- There's a mental health crisis in adolescence, and it's not getting better anytime soon unless we change something. Our kids are depressed and anxious and not performing to their best in school. But what if there was a way to improve all these things that doesn't involve medication or therapy, but rather exercise? In today's podcast, we'll dive into a recent study that looked at how exercise can affect all of these things. And stick around to the end where I give the practical takeaways on what we can do to actually help our children succeed. Welcome back team to the Building Lifelong Athletes podcast. Thanks so much for stopping by. My name is Jordan Wrennke. I'm a dual board certified physician in sports and family medicine. And the goal of this podcast to help you stay active and healthy for life through actionable, evidence-informed education. Let's dive into the study here. This study was the PANIC study. That was the acronym for it. It's looking at childhood physical fitness and adolescent health. And it's by Hippoll et al. So what this study looked at was it was investigating the relationship between childhood physical fitness and outcomes in the cognitive and mental health domains. So they're looking at your childhood physical fitness. If you were fit as a kid, if that impacted your cognition and mental health in adolescence. They followed 241 adolescents in Finland for eight years. So going from ages six through nine to all the way to ages 15 through 17. And they measured a bunch of different things. So they measured various aspects of physical fitness including cardiorespiratory fitness, motor fitness, muscular fitness, the way they kind of divide that up. Cardiorespiratory fitness, you think about that's like you're running and you're doing all that stuff and your engine essentially, the way I think about it. Motor fitness is gonna be looking at like kind of do like shuttle drills is what they're looking at. And then also they look at muscular. So jumping, hand grip, stuff like that. So pretty much like strength, endurance and like agility and speed kind of are the main things they were looking at there. And they also looked at cognitive assessments, right? They're looking at different tests to judge how your mental health is doing. How are you having perceived stress, depressive symptoms, all those things. So we're looking at fitness measures and cognitive measures as well. And what did they find? Well, they found that the higher the average motor fitness in childhood and in lessons that was associated with better cognition and adolescents. So cognition meaning kind of how we're processing, how we're doing certain tasks and the kids who performed better on this 10 by five meter shuttle run test. So that's kind of the one that we look at for motor fitness. This was a measure of that any kind of speed and agility. They tended to score higher on tests of cognition at its adolescents and both higher average cardiorespiratory fitness and improvements in cardiorespiratory fitness also were associated with better mental health and adolescents as well. And so what they're saying there is improving mental health with cardiorespiratory fitness. If you were fit, you seem to have better outcomes, but also if you weren't as fit and became more fit, that also had better outcomes. So they said improvement of that also played a big role. And the higher the cardiorespiratory fitness that was linked to both the lower perceived stress and fewer depressive symptoms. And notably though, increased cardiorespiratory fitness over the study also showed these same things. So once again, saying that it doesn't matter if you just started with it. If you started with it, that's great. But if you didn't have the best and improved, that also seemed to show benefits from the mental health perspective as well, which is really eye-opening. And a really cool thing they talked about here is the study also highlighted a potential role for screen time. So when the researchers factored in screen time, so they kind of did some fancy statistical analysis to say, hey, how much stream time did you typically have for these participants? They kind of looked at that. And when they're averaging those things out, it's intended to show that there was a positive association between cardiorespiratory fitness and mental health, but it was weakened when you included screen time. So what they're saying here is cardiorespiratory fitness and mental health, there seemed to be a good correlation where like the more fit you were, the better mental health. But what they found is it wasn't quite that simple. When they added in screen time and looked at how much you're looking at screens, when they kind of counteracted that and they kind of looked at, hey, how do these screens play in? It wasn't quite as strong association between fitness and mental health. So saying that, hey, maybe screen time somewhere in there is doing something that's affecting it, something that we have to just consider, which I thought was very interesting as well. And they kind of proposed that it's likely because less physically active, less physically fit adolescents may also have more screen time. And high screen time is independently linked to negative health outcomes and other studies as well. And so, but their overall study here, they found that this research did emphasize the value of physical fitness for both cognitive and mental wellbeing in young people. And the findings suggest that promoting physical activity and encouraging healthy screen time are important for how to negate potentially poor outcomes with cognition or with health anxiety or depression or anything like that. And so those are the big overarching conclusions. And I kind of wanted to just fly through that 'cause I kind of want to dive into like some bigger takeaways from this article that I thought were interesting and worth discussing. So I kind of want to jump into those right now. Why does motor fitness improve cognition? The short answer is we're not sure, right? We're not gonna know. This is not a interventional trial, right? We're just looking at things. So because it's not an interventional trial, we can't confidently say, hey, it's happening because of this. We just can't say that, right? So it's not how it works. But it does have some cool associations. And some unique things here. This one thing that was unique is it had a really long time horizon, right? Looked at eight years and looked at how they sustain their fitness, not just one single assessment. So a lot of times what you do is you say, at the start of the study, these people were fit. Let's follow them here. They said, hey, what was the fitness like here and down the line as well, which I thought was interesting. And it suggests that consistent engagement in activities that promote speed and agility may be beneficial for cognitive benefits. So speed and agility, you know, I'm not saying you have to get out there and just start doing sprinting all the time. Maybe you are if you're in a sport. But what we're looking at here is these kinds of domains, right, these kind of faster activities, not just necessarily long cardio. Those seem to be most tied with cognition. And why? Well, we're not quite sure, but one explanation, one theory centers around the parallel development of motor skills and specific brain regions, right? So like the cerebellum and certain cortical areas, they're both involved in movement coordination and higher cognitive processes. So what we're saying is these areas of the brain, they're kind of tied together. And if you're improving one aspect, so you're doing the agility stuff, speed, you're doing that, and that's improving that area of the brain, then maybe the cognition side is also going along with the ride and taking that freebie in terms of improving that. That's one idea as to what may be happening. And so as kids refine their motor skills, right, they may also be strengthening these brain areas and leading to enhancement in these cognitive abilities. And another possibility is that motor skill development supports cognitive function more indirectly. For example, kids who are more physically active and adept might have more opportunities to engage in complex social interactions which can stimulate cognitive growth. So if you're a kid who's a stellar athlete or good athlete, you have these opportunities to be at these diverse exposures of activities, you're doing more sports, you're invited to be on these teams, who knows? That's another idea for what they're saying. Why it might happen. Once again, they don't know, but I thought it was just overall very interesting. But simple playground games like tag and running around and all that stuff, they may be good for growing minds. And I think we've all kind of known that intuitively. That's, hey, letting kids be kids is probably a good idea. But it's one of those things where letting your kid have a wide range of activities, probably a good idea, right? So it's okay to sign up for cross-country, but it's also okay to do basketball where you're getting some sprinting on it. Just lots of activities are good. And that's kind of like the takeaway from this is like a wide domain of activities probably gonna be good long-term for our kids. So now let's move on to our next section looking at cardiorespiratory fitness and mood. And the study found that the higher the level of cardiorespiratory fitness, they were associated with better mental health in adolescence, specifically lower perceived stress and fewer depressive symptoms. However, this may not tell the whole story when we're equating for a lean body mass. I'll kind of talk about that in a second here, but their overarching theme is like, yeah, cardiorespiratory fitness, definitely affects mental health. And that's a big outcome. And then in kind of buried in their discussion results, talks about lean body mass and how that negates some of the findings. So we'll talk about that here. But the overarching theme is that cardiorespiratory fitness is good for mental health. And they did find that even those who didn't necessarily start with the highest level, but improve their cardiorespiratory fitness over the eight year period, they were also linked to better mental health outcomes as well. And it means that adolescents who increase their fitness levels experience the most significant mental health advantages. So if you're starting from a lower state saying, hey, I'm not that fit and it's over, no, I'm just kidding, nobody's gonna say that. But if you start from a lower level of fitness, you still get huge improvements in not only your fitness, but then also for mental health outcomes as well, which is fantastic. And that's really, really what we're looking at. And it kind of reinforces the idea that physical activity is not a static factor, rather a dynamic process that can have significant impact on mental wellbeing in multiple stages of your life. And it is important here, when talking about lean body mass, it's important to mention this study used a method to assess cardiorespiratory fitness that normalized for lean body mass. And this helps isolate the specific effects of the fitness versus lean body mass and body mass effects. So essentially we have seen previous studies that adipose tissue is not inert, right? It doesn't just sit there and do nothing. Adipose tissue does indeed have effects and it can have potential effects for mental health. And so they're trying to equate out that idea, meaning, hey, does body mass change things? And what they did find was that some of the improvement in fitness went away when equating for lean body mass. And the takeaway is that body composition may also matter. And previous studies that saw the association with increased fitness may not have controlled for lean body mass as well. And why is this happening? Well, there's a couple of different mechanisms that may be happening. One, physical activity has been shown to influence various brain processes related to mood regulation, including the release of endorphins, increased neurogenesis or the growth of brain cells, and improved regulation of the stress response. Another idea is that exercise can also enhance self-esteem, self-efficacy and social connections, all of which are important to proper mental health. And so the takeaway here is that getting fit can lead to mood benefits, not just being fit, right? So if you don't, it's never too late to start, you can make improvements and that's good for you. And also we wanted to do our, our kids do activities that will get them fit, right? As cool as bowling or video games are, it's not the same as other sports. So we want them to breathe hard, generally want them to be sweating, we want them to work hard 'cause we're not just gonna improve our fitness by sitting there. Like, great, if you're very deconditioned and have done nothing, walking will get you more fit. That's gonna happen. But eventually you're gonna kind of level out and you're gonna have to do more and more and more. And so that's why choosing a broad range of activities. Now I'm not saying you have to go out there and start running crazy laps or counting miles with your kid. I'm not saying that, but we want our kids to be kids and run around and breathe hard. And as they're improving their fitness, hopefully they're improving their mental health as well. And so just things to consider. And the last section I wanna talk about is the screen time dilemma, which today screens are a huge topic of conversation in pop culture. I will probably do a future podcast specifically on screen time and all that, but this is interesting that they mentioned it here. So I wanted to kind of talk about it. One of the most intriguing findings here was that there is a potential moderating role of screen time in the relationship between physical activity and physical fitness and mental health. So the research observed a strong positive association between fitness and mental wellbeing, but these links were generally weaker when they adjusted for screen time. So this finding kind of raises questions about the complex interplay of different lifestyle factors and their combined influence on mental health in young people. Specifically, adjustments for screen time lessened the inverse association between the average cardiorestory fitness and improvements in cardiovascular fitness with measures of both perceived stress and depressed symptoms. So what that means in English is that when you took screen time, so right, let's say on this side, we had cardiorestory fitness and our mental health outcomes. It was a pretty like, the more fit you were, the lower your scores were, meaning you had less depressive symptoms. So it's good, so that's good. When we started to equate screen time, we just saw less of a direct association. So we just saw it wasn't quite as tied there in screens, maybe playing a factor on that specifically. And the author suggests that this weakening of the association could be due to the fact that adolescents with lower levels of cardiorestory fitness may also tend to have higher levels of screen time. So it kind of goes hand in hand, right? If you're on a screen all the time, by definition, you're not being physically active doing that necessarily. And so you may be less physically active and that may lead to more depressive type symptoms. Either way, what they found is that screens may be a proxy for more sedentary behavior. It's not necessarily we're saying the screen itself does it, it's just maybe more of the sedentary nature of being on a screen. But that's really what it is because there is a growing body of evidence that excessive screen time, especially when it replaces physical activity is not good. And also you're getting rid of social interaction and all those other good things as well. And so that's not great. And so it doesn't necessarily, this doesn't negate the potential health benefits of physical activity, but it does highlight the importance of, should be looking at this, looking at lifestyle, how much we're moving, all those things. And so I thought that was super interesting. And the practical takeaways here that I saw is, if we wanna hit all the benefits talked about in this, we should do four main things. I kind of think there's four main things we're looking at here and I'll go through them here. The first is have kids participate in a wide variety of movements. And for me as a sports medicine doc, this is why I'm so adamant about kids doing multiple sports. In today's world, it seems like you've got to decide a sport by age six, 'cause we're doing travel ball and we got this. And I just don't think that's great for multiple reasons. One, we wanna create robust athletes and kids who can do lots of things, right? Kids who can run, kids who can jump, kids who can run for a long time, have endurance, kids who are strong, all these things we want, all these things. And sometimes specializing in a sport too early leads to early, early specialization and becoming very focused on this one area. Like you are very good at baseball. And coming from a former baseball player, baseball is amazing. I love baseball. I will forever love baseball. I'll forever be my favorite sport, but it doesn't create necessarily robust athletes all the time. Obviously they've gotten much better on physical training now and training and conditioning, but just the game itself, you're sitting there, sitting there, maybe do a sprint down to first, who knows? So that being said though, having multiple sports develops different things. And that's the really, the main takeaway here is doing diverse activities. Because we saw that having diverse skill sets in terms of motor control or cardiovascular fitness, all those things can affect different things, whether it's cognition or mental health. And so we want kids doing a variety of activities. The second thing is that we want our children to participate in activities that improve their fitness. So simple things like walking are not bad. They're just not gonna be optimal, right? Eventually you get to a point, you plateau out. And once again, this is not saying you have to go out there and crack the whip and say, "Hey, you've got to go run laps with dad. We got to do this." No, but have them do activities that make them more fit. And whether that's you challenging them saying, "Hey, let's run to the mailbox," or, "Hey, let's run this and do that." That's great. Getting their heart rate up is important, but we want them to do things that challenge them and make them more fit. The third thing is aim to have our children have a healthy body composition, which arguably this might be just as important as fitness. 'Cause as we talked about, when we averaged out for that lean body mass, it did show a big difference. So having a healthy body composition is important. Childhood obesity is on the rise, it is rampant. And so having a healthy body composition, very, very important. As you probably heard me talk about that before, it's one of our necessary nine. It's very, very important. And it's very important for kids too, 'cause we know the negative effects that excess adiposity may have. So always something to consider. We want to maintain a healthy body composition. And four, limit screening time or sedentary time. Everyone's talking about this, but it just seems it's more important than ever is to, we don't want to have hours and hours and hours on a screen being sedentary. Once again, do I think it's the actual screens causing the problem? Not necessarily, because I would still say the same thing. If kids are reading books for hours and hours and hours and hours, they're still not doing exercise. And the big thing is we want exercise. Do screens have some unique things in terms of they're connected to the internet and connected to social media and algorithms that are designed to keep them addicted to it? Yes, that's a, once again, a whole nother discussion. So screens, I don't think screens are fantastic, but I think it's the replacement of physical activity. Kids used to go outside and do things. And so it's avoiding screens potentially because I think that's replacing physical fitness. That's the big thing. So those four things we really want to look out for are have your kids participate in a wide variety of movements have them participate in activities that get them more fit, aim to have our children have healthy body composition and limit their screen time or sedentary time. I think those are the big four takeaways from the article saying, hey, if we can do this, I feel much better about our chances of having, our kids have a chance of having robust mental health and hopefully increased cognition as well. And that's gonna do it today for the podcast. Thanks so much for stopping by. If you'd like to be in the world with me, if you either liked the video on YouTube, subscribe to the podcast or YouTube channel or share with a friend as that is the biggest comment you can give us. Now, thanks again for stopping by. Get off your phone, get outside, have a great rest of your day. We'll see you next time. Disclaimer, this podcast is for entertainment, education and informational purposes only. The topics discussed should not solely be used to diagnose, treat or prevent any condition. The information presented here was created with an evidence-based approach, but please keep in mind that science is always changing and at the time of listening to this, there may be some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified healthcare provider for questions regarding any medical condition.
