text:
Poor mental health, including diseases of the central nervous system
(CNS), reduces the quality of life and adds a burden on public health. People
with anxiety or depression disorders are more likely to have chronic physical
conditions (1), and depression and dementia were among the
10 leading risk factors of disability-adjusted life expectancy in high-income
nations worldwide during 2001 (2). They are projected to
rank first and third by the year 2030 (3). In the United
States, dementia and other CNS disorders are a leading cause of death, and
mental disorders are estimated to account for more than 40% of years lost to
disability (4).
The scientific evidence from prospective cohort studies and randomized
controlled trials (RCTs) supports the overall conclusion that regular
participation in moderate-to-vigorous physical activity is associated with
improved aspects of mental well-being and reduced symptoms of several mental
health disorders.
This chapter addresses 7 general questions about physical activity and
mental health conditions. Each question includes subsections that focus on
whether physical activity can protect against the onset of, or reduce,
symptoms; whether the effects of physical activity on the symptoms differ by
age, sex, race/ethnicity, or medical condition; and whether the effects of
physical activity differ by the type, intensity, or timing of the physical
activity. The general questions are:
The chapter also considers a final question dealing with mechanisms that
could plausibly explain the association between physical activity and mental
To provide evidence-based answers to the above questions, the Mental
Health subcommittee obtained data from a search of the Physical Activity
Guidelines for Americans Scientific Database (see Part F: Scientific Literature Search
Methodology, for a full description of the Database), which
contains studies published in 1995 and later. Conclusions regarding the
evidence-based review were restricted to results of RCTs and observational
studies that used a prospective cohort design. Findings from selected
cross-sectional, observational studies are presented when they provided
additional information for questions that had a limited number of RCTs and
prospective cohort studies (e.g., anxiety disorders and sleep). Studies of
physical activity and mental health published since 1995 were evaluated using
meta-analytic or otherwise systematic reviews when they were available. When
such reviews were not available or were not sufficiently current, a systematic
quantitative synthesis of results from published studies was conducted using a
random effects model that weights results by the size of each study and
variation in the effects across studies. Odds ratios in observational studies
and standardized effect sizes in RCTs were retrieved from the published papers,
or they were otherwise estimated from data and test statistics reported in the
papers (5).
The American Psychiatric Association (6) recognizes
4 types of mood disorders: (1) depression, (2) bipolar or
manic-depressive disorder, (3) mood disorders due to a medical
condition, and (4) substance-induced mood disorders. Depression
has an annual prevalence of about 8% among women and 4% among men worldwide and
in the United States. The annual cost of depression in the United States is
estimated at $83 billion per year (7). This condition
includes a mild chronic form, dysthymia, and a more severe form,
major depressive disorder. The rate of major depression has increased
steadily during the past 50 years, with a lifetime prevalence of about 16%; the
rate is higher among Hispanics than whites, and lowest, though still
substantial, among African Americans. The lifetime rate of depression among
adults aged 30 to 60 years is about twice the rate among people older than age
60 years (8).
People have a major depressive episode when they have depressed mood or
lose interest or pleasure in normal activities most of the time for at least 2
weeks. Other symptoms include abnormalities in appetite, libido, sleep, energy
levels, concentration and, often, suicidal thoughts. In some cases, anxiety and
motor agitation can be more prominent symptoms than depressed mood. Also, mood
disturbance can be less apparent than other features such as irritability,
abuse of alcohol, and worsening of comorbid phobias, obsessions, or
preoccupation with physical symptoms. Depression is not considered a major
depressive episode if it is caused by grief (less than 2 months), drug abuse or
medication, or a medical condition such as hyperthyroidism, heart disease,
diabetes, multiple sclerosis, hepatitis, or rheumatoid arthritis. Many older
patients with symptoms of depression do not meet the full criteria for major
depressive disorder. If they have similar, but fewer, symptoms they may have
minor depression, a sub-syndromal form of depression.
Population-based, prospective cohort studies provide substantial
evidence that regular physical activity protects against the onset of
depression symptoms and major depressive disorder. Evidence is insufficient to
draw conclusions about bipolar disorder and other mood disorders.
An association between physical activity and reduced symptoms of
depression among adults has been generally supported in more than 100
population-based observational studies published since 1995, including
nationally representative samples of nearly 190,000 Americans (9-15). Most of the studies looked at cross-sectional
associations, which indicated that active people on average had nearly 45%
lower odds of depression symptoms than did inactive people. In the national
samples of Americans, active people had approximately 30% lower odds of
Twenty-eight of the studies used a prospective cohort design, which
reduces the likelihood that the association is explainable by people becoming
less active after they experience depression symptoms. The median follow-up was
about 4 years, and the range was 9 months to 37 years. The studies came from 11
nations (Australia, Canada, China, England, Finland, Germany, Israel, Italy,
Netherlands, Japan), including 13 studies from the United States. In the cohort
studies, the average odds of elevated symptoms were about 25 to 40% lower among
active compared with inactive people, without adjustments for depression risk
factors that might have differed between the active and inactive groups
(OR = 0.67, 95% CI = 0.59 to 0.77). After adjustment
for risk factors, such as age, sex, race, education, income, smoking, alcohol
use, chronic health conditions, and other social and psychological variables,
the odds remained nearly 15 to 25 percent lower among active people
(OR = 0.82, 95% CI = 0.78 to 0.86).
Nearly all the comparisons (66 of 67) in the cohort studies showed less
depression among physically active than inactive adults, but half the results
did not reach statistical significance, often because the sample sizes were not
big enough. The average number of people for each comparison was about 1,100
people, but a fourth of the comparisons included 500 people or fewer. Studies
of 8 cohorts (16-23) used a clinical diagnosis to measure
depression symptoms, reporting a reduction in the odds of incident cases of
depression that averaged 30 percent (OR = 0.71, 95% CI: 0.61 to 0.77)
among active people compared to inactive or low active people. In those
studies, 18 of 19 comparisons favored active people, and nearly half the
comparisons were statistically significant. Thus, the protective effect of
physical activity is not limited to self-rated symptoms measured by
questionnaires. Figures G8.1a and G8.1b illustrate crude and adjusted odds
ratios and 95% confidence intervals from the 28 prospective cohort studies
of physical activity and depression in nearly 40,000 adults from 11 countries,
including 11 studies from the United States.
The results of RCTs indicate that participation in physical activity
programs reduces depression symptoms in people diagnosed as depressed, healthy
adults, and medical patients without psychiatric disorders.
A meta-analysis of 14 RCTs of chronic exercise among people diagnosed
with depression (24) reported a cumulative, mean reduction
in depression symptoms of 1.1 SD (95% CI: 1.5 to 0.60). However, the studies
had scientific weaknesses that made it hard to conclude that the reduced
depression symptoms were the independent result of exercise, and only 2 of the
studies had been published after 1995 (25;26). Since that review, at least 11 RCTs have used exercise
training to reduce depression symptoms in about 500 depressed patients. In
3 studies (27-29), depression was identified using
cut-point scores on symptom questionnaires that have good predictive validity
as screening tests to detect depression. In another 8 studies (30-37), patients were identified by diagnostic interview as
having major depressive disorder, minor depression, or dysthymia.
In the studies published since the Lawlor & Hopker review (24), the average effect of exercise for symptom reduction was
1.1 SD (95% CI: 1.55 to 0.64) compared to a no treatment control group,
virtually identical to the Lawlor & Hopker results. These recent studies
compared the effects of exercise to a placebo (29;32-34;36;38) or to
drug therapy (30;38) or bright light
therapy (35). The reductions, on average, favored exercise
over placebo (0.35 SD, 95% CI: 0.49 to 0.22), and 6 of 14 comparisons were
statistically significant. The average sample size was 58 people, but 25% of
the studies had 25 people or fewer. Symptom reduction after exercise was
similar to drug therapy and similar or superior to bright light therapy. Four
of the studies reported that reductions in symptoms met criteria for a
clinically meaningful decrease in symptoms (50%) or remission (32;35;37;38). Long-term reductions in symptoms were examined in a few
studies and were generally favorable after supervised exercise training ended,
especially when people maintained regular physical activity (28;29;36;39). The trial by Dunn and colleagues. (2005) was a placebo
trial that controlled for social interaction and sunlight exposure (2
confounders common in other studies) and reported response and remission rates
after exercise training that were 40 to 50% better than placebo (32).
At least 42 RCTs since 1995, including more than 2,600 people, have
examined the effects of exercise on depression symptoms in healthy adults or
adults with medical conditions other than depression or disabling conditions
that severely limit physical activity (i.e., spinal cord injury, multiple
sclerosis, and stroke or traumatic head injury). Most of the medical patients
studied had cardiovascular diseases, arthritis, chronic pain, obesity, or were
cancer survivors. The mean effect of exercise compared to a control condition
was 0.35 SD (95% CI: 0.24 to 0.46). The outcomes favored exercise in 90%
(34 of 38) of the comparisons with control conditions, of which 60% (23 of 38)
reached statistical significance. The average sample size was about 65 people,
but in about a fourth of the studies it was less than 35, which was too small
to detect an effect smaller than a half standard deviation (SD). When compared
to a placebo (usually stretching or health education), the effect of exercise
was halved to 0.15 SD (95% CI: 0.24 to 0.06). Although exercise effects
exceeded placebo effects in 19 of 22 comparisons, only 4 reached statistical
significance. The average sample size in the placebo studies was nearly 100
people, but samples more than 4 times that size would be needed to detect an
effect that small.
The available evidence supports the conclusion that regular physical
activity reduces depression symptoms regardless of age, sex, race/ethnicity, or
medical condition. Whether these factors modify the association between
physical activity and depression has been understudied. Also, race and
ethnicity have been poorly represented or not described in most studies.
Few prospective cohort studies reported findings according to sex or age
groups. Just 1 study reported results for men and women, finding that
lower levels of depression symptoms were associated with more physical activity
in both men and women (40). Only 11 studies had separate
results for men or women. Reductions were smaller for active men
(OR = 0.96, 95% CI = 0.93 to 0.99) than women
(OR = 0.72, 95% CI = 0.68 to 0.77), but men were less
studied. Five studies totaled fewer than 4,000 men, while 6 studies totaled
more than 14,000 women. After adjusting for the number of comparisons made in
each of the other cohort studies, in which men and women were represented
evenly, effects for men and women did not differ. Crude odds reduction among
active people were greater for people aged 55 years or older
(OR = 0.58; 95% CI = 0.46 to 0.72) than people younger than
age 55 year (OR = 0.72; 95% CI = 0.64 to 0.81), but
physical activity was protective for all age groups, regardless of sex.
Most of the prospective cohort studies were population-based, but only a
third specified the proportions of racial and ethnic groups included, and only
4 studies had evidence of good representation of African Americans and/or
Hispanics/Latinos (41-44). One study reported that the
odds of depression symptoms were similarly lower among white and African
American adults who were active (42). Other studies had
poor or no representation of other minority groups.
In RCTs of people without depression, the average effect of exercise
compared to a control condition is 0.35 SD in people with medical conditions
(24 studies; 95% CI: 0.47 to 0.23) and 0.35 SD in people who have not been
diagnosed with a medical condition (7 studies; 95% CI: 0.59 to 0.11).
Figure G8.2 illustrates effect sizes and 95% confidence intervals comparing
exercise with a control condition from the RCTs of depression in adults with or
without medical conditions.
These trials reported similar reductions in depression for groups of
varying ages from 28 to 83 years, but the studies were not designed to compare
groups according to sex, race/ethnicity, or age. Only 1 of the trials compared
men and women (45) and none compared effects between
people of different ages or race/ethnicities. Seven of 11 studies of Americans
described the racial/ethnic composition of their samples, but only 5 studies
included African Americans (46-50); 3 studies included
small numbers of Hispanics, Asian Americans or American Indians (49-51). Effects were larger in 6 studies of men
(mean = 0.86 SD, 95% CI = 0.45 to 1.26), compared to 9
studies of women (mean = 0.27 SD, 95% CI = 0.04 to 0.51)
and to 23 studies that combined results of men and women (mean = 0.27
SD, 95% CI = 0.16 to 0.37). Thus, it is likely that other features of
the studies of men might explain the larger effects.
Reductions in depression symptoms were larger in 8 studies of heart
patients (mean = 0.60 SD, 95% CI = 0.33 to 0.86) than in
studies of other medical conditions (mean = 0.23 SD, 95%
CI = 0.11 to 0.34) and were largest in the 3 studies of heart
patients that included only men (52-54)
(mean = 1.0 SD, 95% CI = 0.50 to 1.5). The small number of
studies precluded meaningful comparisons among the other medical
The evidence from prospective cohort studies and RCTs published since
1995 suggests that moderate and high levels of physical activity similarly
reduce the odds of developing depression symptoms compared to low levels of
physical activity exposure, which is nonetheless more protective than
inactivity or very low levels of physical activity. The minimal or optimal type
or amount of exercise for reducing depression symptoms is not yet known, but it
appears that an increase in physical fitness is not required.
Epidemiologic studies typically use a variety of criteria and methods to
classify people into 2 or more activity groups. This limits the evaluation of
the dose-response relation across the full range of reported physical activity
and can misclassify people who overestimate or underestimate their activity.
Only 7 prospective cohort studies of depression symptoms included the 3 or more
levels of physical activity necessary to determine whether the association of
physical activity with lower odds of depression has a dose-gradient with
increased levels of exposure (16;18;21;22;55-57). After adjustment for age, sex, and other risk
factors, the reduction of odds was smaller for the lowest level of physical
activity (OR = 0.86, 95% CI = 0.79 to 0.94) compared to the
next 2 levels of physical activity, which did not differ (OR = 0.77,
95% CI = 0.72 to 0.82). Thus, the highest levels of participation did
not confer more protective benefits than did more moderate levels. Each was
more protective than the lowest levels in the studies.
Figure G8.3 shows the odds ratios and 95% CI in prospective cohort
studies that examined the dose-response association between levels of physical
activity and depression symptoms.
Those studies used different measures and criteria for defining levels
of physical activity, so it is not possible to convert their findings to a
standard estimate (e.g., MET-hours or kilocalories per kilogram) of the amount
of physical activity at each level. However, about half the prospective cohort
studies provided enough information to determine whether active people were
meeting existing public health recommendations (58;59) for participation in moderate or
vigorous physical activity (i.e., moderate-intensity aerobic [endurance]
physical activity for a minimum of 30 minutes on 5 days per week, or
vigorous-intensity aerobic physical activity for a minimum of 20 minutes on 3
days per week). Odds reduction favored people who met or exceeded
recommendations for moderate or vigorous participation (OR = 0.64,
95% CI = 0.57 to 0.73) compared to active people who did not meet
either recommended level (OR = 0.70, 95% CI = 0.58 to
0.82). Odds were not different between vigorous and moderate participation, but
it was possible to distinguish moderate from vigorous participation in only a
few studies. After adjustment for other risk factors, a similar protective
benefit favored regular participation in moderate or vigorous physical activity
(OR = 0.77, 95% CI = 0.72 to 0.82) compared to
participation at levels less than recommended (OR = 0.84, 95%
CI = 0.78 to 0.90).
A few RCTs of people without depressive disorders have manipulated type
(e.g., aerobic versus resistance or walking versus aquatic exercise or Qigong)
or timing (i.e., continuous versus intermittent [the intermittent studies often
used resistance, circuit, interval or mixed-mode exercise]), of exercise to
examine whether those features modify the effects of exercise on symptoms of
depression (60-64). However, these studies did not include
a control group who did not exercise. Only a few studies have evaluated Eastern
health practices that include exercise (65). About 40
percent of the studies used an aerobic exercise intervention such as walking,
jogging, cycling, or aquatic exercise, and another third of the studies
combined aerobic activity with resistance exercise. Only 3 studies used
resistance exercise alone, and none compared aerobic versus resistance
exercise. On average, reductions in depression have been similar regardless of
the mode of activity used. About two-thirds of the studies used continuous
exercise. Regardless of mode, a larger reduction in depression tends to occur
after continuous exercise (0.45 SD, 95% CI = 0.63 to 0.27) than
intermittent exercise (0.18 SD, 95% CI = 0.30 to 0.06), but differing
features of the studies other than timing might explain this finding.
Three-fourths of the RCTs of healthy adults and non-psychiatric medical
patients used a moderate-to-vigorous exercise intensity of 60-80% of
peoples aerobic capacity or maximum strength that occurred 3 days per
week. Intensity was lower or the frequency was 2 days per week in the other
studies. The average duration of each session was about 35 minutes, but it
was less than 30 minutes in a fourth of the studies and more than 1 hour in
another fourth of the studies. However, fewer than half the studies were clear
about how the time was partitioned into warm-up, exercise, and cool down.
Nonetheless, reductions in depression symptoms did not differ across these
varying features of exercise. Studies lasted an average of 6 months, and a
fourth of the studies lasted less than 3 months. Length of the exercise program
also was unrelated to symptom outcome. About half the studies measured
cardiorespiratory fitness, which was increased significantly in 16 of 24
comparisons. Only 3 studies measured strength. In each study, fitness
increases and symptom reduction were not associated when changes were defined
by statistical significance, which depends on both the size of change and the
sample size. After adjusting for sample sizes, the magnitude of depression
reduction was moderately correlated with the magnitude of fitness increase
(r = 0.40). However, that relation was not independent of increases
in primary outcomes other than fitness in the studies of medical patients.
Perhaps the clearest experimental evidence for a dose-dependent effect
of exercise on symptom reduction comes from the dose study (32). Adults aged 20 to 45 years diagnosed with mild to
moderate major depressive disorder expended either 7.0 or 17.5 kilocalories per
kilogram per week at a frequency of 3 or 5 days per week or engaged in 3 days
per week of stretching exercises as a placebo control. Physician-rated symptoms
after 12 weeks were reduced 47% from baseline for the higher dose, compared
with 30% for the lower dose and 29% for control, regardless of whether exercise
frequency was 3 days or 5 days each week.
Anxiety is characterized by apprehensive or worrisome thoughts and is
typically accompanied by agitation, feelings of tension, and activation of the
autonomic nervous system. A distinction is made between transient anxiety
symptoms, termed state anxiety, persistent symptoms, termed trait
anxiety, and a group of disabling conditions characterized by excessive,
chronic anxiety that are known as anxiety disorders. The anxiety
disorders, listed from most to least common, are:
Anxiety disorders are common, affecting more than 16 million people in
the United States each year (roughly 4% of women and 2% of men). More than 80
million people in the United States at some point in their lives suffer from an
anxiety disorder (8). Anxiety disorders begin at a median
age of 15 years, often persist throughout life and are associated with numerous
physical and mental co-morbidities, especially depression (66). People aged 15 to 24 years experience episodes of
anxiety about 40% more often than people aged 25 to 54 years, regardless of
race. Although less than 30% of those who suffer from anxiety disorders seek
treatment, they strain the health care system because of direct psychiatric and
nonpsychiatric treatment costs. Additional indirect costs of anxiety disorders
are incurred from reduced work productivity. The total annual costs in 1990 of
all anxiety disorders were estimated to be $42 billion to $47 billion dollars
(67;68), and they likely cost double
that amount today.
The weight of evidence from a small number of nationally representative
and population-based cross-sectional and prospective cohort studies supports
that regular physical activity protects against the onset of anxiety disorders
and anxiety symptoms.
At least 4 population-based cross sectional studies published since
1995, including data from nationally representative samples of nearly 121,000
Americans, show that regular physical activity is associated with lower odds of
anxiety symptoms (13;69-71). Results
of the US National Co-Morbidity Study found that regular physical activity
reduced the odds of a diagnosed anxiety disorder (i.e., specific phobia, social
phobia, generalized anxiety, panic, and agoraphobia) by an average of 43% (10). After controlling for sociodemographic and illness
variables, regular physical activity reduced the odds of an anxiety disorder by
an average of 28% (10).
At least 2 population-based studies used a prospective cohort design.
The odds of developing any anxiety disorder were reduced by an average of 53%
among Australians who reported more than 3 hours per week of vigorous physical
activity compared to those reporting no activity (16). The
effect was not statistically significant, in part due to the small number of
participants who developed an anxiety disorder (n=67). The second study, which
adjusted for age and sex and had more participants who developed an anxiety
disorder (n=228), found that regularly active young adults (representative of
Munich, Germany) on average had a statistically significant, 48% lower odds of
developing any anxiety disorder compared to those reporting no activity (22).
The results of RCTs conducted with medical patients and healthy adults
indicate that participation in physical activity programs reduces anxiety
Before 1995, no reports of RCTs of anxiety disorder patients had been
reported. Since then, 2 RCTs have been conducted with anxiety disorder patients
and reported statistically large effects. One trial conducted with 46 panic
disorder patients found that those who completed a 10-week (3 times per week)
walking or jogging program reported, on average, a large reduction in anxiety
symptoms (1.1 SD) compared to those who took daily placebo capsules (72). The other trial involved 74 patients with social phobia,
generalized anxiety, or panic disorder. The addition of a moderate intensity
home-based exercise program to 8 to 10 weeks of group cognitive-behavioral
therapy (GCBT) resulted in a large reduction in anxiety symptoms (1.36 SD)
compared to the control condition (GCBT + nutrition education) after
statistically controlling for potential confounding variables (73).
Before 1995, at least 40 quasi-experimental and experimental exercise
training studies of varying quality had reported a cumulative effect on
reducing anxiety symptoms of approximately 0.40 SD (74).
Since 1995, at least 46 RCTs involving more than 3,550 people have examined the
effects of chronic exercise on anxiety symptoms among inactive adults who were
healthy or had a medical condition other than anxiety disorders or disabling
CNS disorders including multiple sclerosis, traumatic head injury, stroke or
spinal cord injury. The effect of exercise compared to control conditions in
reducing anxiety symptoms was 0.38 SD (95% CI: 0.30 to 0.46). Outcomes favored
exercise in 84% (67 of 80) of the comparisons with control conditions, and 28%
(22 of 80) reached statistical significance. In 6 studies that compared
moderate-to-vigorous exercise to a placebo-type condition (usually low
intensity exercise such as stretching) the effect of moderate-to-vigorous
exercise on reducing anxiety symptoms was 0.19 SD (95% CI: 0.05 to 0.33).
Exercise effects were favorable in 90% (9 of 10) of the placebo-type
comparisons, and 30% reached statistical significance. The average study
included about 60 people, but a fourth of the studies had less than 40
participants, too few to detect small but possibly meaningful effects.
The weight of the evidence supports the conclusion that regular physical
activity reduces anxiety symptoms regardless of age, sex or medical condition.
No published data address whether race or ethnicity modifies the effects of
physical activity on anxiety symptoms.
In the 46 RCTs of healthy adults and medical patients, the mean age of
the samples was weakly related to anxiety reductions after exercise training.
Two of the trials compared men and women and found no sex-related difference in
the effect of exercise on anxiety symptoms (45;75). The average effect of exercise training on reduced
symptoms of anxiety was larger in those studies that involved only men
(mean = 0.62 SD, 95% CI: 0.34 to 0.89, n=7) compared to those that
included only women (mean = 0.33 SD, 95% CI: 0.16 to 0.50, n=12) and
those that included similar proportions of men and women (mean = 0.42
SD, 95% CI: 0.28 to 0.57, n=19). It is likely that other features of the
studies of men might explain the larger effects. Regardless, exercise benefited
both men and women.
None of the available investigations was designed to determine whether
the effect of chronic exercise was moderated by race or ethnicity. The racial
or ethnic composition of the samples was described in 17% of the reviewed
studies (25;51;76-81). Of the 3,550 people who participated in the RCTs,
approximately 89% were whites and approximately 11% were African Americans or
Hispanics. Statistical analyses by race or ethnic category were not presented
in any of the studies.
Of the RCTs, about 40% (19 of 46) were conducted with healthy adults,
and 60% (27 of 46) involved patients with various medical conditions. The most
frequently studied conditions were cancer and cardiovascular diseases. The
average effect of exercise compared to a control condition was 0.40 SD in
healthy adults (40 comparisons; 95% CI: 0.27 to 0.53) and 0.36 in people with
medical conditions (40 comparisons; 95% CI: 0.26 to 0.47). The reduction in
anxiety symptoms was somewhat larger than average in studies of cardiovascular
conditions (mean = 0.53 SD, 95% CI: 0.15 to 0.92, n=6), but too few
studies are available to conclude that the effect of exercise training on
anxiety symptoms is modified by medical condition. Figures G8.4a and G8.4b
summarize the findings from the RCTs of physical activity and anxiety symptoms
in healthy adults and medical patients.
Epidemiologic studies have not yet examined race/ethnicity or medical
condition as potential modifiers of the effect of exercise on anxiety disorders
or symptoms. One cross-sectional study of 41,914 participants in the 2001
Behavioral Risk Factor Surveillance System found low anxiety symptoms among
physically active people compared to inactive people across young (age 18 to 40
years), middle-aged (aged 41 to 60 years) and older adult (aged 61 years and
older) categories, but the inactive younger adults were approximately 20% more
likely to experience anxiety symptoms than inactive middle-aged and older
adults (13). In a population-based cross sectional study
of 19,288 twins and their families, potential interactions of exercise and age,
exercise and sex and exercise, age and sex on anxiety symptoms were
statistically non-significant (69).
Limited cross-sectional, observational evidence suggests that the odds
of an anxiety disorder may be reduced by higher weekly frequency of exercise
bouts. However, there is an absence of evidence from prospective cohort studies
or RCTs that examine whether anxiety symptoms vary according to features of
physical activity exposure.
One large population-based study found a dose-response relation between
cross-sectional measures of physical activity frequency and lower prevalence of
anxiety disorders (i.e., specific phobia, social phobia, generalized anxiety,
panic, and agoraphobia) (10). The percentage of adults
with these anxiety disorders was highest among those who reported no physical
activity and was reduced in a step-wise fashion among those who reported rare,
occasional, and regular physical activity (10).
Prospective cohort studies show mixed results as to whether
participation in sports, activities that often involve high-intensity exercise,
has a protective effect against anxiety symptoms. Some show a protective effect
(23) and others show no protection (82). One nationally representative cross-sectional study
found that a group of regularly physically active (i.e., met or exceeded the
Healthy People 2010 physical activity guidelines) people reported a
higher frequency of anxiety symptoms compared to those who were physically
active but not active enough to meet the Healthy People 2010
recommendations (13).
Few RCTs of healthy adults or people with medical conditions have
manipulated any feature of an exercise intervention to learn whether those
features causally modify anxiety symptoms. No exercise training studies have
manipulated exercise program length or exercise type for the purpose of
examining anxiety symptom outcomes.
About 43% (20 of 46) of the studies used a single aerobic exercise
intervention such as walking, jogging, or cycling, 13% (6 of 46) used
resistance exercise alone, and 9% (4 of 46) combined aerobic with resistance
exercise. The magnitude of anxiety reduction has been similar across these 3
categories of studies. Regardless of mode, anxiety reductions also were similar
after continuous (0.36 SD, 95% CI: 0.27 to 0.45) and intermittent (0.39 SD, 95%
CI: 0.16 to 0.63) exercise (about 60% of studies used continuous exercise).
Three investigations manipulated exercise session duration and found no
significant differences in anxiety symptom outcomes among exercise training
studies that used bouts of varying session durations (80;83;84). Across
all trials, the average duration of the exercise sessions was approximately 40
minutes. In a fourth of the studies, the duration was less than 25 minutes, and
in another fourth the duration was more than 60 minutes. The effects of
exercise training on anxiety symptoms were similar across studies of all
durations. Imprecise descriptions of exercise duration contributed to the
difficulty in determining whether session duration has a true effect. For
example, less than half of the studies were specific regarding how time was
partitioned into warm-up, exercise, and cool down.
Only 2 exercise training experiments manipulated exercise intensity to
examine whether it modifies the effects of exercise on anxiety symptoms.
Statistically non-significant differences in anxiety symptoms were found
between moderate- and high-intensity resistance exercise conditions on the
anxiety symptom outcomes (81;85).
About 55% (44 of 80) of the comparisons from all the trials used
moderate-to-vigorous exercise intensity (i.e., 60 80% of
aerobic capacity or maximum strength) with a weekly frequency of 3 or more days
per week. Reductions in anxiety symptoms were similar across variations in
exercise intensity.
About 63% (29 of 46) of the trials measured fitness, 7 studies measured
strength, and 22 studies measured cardiorespiratory fitness.
Cardiorespiratory fitness was increased significantly in 36% (13 of 36) of the
comparisons and strength was increased significantly in 25% (2 of 8) of the
comparisons. Those studies that defined changes by statistical significance
showed no association between fitness increases and anxiety symptom reduction.
After adjusting for sample sizes, the magnitude of anxiety reduction was weakly
correlated with the magnitude of fitness increase (r = .24). This
relation was independent of increases in primary outcomes other than fitness in
the studies.
Psychological distress is a risk factor for psychiatric disorders (86;87) and coronary heart disease (88), and it is negatively associated with quality of life.
Conversely, a feeling of well-being can reduce psychiatric risk and is an
important feature of high life quality and health (89).
People frequently experience feelings of distress during the normal course of
living and during challenging life events, including chronic medical
conditions. Thus, it is important to understand the association between
physical activity and feelings of distress or well-being because they bear not
only on disease risk but also on overall mental health. Measures in this area
are not uniform, but most studies have used a scale that assessed the presence
of distress (e.g., combined symptoms of anxiety and depression or perceived
stress) or the absence of distress (e.g., well-being or positive mental
health). Findings of physical activity studies have not differed when measures
of distress or well-being were used, so the following results apply regardless
of the direction of odds (i.e., decrease in distress or increase in
The available evidence from prospective cohort studies indicates a
small-to-moderate association that favors people who are physically active.
The association between physical activity and reduced feelings of
distress or enhanced well-being among adults was virtually unstudied in large
groups of people before 1995 (90). Since then, more than
30 population-based observational studies have been published, including
nationally representative samples of more than 175,000 Americans (91-95). Most of the studies looked at cross-sectional
associations, which indicated that active people on average had more than a 30%
lower odds of feeling of distress or 30% higher odds of enhanced well-being
than did inactive people. In the national samples of Americans, the odds
favored active people by approximately 25%.
Thirteen studies of adults in Australia, Canada, Denmark, England,
Netherlands, Scotland, Wales, and 3 studies of Americans (18;23;94) used a
prospective cohort design. In those studies, the average odds of reduced
feelings of distress or of enhanced well-being favored active people by about
30% compared with inactive people, without adjustments for risk factors
(OR = 0.69, 95% CI = 0.61 to 0.78). After adjustment for
risk factors, such as age, sex, race, education, social class, occupation,
income, smoking, alcohol use, substance abuse, chronic health conditions,
disability, marital status, life events, job stress, and social support, the
odds still favored active people by nearly 20% (OR = 0.82, 95%
CI = 0.77 to 0.86). About 80% of the comparisons (58 of 70) favored
active adults, but half the results did not reach statistical significance,
often because of too small sample sizes. The average number of people for each
comparison was approximately 1,300 people, but a fourth of the comparisons had
700 people or less. Figure G8.5 illustrates 18 crude and/or adjusted odds
ratios and 95% confidence intervals from the 13 prospective cohort studies of
physical activity and distress or well-being in more than 100,000 adults from 8
countries, including 67,000 American women (23;94).
The effects of RCTs indicate small benefits of physical activity that
often do not exceed the effects of placebo control conditions, such as health
education or stretching.
Since 1995, at least 26 RCTs, including nearly 3,000 people, have
examined the effects of exercise on feelings of distress or well-being in
healthy adults or adults with medical conditions other than psychiatric
disorders or disabling conditions that severely limit physical activity (i.e.,
spinal cord injury, multiple sclerosis, and stroke or severe head trauma). The
average effect of exercise compared to a control condition was 0.27 SD
(95% CI = 0.16 to 0.38). The outcomes were favorable after
exercise in nearly 80 percent of the comparisons (26 of 33) with control
conditions, but only 13 of 33 comparisons reached statistical significance. The
average sample size was about 60 people, but a fourth of the studies had less
than 45, a much smaller number than the 200 or so people needed to detect an
effect as small as one-third SD. When compared to a placebo (usually stretching
or health education), the effect of exercise was reduced to 0.10 SD (95% CI:
−0.12 to 0.32) and was significant in just 2 of 9 comparisons.
The available evidence supports that regular physical activity is
associated with reduced feelings of distress and enhanced feelings of
well-being regardless of age, sex, race/ethnicity, or medical condition.
However, whether these factors modify those associations has not been studied.
Race and ethnicity have been poorly represented or not described in most
Cross-sectional samples of Americans in the National Health Interview
Survey (92), the Behavioral Risk Factor Surveillance
Survey (93;95), and the National
Physical Activity and Weight Loss Survey (91) included
African American, Hispanics, and small numbers of Asian Americans and American
Indians, but results were not compared between groups. Most of the prospective
cohort studies were conducted in Europe or Australia and did not describe
minority representation of the sample. The US Nurses Health Study
includes minority women, but their representation was not described in the
study of physical activity and well-being in the cohort (94).
Similarly, it is unclear whether sex and age modify the protective
effect of physical activity on distress/well-being. Only 4 cohort studies
reported findings separately for males and females, with mixed results (96-99),
and none compared age groups. Across cohort studies, findings were similar for
men and women. However, age was inversely related to reduced odds of distress
or increased odds of enhanced well-being regardless of sex. After adjustment
for other risk factors, odds were 0.65 (95% CI = 0.61 to 0.72) for
men and women younger than age 55 years and 0.90 (95% CI = 0.86 to
0.97) for men and women aged 55 years and older. In RCTs, the average effect of
exercise compared to a control condition is similar in both healthy adults
(0.28 SD, 95% CI = 0.16 to 0.41) and people with non-psychiatric
medical conditions (0.26, 95% CI: 0.10 to 0.41). Figure G8.6 illustrates effect
sizes and 95% confidence intervals feelings of distress or well-being in
studies comparing exercise with a control condition from the RCTs of adults
with or without medical conditions.
These trials reported similar effects of exercise in both men and women
and in groups varying in mean aged 31 to 74 years. However, the studies were
not designed to compare groups according sex, race/ethnicity, or age. Only 1 of
the trials compared men and women (45), and results were
mixed across the 3 studies of men (0.49 SD, 95% CI = −0.11 to
1.08). Ten studies reported results for women (0.21 SD, 95% CI = 0.02
to 0.40), and 15 studies combined results for similar proportions of men
and women (0.26 SD, 95% CI = 0.12 to 0.41). None compared
effects between people of different ages or race/ethnicities. Seven of 16
studies of Americans described the racial/ethnic composition of their
samples, but only 2 studies included a substantial portion of African Americans
(46;100). Three studies included
small numbers of Hispanics and/or Asian Americans (51;78;100). The small number of studies
precluded meaningful comparisons among the medical conditions.
Population-based studies indicate that participation in either moderate
or high levels of physical activity is associated with reduced feelings of
distress or enhanced well-being, when compared with inactivity or very low
physical activity exposure. The minimal or optimal type or amount of exercise
for reducing feelings of distress or enhancing feelings of well-being are not
yet known, but it appears that an increase in physical fitness is not
Seven prospective cohort studies of feelings of distress or well-being
included 3 or more levels of physical activity, using inactivity or low
activity as the reference group (18;55;56;94;96;97;101).
Independently of age and sex, and with or without adjustment for other risk
factors, a linear reduction in odds of about 10% occurred for each level of
physical activity compared to people who were inactive or had very low
activity. Similarly, odds favored people who met or exceeded recommendations
for moderate or vigorous participation by about 5% compared to active people
who did not meet either recommended level. No studies permitted a direct
comparison of moderate and vigorous recommended levels, but unadjusted odds
were lower for participation in moderate-to-vigorous physical activity
(OR = 0.77, 95% CI = 0.70 to 0.84) compared to
participation at levels less than recommended (OR = 0.84, 95%
CI = 0.78 to 0.91). Figure G8.7 shows the odds ratios and 95% CI in
prospective cohort studies that examined the dose-response association between
levels of physical activity and feelings of distress or well-being.
A few RCTs manipulated type (walking versus aquatic exercise or Qigong)
or timing (i.e., intermittent versus continuous) of exercise to examine whether
those feature modify the effects of exercise on feelings of distress or
well-being (60-62;64), but the
studies did not include a control group who did not exercise. About 45 percent
of the controlled studies used an aerobic exercise intervention such as
walking, jogging, cycling, or aquatic exercise, and another 30 percent of the
studies combined aerobic activity with resistance exercise. Only 3 studies used
resistance exercise alone, and none compared aerobic with resistance exercise.
About half the studies used continuous exercise, and a third used intermittent
exercise. One study of home-based aerobic dance reported positive effects when
daily exercise was a continuous 30-minute session but not when it was 2
sessions of 15 minutes each separated by 4 hours (80).
Timing of the exercise could not be determined in the other studies. Effects of
exercise did not differ according to the mode or timing of exercise.
Three-fourths of the studies used a moderate-to-vigorous exercise
intensity of 60% to 80% of peoples aerobic capacity or maximum strength.
The average session lasted 45 minutes and occurred 3 days per week, but studies
had a wide range of session duration (10 to 85 minutes) and weekly frequency (1
to 7 days). Nonetheless, these features of exercise did not modify effects
independently of each other. Studies lasted an average of 6 months, and a
fourth of the studies lasted less than 3 months. Length of the exercise program
was also unrelated to symptom outcome.
Eleven of 13 studies that measured cardiorespiratory fitness reported a
significant increase that averaged 1 SD, or about 20%. Strength was
significantly increased in each of 3 studies that measured strength. However,
there was no association between fitness increases and changes in feelings of
distress or well-being.
Cognition can be conceptualized as processes involved in selecting,
manipulating, and storing information derived from experiences and how these
processes guide behavior. Cognitive abilities are functional properties of the
individual that are not directly observed but are inferred from behavior.
Researchers in the disciplines of psychometrics, cognitive psychology, and
neuropsychology have developed more than 400 tests designed to assess specific
types of mental processing (102). They range from those
designed to evaluate specific processes (e.g., working memory,
information-processing speed, inhibition) to those that assess global mental
functioning involving multiple processes. Assessment methods include those
designed specifically to evaluate the effects of injury and degenerative
disease on cognitive function and those designed to evaluate individual
differences in healthy individuals. The multidimensionality of cognitive
function and the diversity of assessment methods present a special challenge
for the interpretation of the evidence about the effect of physical activity
and exercise on cognitive function.
The weight of the available evidence from prospective cohort studies
supports the conclusion that physical activity delays the incidence of dementia
and the onset cognitive decline associated with aging.
At least 17 prospective population-based cohort studies have been
published since 1995 that have assessed the association of individuals
level of physical activity with the onset of age-related decline in cognitive
functioning among healthy adults or with incident cases of dementia. Studies
that confounded the measure of physical activity with other leisure or mental
activities were not considered. Four studies showed protective effects against
cognitive decline in healthy aging adults (103-106) and
two studies did not find protective effects (107;108).
Of the 11 studies of dementia, 7 reported a protective effect of
physical activity. Nine of 16 comparisons were statistically significant (mean
OR = 0.63 95% CI = 0.50 to 0.80). Though limited in number,
results were stronger for Alzheimers disease than for other dementias,
including vascular dementia. Figure G8.8 describes results from prospective
cohort studies of physical activity and incident dementia or Alzheimers
The studies varied considerably in sample size, methods used to assess
participants physical activity level and mental function, and the
duration between baseline and follow-up measurements. In general, most studies
with sample sizes greater than 1,000 individuals report that physical activity
delays the onset of cognitive decline or dementia. The results of studies
conducted with smaller numbers of participants are inconsistent. The lack of
agreement among the studies reviewed may be explained, at least in part, in
terms of statistical power. An alternative explanation for the inconsistencies
among the results of these studies is the confounding influence of cognitive
stimulation derived while engaged in physical activities (108). In studies that report a relation between physical
activity and delayed onset of dementia, the effects were detected using both
clinical assessments and standardized measures of cognitive function. Further,
early-life (103), mid-life (109),
and current levels of physical activity all appear to postpone symptoms of
dementia. Thus, although exercise does not prevent dementia, it may be
associated with a delay in its onset, perhaps by maintaining a higher level of
cognitive function for physically active adults than less physically active
individuals as they age (110).
A meta-analysis of 18 RCTs (111) indicated that
aerobic exercise training produced an effect size (SD) of 0.48 for improving
performance on all cognitive tasks, with the greatest effect size (0.68) for
executive processing tasks that measure goal-oriented decision-making behavior,
compared to 0.46 for controlled-processing tasks that assess attentional
effort, 0.42 for visuospatial tasks that evaluate the perceptual organization,
and 0.27 for speeded tasks that focus on rapid responses and movements. The
results of 2 recently conducted experiments provide support for the
facilitative effects of resistance exercise training on information-processing
functions of cognitively healthy older adults (85;112), though one experiment found no significant effects of
either yoga training or a walking program on older adults memory or
information-processing speed (113).
Evidence from RCTs of healthy older adults and people with
Alzheimers disease or other dementias support that regular participation
in physical activity improves aspects of cognitive function or reduces symptoms
of dementia.
A meta-analytic review of 10 randomized controlled studies of older
adults diagnosed with cognitive impairments (114)
concluded that physical activity interventions benefit the cognitive function
of older adults regardless of disease status. Similar to the finding of
Colcombe and Kramer (111) with healthy older adults,
older adults with impairments who participated in physical activity
interventions show better cognitive function than those assigned to control
conditions (ES = .57). However, concerns of the methodological
integrity of many of the studies reviewed led the authors to recommend caution
in the interpretation of these findings. The beneficial effects of physical
activity on older adults with dementia have been reported in 2 recent
experiments (115;116).
Although individuals with dementia benefit cognitively from
participation in exercise training, it is not clear whether physical activity
ameliorates symptoms of dementia or simply maintains the level of cognitive
function for those who are active. In several experiments, differences in
cognitive function and information-processing performance in older adults
assigned to physical activity or control conditions was due to the degradation
of performance by inactive individuals. Further, although relatively short-term
exercise programs demonstrate improvements on older adults cognitive
function, the durability of the effect remains to be determined.
The available evidence supports the benefits of physical activity for
improving or maintaining cognitive function among healthy older adults, more so
than for young adults whose cognitive health is normally near peak function.
The smaller, but generally favorable effects of physical activity on cognitive
function and symptoms among people with dementia may be modified by the
severity of dementia and other health factors.
The protein apolipoprotein E4 (ApoE4) is a known risk factor for
Alzheimers disease. Individuals who have two copies of the ApoE4 allele
are at greatest risk for the disease, followed by individuals with one copy of
the ApoE4 allele, followed by those who are non-carriers. Investigators have
suggested that physical activity diminishes the effects of ApoE4 on the
development of Alzheimers disease. The evidence from prospective cohort
studies has been inconsistent, however, with some reporting that physical
activity benefits the cognitive functioning of ApoE4 non-carriers and has no
effect for ApoE4 carriers (117), and others report that
physical activity benefits cognitive functioning for ApoE4 carriers, but has no
effect for ApoE4 non-carriers (117;118). Nevertheless, evidence that genetic factors may
influence the relation between physical activity and cognition is important as
it may help to explain some of the inconsistencies among studies that have
examined the effects of physical activity on cognitive performance in the
general population of older adults.
The results of one of 15 prospective cohort studies reviewed suggest
that sex may modify the relation between physical activity experiences and
cognitive function (103). Older Dutch men, but not women,
who reported being physical active early in their lives (ages 15 to 25 years)
had faster information-processing abilities than those who were less physically
active during those years of their lives.
The benefits of physical activity on the cognitive function of older
adults who have dementia may be reduced in individuals with cardiovascular risk
factors. Daily walking or gardening reduced the 16-year combined risk of
Alzheimers and vascular dementia among elderly male residents of Dubbo,
New South Wales in Australia but only daily gardening was protective among
females (119). An evaluation of the changes in brain
structure and function that accompany Alzheimers disease and changes in
cerebral metabolic processes that accompany ischemia led Eggermont and
colleagues (120) to speculate that an individuals
cardiovascular risk factors may attenuate or even reverse the positive effects
of exercise on cognition and that participation in structured exercise programs
may not be beneficial for all patients. Thus, while the bulk of scientific
evidence obtained thus far provides compelling support for the benefits of
physical activity for healthy older adults, the favorable effects of physical
activity may be modified by cardiovascular health or risk. Additionally, the
gains in cognitive function brought about by physical activity may be observed
more clearly in older adults than young adults, whose level of cognitive health
is near its peak and provides less room for exercise-related improvement (121).
Evidence from prospective cohort studies or RCTs is insufficient to
determine whether cognitive function or symptoms of dementia vary according to
features of physical activity exposure.
Four of 6 prospective cohort studies of cognitive decline with aging in
healthy people examined more than 2 levels of physical activity exposure. Three
of them, including a large cohort of women from the Nurses Health Study
(105), found a dose-response relation, whereby the
decline in risk was greater at higher levels of physical activity
participation. Four of 10 prospective cohort studies of dementia risk examined
more than 2 levels of physical activity exposure. Two of the 4 studies reported
a dose-response relation such that higher levels of physical activity result in
greater protection against dementia (122;123). The other 2 studies of dementia (124;125) reported similar trends, but
the cohorts were too small to detect statistical significance.
The methods used to measure physical activity vary greatly, both among
RCTs and prospective cohort studies, which makes it difficult to identify the
effects of specific features of physical activity on cognitive function. The
use of self-report measures of physical activity is a limitation of prospective
studies in general, but it is a unique problem for studies of cognitive
function when the measures of physical activity include leisure activities that
involve social and cognitive activities but light physical exertion (e.g.,
crossword puzzles, card games).
Cognitive function has been associated with levels of and gains in
cardiorespiratory fitness among healthy, older adults (126-128), and fitness also has been positively correlated
with white matter integrity (129), brain volume (130;131), and hippocampal neurogenesis
(132). However, the cumulative evidence does not provide
clear support that cardiorespiratory fitness is associated with cognitive
performance (133).
The sole randomized controlled experiment designed specifically to
assess the dose-effect relation between resistance training and information
processing in healthy older adults reported that similar benefits were derived
from interventions that involved weight loads of either 50% or 80% of maximal
strength (85). The results of a large prospective cohort
study, led Podewils and colleagues (117) to conclude
that, with respect to the onset of dementia, the number of different physical
activities in which older adults engage may be more important than their
frequency, intensity, or duration. At this time, the dose-response relation
among mode, duration, and intensity of exercise training and changes in
cognition remains unclear.
Nearly one-third of the adult population in the United States
experiences insomnia every year, and each year 50 to 70 million Americans
experience some effects on their health from sleep disorders, sleep
deprivation, and excessive daytime sleepiness (134). The
financial cost is approximately $65 billion, $50 billion of which represents
costs to industry from lost productivity. Approximately 70 sleep disorders
exist, the most studied of which are insomnia and obstructive sleep apnea. Many
neurological disorders are associated with poor sleep, and poor sleep itself
can have important health-related outcomes. Only about 5% to 20% of people who
suffer sleep disturbances will seek help from a primary care physician, and
many will purchase over-the-counter sleep aids.
A small number of observational, population-based studies provides
initial evidence supporting a positive association of regular participation in
physical activity with lower odds of disrupted or insufficient sleep, including
sleep apnea.
Population-based studies have found that physically active people report
better sleep than inactive people (135), but most of the
studies used a cross-sectional design and do not permit conclusions about the
temporal sequence of physical activity and sleep. One prospective cohort study
(136) found that those who reported more physical
activity had nearly 40% lower odds of incident insomnia. Eleven of 13
cross-sectional studies show that the chances of having insufficient or
interrupted sleep are lower (mean OR = 0.73 95% CI = 0.66
to 0.81) among adults who are engaged in more physical activity than among
those who have less physical activity or are sedentary (136-146). At least 2 population-based, cross-sectional
studies found that men and women who exercise at least 3 hours per week had
lower odds of sleep apnea measured by polysomnography (147;148). Figure G8.9 shows odds
ratios from population-based cross-sectional studies of physical activity and
self-ratings of disrupted or insufficient sleep.
The weight of the evidence from a small number of RCTs supports the
conclusion that regular participation in physical activity has favorable
effects on sleep quality and is a useful component of good sleep hygiene.
Six RCTs, all published since 1995, show positive and large effects
(more than 1 SD) of exercise training on symptoms of poor sleep and self-rated
sleep quality (26;37;149-152). Acute aerobic exercise of varying intensities
elicits small to moderate improvements (approximately 4 to 13 minutes) in
several features of objectively measured sleep quality, including increases in
time spent in slow-wave sleep, total sleep time, and latency for rapid eye
movement (REM) sleep, and a decrease in REM sleep among normal sleepers (153). The effects for total sleep time are larger when the
exercise lasts more than an hour but do not vary according to peoples
fitness levels or the intensity of the exercise. The effects of a single
exercise session on the sleep of people with sleep disorders are not known. The
long-term effects of exercise on objective measures of sleep among poor
sleepers have not been studied much (154), and the
results of a few RCTs (155-157) and quasi-experimental
studies (158;159) of nursing home
residents or patients with sleep apnea have been mixed.
The few RCTs and the scarcity of prospective cohort studies do not
permit conclusions about whether the effects of physical activity on sleep
differ according to types of people, age, type of sleep disorder, or other
medical conditions.
Self-reports of exercise frequency and sleep problems were inversely
related in a cross-sectional study of a thousand elderly African American
residents of New Orleans (138). Older, sedentary adults
without cardiovascular disease who complained of sleep problems reported
improvements in self-rated sleep after a 16-week exercise program of moderate
intensity consisting of 30 to 40 minutes of low-impact aerobics and brisk
walking 4 times a week (150). Similarly, older, depressed
adults with sleep problems who were not currently being medically treated
reported improvements in self-rated sleep that was accompanied by a reduction
in depression symptoms (160) after a 10-week,
3-days-per-week, moderately intense (80% of one maximum repetition) resistance
training program (26).
Evidence from prospective cohort studies or RCTs is insufficient to
determine whether features of sleep quality vary according to features of
physical activity exposure.
In a year-long study of moderate intensity (60% to 85% maximal heart
rate) walking or leg cycling exercise (45 minutes or more, 5 or more days each
week) among postmenopausal, overweight or obese, sedentary women not taking
hormone replacement therapy, morning exercisers who exercised at least 225
minutes per week reported less trouble falling asleep compared with those who
exercised less than 180 minutes per week. In contrast, evening exercisers who
exercised at least 225 minutes per week reported more trouble falling asleep
compared to those who exercised less than 180 minutes per week (152). However, those differences might have been biased, as
the timing of exercise sessions were self-selected and most evening exercisers
were employed while the morning exercisers were mostly retired or not working.
Regardless, increases in cardiorespiratory fitness were related to reduced odds
of poor sleep quality, independently of changes in body mass index or time
spent outdoors.
Fifteen, 60-minute sessions once a week that emphasized
moderate-intensity recreational sports activities (e.g., softball, dance,
self-defense, swimming, and athletics) were accompanied by a small increase in
self-rating of total time spent sleeping among older, sedentary adults who were
group-randomized according to age and socioeconomic status (161). Other studies of less vigorous exercises, such as
walking or yoga, have reported smaller or statistically non-significant
reductions in self-rated sleep (47;162;163).
Physical activity and exercise may have the potential to reduce the
onset or progression of central nervous system disorders other than dementia
that contribute to disability and mortality risk, such as multiple sclerosis
(164) and Parkinsons disease (165). They also may reduce the adverse impact of these
disorders on quality of life. However, too few prospective cohort studies and
RCTs have been conducted to allow conclusions about the protective effects of
physical activity for CNS diseases other than Alzheimers disease and
other dementias.
Benefits of physical activity may also extend to other aspects of mental
health that are less directly linked to disability and mortality risks but are
important contributors to overall quality of life, such as self-esteem and
feelings of energy/fatigue. Sufficient evidence exists to encourage more study
in these areas, but presently not enough studies are available to draw
conclusions about how the effects of physical activity or exercise might differ
according to types of people or types and amounts of physical activity.
Enhanced self-esteem has significance for mental health because it
conveys a feeling of value or self-worth and it is a generalized indicator of
psychological adjustment and health risk (89). A
meta-analysis of about 50, mostly small, RCTs of various types of exercise
reported an average increase in self-esteem of about 0.25 SD among adults (166). Self-esteem is increased among adults (166) when physical fitness is increased. However, because
features of physical activity exposure were not associated with self-esteem
outcomes in the studies, it is difficult to conclude that fitness influences
self-esteem independently of other diverse aspects of the studies
methods, social contexts, and participant expectations of benefit. Nonetheless,
larger gains in self-esteem can be expected for individuals with low initial
levels, and for whom physical attributes have a relatively high value as a part
of global self-concept.
The literature on physical activity and chronic fatigue syndrome is
small, and epidemiologic studies of this condition rarely have included
measures of physical activity. Five relatively small RCTs all show a positive
effect of exercise training on symptoms of chronic fatigue syndrome (167-171). A dozen population-based observational studies,
including 4 prospective cohorts published since 1995, suggest a protective
effect of physical activity against feelings of fatigue or low energy
(OR = 0.61, 95% CI = 0.52 to 0.72) (172), and RCTs of groups of medical patients and other
adults show a moderate reduction in symptoms of fatigue (173;174).
Some adverse psychological events have been reported among extremely
active people, but whether they are causally influenced by physical activity
exposure is not yet known. Clinical cases of running addiction,
were described 30 years ago (175), whereby motivation for
running exceeded commitments to work, family, social relations, and medical
advice. Similar cases have been labeled positive addiction, runners
gluttony, fitness fanaticism, athletes neurosis, obligatory running,
and exercise abuse.
However, little is understood about the origins, valid diagnosis, or
mental health impact of exercise abuse (176;177). Though exercise abuse or addiction is a recognized
problem for clinical medicine, its population prevalence is unknown but likely
low. Likewise, it is not known whether excessive exercise and disordered eating
share a common course that is motivated by common goals and followed by common
medical outcomes. It has been proposed that anorexia athletica is a subclinical
syndrome of anorexia nervosa (178), but the prevalence of
disordered eating and the independent risk caused by sport and exercise have
not yet been established by controlled epidemiologic and clinical studies. In
most cases, the eating behaviors of athletes do not appear to signal anorexia
nervosa or bulimia (i.e., bingeing and purging (179)),
which have prevalence rates in the United States of about 1% and 4%,
respectively. Cases of muscle dysmorphia, a proposed form of body dysmorphic
disorder, in which a person develops a pathological preoccupation with his or
her muscularity and has associated symptoms of severe subjective distress,
impaired social and occupational functioning, and abuse of anabolic steroids
and other substances, have been reported (180;181). No population-based studies have been conducted to
determine the prevalence of muscle dysmorphia nor any prospective cohort
studies or randomized clinical studies to determine whether muscle dysmorphia
or body dysmorphia results from participation in resistance exercise training
or whether people who have existing vulnerability to a distorted body image and
self-concept are drawn to weightlifting.
Results from nearly 100 studies on these potential adverse events of
participation in exercise training and sports are inconclusive because the
studies described symptoms among different groups of active or inactive people
without fully considering attributes other than activity history that might
account for abusive exercise or eating problems (177).
Risk profiles of exercise abusers or athletes have not been evaluated against
those of non-athletes from the same academic, socioeconomic, or psychological
backgrounds. The studies often lack standard definitions or valid measures of
physical activity or disordered eating. Though anorexics often augment food
restriction by hyperactivity, their aerobic fitness is well below average
because of muscle wasting and anemia, in contrast to the above-average aerobic
fitness of habitual runners and trained athletes. In addition, cross-sectional
studies have not revealed a common psychopathology between obligatory (i.e.,
excessively committed) runners and anorexic patients.
Anxiety can be elevated slightly immediately after maximal exercise
testing or heavy resistance exercise (i.e., approximately 80% of 1 repetition
maximum (182;183)), but that
elevation is temporary. Nonetheless, overall reductions in anxiety can be
delayed by 1 or 2 hours after resistance exercise is completed. Evidence from
15 studies refutes the potential association between exercise and panic
attacks; only 5 panic attacks were reported during exercise involving 444
exercise bouts performed by 420 panic disorder patients (184). Research has also shown that lactate accumulation
resulting from exercise is not related to increased risk of panic attacks among
patients with panic disorder (185) or postexercise
anxiety in normal individuals (186). Moreover, a small,
randomized clinical trial recently showed that 10 weeks of aerobic exercise
training was effective in reducing symptoms of anxiety among patients with
panic disorder and agoraphobia (72).
Very limited evidence exists about biological mechanisms that can
explain the effects of physical activity or exercise on mental health (187). It is accepted that the brain and the rest of the
central nervous system regulate moods, emotions, cognitions, sleep, and
neurological functions, and that social and environmental factors interact with
genes to regulate the brain. Experimental animal studies show that both
voluntary and forced running activate and produce adaptations in several
aspects of brain neural circuits involved with learning, memory, motivation,
and behaviors that mimic features of human depression, anxiety, and cognitive
function. These include neurotransmitters (e.g., acetylcholine, glutamate, and
gamma-aminobutyric acid), neuromodulators (e.g., dopamine, norepinephrine, and
serotonin) and their receptors, neuropeptides that influence neurotransmission
(e.g., galanin and neuropeptide Y), and neuronal growth factors (e.g., brain
derived neurotrophic factor and VGF), all of which are targets of experimental
treatments for depression and anxiety. However, only a few studies have used
animal models of mental or neurological disorders, testing whether brain and
behavior changes coincide as predicted after physical activity (e.g.,
188-194). Likewise, the way in which exercise regulates
sleep has received little study and is unknown. Indirect evidence suggests that
acute bouts of exercise are positively associated with melatonin production in
women (195) and can induce circadian phase shifts (196) including a phase delay in circadian melatonin rhythm
(197), influence adenosine metabolism (198), and activate brain neurological circuits hypothesized
to help people feel less anxious and depressed (154).
Unlike other chronic diseases, non-biological mechanisms also may
explain the effect of physical activity on mental health. Cognitive
explanations include increased self-esteem (e.g., 199),
perceptions of social support, and efficacy beliefs about personal control.
Similarly, acute responses to single exposures of physical activity, such as
transient changes in moods (200;201) or feelings of energy; pleasant (e.g., enjoyment) or
unpleasant (e.g., discomfort or pain) affective experiences during exercise; or
nightly sleep (153), are likely to contribute to the
accumulative psychological responses that typically are measured only after
chronic exposure to physical activity. Also such responses might contribute
indirectly by increasing exposure to physical activity (e.g. better adherence
to exercise) or by influencing other factors important to mental health (e.g.,
social engagement). Tests of those contributions will require research designs
and methodologies that are difficult to implement with tight control in
clinical or public health settings (e.g., 202-206). Thus,
continued experimental research on biological mechanisms and innovative tests
of social or cognitive mediators of psychological responses are needed to
confirm and explain the evidence from prospective observational studies and
RCTs that physical activity and exercise promote mental health.
The weight of the cumulative evidence from prospective cohort studies
and RCTs of uneven quality supports the conclusion that physical activity has
protective benefits for several aspects of mental health. The evidence is
strongest for protection against symptoms of depression and cognitive decline
associated with aging, including the onset of dementia. Substantial evidence
also suggests that physical activity reduces symptoms of anxiety and poor
sleep, as well as feelings of distress and fatigue, and enhances well-being.
Physical activity generally appears equally beneficial for adults regardless of
age, sex, race/ethnicity, or health status, but few studies have directly
compared benefits or hazards of physical activity among those population
segments. Minority groups have been poorly represented in most studies. A small
number of prospective cohort studies suggest that health benefits for
depression and dementia are greater with higher levels of physical activity
exposure, but insufficient evidence precludes conclusions about the minimal or
optimal types or amounts of physical activity for mental health. Benefits do
not appear to depend on fitness or fitness gains. Current evidence supports the
conclusion that regular participation in moderate-to-vigorous physical
activity, consistent with current public health guidelines, confers mental
health benefits when compared to participation in low levels of physical
activity or a sedentary lifestyle.
This review of physical activity and mental health identified a number
of research needs. First, more prospective cohort studies and tightly
controlled RCTs are needed, especially for anxiety and sleep disorders.
A second important research need is studies that manipulate or directly
compare standardized features of physical activity, including type, intensity,
and timing, with the settings in which activity takes place (e.g., group vs.
solitary, community vs. home, indoor vs. outdoor).
Finally, it would be helpful to accelerate the synergy between human
brain imaging studies and neuroscience studies that use animal models of human
disease. This improved synergy could help elucidate biological mechanisms
underlying the benefits of physical activity to mental health. An increased
emphasis on modeling of social-cognitive mediators of mental health outcomes
and studies of gene-environment interactions also would be valuable additions
to the field.
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Physical Activity
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Last updated: 9/15/2019
This site is coordinated by the Office of Disease Prevention and Health Promotion,
Office of the Assistant Secretary for Health, Office of the Secretary,
U.S. Department of Health and Human Services.
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1 teaspoon olive oil
1 large onion, sliced (about 1 1/2 cups)
2 1/2 cups low-sodium chicken broth
3/4 teaspoon dried tarragon
1/2 teaspoon salt
Freshly ground black pepper
1 (10-oz) bag frozen peas
4 teaspoons plain nonfat yogurt, optional
In a large pot, heat the olive oil over moderately-low heat. Add the onion, cover and cook, stirring occasionally, until softened, about 5 minutes. Add the broth, tarragon, salt and a few turns of freshly ground black pepper and bring to a boil. Add the peas and cook just until defrosted.
In a blender, puree the soup in 2 batches until very smooth. If serving hot, return the soup to the pot and bring just to a simmer. If serving cold, transfer to the refrigerator to chill. Ladle into bowls. Stir the yogurt so that it is smooth and top each serving with a swirl of yogurt.

subset: commoncrawl


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My neighbor came and knocked on my door and was freaking out saying something about UFO's, I walked out front and saw two orange orbs floating over the city, I didn't know what they were but they were unlike anything I had ever seen before, they definitely weren't planes. I ran inside to grab my camera but when I got back out they had disappeared, my neighbor said she saw them go out like someone switched out the light. After a few minutes she went back inside, I continued to look for them and saw them reappear in a different part of the sky and thats when I started filming. Around 3:30 they both disappear as a plane approaches and then one of them reappears in a different spot further east.
This is what military flares at night look like, (http://www.youtube.com/watch?v=BfOcq246sQU) these are not military flares. Chinese lanterns? If you pay attention to the cluster of bright redish tinted lights under the "orbs" on the horizon you can use that as a reference to where the orbs were in the sky before they disappear (3:30) if you keep paying attention to those redish lights on the horizon after they disappear it is clear that when the "orb" reappears it is further east than it was before they disappeared as you can see the cluster of redish lights are way off to the right, which is west. You can also see the area of the sky the the orb reappears in AS THEY DISAPPEAR when it's zoomed out and it is clear that there was nothing previously there in that part of the sky. If it was a chinese lantern it would have to rise up from the ground and would have previously been visible. Maybe theres an explanation, but as of now they're unidentified....
This video is featured on the homepage of KTAR.com The Voice of Arizona. Thanks for sharing KTAR!
My name is Tony Aguilera, I am 24 years old. I am a photographer and drummer from Phoenix, AZ. You can view my work at www.tonyaguileraphoto.com.
Views: 256


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Football fans may be placing their bets on their favorite team, but investors are making a few Super Bowl-related bets themselves.
Shares of a number of pizza, chicken wing, and beer makers rose Friday ahead of the big game, an annual festival of gluttony that is celebrated by fans and non-fans alike.
More than 1.23 billion portions of wings will be consumed during Super Bowl weekend, according to the National Chicken Council.
The restaurant chain Buffalo Wild Wings (NASDAQ:BWLD) was upgraded Friday by KeyBanc Capital Markets. Analyst Christopher O'Cull gave the restaurant chain a "Buy" rating with an $85 price target, saying that the company's stock makes an attractive investment after a recent price drop. He said Buffalo Wild Wings said its stock trades at a significant discount compared to the rest of the casual dining sector, despite its above-average growth rate and significant growth potential.
Buffalo Wild Wings shares increased $2.56, more than 3 percent, to $76.11 by early afternoon. Its stock had fallen about 17 percent since October, when it issued a disappointing third-quarter earnings report.
And what better to wash down a dozen wings than with a frosty brew? Not many better ways, according to figures compiled by the Nielsen ratings company.
The volume of cases of beer scored in the two weeks before the big game soar to more than 49 million.
Despite what could be a huge legal setback on Thursday, shares of Anheuser-Busch InBev (NYSE:BUD) jumped in trading Friday.
The Justice Department filed a lawsuit Thursday to stop Anheuser-Busch InBev's proposed $20.1 billion purchase of Mexican brewer Grupo Modelo (UNKNOWN:GPMCY.DL), which would unite the ownership of popular beers like Budweiser and Corona. The government said the deal could lead to higher beer prices in the U.S. because it would substantially reduce competition in the domestic beer market, particularly in 26 metropolitan areas. It said the merged firm would control nearly half the beer sales in the U.S. In response, Anheuser-Busch InBev promised a court fight to preserve its deal.
The company's shares increased $3.04, more than 3 percent, to $91.64, nearing the top of its 52-week trading range.
Investors were also craving pizza stocks.
Domino's Pizza's (NYSE:DPZ) shares increased $1.20, nearly 3 percent, to $47.77. And Papa John's (NASDAQ:PZZA) shares increased 42 cents to $456.52.


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The St. Louis Cardinals announced today that Senior Vice President and General Manager John Mozeliak has agreed to a two-year contract extension with the team through the 2018 season.
"Over the last six seasons Mo has done an outstanding job leading our baseball operations," said Cardinals Chairman Bill DeWitt Jr. "By extending Mo's contract with the club, we look forward to continuing our approach which emphasizes excellence at the Major League level, supported by a strong player procurement and player development program."
The 12th General Manager in Cardinals history, Mozeliak, 45, is a 19-year veteran of the Cardinals front office who has served as the team's General Manager the last six seasons (2008-2013). During his tenure as General Manager, the Cardinals have advanced to the postseason four times, winning a World Championship in 2011, and the National League Championship last year. The Cardinals have twice been recognized by Baseball America as the Organization of the Year (2011 & 2013). The prestigious honor recognized the Cardinals for their success in scouting and player development
Mozeliak was named Executive of the Year in 2011 by MLB.com and in recent years he has been successful in locking up core players Matt Holliday, Yadier Molina, Adam Wainwright, Allen Craig, and Matt Carpenter with long-term agreements with the Cardinals.
"I am fortunate to work with one of the true leaders in our game today," said Mozeliak. "Bill DeWitt is a visionary leader who has overseen one of the most successful periods in our storied history. I look forward to continuing my relationship with this great franchise as we try to bring another championship to our fans and city."
source: St. Louis Cardinals News Release


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Just a heads up, this week's CoffeeHouseCoders (CHC) Detroit-ish will be a bit different. One of the goals of moving the location to the new Caribou was that we get access to the meeting room. This opens up the opportunity for us to have some group discussion and such around various topics. We're going to give that a shot this week with a group viewing of YUI Theater video viewings and JavaScript discussion.
Most of us do at least some JavaScript in our work and projects so I think it's relevant and should be fun to geek out before the holidays start up. I'll have a little projector and speaker and with the new videos from YUIConf 2011 going up, it'll be nice to set aside some time to catch up on some of the recorded presentations. Take a peek and set aside one or two "must watch" videos for Wed night! Not all of the videos are YUI specific, so it should be useful for all of us doing JavaScript.


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cane(redirected from quadripod cane)
Also found in: Dictionary, Thesaurus, Legal, Encyclopedia.
an assistive device that provides partial support and balance for ambulation and standing.
adjustable cane a cane whose length can be easily altered.
quadripod cane a cane adapted for increased stability by providing a four-legged rectangular base of support.
tripod cane one similar to a quadripod cane except that its base is triangular with three legs.
white cane a cane used by the visually handicapped to increase awareness of the immediate environment; the white color is a sign to others that the user is blind.
A stick used as an aid in walking or carried as an accessory.
can′er n.
Etymology: Ar, qanah, reed
a sturdy wooden or metal shaft or walking stick used to give support and mobility during walking to a person with impaired mobility. A cane should be of an appropriate length to allow a person with an injured leg to walk with it held on the side of the noninjured leg. In walking, the person may rest his or her weight on the cane and the injured leg while moving the unaffected leg forward. To take the next step, the weight is placed on the sound leg while the injured leg and cane are moved forward. The cane should allow 25 degrees of elbow flexion.
An assistive device prescribed to provide support during ambulation and transfers for individuals with weakness, instability, pain, or balance loss. It also may be used to unload a lower extremity joint or to partially eliminate weight-bearing. Standard (conventional) canes are made from wood or aluminum and have a variety of hand grip styles. Other styles include tripod canes, quadruped (quad) canes, and walk ("hemi") canes. Canes should be used on the unaffected (stronger) side of the body.


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We currently have 2 Supernova Plus testers, 1 for each area we work in. All the test results are downloaded to a laptop at our main office. As at times the 2 testers are at the main offices, we get them mixed up when doing PAT testing on site. We have our own workshops here and many electric hand tools, as well as many electric hand tools out on various sites. We try to test all the hand tools on a yearly cycle.
Problem 1:
If user 1, on tester 1, gives a site a name. ie "Site 1", and if user 2, on tester 2, gives the same site a different name, ie " Main Office", is it possible to change the name of the sites in PATGuard Plus, to the same name and locations?
Problem 2:
On the main menu, Appliance id, we input a number, this number is unique to each item and never changes. This number becomes the Asset id, in the Asset details page on PATGuard Plus. No problem so far...
When the re-test period is up for an item (Asset), we input the Appliance id number and conduct the test. When the test results are downloaded to our laptop, only the first test results are shown, not the new ones and each item is still flagged red, due for re-testing. Do we have to manually remove / delete the old test results before the new ones are downloaded? We would like to keep a record of all tests carried out on an item over its life time and a paper record isn't ideal.
Thanks in advance, Phil


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Join us for a morning group road bike ride!
We will be leading an approximately 20 mile loop starting and ending at Good Bike Co. This will be a no-drop ride, meaning we will ride at the pace of the slowest rider. However, differently paced and/or distance groups may form based on riders' abilities.
Meet at the shop at 8:45am, and be ready to roll at 9:00am.
Be sure to come prepared with:
Energy food
Road bike
Flat tire repair kit
If you'd like to rent a bike, give us a call/email ahead of time to reserve yours!


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New Fossil Indicates Origin And Rise Of Modern Mammals main content.
by AMNH on
Illustration: Paul Bowden/Carnegie Museum of Natural History
The fossilized remains of an extinct, shrew-like animal found in Mongolia have helped pinpoint the origin of most modern mammals, according to new work by Michael J. Novacek from the American Museum of Natural History and colleagues. Their report in the upcoming issue of the journal Nature places the rise of placental mammals, including humans, near the Cretaceous-Tertiary (K/T) boundary 65 million years ago in the Northern Hemisphere. This finding contradicts recent gene studies that put the origin between 129 and 78 million years ago in the Southern Hemisphere.
The fossil was unearthed in 1997 in the Gobi Desert by members of the Mongolian Academy of Sciences-American Museum of Natural History Expeditions (MAE) and later named Maelestes gobiensis. The remains included parts of the animal's skull, lower jaw, backbone, ribs, shoulder blade, collar bone, and legs. From these, the paleontologists were able to identify it as a previously unknown and extinct species of Eutheria, the ancient relatives of modern placental mammals, that lived more than 70 million years ago during the Cretaceous Period.
"This is another of recent discoveries from central Asia that gives us a much better picture of the pattern and timing of the great evolutionary radiation of modern mammals," said Dr. Novacek, Senior Vice President and Provost of the American Museum of Natural History, Curator in the Division of Paleontology, and coleader of the MAE. "For over 140 million years mammals lived alongside dinosaurs, but these were mainly archaic lineages. It wasn't until nonavian dinosaurs went extinct at the end of the Cretaceous that modern mammals, like the placentals, the group to which we belong, started to really diversify."
Placentals make up more than 90 percent of living mammals. The rest are egg-laying monotremes, such as the platypus, and marsupials, such as the kangaroo, that carry their embryo to term outside the womb. The vast majority of mammals that have ever lived are now extinct, and hypotheses describing the timing and nature of the diversification events that led to modern mammal lineages are nearly as numerous as the animals themselves.
Analysis of Maelestes led the MAE team, which also included members from the University of Louisville (Kentucky) and Cambridge University, to compare 408 anatomical features across 69 species, including living mammals and well-preserved early mammal fossils. The genealogical tree of living and extinct mammals they produced traces the ancestry of today's placentals to the K/T boundary. It also supports the idea that the disappearance of non-avian dinosaurs, which occurred at roughly the same time, permitted mammals to diversify explosively over a relatively short period of time.
"Our research gives credence and weight to the traditional paleontology viewpoint of placental mammals appearing 65 million years ago when the dinosaurs died off," said Dr. Wible, lead author on the study. "When dinosaurs became extinct, ecological niches emerged that gave modern placental mammals opportunities to thrive and diversify."
The study was supported by the National Science Foundation, the Carnegie Museum of Natural History, and the American Museum of Natural History.
Media Inquiries: Department of Communications, 212-769-5800


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6-20-16. Numbers 14:20-35. Do Not Treat The Lord With Contempt-my devotional Numbers 14:20-35 By Kevin E. Jesmer Key verse 14:23-24 6-20-16 "not one of them […]Read More...
"But if serving the Lord seems undesireable to you, then choose for yourselves this day whom you will serve, whether the gods your forefathers served beyond the River, or the gods of the Amorites, in whose land you are living. But as for me and my household, we will serve the Lord." Joshua 24:15
Recent Posts
- Bruce Morton's Obituary (d. June 27, 2019) He is my dad's first cousin.
- James 5:1-12. Patience Through The Promises of God. 6-7-19 Devotional
- James 4:13-17. TRUST GOD FOR TOMORROW- 6-3-19 devotional
- James 4:7-12. RESIST THE DEVIL- 5-28-19 devotional
- The Parents of my aunt, Emily (Wilks) Sawicki. Pauline (Wasalyshen) Wilks and her husband, Frank Wilks
Recent Comments
- Links to other UBF Bible material These are some links to other UBF ministries Bible material
Blogs That I Follow
- Dr John Armstrongs blog site A blog site of a professor building up a missional church
- Photos This is link to pictures of our housechurch ministry


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Keith Wright and the Crimson are now 11-2 in the Ivy League (Gene Boyars).
NEW YORK – Keith Wright scored 16 points on 8-of-11 shooting and had eight rebounds, while Kyle Casey tallied 19 points, as the Harvard men's basketball team earned a 77-70 win in overtime on the road at Columbia Friday evening. The Crimson improves to 25-4 overall, a program record for wins, and 11-2 in the Ivy League and holds a one-half game lead over Penn (18-11, 10-2 Ivy) with one contest remaining for Harvard.
Harvard will conclude the regular season by visiting Cornell Saturday evening in a game that will be shown live on ESPN3 at 7 p.m. A Crimson victory would clinch at least a share of the program's second straight Ivy League title, while a Harvard victory combined with a Penn loss to Yale Saturday or a Quaker loss at Princeton Tuesday would clinch the outright Ancient Eight crown and the NCAA tournament automatic berth for the Crimson.
Brandyn Curry dished out eight assists for Harvard, while Oliver McNally went 7-of-8 from the line, finishing with 12 points. Brian Barbour led Columbia (14-15, 3-10) with 23 points, hitting nine baskets. The Crimson shot 56.3 percent for the game (27-of-48) from the field and was 6-of-13 from behind the arc (.462), while controlling the boards, 28-23.
Harvard scored its first two buckets in the paint, as Wright and Casey converted on layups, giving the Crimson a 4-2 lead. With 16:16 left in the first, Laurent Rivard drained two free throws, making it 8-2. With 14:30 to go, the Crimson continued to attack down low, as Wright added another basket in the paint, 12-4. Harvard went up by 10, 18-8, when Corbin Miller dribbled to the top of the key and drained a jump shot with just under 12 minutes remaining.
With 8:15 to play, McNally stepped up and drilled a triple from the right side, making it 21-14 in favor of the Crimson. After Columbia got back within four, 21-17, the Lions pulled even closer, cutting the deficit to one, 21-20, with just over five minutes left. The Lions continued the 8-0 run with a layup by Brian Barbour, but Casey hit a basket on the other end after being fouled. Casey hit the free throw, putting the Crimson back on top, 24-22.
Wesley Saunders drew contact in the paint and made the layup and ensuing free throw, keeping Harvard in front, 29-25. Rivard connected on a trey with 1:10 left, as the Crimson led, 34-28. At the break, Harvard was up, 34-30, with Saunders and Casey pacing the team with seven points apiece, while Curry had five assists. The Crimson shot 75.0 percent (12-of-16) in the first stanza, while the Lions went 11-of-21 (.524).
With 17:48 left in the second, McNally sent a pass down the court after a Columbia turnover and Wright finished with a two-handed jam, 38-34. Moments later, Curry scored another bucket after a Crimson steal, making it 40-34 and forcing a Columbia timeout. After the Lions responded with a 7-0 run to move in front, 41-40, Wright used his size to maneuver for a bucket under the hoop, reclaiming the lead, 42-41.
Columbia went ahead by three, 45-42, but Casey faked a 3-pointer and made a quick pass down low to Wright for a jam, 45-44. Seconds later, Casey gave the Crimson a 46-45 lead at 12:42 when he flew down the baseline and finished with another Harvard dunk. With 10:48 left, Casey gave Harvard a four-point edge, 51-47, when he nailed a trey from the top of the key.
Steve Moundou-Missi gave Harvard a 55-51 lead with another Crimson dunk, and Curry gave Harvard six-point advantage, 57-51, with a floater in the lane with five minutes remaining. After Columbia got back within one, 59-58, Curry nailed a huge triple from the right side, upping Harvard's lead to 62-58.
After Columbia got back within two, Barbour tied the game, 62-62, with a layup with only 35 ticks left on the clock. In the final seconds of regulation, McNally shot a triple from the right side, but it rattled out of the hoop, forcing overtime.
Casey started overtime with a bucket in the lane, putting the Crimson ahead, 64-62. Rivard added to the lead with a trey from the left wing, making it 67-62 with 1:55 remaining in the extra session. With 1:12 left, Casey also drained a triple, putting Harvard up six, 70-64. McNally was fouled and went to the line with 44.5 ticks remaining on the clock, putting the game out of reach, 72-65.