptoms of stress, anxiety, and depression, and improve self-concept without significant safety concerns. ^{4 6 7 8 9}

How does the Physical Activity Intervention treatment differ from other treatments for student mental health?

The Physical Activity Intervention is unique because it focuses on using exercise, particularly short-term and structured programs, to improve mental health in students. Unlike traditional treatments that may involve medication or therapy, this approach leverages the benefits of physical activity to reduce anxiety and stress, making it a novel and accessible option for students. ^{5 9 10 11 12}

Eligibility Criteria

This trial is for post-secondary students who are experiencing mental health issues such as feeling overwhelmed, anxious, or depressed. Participants will be randomly assigned to either individual physical activity training, group-based training, or a waitlist control group.

Inclusion Criteria

I have felt my mental health was poor, fair, or good in the last month.

Moderately or insufficiently active (< 23 units of weekly leisure activity) based on interpretation scores from the Leisure-Time Physical Activity Questionnaire

Fluent in English (e.g., proficiency in reading and verbal expression - written and oral)

Exclusion Criteria

Physically active (24 units or more of weekly leisure activity) based on interpretation scores from the Leisure-Time Physical Activity Questionnaire

Unsuccessful exercise clearance using the physical activity readiness questionnaire (PAR-Q)

I consider my mental health to be very good or excellent.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Treatment

Participants engage in a 6-week physical activity intervention with weekly 1-hour sessions, including 30 minutes of behavior change coaching and 30 minutes of supervised physical activity.

6 weeks

6 visits (in-person)

Follow-up

Participants are monitored for maintenance effects on mental health and physical activity behavior 1 month after the intervention.

4 weeks

1 visit (in-person)

Waitlist Control

Participants in the waitlist control group are assessed at baseline, post-intervention, and follow-up, and offered the intervention after the follow-up period.

10 weeks

Treatment Details

Interventions

• Physical Activity Intervention

Trial Overview The study tests the effectiveness of one-on-one versus group-based physical activity interventions on student mental health and well-being. It involves weekly sessions combining behavior change coaching with structured exercise over six weeks.

Participant Groups

Group I: Group Physical Activity Intervention Delivery Experimental Treatment 1 Intervention

The group physical activity intervention will receive the physical activity intervention delivered in small groups of 3-8 students led by a trained sport and recreation coach.

Group II: 1:1 Physical Activity Intervention Delivery Experimental Treatment 1 Intervention

The physical activity intervention will be delivered using 1:1 coaching.

Group III: 10-Week Waitlist Control Group Active Control 1 Intervention

Students who are assigned to the 10-week waitlist control condition will be assessed on primary and secondary outcomes at baseline (T1), at 6-weeks (T2) and at 1-month follow-up (T3). At completion of the 1-month follow-up assessment, students in the wait-list control condition will be offered participation in the physical activity intervention; however, their behaviour will not be monitored or evaluated. Participants will have a choice of engaging in 1:1 physical activity intervention delivery or group-based physical activity intervention delivery.

Who Is Running the Clinical Trial?

University of Toronto

Lead Sponsor

Trials

739

Recruited

1,125,000+

Findings from Research

A systematic review of 57 studies involving physical activity interventions in adolescents found small-to-moderate positive effects on externalizing problems (d=0.320), internalizing problems (d=0.316), self-concept (d=0.297), and academic achievement (d=0.367).

The effectiveness of these interventions was influenced by various factors, including the type of outcome measured, study design, sample characteristics, and specific intervention methods, highlighting the need for tailored approaches in adolescent mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of physical activity interventions on psychosocial outcomes in adolescents: A meta-analytic review. Spruit, A., Assink, M., van Vugt, E., et al.[2018]

A 9-week aerobic exercise program for adolescents in a psychiatric institution led to significant improvements in mental health, including reductions in depression, anxiety, and fatigue, particularly among girls.

All participants showed increased self-efficacy and vigor, suggesting that regular physical activity can enhance both physical fitness and psychological well-being in institutionalized youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic exercise in the psychological treatment of adolescents. Brown, SW., Welsh, MC., Labbé, EE., et al.[2004]

Exercise and physical activity have been shown to prevent or delay the onset of various mental disorders and can provide therapeutic benefits, either alone or as a supplement to other treatments.

Despite the promising evidence for exercise interventions in mental health, there is a lack of controlled studies across most disorder groups, indicating a need for more rigorous research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise and physical activity in mental disorders: clinical and experimental evidence. Zschucke, E., Gaudlitz, K., Ströhle, A.[2021]

This scoping review analyzed 16 studies involving young people aged 12-25.9 years with diagnosed mental disorders, highlighting that moderate-to-vigorous exercise is particularly effective in reducing symptoms of depression.

While the evidence for exercise's impact on other mental health issues like anxiety, psychosis, and eating disorders is mixed, the overall findings suggest that exercise interventions could be a promising avenue for improving mental health in young people, warranting further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise interventions for mental disorders in young people: a scoping review. Pascoe, MC., Bailey, AP., Craike, M., et al.[2023]

Physical activity and exercise interventions, particularly low- to moderate-intensity aerobic exercises, have been shown to positively impact mental health by alleviating depressive symptoms and perceived stress among university students, a group particularly vulnerable to mental disorders.

Acute bouts of exercise, especially yoga, can immediately enhance the perception of bodily signals and improve emotion processing, suggesting that both regular and immediate physical activity can significantly benefit the mental well-being of emerging adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing Mental Health, Well-Being and Active Lifestyles of University Students by Means of Physical Activity and Exercise Research Programs. Herbert, C.[2023]

In a study of 32,829 Finnish adolescents aged 15-16, engaging in at least 30 minutes of moderate-to-vigorous physical activity weekly was linked to a 17% reduction in chronic stress symptoms, highlighting the mental health benefits of physical activity.

Conversely, more than 30 minutes of daily active school transport was associated with increased odds of depression symptoms and visits to school psychologists, suggesting that while physical activity is beneficial, certain types of active transport may have adverse mental health effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations of leisure-time physical activity and active school transport with mental health outcomes: A population-based study. Jussila, JJ., Pulakka, A., Ervasti, J., et al.[2023]

The COPE Healthy Lifestyles TEEN intervention, implemented with 31 preadolescents aged 11 to 13, led to significant decreases in anxiety and improvements in physical activity and healthy lifestyle beliefs.

Participants with higher initial levels of anxiety, depression, and suicidal thoughts showed notable improvements in self-concept and reductions in these mental health issues after completing the COPE program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

COPE: A Pilot Study With Urban-Dwelling Minority Sixth-Grade Youth to Improve Physical Activity and Mental Health Outcomes. Hoying, J., Melnyk, BM.[2019]

Supervised exercise interventions were found to significantly reduce body mass index (BMI) in overweight and obese adolescents, indicating their effectiveness in managing obesity.

While the overall impact on increasing physical activity levels was small and varied, some interventions also showed positive effects on psychological symptoms, suggesting a multifaceted benefit of exercise programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. Ruotsalainen, H., Kyngäs, H., Tammelin, T., et al.[2018]

Physical activity and exercise interventions can significantly reduce symptoms of depression and anxiety in young people, with both moderate-to-vigorous and light-intensity activities showing positive effects.

Despite some promising results, the overall evidence base is limited, indicating a need for more robust research to fully understand the impact of physical activity on various mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity and exercise in youth mental health promotion: a scoping review. Pascoe, M., Bailey, AP., Craike, M., et al.[2022]

The Stride program, a 12-week structured exercise initiative for university students experiencing mental distress, was found to be feasible and well-received by participants, with positive feedback on its components and delivery.

Participants showed significant improvements in depressive symptoms, physical activity levels, and mental health-related quality of life from pre- to post-program, suggesting that structured exercise can effectively support mental health in higher education settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Stride program: Feasibility and pre-to-post program change of an exercise service for university students experiencing mental distress. Jeftic, I., Furzer, B., Dimmock, JA., et al.[2023]

Short-term exercise interventions, lasting from a single session to three weeks, can effectively reduce anxiety symptoms and help maintain mood during stressful situations for tertiary students, based on a review of 14 controlled trials.

There is a need for more research on the effects of short-term exercise on depression and other mental health issues, highlighting the importance of universities promoting awareness and access to exercise facilities for students.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single Session and Short-Term Exercise for Mental Health Promotion in Tertiary Students: A Scoping Review. Pascoe, MC., Bailey, AP., Craike, M., et al.[2021]

The HAPPY Study will assess the effectiveness of a comprehensive intervention in six primary schools in New South Wales over 12 months, focusing on increasing physical activity and improving psychological well-being among students.

The study will utilize various quantitative tools to measure physical activity levels, on-task behavior, and social support, aiming to establish a link between increased physical activity and enhanced student behavior and social skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rationale and protocol paper for the Healthy Active Peaceful Playgrounds for Youth (HAPPY) study. Cotton, W., Dudley, D., Jackson, K., et al.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

The effects of physical activity interventions on psychosocial outcomes in adolescents: A meta-analytic review. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Aerobic exercise in the psychological treatment of adolescents. [2004]

3. Korea (South) pubmed.ncbi.nlm.nih.gov

Exercise and physical activity in mental disorders: clinical and experimental evidence. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Exercise interventions for mental disorders in young people: a scoping review. [2023]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Enhancing Mental Health, Well-Being and Active Lifestyles of University Students by Means of Physical Activity and Exercise Research Programs. [2023]

6. Denmark pubmed.ncbi.nlm.nih.gov

Associations of leisure-time physical activity and active school transport with mental health outcomes: A population-based study. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

COPE: A Pilot Study With Urban-Dwelling Minority Sixth-Grade Youth to Improve Physical Activity and Mental Health Outcomes. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. [2018]

9. England pubmed.ncbi.nlm.nih.gov

Physical activity and exercise in youth mental health promotion: a scoping review. [2022]

10. Netherlands pubmed.ncbi.nlm.nih.gov

The Stride program: Feasibility and pre-to-post program change of an exercise service for university students experiencing mental distress. [2023]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Single Session and Short-Term Exercise for Mental Health Promotion in Tertiary Students: A Scoping Review. [2021]

12. England pubmed.ncbi.nlm.nih.gov

Rationale and protocol paper for the Healthy Active Peaceful Playgrounds for Youth (HAPPY) study. [2018]