Gymnastik- och idrottshögskolan, GIH

PURPOSE: Mental health problems are increasingly prevalent during adolescence. Nutritional factors, particularly antioxidants, are of interest due to their potential to reduce oxidative stress and inflammation linked to mental health issues. However, the relationship between dietary antioxidants and adolescent mental health remains unclear. This study aimed to investigate this association in Swedish adolescents and explore potential gender differences.

METHODS: Cross-sectional data were gathered among Swedish boys and girls aged 13-14 years (n = 1139). Participants reported their dietary intake using a detailed web-based method and mental health outcomes, including anxiety, psychosomatic symptoms, and health-related quality of life (HRQoL) using self-report scales. Multiple linear regression analysis, adjusted for confounders, was used to investigate the associations between mental health outcomes and tertiles of dietary intake of vitamin C, E and β-carotene.

RESULTS: Adolescents in the highest tertile of β-carotene intake reported lower anxiety (β=-1.23, 95% CI=-2.34, -0.12), fewer psychosomatic symptoms (β=-0.91, 95% CI=-1.69, -0.13), and better HRQoL (β = 0.89, 95% CI = 0.11, 1.68). Similarly, higher vitamin C intake was associated with fewer psychosomatic problems (β=-1.00, 95% CI=-1.79, -0.21). Vitamin E intake showed no associations. Significant gender interactions were observed on the multiplicative scale analysis and limited to the middle tertiles of β-carotene and vitamin C for anxiety and psychosomatic symptoms, respectively.

CONCLUSION: Our findings underscore the potential role of dietary antioxidants, particularly β-carotene and vitamin C, in adolescent mental health. Further research including diverse populations and employing prospective designs could deepen the understanding and inform public health interventions.

PURPOSE: The transition phase between childhood and adolescence is critical, given the observation of increased mental health issues during this period, coupled with the absence of efficient intervention tools. This study aims to examine a possible effect of physical activity on mental health symptoms in adolescents during this transitional age.

METHODS: We used data from a large-scale population-based Swedish twin sample of 14,083 individuals to investigate cross-sectional and longitudinal associations between physical activity and mental health problems during childhood and adolescence. We examine different aspects of mental health symptoms, including internalizing and externalizing symptoms. We applied generalized estimating equations to investigate the associations and explored potential familial confounding using within-twin pair analysis.

RESULTS: We found high physical activity intensity and frequency to be associated with better mental health throughout childhood and adolescence, cross-sectionally and longitudinally. Compared to those who reported low, those reporting high physical activity intensity and frequency in both childhood and/or adolescence had significantly lower symptoms of mental health at age 15. This association was statistically significant for both internalizing and externalizing symptoms. The within-twin pair analysis showed that familial confounding factors can largely explain the association with the externalizing scale, but not the internalizing scale.

DISCUSSION: Physical activity in childhood and adolescence may play an essential role in reducing the risk of developing mental health problems, especially internalizing symptoms. Implementing acceptable, low-risk, and cost-effective interventions to promote physical activity could effectively safeguard young individuals from these symptoms.

Background

Is exercise beneficial or detrimental for patients with stress-induced exhaustion disorder (ED)? While previousstudies have shown the benefits of exercise for various mental health conditions, its effects on ED —characterized by persistent fatigue following chronic psychosocial stress — remain underexplored.This study compares the effects of acute exercise on heart rate variability (HRV) and cortisol between patientswith ED and healthy controls across two exercise intensities. The results could provide insights into how EDinfluences the body’s ability to handle and recover from exercise.

Methods

We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Onseparate occasions, they performed 22-minute cycling sessions at either low or moderate intensity. Wemeasured HRV and salivary cortisol before, after, and 30 minutes after exercise. HRV measures RMSSD,LF/HF, and SD2/SD1 were analyzed. Exercise effects were assessed using linear mixed models.

Findings

RMSSD was significantly lower in the ED group than controls (p <0.05), but there was no difference in exerciseresponse between groups or intensities. SD2/SD1 and LF/HF values in response to exercise were higher in theED group (p <0.05), indicating increased sympathetic activation. This effect was particularly pronounced atmoderate intensity. There were no differences across groups, time, or intensity for cortisol.

Discussion

The findings indicate chronic dysregulation of the autonomic nervous system in individuals with ED, withaltered autonomic responses to exercise, slower recovery, and increased sympathetic activity post-exercise.These results can inform treatment strategies for ED patients.

AIM: Investigate the longitudinal relationship between physical activity, organised physical activity, fitness, screen time and academic performance among Swedish adolescents.

METHODS: Data from 1139 adolescents at age 13, included vigorous physical activity (accelerometry), fitness (submaximal ergometer test), screen time and organised physical activity participation (self-reported) and academic performance (math and Swedish grades at ages 13 and 16 from registry). Academic performance at age 16 was categorised as A-D (higher grades or pass) or E, F (fail or at-risk of failing). Multilevel logistic regression models were used to examine the relationships while adjusting for gender, parental education, parental country of birth and academic performance at age 13.

RESULTS: Higher fitness at age 13 was associated with increased odds of receiving A-D at age 16 (OR: 1.04 per mL, 99% CI 1.00, 1.07, p = 0.003). High screen time during weekdays was associated with reduced odds (OR: 0.40, 99% CI 0.20, 0.81, p = 0.001) compared to low screen time.

CONCLUSION: Academic performance at the end of compulsory school (age 16) was related to fitness and screen time 3 years earlier. These findings create a paradigm for future randomised controlled trials to explore how influencing these factors might affect academic performance.

Tackling inequities and inequalities related to adolescents' engagement in physical activity and sport is highlighted in recent research. However, rarely addressed are the issues of intersecting hierarchal systems of power that interlocks on both micro and macro levels, affecting how physical activity patterns express social memberships across several contexts. Therefore, this study aimed to explore how adolescents' physical activity during leisure and school hours expressed intersecting social positions and institutional school segregation, using a critical intersectionality approach. Nested in a larger study, a cross-sectional design was applied, including a total of 1139 adolescents in grade 7 (age 13-14) from Swedish school settings. Data was retrieved from surveys, accelerometers, and national registries. Descriptive statistics and stratified analyses were performed to examine levels of moderate-to-vigorous physical activity (MVPA) during school and leisure hours connected to intersecting social positions and school segregation contexts. The statistical analysis indicated that MVPA, to varying extents, expressed both individual social position and school segregation across the sub-groups explored. Inequalities in MVPA were closer connected to intercategorical gendered social positions in school contexts, rather than during leisure hours. However, there were significant intracategorical differences among girls during leisure hours across segregated contexts. Our results suggest that the power structures of school segregation together with educational and sport logics intertwined seem to 'disadvantage' especially girls with a non-ethnically Swedish background. Yet, it also highlights a need to problematize 'the absent minority girl' in equity focused physical activity research. This study emphasizes how an intersectionality approach can shed light on social (dis)advantages connected to adolescents' MVPA from two poles of power, contributing to a more comprehensive and critical understanding of social inequities in physical activity and health research.

BACKGROUND AND OBJECTIVES: Individuals aged 70 and older frequently experience an increased risk of deficits in both physical and cognitive functions. However, the natural progression and interrelationship of these deficits, as well as their neurologic correlates, remain unclear. We aimed to classify the data-driven physical-cognitive phenotypes and then investigate their associations with neuroimaging markers.

METHODS: This cross-sectional study included 70-year-old participants from the Gothenburg H70 Birth Cohort (2014-2016). Based on physical performance (grip strength, balance, walking speed, and chair stand) and cognitive measures (episodic memory, perceptual speed, executive function, verbal fluency, and visuospatial abilities), we applied latent class analysis to identify physical-cognitive phenotypes. Based on the brain MRI measurements, 3 groups of neuroimaging markers were involved-neurodegeneration, cerebral small vessel disease (cSVD), and microstructural white matter (WM) integrity. We performed multinomial logistic regressions to examine the differences between the physical-cognitive phenotypes.

RESULTS: In total, 1,140 participants (female: 53.3%) without dementia and disability were included in the study, with 721 (female: 52.2%) undergoing MRI scans. Three physical-cognitive phenotypes were identified: an "optimal" group characterized by high performance in both physical and cognitive functions, an "intermediate" group showing a slight reduction in both domains, and a "physical deficit" group marked by a significant reduction in physical performance. Compared with the optimal group, the other 2 groups were more likely to present with vascular risk factors. The physical deficit group had higher odds of experiencing depression compared with the intermediate group (adjusted odds ratio [aOR] 2.9, 95% CI 1.4-5.9). Compared with the optimal group, the odds of presenting all 3 severe neuroimaging markers were higher in both the intermediate (aOR 3.4, 95% CI 1.5-7.9) and physical deficit (aOR 10.3, 95% CI 2.4-45.0) groups.

DISCUSSION: This study highlights the variability in physical and cognitive performance among older adults and suggests that neuroimaging markers of neurodegeneration, cSVD, and microstructural WM integrity may account for these variations. Our findings indicate the potential for developing group-based strategies to prevent and manage age-related functional decline. Further research with larger sample sizes is needed to deepen our understanding of physical-cognitive decline patterns.

Aim: Insufficient physical activity among adolescents, combined with poorer well-being and mental health, are worrying societal problems. Adolescents with ADHD encounter daily challenges and are more prone to experiencing mental and physical health issues compared to their peers. The aim was to investigate associations between moderate-to-vigorous physical activity, sedentary time, screen-time, psychosomatic problems, and ADHD symptoms in adolescents. Method: Data came from a cross-sectional study. Participants (N = 1139) were seventh-grade students who answered questionnaires on screen-time, psychosomatic problems, hyperactivity, and ADHD and were assigned an accelerometer, worn for seven consecutive days. Data were analyzed using linear regression. Results: A negative association was found between moderate to vigorous physical activity and psychosomatic problems in the entire sample. Moderate-to-vigorous physical activity was more strongly associated with psychosomatic problems for adolescents with self-reported ADHD symptoms (B = -0.14 (-0.24, -0.04)) than adolescents without ADHD symptoms (B: -0.03 (-0.05, -0.01)). Conclusions: Moderate-to-vigorous physical activity, sedentary time, and screen-time were all significantly associated with psychosomatic problems among all participants. Moderate-to-vigorous physical activity showed a stronger association with psychosomatic problems among participants with ADHD. This indicates that this group may be particularly responsive to interventions attempting to promote mental health through physical activity.

Numerous scholars within sport and health sciences have emphasized the critical role of the school environment in shaping young people’s physically active lives. While this PhD project addresses this specific dimension, the inquiry is also situated within wider academic discourses (ways of thinking, speaking, and producing knowledge within scholarly communities) concerning adolescents’ physical activity in school settings. School contexts are often narrated as ‘ideal’ for promoting young people’s physically active lives, with physical activity research carrying broader assumptions where the goal often is to prescribe movement, to get students to be more active. However, such assumptions rest on a set of foundational commitments: ontological (concerning the nature of reality), epistemological (concerning how we come to know things), and axiological (concerning values). Together, these shape our understanding of what physical activity is, how it should be studied, and why it matters. Similarly, the ways in which school contexts are portrayed – including the roles of students and staff within these spaces – are shaped differently across academic discourses, depending on the underlying commitments of interventionist, pedagogical, and critical research traditions.  As the school context emerges not merely as a backdrop but as a lived and negotiated space, whole-school and comprehensive strategies have gained traction among global agencies and physical activity scholars. These strategies emphasize holistic initiatives that span from individual to systemic levels, integrating curriculum, school culture, policies, student and staff sub-groups, and community engagement. Ecological frameworks and theories are often advocated to guide such strategies, highlighting the interplay between individual actions and broader social and environmental influences. However, the way ecological frameworks are applied varies depending on the academic discourse in which the research is situated, as different discourses engage with them from distinct perspectives. In particular, engagement with the concept of agency varies significantly. Despite their widespread use, the frameworks often lack critical perspectives, with issues such as power dynamics and equity rarely being foregrounded. These differences and omissions need to be critically examined for current and future research initiatives, particularly as scholars and agencies increasingly advocate for inter- and transdisciplinary collaborations.

The current PhD project adopts a meta-perspective, analyzing patterns in how school contexts are articulated across academic discourses. Four individual articles – each situated within different research paradigms, perspectives, or discourses – serve as illustrations of what can be learned from their juxtaposition, building on prior research. The individual articles are founded on three sub-studies: an ethnographic study combined with a social network survey, a cross-sectional study using data from surveys, accelerometers, and national registries, and a systematic review assessing school context measurements. This methodological combination is both novel and cross-paradigmatic when studying physical activity during the school day for young people in secondary school.

An analysis was conducted to explore how school contexts are constructed in relation to adolescents’ physical activity, using the included articles as the basis for inquiry. Through an examination using three analytical components – diverse goals, multiple strategies, and varied interest groups – three rhetorical patterns were generated. The patterns frame school contexts as (in)effective backdrops, as spaces of student and teacher meaning-making, and as oppressive and empowering environments. The articles were further mapped against four complex elements that shape school environments: organizational subgroups, formal structures, sociocultural aspects, and broader networks. The findings suggest that these elements are deeply intertwined across the articles, with varying degrees of emphasis and integration, providing a more nuanced understanding of the rhetorical constructions and contextual dynamics that inform physical activity research within school settings. The three patterns and how the elements are addressed adhere in different ways to interventionist, pedagogical, and critical research.

Concluding with a discussion on the potential spaces for rethinking physical activity research in school contexts, the exploration focused on where boundaries between academic discourses become more permeable – sites where interventionist, pedagogical, and critical research can coexist not through resolution, but in productive tension. Rather than seeking synthesis, the aim was to hold the perspectives in juxtaposition, allowing their distinct logics and values to interact and inform one another. This opens up opportunities for multidimensional thinking, addressing effectiveness, meaningfulness, and equity. The conceptualization of agency and participatory methodologies is central, which are well-established yet increasingly relevant concepts that offer spirited passageways for advancing physical activity research in school contexts. By attending to the relational and spatiotemporal dimensions of agency, and foregrounding the voices of students, staff, and school communities, the thesis is not thought of as a solution. Rather, it is positioned as a strategic entry point for inter- and transdisciplinary collaboration – an invitation to play with and imagine futures shaped through dialogue, reflexivity, and shared inquiry.

Background: Poor-quality sleep has been linked to increased dementia risk. We investigated the relationship between healthy sleep pattern and older brain age, and the extent to which this is mediated by systemic inflammation.

Methods: The study included 27,500 adults from the UK Biobank (mean age 54.7 y, 54.0% female). The presence of five self-reported healthy sleep characteristics (early chronotype, 7-8 h daily sleep, no insomnia, no snoring, no excessive daytime sleepiness) were summed into a healthy sleep score (0-5 pts) and used to define three sleep patterns: healthy (≥4 pts), intermediate (2-3 pts), and poor (≤1 pt). Low-grade inflammation was estimated using the INFLA-score, a composite index of inflammatory biomarkers. After a mean follow-up of 8.9 y, brain age was estimated using a machine learning model based on 1079 brain MRI phenotypes and used to calculate brain age gap (BAG; i.e., brain age minus chronological age). Data were analysed using linear regression and generalised structural equation models.

Findings: At baseline, 898 (3.3%) participants had poor sleep, 15,283 (55.6%) had intermediate sleep, and 11,319 (41.2%) had healthy sleep. Compared to healthy sleep, intermediate (β = 0.25 [0.11, 0.40], P = 0.010) and poor (β = 0.46 [0.05, 0.87], P < 0.001) sleep were associated with significantly higher BAG. In mediation analysis, INFLA-score mediated 6.81% and 10.42% of the associations between intermediate and poor sleep and higher BAG.

Interpretation: Poor sleep health may accelerate brain ageing. This may be driven by higher levels of systemic inflammation.

BACKGROUND: Understanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.

AIMS: This study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.

METHODS: We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.

RESULTS: ED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.

CONCLUSIONS: A 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.

TRIAL REGISTRATION: The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022-04943-01.