Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence

Vanessa Roriz Ferreira; Thiago Veiga Jardim; Thaís Inácio Rolim Póvoa; Ricardo Borges Viana; Ana Luiza Lima Sousa; Paulo César Veiga Jardim

doi:10.11606/s1518-8787.2020054001888

. 2020 Nov 23;54:128. doi: 10.11606/s1518-8787.2020054001888

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Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence

Vanessa Roriz Ferreira ^I, Thiago Veiga Jardim ^I,^II,^III, Thaís Inácio Rolim Póvoa ^IV, Ricardo Borges Viana ^IV,^✉, Ana Luiza Lima Sousa ^I, Paulo César Veiga Jardim ^I

PMCID: PMC7688259 PMID: 33295594

ABSTRACT

OBJECTIVE:

To investigate the association of physical inactivity in leisure and school time with common mental disorders during adolescence.

METHODS:

The sample consisted of 73,399 adolescents (12–17 years old), participants in the Estudo de Riscos Cardiovasculares em Adolescentes (Erica — Study of Cardiovascular Risks in Adolescents). This cross-sectional, national and school-based study was conducted in 2013 and 2014 in Brazilian municipalities with more than 100,000 inhabitants. Leisure time physical activity was categorized according to weekly practice volume, and adolescents were classified as active (≥ 300 minutes/week), inactive (0 minute/week) and insufficiently active (1–299 minutes/week). Sports practice and participation in physical education classes at school were also analyzed. The presence of common mental disorders was assessed based on the general health questionnaire, with a cutoff point greater than or equal to 3. Odds ratios (OR) were estimated using multiple logistic regression.

RESULTS:

The chance of common mental disorders was 16% higher in the group that reported being inactive (0 minute/week) at leisure time (OR = 1.16; 95%CI 1.06 (1.27). The prevalence of common mental disorders was higher among young people who did not practice sports (37.2% vs. 25.9%; OR = 1.14; 95%CI 1.04–1.25) and did not participate in physical education classes at school (39.5% vs. 29.6%; OR = 1.25; 95%CI 1.15–1.36). Insufficient physical activity (1–299 minutes/week) did not increase the OR of common mental disorders. Practicing physical activity during leisure time, regardless of duration and weekly frequency, reduced the chances of common mental disorders in this population by 26%.

CONCLUSIONS:

Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence. The results suggest that sports practice, school physical education and physical activity during leisure time, even without reaching the current recommendation, are related to the mental health of young people.

DESCRIPTORS: Adolescent, Sedentary Behavior, Mental Disorders, Mental Health, Physical Education and Training

INTRODUCTION

Epidemiological data show that up to 20% of children and adolescents suffer from a disabling mental illness and that about 50% of mental disorders start in adolescence¹. Worldwide, neuropsychiatric disorders are the main cause of years of life lost due to disability in the age group between 10 and 24 years². In Brazil, data from the Estudo de Riscos Cardiovasculares em Adolescentes (Erica — Study of Cardiovascular Risks in Adolescents) reported a high prevalence (30.0%) of common mental disorders in the young population³.

Common mental disorders, also known as minor psychiatric disorders or psychological distress, are mental disorders without psychotic character not contemplated in the diagnostic criteria of categorical classification systems. They are characterized mainly by the presence of symptoms of depression and anxiety, as well as nonspecific somatic symptoms. These disorders, which may be early manifestations of more serious psychiatric diseases, harm the adolescent's school life and social relations⁴^,⁵.

Recent evidence has related symptoms of depression and anxiety to physical inactivity⁶^,⁷. A cross-sectional study with Australian adolescents showed that boys with low level of physical activity are more prone to depressive symptoms⁶. On the other hand, longitudinal research conducted in Germany showed that young women (12–26 years), when practicing physical activity for longer than usual, felt less depressed in the next morning⁷.

Being active during adolescence also increases the chance of staying active in adulthood, prevents cardiovascular diseases, improves body composition and increases muscle strength, in addition to immediate benefits, such as well-being and greater self-esteem⁸. Nevertheless, in Brazil, one in four adolescents does not practice any physical activity during leisure time (0 min/week)⁹. This fact is worrisome, because sedentary lifestyle in adulthood is the fourth leading cause of death in the world¹⁰.

Additionally, adolescence is marked by intense transformations, both physiological and social. There may be more complex homework, parents divorced and greater demand of society regarding future plans. This complexity of factors can affect the adolescent's desire or ability to be physically active in daily life, as well as intensify their common mental disorder¹.

To date, most studies have focused on adult populations in developed countries, sedentary behaviors (screen time) and patients with psychiatric illnesses. In addition, little is known about school physical education and sports practice in the context of common mental disorders¹¹. In this sense, this study aimed to investigate the association of physical inactivity in leisure and school with common mental disorders in Brazilian adolescent students.

METHODS

The Study of Cardiovascular Risks in Adolescents (Erica) is a cross-sectional, multicenter, national, school-based study that assessed adolescents aged between 12 and 17 years, enrolled in public and private schools (morning and afternoon classes), from Brazilian municipalities with more than 100,000 inhabitants. Data were collected from March 2013 to February 2014. Erica's protocol was previously described¹².

The population under research was divided into 32 geographic strata comprising 27 capitals and five sets of municipalities with more than 100,000 inhabitants in each of the five geographical macro-regions of the country. Then a probabilistic sampling of schools was carried out in two stages. For each geographic stratum, we selected schools with probability proportional to size and inversely proportional to the distance from the capital. In the second stage, three classes in each school were selected with equiprobability during the field work, using the school year as an informative variable of age. The sample is representative for medium and large municipalities (> 100,000 inhabitants) at national and regional level and for all Brazilian capitals.

In the classes selected, all students who signed the consent term and brought the informed consent form signed by the guardians (when required by the local Research Ethics Committee) were interviewed and examined. Adolescents outside the elective age group, with physical or mental disabilities and pregnant were not considered eligible.

The data collection instrument was a self-completed questionnaire, applied in the classroom, under the supervision of the study team, through an individual and portable electronic data collector PDA (personal digital, assistant, model LG® GM750Q). To characterize the sample studied, the adolescents answered questions about gender (male or female), age in complete years (later categorized: 12–14 and 15–17 years), declared skin color, type of school (public or private), sexual maturation (self-assessment based on five stages)¹³ and weight status, from the body mass index curves for age proposed by the World Health Organization in 2007.

To determine the level of physical activity of adolescents, an adaptation of the self-administered physical activity checklist, was used, which consists of a list of 24 modalities and allows the adolescent to inform the frequency (days) and time (hours and minutes) they practiced, in the last week, any of the activities listed¹⁴. The version of this questionnaire used in Erica was validated in Brazilian adolescents¹⁵. In the estimation of the total time of physical activity, moderate to vigorous intensity modalities were considered (greater than or equal to three metabolic equivalents [MET]).

The product between time and frequency in each activity and the sum of the times obtained were estimated to determine the level of physical activity. Adolescents who accumulated at least 300 minutes/week of physical activity were considered active during leisure time, based on the level recommended by the WHO¹⁶. Individuals who did not report any leisure time physical activity in the week before the study (0 minute/week) were considered inactive. And those whose accumulated time in the previous seven days was higher than 0 and lower than 300 minutes were called insufficiently active¹⁷.

Participation in the physical education classes at school (yes/no and number of times per week) and the practice of sports outside/in the school (yes/no) were also assessed. Of the 24 modalities assessed to determine the adolescents’ level of physical activity, 12 were considered sports: athletics, swimming, martial arts (such as judo and karate), tennis, gymnastics, soccer, futsal, beach soccer, handball, basketball, court volleyball and beach volleyball.

Common mental disorders were assessed using the general health questionnaire (GHQ-12), a psychiatric screening instrument⁵. The GHQ-12 assesses mental health status and psychological distress without psychotic character, from 12 questions referring to the previous two weeks, with four answer options (more than usual, the same as usual, less than usual, much less than usual or much more than usual). The scores of the individual items were coded using a dichotomous scale. The answers with 1 or 2 points indicated absence (0), and the answers with 3 or 4 points, presence (1). Then all items were summed up. Using this method, the participant was able to reach from 0 to 12 points; scores of 3 or more³ indicated the presence of common mental disorders, which poses risk for the development of psychiatric disorders⁴. The GHQ-12 was validated for the Brazilian population, with a psychiatric interview structured as gold standard¹⁸.

Measures of relative frequency (prevalence) of a score equal to or greater than 3 were estimated for the different categories of leisure time of physical activity (active, insufficiently active and inactive), for sports practice (yes/no) and for the practice of physical education at school (yes/no and by number of times/week). Considering the sample design, odds ratios (OR), with their respective 95% confidence intervals (95%CI), were estimated by simple logistic regression adjusted by gender, age, type of school, stage of sexual maturation, body mass index, smoking (smoked at least once in the last thirty days) and alcohol consumption (consumed at least one glass or dose of alcoholic beverage in the last thirty days). The survey module of the Stata version 12.0 (StataCorp) program was used for complex sample data analysis, since it employs stratification and conglomeration in its selection stages.

Erica was carried out in accordance with the principles of the Declaration of Helsinki. The study was approved by the Research Ethics Committees of the Universidade Federal do Rio de Janeiro (Process 45/2008) and each federation unit.

RESULTS

A total of 73,399 adolescents (71.7% of eligible students) from 1,247 schools in 124 Brazilian municipalities were evaluated. National coverage of eligible adolescents was 74.8% (n = 40,675) in females and 68.3% (n = 32,724) in males. Thirty-six-year-old students with physical disabilities that prevented the measures, and 215 pregnant women were not considered eligible, representing 0.6% of the total sample aged 12 to 17 years. The refusal to participate in the study was higher in male adolescents in all age groups. The participation of younger people was always higher than that of older people in both male and female genders.

Table 1 shows most of the population is composed of individuals with brown skin color (52.5%), from public schools (78.7%) and adequate weight status (72.6%). Average age was 14.7 years (standard deviation (SD) = 1.6). Less than half of the sample (44.4%) was composed of active adolescents (≥ 300 minutes/week), 29.1% reported no leisure time physical activity (0 minute/week), and 26.5% were considered insufficiently active (1–299 minutes/week). A significant proportion of the young people did not practice any sport (52.4%). Regarding physical education at school, 77.6% participated in classes, and 40.6% did once/week; 32.6%, twice/week; and 4.4%, three times/week.

Table 1. Characterization of the sample of Brazilian adolescents, according to sociodemographic variables, sexual maturation and weight status. Erica, Brazil, 2013–2014 (n = 73,399).

Variables		%
Gender
	Boys	44.6
	Girls	55.4
Age (years)
	12–14	45.9
	15–17	54.1
Skin color
	Black	7.8
	Mixed race	52.5
	White	36.4
	Yellow	2.6
	Indigenous	0.7
Type of school
	Public	78.7
	Private	21.3
Stage of sexual maturation^a
	Prepubescent	0.5
	Pubescent	62.9
	Postpubescent	36.6
Weight status^b
	Underweight	2.9
	Adequate	72.6
	Overweight	16.8
	Obesity	7.7
Common mental disorders
	Yes	31.8
	No	68.2

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Prepubescent (Tanner stages 1 and 2), pubescent (Tanner stage 3) and postpubescent (Tanner stages 4 and 5).

Classification of nutritional status according to z score of body mass index for age³³.

Table 2 shows the association of common mental disorders with the volume of leisure time physical activity and sports practice. The frequency of individuals with a score ≥ 3 in the GHQ-12 was higher in the group of adolescents who did not practice sports (OR = 1.14) and did not perform any leisure time physical activity (0 minute/week) (OR = 1.16), when compared with active young people.

Table 2. Prevalence of Brazilian adolescents with common mental disorders/CMD (GHQ ≥ 3) and corresponding odds ratios (OR), according to leisure time physical activity and sports practice. Erica, Brazil, 2013–2014.

		Total (n)	With CMD (%)	Gross OR (95%CI)	Adjusted OR^b (95%CI)
Leisure time physical activity^c
	No	13,334	38.5	1.00 (reference)	1.00 (reference)
	Yes	60,065	30.4	0.64 (0.58–0.70)^a	0.74 (0.66–0.82)^a
Leisure time physical activity					1.00
	Active (≥ 300 minutes/week)	32,613	28.4	1.00 (reference)	(reference)
	Insufficiently active (1–299 minutes/week)	19.453	30.4	1.07 (0.95–1.19)	0.92 (0.82–1.03)
	Inactive (0 minute/week)	21,333	38.4	1.58 (1.46–1.69)^a	1.16 (1.06–1.27)^a
Sports practice^d
	Yes	34,932	25.9	1.00 (reference)	1.00 (reference)
	No	38,467	37.2	1.63 (1.52–1.74)^a	1.14 (1.04–1.25)^a

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95%CI: 95% confidence interval.

p < 0.01.

Multiple logistic regression model, adjusted for gender, age, type of school, stage of sexual maturation, body mass index, smoking and alcohol consumption.

Practice of any physical activity during leisure time, regardless of modality, duration or weekly frequency.

Practice of one of the following modalities: athletics, swimming, tennis, wrestling, gymnastics, soccer/futsal, handball, basketball and volleyball.

Insufficient physical activity (1–299 minutes/week) did not increase the OR of common mental disorders. Likewise, no significant increase was found in OR after subdivision of insufficiently active adolescents into two categories (1–149 minutes/week and 150–299 minutes/week). When compared with individuals who did not practice any leisure time physical activity, those insufficiently active were less likely to have common mental disorders (adjusted OR = 0.79; 95%CI 0.70–0.89).

The practice of leisure time physical activity, regardless of modality, duration or weekly frequency, reduced by 26% the chances of common mental disorders in this population (Table 2), while the practice in accordance with the recommendation of at least 300 minutes/week decreased by 14% (adjusted OR = 0.86; 95%CI 0.79–0.94).

Regarding the practice of physical education at school (Table 3), an inverse relationship was observed between participation in classes and common mental disorders (p < 0.01). The prevalence of common mental disorders was higher among young people who did not participate in physical education classes (39.5%), compared with those who did (29.6%).

Table 3. Prevalence of Brazilian adolescents with common mental disorders/CMD (GHQ ≥ 3) and corresponding odds ratios (OR), according to participation in physical education classes at school. Erica, Brazil, 2013–2014.

		Total (n)	With CMD (%)	Gross OR (95%CI)	Adjusted OR^b (95%CI)
Participation in physical education classes^c
	Yes	56,920	29.6	1.00 (referência)	1.00 (referência)
	No	16,479	39.5	1.56 (1.45–1.68)^a	1.25 (1.15–1.36)^a
Frequency of physical education at school
	Did not participate	16,479	39.5	1.00 (referência)	1.00 (referência)
	1 time per week	29,791	31.3	0.71 (0.65–0.77)^a	0.85 (0.77–0.93)^a
	2 times per week	23,929	27.8	0.58 (0.54–0.63)^a	0.74 (0.68–0.82)^a
	3 times per week	3,200	27.5	0.63 (0.53–0.73)^a	0.91 (0.76–1.09)

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95%CI: 95% confidence interval.

p < 0.01.

Multiple logistic regression model, adjusted for gender, age, type of school, stage of sexual maturation, body mass index, smoking and alcohol consumption.

participation in physical education classes at school at least once per week.

DISCUSSION

This is the first epidemiological study conducted in Brazil, with national representativeness, which assessed the relationship between common mental disorders and levels of physical activity during adolescence. The research produced three results for discussion. First, the frequency of common mental disorders was higher among adolescents who did not play sports, did not participate in physical education classes at school and were inactive (0 minute/week). According to the result, insufficient physical activity (1–299 minutes/week) did not increase the OR of common mental disorders in this population. Third, we observed that the practice of physical activity in accordance with the recommendation of at least 300 minutes/week reduced the OR for common mental disorders but did not offer additional benefit to the mental health of young people. A significant reduction in the chance of common mental disorders was observed with leisure time physical activity regardless of modality, duration and weekly frequency.

The few currently available evidence on the subject has shown the negative impact of insufficient physical activity on the mental health of young people¹⁹^,²⁰. A study conducted in Norway with adolescents aged 12 to 15 years showed a cross-sectional and longitudinal relation between low levels of vigorous activity and depressive symptoms (using the Mood and Feelings Questionnaire)¹⁹. Prospective cohort (2004–2010), conducted in Denmark, presented similar results, but only for females. Girls with low level of leisure time physical activity at 14/15 years had an increased risk of 60% for mental health problems at 20/21 years, compared with those with high level (> 4 hours/week)²⁰.

The results of this study are in line with a systematic review of prospective studies involving children, adolescents and adults (1988–2012), which suggested any level of physical activity, such as walking less than 150 minutes/week, to prevent depression (defined by cutoff points on self-report scales or medical diagnosis)²¹. Recent research has also provided encouraging support for physical activity as beneficial intervention in mood. Thirty minutes of running at moderate intensity during the morning, for three consecutive weeks, positively affected concentration during the day and psychological functioning of adolescents, compared with control individuals²².

A similar beneficial effect was observed in a study with Australian adolescents, which showed a 9% decrease in the probability of depressive symptoms among boys who practiced moderate to vigorous activities daily for more than one hour⁶. Alghadir et al.²³, studying individuals aged 7 to 18 years, concluded that the practice of physical activity is important for the improvement of depressive symptoms (Children's Depression Inventory scale),in addition to increasing serotonin levels and reducing serum cortisol.

This study showed a positive association between leisure time physical activity and mental health, regardless of modality, duration or frequency. Thus, public policies could consider the inclusion of the mental health dimension of totally inactive young people (0 minute/week), since there seems to be no additional benefit for mental health associated with compliance with the levels of activity recommended by the WHO. Scientific evidence show that the physical health of adolescents is improved by frequent physical activity²⁴.

The findings of this study showed a higher occurrence of common mental disorders in the portion of the population that did not practice sports. Corroborating our study, Sabiston et al.²⁵ found that participation in team sports during high school can protect against depressive symptoms in early adulthood, probably because team sport provides group work, opportunity for interaction with people and better perceived social acceptance. Leisure time physical activity and participation in sports also contributed to a greater sense of well-being and lower levels of anxiety and depression among European adolescents²⁶.

Regarding physical activity at school, we observed that participation in physical education classes was negatively associated with common mental disorders in Erica's sample. A cross-sectional study with Australian adolescents (10–16 years) also detected that being more active in school, participating in physical education (OR = 0.77; 95%CI 0.69–0.86) and sports teams (OR = 0.77; 95%CI 0.67–0.88) may decrease the OR for depressive symptoms²⁷. From this perspective, the school is a privileged space for adolescents to perform physical activities, considering that it is a safe place, with available equipment and appropriate professional guidance⁹. However, it is noteworthy the absence of a clear dose-response relation between the level of physical activity and the presence of common mental disorders.

The relation between mental well-being and physical activity has drawn the attention of researchers; however, some studies have not shown consistent associations. According to Rothon et al.²⁸, each additional hour of physical activity undertaken during the week decreases the probability of depressive symptoms in adolescence by about 8%. However, the relation between these variables was not significant in a longitudinal analysis after two years of follow-up. A cohort study in the United Kingdom also did not support the hypothesis that physical activity, objectively measured by heart rate and motion detection, prevents the development of depressive symptoms (Mood and Feelings Questionnaire) during adolescence²⁹.

Several hypotheses have been proposed to explain the protective effect of physical activity. Biological mechanisms, such as increased levels of monoamines in the circulation (norepinephrine, dopamine and serotonin) and lower cortisol secretion, may explain the antidepressant action of physical activity²³. In addition, the fulfillment of goals and challenges of motor activity causes a feeling of self-efficacy, improves self-esteem and generates distraction from daily stressors¹⁹. The social network built on sports activity can also be important, just as sedentary behavior can reduce social interactions among individuals, causing loneliness³⁰.

Otherwise, depressive symptoms, even below the threshold of clinical diagnosis, apathy and feelings of hopelessness can initiate a negative pattern in which it is difficult to gather energy and motivation to start exercising¹⁹. The protective effect of physical activity and the inhibiting effect of depressed mood may also coexist. Data from a longitudinal study with girls aged 11 to 15 years, assessed annually for six years, indicated a bidirectional relationship between physical activity and depression. Physical activity significantly reduced both the risk of major depressive disorder and the risk of future depressive symptoms, and vice versa³¹.

One of the limitations of this study was the use of a questionnaire to determine the adolescents’ level of physical activity. Although this instrument has been validated¹⁵, it does not always produce accurate estimates, and its agreement with direct measures is partial³². However, the use of direct measurement methods, such as accelerometry, would be unfeasible in a study such as Erica, due to its high cost and complexity. The variety of instruments and cut-off points (to measure common mental disorders and levels of physical activity) in the scientific literature also limited our study, making it difficult to compare with our results. THE GHQ-12 is a screening tool, and therefore it was not possible to establish a formal diagnosis of psychopathologies.

Another limitation is related to the cross-sectional nature (reverse causality). It is also noteworthy that the use of OR may overestimate the strength of the association in cross-sectional studies, when the outcome has a high prevalence in the population, which possibly occurred in this study. In addition, another question that discusses the plausibility of the association having a causal relationship is the relatively small magnitude of the association. The power of the sample could identify magnitudes even lower than those found in this study, which reflects on the relevance/property of making more incisive recommendations. On the other hand, the strengths of this study include the large and representative sample for Brazilian adolescents, the use of validated questionnaires, the high participation rate, and the analyses adjusted for several confounding factors (gender, age, type of school, stage of sexual maturation, body mass index, smoking and alcohol use).

In conclusion, common mental disorders are associated with physical inactivity at leisure (0 minute/week) and at school during adolescence. Leisure time physical activity, even without reaching the current health recommendation (≥ 300 minutes/week), may reduce the OR of common mental disorders, according to the data of this study. Sports practice and school physical education can also have beneficial effects on the mental health of young people. Erica's results reinforce the need to transition from total inactivity to regular physical activity, regardless of weekly frequency and volume of the physical activity initially practiced.

Funding Statement

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq — Processes 565037/2010-2 and 405009/2012-7).

Footnotes

Funding: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq — Processes 565037/2010-2 and 405009/2012-7).

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Rev Saude Publica. 2020 Nov 23;54:128. [Article in Portuguese]

Inatividade física no lazer e na escola está associada à presença de transtornos mentais comuns na adolescência

Vanessa Roriz Ferreira ^I, Thiago Veiga Jardim ^I,^II,^III, Thaís Inácio Rolim Póvoa ^IV, Ricardo Borges Viana ^IV,^✉, Ana Luiza Lima Sousa ^I, Paulo César Veiga Jardim ^I

RESUMO

OBJETIVO:

Investigar a associação da inatividade física no lazer e na escola com os transtornos mentais comuns durante a adolescência.

MÉTODOS:

A amostra foi composta por 73.399 adolescentes (12–17 anos), participantes do Estudo de Riscos Cardiovasculares em Adolescentes (Erica). Esse estudo transversal, nacional e de base escolar foi realizado em 2013 e 2014, nos municípios brasileiros com mais de 100 mil habitantes. A atividade física no lazer foi categorizada de acordo com o volume de prática semanal, e os adolescentes foram classificados em ativos (≥ 300 minutos/semana), inativos (0 minuto/semana) e insuficientemente ativos (1–299 minutos/semana). A prática esportiva e a participação em aulas de educação física na escola também foram analisadas. A presença de transtornos mentais comuns foi avaliada a partir do general health questionnaire, com ponto de corte maior ou igual a 3. Odds ratios (OR) foram estimados utilizando regressão logística múltipla.

RESULTADOS:

A chance de transtornos mentais comuns foi 16% maior no grupo que relatou ser inativo (0 minuto/semana) no lazer (OR = 1,16; IC95% 1,06–1,27). A prevalência de transtornos mentais comuns foi maior entre jovens que não praticaram esportes (37,2% vs. 25,9%; OR = 1,14; IC95% 1,04–1,25) e não participaram das aulas de educação física na escola (39,5% vs. 29,6%; OR = 1,25; IC95% 1,15–1,36). Atividade física insuficiente (1–299 minutos/semana) não aumentou a razão de chances de transtornos mentais comuns. Praticar atividade física no lazer, independentemente da duração e frequência semanal, reduziu em 26% as chances de transtornos mentais comuns nessa população.

CONCLUSÕES:

A inatividade física no lazer e na escola foi associada à presença de transtornos mentais comuns na adolescência. Os resultados sugerem que prática esportiva, educação física escolar e atividade física durante o lazer, mesmo sem atingir a recomendação atual, têm relação com a saúde mental dos jovens.

DESCRITORES: Adolescente, Comportamento Sedentário, Transtornos Mentais, Saúde Mental, Educação Física e Treinamento

INTRODUÇÃO

Dados epidemiológicos mostram que até 20% das crianças e adolescentes sofrem de uma doença mental incapacitante e que cerca de 50% dos transtornos mentais têm início na adolescência¹. Mundialmente, os transtornos neuropsiquiátricos são a principal causa de anos de vida perdidos por incapacidade na faixa etária entre 10 e 24 anos². No Brasil, dados do Estudo de Riscos Cardiovasculares em Adolescentes (Erica) relataram elevada prevalência (30,0%) de transtornos mentais comuns na população jovem³.

Os transtornos mentais comuns, também conhecidos como distúrbios psiquiátricos menores ou sofrimento psíquico, são desordens mentais sem caráter psicótico não contempladas nos critérios diagnósticos dos sistemas de classificação categórica. São caracterizados principalmente pela presença de sintomas de depressão e ansiedade, além de queixas somáticas inespecíficas. Esses transtornos, que podem ser manifestações iniciais de doenças psiquiátricas mais graves, prejudicam a vida escolar e as relações sociais do adolescente⁴^,⁵.

Evidências recentes relacionaram sintomas de depressão e ansiedade com inatividade física⁶^,⁷. Estudo transversal com adolescentes australianos mostrou que meninos com baixo nível de atividade física estão mais propensos à sintomatologia depressiva⁶. Por outro lado, pesquisa longitudinal conduzida na Alemanha revelou que mulheres jovens (12–26 anos), ao praticarem atividade física por mais tempo que o usual, sentiam-se menos deprimidas na manhã do dia seguinte⁷.

Ser ativo durante a adolescência também aumenta a chance de se manter ativo na idade adulta, previne doenças cardiovasculares, melhora a composição corporal e aumenta a força muscular, além dos benefícios imediatos ao jovem, tais como sensação de bem-estar e maior autoestima⁸. Apesar disso, no Brasil, um em cada quatro adolescentes não pratica nenhuma atividade física no lazer (0 min/semana)⁹. Este fato é preocupante, pois o estilo de vida sedentário na vida adulta é a quarta maior causa de mortes no mundo¹⁰.

Adicionalmente, a vida na adolescência é marcada por intensas transformações, tanto fisiológicas quanto sociais. É possível que ocorram trabalhos escolares de maior complexidade, separação dos pais e maior exigência da sociedade referente a planos futuros. Essa complexidade de fatores pode afetar o desejo ou a capacidade do adolescente de ser fisicamente ativo na vida diária, bem como intensificar seu transtorno mental comum¹.

Até a data, a maioria das pesquisas tem focado em populações adultas de países desenvolvidos, nos comportamentos sedentários (tempo em atividades de tela) e nos portadores de enfermidades psiquiátricas. Além disso, pouco se sabe sobre a educação física escolar e a prática esportiva no contexto dos transtornos mentais comuns¹¹. Nesse sentido, o presente estudo teve como objetivo investigar a associação de inatividade física no lazer e na escola com transtornos mentais comuns em adolescentes escolares brasileiros.

MÉTODOS

O Estudo de Riscos Cardiovasculares em Adolescentes (Erica) é um estudo transversal, multicêntrico, nacional, de base escolar, que avaliou adolescentes com idades entre 12 e 17 anos, matriculados em escolas públicas e privadas (período matutino e vespertino), de municípios brasileiros com mais de 100.000 habitantes. Os dados foram coletados entre março de 2013 e dezembro de 2014. O protocolo do Erica foi previamente descrito¹².

A população da pesquisa foi dividida em 32 estratos geográficos, constituídos por 27 capitais e cinco conjuntos de municípios com mais de 100 mil habitantes em cada uma das cinco macrorregiões geográficas do país. Em seguida, realizou-se uma amostragem probabilística de escolas em duas etapas. Na primeira, foram selecionadas escolas para cada estrato geográfico, com probabilidade proporcional ao seu tamanho e inversamente proporcional à distância da capital. Na segunda etapa, três turmas em cada escola sorteada foram selecionadas com equiprobabilidade durante o trabalho de campo, usando o ano da turma como variável informativa da idade. A amostra é representativa para municípios de médio e grande porte (> 100 mil habitantes) em âmbito nacional e regional e para as capitais brasileiras.

Nas turmas selecionadas, foram entrevistados e examinados todos os alunos que assinaram o termo de assentimento e trouxeram o termo de consentimento livre e esclarecido assinado pelos responsáveis (quando exigido pelo Comitê de Ética em Pesquisa local). Foram excluídos das análises, por não serem considerados elegíveis, adolescentes fora da faixa etária eletiva, com deficiência física ou mental e grávidas.

O instrumento de coleta dos dados foi um questionário autopreenchível, aplicado em sala de aula, sob supervisão da equipe do estudo, por meio de um coletor eletrônico de dados individual e portátil PDA (personal digital assistant, modelo LG^® GM750Q). Para caracterização da amostra estudada, os adolescentes responderam a questões sobre sexo (masculino ou feminino), idade em anos completos (posteriormente categorizada: 12–14 e 15–17 anos), cor da pele declarada, tipo de escola (pública ou privada), maturação sexual (autoavaliação baseada em cinco estágios)¹³ e estado de peso, a partir das curvas de índice de massa corporal para idade propostas pela Organização Mundial de Saúde em 2007.

Para determinação do nível de atividade física dos adolescentes, foi utilizada uma adaptação do self-administered physical activity checklist, que consiste em uma lista de 24 modalidades e permite que o adolescente informe a frequência (dias) e o tempo (horas e minutos) que praticou, na última semana, alguma das atividades listadas¹⁴. A versão desse questionário utilizada no Erica foi validada em adolescentes brasileiros¹⁵. No cálculo do tempo total de atividade física, consideraram-se modalidades de intensidade moderada a vigorosa (maior ou igual a três equivalentes metabólicos [METs]).

O produto entre o tempo e a frequência em cada atividade e o somatório dos tempos obtidos foram calculados para determinar o nível de atividade física. Os adolescentes que acumularam pelo menos 300 minutos/semana de atividade física foram considerados ativos no lazer, com base no nível recomendado pela OMS¹⁶. Os indivíduos que não referiram qualquer prática de atividade física no lazer na semana anterior à pesquisa (0 minuto/semana) foram considerados inativos. E aqueles cujo tempo acumulado nos últimos sete dias foi maior que 0 e menor que 300 minutos foram denominados insuficientemente ativos¹⁷.

A participação nas aulas de educação física da escola (sim/não e número de tempos por semana) e a prática esportiva fora/dentro da escola (sim/não) também foram avaliadas. Das 24 modalidades avaliadas para determinação do nível de atividade física dos adolescentes, 12 foram consideradas modalidades esportivas: atletismo, natação, lutas (como judô e caratê), tênis, ginástica olímpica, futebol, futsal, futebol de praia, handebol, basquete, vôlei de quadra e vôlei de praia.

Os transtornos mentais comuns foram avaliados por meio do general health questionnaire (GHQ-12), um instrumento de rastreamento psiquiátrico⁵. O GHQ-12 avalia o estado de saúde mental e o sofrimento psíquico sem caráter psicótico, a partir de 12 questões referentes às duas semanas precedentes, com quatro opções de resposta (mais que de costume, o mesmo de sempre, menos que de costume, muito menos que de costume ou muito mais que de costume). Os escores dos itens individuais foram codificados por meio de uma escala dicotômica. As respostas com 1 ou 2 pontos indicaram ausência (0), e as respostas com 3 ou 4 pontos, presença (1). Em seguida, todos os itens foram somados. Usando esse método, o participante pôde alcançar de 0 a 12 pontos; escores de 3 ou mais³ indicaram a presença de transtornos mentais comuns, que refere-se a um estado de risco para o desenvolvimento de distúrbios psiquiátricos⁴. O GHQ-12 foi validado para a população brasileira, tendo uma entrevista psiquiátrica estruturada como padrão ouro¹⁸.

Foram calculadas medidas de frequência relativa (prevalências) de escore igual ou maior que 3 para as diferentes categorias de tempo de atividade física no lazer (adolescentes ativos, insuficientemente ativos e inativos), para a prática esportiva (sim/não) e para a prática de educação física na escola (sim/não e por número de tempos/semana). Considerando o desenho amostral, odds ratios (OR), com seus respectivos intervalos de 95% de confiança (IC95%), foram estimados por meio de regressão logística simples e ajustada por sexo, idade, tipo de escola, estágio de maturação sexual, índice de massa corporal, tabagismo (fumou pelo menos uma vez nos últimos trinta dias) e consumo de álcool (consumiu pelo menos um copo ou dose de bebida alcoólica nos últimos trinta dias). Utilizou-se o módulo survey do programa Stata versão 12.0 (StataCorp) para análise de dados de amostra complexa, uma vez que emprega estratificação e conglomeração em seus estágios de seleção.

O Erica foi realizado de acordo com os princípios da Declaração de Helsinque. O estudo foi aprovado pelos Comitês de Ética em Pesquisa da Universidade Federal do Rio de Janeiro (Processo 45/2008) e de cada unidade da federação.

RESULTADOS

Foram avaliados 73.399 adolescentes (71,7% dos alunos elegíveis), de 1.247 escolas, em 124 municípios brasileiros. A cobertura nacional dos adolescentes elegíveis foi de 74,8% (n = 40.675) no sexo feminino e 68,3% (n = 32.724) no sexo masculino. Não foram considerados elegíveis 364 escolares com deficiência física que inviabilizava as medidas e 215 grávidas, representando 0,6% do total da amostra de 12 a 17 anos. A recusa de participação no estudo foi maior nos adolescentes do sexo masculino em todas as faixas etárias. A participação dos mais jovens foi sempre maior do que a dos mais velhos, em ambos os sexos.

A Tabela 1 mostra que a maioria da população é composta por indivíduos com cor da pele parda (52,5%), de escolas públicas (78,7%) e estado de peso adequado (72,6%). A média de idade foi de 14,7 (desvio padrão = 1,6) anos. Menos da metade da amostra (44,4%) foi composta por adolescentes ativos (≥ 300 minutos/semana), 29,1% reportaram nenhuma atividade física no lazer (0 minuto/semana), e 26,5% foram considerados insuficientemente ativos (1–299 minutos/semana). Uma parcela significativa dos jovens não praticava nenhum esporte (52,4%). Sobre a educação física na escola, 77,6% participavam das aulas, sendo que 40,6% faziam um tempo/semana; 32,6%, dois tempos/semana; e 4,4%, três tempos/semana.

Tabela 1. Caracterização da amostra de adolescentes brasileiros, segundo variáveis sociodemográficas, maturação sexual e estado de peso. Erica, Brasil, 2013–2014 (n = 73.399).

Variáveis		%
Sexo
	Meninos	44,6
	Meninas	55,4
Idade (anos)
	12–14	45,9
	15–17	54,1
Cor da pele
	Preta	7,8
	Parda	52,5
	Branca	36,4
	Amarela	2,6
	Indígena	0,7
Tipo de escola
	Pública	78,7
	Privada	21,3
Estágio de maturação sexual^a
	Pré-púberes	0,5
	Púberes	62,9
	Pós-púberes	36,6
Estado de peso^b
	Baixo peso	2,9
	Adequado	72,6
	Sobrepeso	16,8
	Obesidade	7,7
Transtornos mentais comuns
	Sim	31,8
	Não	68,2

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Pré-púberes (estágios de Tanner 1 e 2), púberes (estágio de Tanner 3) e pós-púberes (estágios de Tanner 4 e 5).

Classificação do estado nutricional, segundo escore z de índice de massa corporal para a idade³³.

Na Tabela 2 pode-se observar a associação dos transtornos mentais comuns com o volume de atividade física no lazer e com a prática esportiva. A frequência de indivíduos com pontuação ≥ 3 no GHQ-12 foi maior no grupo dos adolescentes que não praticaram esportes (OR = 1,14) e não realizaram nenhuma atividade física no lazer (0 minuto/semana) (OR = 1,16), quando comparados aos jovens ativos.

Tabela 2. Prevalência de adolescentes brasileiros com transtornos mentais comuns/TMC (GHQ ≥ 3) e odds ratios (OR) correspondentes, de acordo com a atividade física no lazer e a prática esportiva. Erica, Brasil, 2013–2014.

		Total (n)	Com TMC (%)	OR bruto (IC95%)	OR ajustado^b (IC95%)
Prática de atividade física no lazer^c
	Não	13.334	38,5	1,00 (referência)	1,00 (referência)
	Sim	60.065	30,4	0,64 (0,58–0,70)^a	0,74 (0,66–0,82)^a
Tempo de atividade física no lazer
	Ativos (≥ 300 minutos/semana)	32.613	28,4	1,00 (referência)	1,00 (referência)
	Insuficientemente ativos (1–299 minutost/semana)	19,453	30,4	1,07 (0,95–1,19)	0,92 (0,82–1,03)
	Inativos (0 minuto/semana)	21.333	38,4	1,58 (1,46–1,69)^a	1,16 (1,06–1,27)^a
Prática esportiva^d
	Sim	34.932	25,9	1,00 (referência)	1,00 (referência)
	Não	38.467	37,2	1,63 (1,52–1,74)^a	1,14 (1,04–1,25)^a

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IC95% = intervalo de confiança de 95%.

p < 0,01.

Modelo de regressão logística múltipla, ajustado por sexo, idade, tipo de escola, estágio de maturação sexual, índice de massa corporal, tabagismo e consumo de álcool.

Prática de alguma atividade física no lazer, independentemente da modalidade, duração ou frequência semanal.

Prática de uma das seguintes modalidades: atletismo, natação, tênis, lutas, ginástica olímpica, futebol/futsal, handebol, basquete e vôlei.

Atividade física insuficiente (1–299 minutos/semana) não aumentou a razão de chances de transtornos mentais comuns (Tabela 2). Do mesmo modo, não houve aumento significativo no OR após subdivisão dos adolescentes insuficientemente ativos em duas categorias (1–149 minutos/semana e 150–299 minutos/semana). Quando comparados com indivíduos que não praticaram nenhuma atividade física no lazer, os insuficientemente ativos tiveram menores chances de transtornos mentais comuns (OR ajustado = 0,79; IC95% 0,70–0,89).

A prática de atividade física durante o lazer, independentemente de modalidade, duração ou frequência semanal, reduziu em 26% as chances de transtornos mentais comuns nessa população (Tabela 2), enquanto a prática em conformidade com a recomendação de pelo menos 300 minutos/semana reduziu em 14% (ajustado = 0,86; IC95% 0,79–0,94).

Com relação à prática de educação física na escola (Tabela 3), foi observada relação inversa entre participação nas aulas e os transtornos mentais comuns (p < 0,01). A prevalência de transtornos mentais comuns foi maior entre jovens que não participavam das aulas de educação física escolar (39,5%), comparados com os que participavam da educação física escolar (29,6%).

Tabela 3. Prevalência de adolescentes brasileiros com transtornos mentais comuns/TMC (GHQ ≥ 3) e odds ratios (OR) correspondentes, de acordo com a participação em aulas de educação física na escola. Erica, Brasil, 2013–2014.

		Total (n)	Com TMC (%)	OR bruto (IC95%)	OR ajustado^b (IC95%)
Participação nas aulas de educação física^c
	Sim	56.920	29,6	1,00 (referência)	1,00 (referência)
	Não	16.479	39,5	1,56 (1,45–1,68)^a	1,25 (1,15–1,36)^a
Frequência da educação física na escola
	Não participaram	16.479	39,5	1,00 (referência)	1,00 (referência)
	1 tempo por semana	29.791	31,3	0,71 (0,65–0,77)^a	0,85 (0,77–0,93)^a
	2 tempos por semana	23.929	27,8	0,58 (0,54–0,63)^a	0,74 (0,68–0,82)^a
	3 tempos por semana	3.200	27,5	0,63 (0,53–0,73)^a	0,91 (0,76–1,09)

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IC95%= intervalo de confiança de 95%.

p < 0,01.

Modelo de regressão logística múltipla, ajustado por sexo, idade, tipo de escola, estágio de maturação sexual, índice de massa corporal, tabagismo e consumo de álcool.

Participação nas aulas de educação física da escola pelo menos um tempo por semana.

DISCUSSÃO

Este é o primeiro estudo epidemiológico conduzido no Brasil, com representatividade nacional, que avaliou a relação entre transtornos mentais comuns e níveis de atividade física durante a adolescência. A pesquisa produziu três resultados para discussão. Primeiro, a frequência de transtornos mentais comuns foi maior entre adolescentes que não praticavam esportes, não participavam das aulas de educação física na escola e eram inativos (0 minuto/semana) no lazer. Segundo resultado, atividade física insuficiente (1–299 minutos/semana) não aumentou a razão de chances de transtornos mentais comuns nessa população. Terceiro, foi observado que a prática de atividade física em conformidade com a recomendação de pelo menos 300 minutos/semana reduziu a razão de chances para os transtornos mentais comuns, contudo não ofereceu benefício adicional para a saúde mental dos jovens. Redução significante na chance de transtornos mentais comuns foi observada com atividade física no lazer independentemente de modalidade, duração e frequência semanal.

As poucas evidências atualmente disponíveis sobre o assunto têm mostrado o impacto negativo de atividade física insuficiente na saúde mental da população jovem¹⁹^,²⁰. Estudo realizado na Noruega, com adolescentes de 12 a 15 anos, mostrou relação transversal e longitudinal entre baixos níveis de atividade vigorosa e sintomas depressivos (usando o Mood and Feelings Questionnaire)¹⁹. Coorte prospectiva (2004–2010), conduzida na Dinamarca, apresentou resultados semelhantes, mas somente para o sexo feminino. Meninas com baixo nível de atividade física no lazer aos 14/15 anos tiveram risco aumentado em 60% para problemas de saúde mental aos 20/21 anos, comparadas com as com alto nível (> 4 horas/semana)²⁰.

Os resultados da presente pesquisa condizem com a revisão sistemática de estudos prospectivos envolvendo crianças, adolescentes e adultos (1988–2012), que sugeriram qualquer nível de atividade física, como caminhar menos de 150 minutos/semana, para prevenir depressão (definida por pontos de corte em escalas de autorrelato ou diagnóstico médico)²¹. Pesquisa recente também forneceu apoio encorajador para a atividade física enquanto intervenção benéfica no humor. Trinta minutos de corrida em intensidade moderada, durante a manhã, por três semanas consecutivas, impactaram positivamente na concentração durante o dia e no funcionamento psicológico de adolescentes, em comparação com indivíduos controle²².

Efeito benéfico similar foi observado em estudo com adolescentes australianos, que evidenciou um decréscimo de 9% na probabilidade de sintomas depressivos entre os meninos que praticavam atividades moderadas a vigorosas, diariamente, por mais de uma hora⁶. Alghadir e colaboradores²³, estudando indivíduos de 7 a 18 anos, concluíram que a prática de atividade física é importante para a melhora dos sintomas depressivos (escala Children's Depression Inventory), além de aumentar os níveis de serotonina e reduzir o cortisol sérico.

Esse estudo apresentou associação positiva entre atividade física no lazer e saúde mental, independentemente de modalidade, duração ou frequência da prática. Assim, as políticas públicas poderiam considerar a inclusão da dimensão saúde mental dos jovens totalmente inativos (0 minuto/semana), já que parece não existir benefício adicional para a saúde mental associado ao cumprimento dos níveis de atividade recomendados pela OMS. Cabe ressaltar que há evidências científicas de que a saúde física dos adolescentes é melhorada por atividade física frequente²⁴.

Os achados do presente estudo evidenciaram maior ocorrência de transtornos mentais comuns na parcela da população que não praticou esportes. Corroborando nosso estudo, Sabiston e colaboradores²⁵ constataram que a participação em esportes de equipe durante o ensino médio pode proteger contra os sintomas depressivos no início da vida adulta, provavelmente pelo fato de o esporte em equipe proporcionar trabalho em grupo, oportunidade de interação com pessoas e melhor aceitação social percebida. Atividade física no lazer e participação em esportes também contribuíram para uma maior sensação de bem-estar e menores níveis de ansiedade e depressão entre adolescentes europeus²⁶.

Com relação a atividade física na escola, foi observado que a participação em aulas de educação física foi negativamente associada a transtornos mentais comuns na amostra do Erica. Estudo transversal com adolescentes australianos (10–16 anos) detectou, do mesmo modo, que ser mais ativo na escola, participando da educação física (OR = 0,77; IC95% 0,69–0,86) e das equipes de esportes (OR = 0,77; IC95% 0,67–0,88), pode diminuir a razão de chances para os sintomas depressivos²⁷. Nessa perspectiva, a escola é um espaço privilegiado para adolescentes realizarem atividades físicas, considerando que é um local seguro, com equipamentos disponíveis e orientação profissional apropriada⁹. Contudo, é importante destacar a ausência de uma relação dose-resposta clara entre o nível de atividade física e a presença de transtornos mentais comuns.

A relação entre bem-estar mental e atividade física tem atraído atenção de pesquisadores, entretanto alguns estudos não apresentaram associações consistentes. De acordo com Rothon e colaboradores²⁸, cada hora adicional de atividade física empreendida na semana diminui em cerca de 8% a probabilidade de sintomas depressivos na adolescência. Todavia, a relação entre essas variáveis não foi significante em uma análise longitudinal, após dois anos de acompanhamento. Estudo de coorte no Reino Unido também não sustentou a hipótese de que atividade física, objetivamente mensurada por frequência cardíaca e detecção de movimento, evita o desenvolvimento de sintomas depressivos (Mood and Feelings Questionnaire) durante a adolescência²⁹.

Várias hipóteses têm sido propostas para explicar o efeito protetor da atividade física. Mecanismos biológicos, como o aumento dos níveis de monoaminas na circulação (norepinefrina, dopamina e serotonina) e menor secreção de cortisol, podem explicar a ação antidepressiva da atividade física²³. Além disso, o cumprimento de metas e desafios da atividade motora provoca o sentimento de autoeficácia, melhora a autoestima e gera distração dos estressores diários¹⁹. A rede social construída na atividade esportiva também pode ser importante, assim como o comportamento sedentário pode reduzir as interações sociais entre os indivíduos, gerando sentimentos de solidão³⁰.

De outro modo, sintomas depressivos, mesmo abaixo do limiar de diagnóstico clínico, apatia e sentimentos de desesperança podem iniciar um padrão negativo em que é difícil reunir energia e motivação para iniciar a prática de atividade física¹⁹. O efeito protetor da atividade física e o efeito inibitório do humor deprimido também podem coexistir. Dados de um estudo longitudinal com meninas de 11 a 15 anos, avaliadas anualmente por um período de seis anos, sinalizaram uma relação bidirecional entre atividade física e depressão. A prática de atividade física reduziu significantemente tanto o risco de transtorno depressivo maior como o risco de sintomas depressivos futuros, e vice-versa³¹.

Uma das limitações deste estudo foi o uso de um questionário para determinar o nível de atividade física dos adolescentes. Apesar desse instrumento ter sido validado¹⁵, nem sempre produz estimativas precisas, e sua concordância com medidas diretas é parcial³². Contudo, a utilização de métodos de mensuração direta, como acelerometria, seria inviável em um estudo como o Erica, devido ao alto custo e à complexidade da logística envolvida. A variedade de instrumentos e pontos de corte (para mensurar os transtornos mentais comuns e os níveis de atividade física) na literatura científica também limitou o presente estudo, dificultando a comparação com nossos resultados. O GHQ-12 é uma ferramenta de triagem, e, por isso, não foi possível estabelecer diagnóstico formal de psicopatologias.

Outra limitação está relacionada à natureza transversal (causalidade reversa). Vale ressaltar, ainda, que o uso do OR pode superestimar a força da associação em estudos de delineamento transversal, quando o desfecho possui elevada prevalência na população, o que possivelmente ocorreu no presente estudo. Além disso, outra questão que coloca em discussão a plausibilidade da associação possuir relação causal é a relativamente pequena magnitude da associação. O poder da amostra poderia identificar magnitudes inclusive menores que as encontradas no presente estudo, o que faz refletir sobre a relevância/propriedade de se fazer recomendações mais incisivas. Por outro lado, os pontos fortes deste trabalho incluem a amostra grande e representativa para os adolescentes brasileiros, a utilização de questionários validados, a alta taxa de participação e as análises ajustadas por diversos fatores de confusão (sexo, idade, tipo de escola, estágio de maturação sexual, índice de massa corporal, tabagismo e uso de álcool).

Em conclusão, transtornos mentais comuns estão associados a inatividade física no lazer (0 minuto/semana) e na escola durante a adolescência. Atividade física no tempo de lazer, mesmo sem atingir a recomendação atual para a saúde (≥ 300 minutos/semana), pode reduzir a razão de chances de transtornos mentais comuns, de acordo com os dados do presente estudo. Prática esportiva e educação física escolar também podem ter efeitos benéficos na saúde mental dos jovens. Os resultados do Erica reforçam a necessidade de realizar a transição da inatividade total para uma prática regular de atividade física, independentemente da frequência semanal e do volume de atividade física inicialmente praticada.

Funding Statement

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq - Processos 565037/2010-2 e 405009/2012-7.

Footnotes

Financiamento: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq - Processos 565037/2010-2 e 405009/2012-7.

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PERMALINK

Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence

Vanessa Roriz Ferreira

Thiago Veiga Jardim

Thaís Inácio Rolim Póvoa

Ricardo Borges Viana

Ana Luiza Lima Sousa

Paulo César Veiga Jardim

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

INTRODUCTION

METHODS

RESULTS

Table 1. Characterization of the sample of Brazilian adolescents, according to sociodemographic variables, sexual maturation and weight status. Erica, Brazil, 2013–2014 (n = 73,399).

Table 2. Prevalence of Brazilian adolescents with common mental disorders/CMD (GHQ ≥ 3) and corresponding odds ratios (OR), according to leisure time physical activity and sports practice. Erica, Brazil, 2013–2014.

Table 3. Prevalence of Brazilian adolescents with common mental disorders/CMD (GHQ ≥ 3) and corresponding odds ratios (OR), according to participation in physical education classes at school. Erica, Brazil, 2013–2014.

DISCUSSION

Funding Statement

Footnotes

REFERENCES

Inatividade física no lazer e na escola está associada à presença de transtornos mentais comuns na adolescência

Vanessa Roriz Ferreira

Thiago Veiga Jardim

Thaís Inácio Rolim Póvoa

Ricardo Borges Viana

Ana Luiza Lima Sousa

Paulo César Veiga Jardim

RESUMO

OBJETIVO:

MÉTODOS:

RESULTADOS:

CONCLUSÕES:

INTRODUÇÃO

MÉTODOS

RESULTADOS

Tabela 1. Caracterização da amostra de adolescentes brasileiros, segundo variáveis sociodemográficas, maturação sexual e estado de peso. Erica, Brasil, 2013–2014 (n = 73.399).

Tabela 2. Prevalência de adolescentes brasileiros com transtornos mentais comuns/TMC (GHQ ≥ 3) e odds ratios (OR) correspondentes, de acordo com a atividade física no lazer e a prática esportiva. Erica, Brasil, 2013–2014.

Tabela 3. Prevalência de adolescentes brasileiros com transtornos mentais comuns/TMC (GHQ ≥ 3) e odds ratios (OR) correspondentes, de acordo com a participação em aulas de educação física na escola. Erica, Brasil, 2013–2014.

DISCUSSÃO

Funding Statement

Footnotes

ACTIONS

PERMALINK

RESOURCES

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