Insulin Sensitivity, Depression/Anxiety, and Physical Fitness in At-Risk Adolescents

Abstract

Poor physical fitness contributes to the early progression of cardiometabolic disease, yet the physiological and psychological factors underpinning poor fitness in at-risk adolescents are not well understood. In this study, we sought to determine the relationship of physical fitness with two developmental phenomena of adolescence, insulin resistance and depression/anxiety symptoms among at-risk youth. We conducted secondary data analyses of 241 overweight or obese adolescents (12–17 years), drawn from two study cohorts. Insulin sensitivity index was derived from oral glucose tolerance tests. Adolescents self-reported depressive symptoms and anxiety symptoms on validated surveys. A walk/run test was administered to determine perceived exertion and physical fitness (distance traveled). Insulin sensitivity was positively associated with walk/run distance (b=0.16, P<0.01), even after accounting for all covariates. Anxiety symptoms were inversely related to perceived exertion (b=–0.11, P<0.05), adjusting for covariates. These findings suggest that insulin resistance and anxiety symptoms are associated with different dimensions of physical fitness in overweight or obese adolescents and could both potentially contribute to declining fitness and worsening metabolic outcomes in at-risk youth.

Key words

adolescents - physical fitness - depression - anxiety - insulin sensitivity

• References

• 1 Berman LJ, Weigensberg MJ, Spruijt-Metz D. Physical activity is related to insulin sensitivity in children and adolescents, independent of adiposity: A review of the literature. Diabetes Metab Res Rev 2012; 28: 395-408
• 2 Chen MJ, Fan X, Moe ST. Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: A meta-analysis. J Sports Sci 2002; 20: 873-899
• 3 Coyle EF, Hagberg JM, Hurley BF, Martin WH, Ehsani AA, Holloszy JO. Carbohydrate feeding during prolonged strenuous exercise can delay fatigue. J Appl Physiol Respir Environ Exerc Physiol 1983; 55: 230-235
• 4 Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, Bell R, Badaru A, Talton JW, Crume T, Liese AD, Merchant AT, Lawrence JM, Reynolds K, Dolan L, Liu LL, Hamman RF. Search for diabetes in youth study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001–2009. JAMA 2014; 311: 1778-1786
• 5 DeFronzo RA, Matsuda M. Reduced time points to calculate the composite index. Diabetes Care 2010; 33: e93
• 6 Drinkard B, McDuffie J, McCann S, Uwaifo GI, Nicholson J, Yanovski JA. Relationships between walk/run performance and cardiorespiratory fitness in adolescents who are overweight. Phys Ther 2001; 81: 1889-1896
• 7 Ekkekakis P, Lind E, Vazou S. Affective responses to increasing levels of exercise intensity in normal-weight, overweight, and obese middle-aged women. Obesity (Silver Spring) 2010; 18: 79-85
• 8 Ganley KJ, Paterno MV, Miles C, Stout J, Brawner L, Girolami G, Warren M. Health-related fitness in children and adolescents. Pediatr Phys Ther 2011; 23: 208-220
• 9 Graham DJ, Wall MM, Larson N, Neumark-Sztainer D. Multicontextual correlates of adolescent leisure-time physical activity. Am J Prev Med 2014; 46: 605-616
• 10 Gungor N, Saad R, Janosky J, Arslanian S. Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents. J Pediatr 2004; 144: 47-55
• 11 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 update. Int J Sports Med 2017; 38: 1126-1131
• 12 Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2016; 8: CD003380
• 13 Jerstad SJ, Boutelle KN, Ness KK, Stice E. Prospective reciprocal relations between physical activity and depression in female adolescents. J Consult Clin Psychol 2010; 78: 268-272
• 14 Kelsey MM, Zeitler PS. Insulin resistance of puberty. Curr Diab Rep 2016; 16: 1-6
• 15 Kimm SY, Glynn NW, Kriska AM, Barton BA, Kronsberg SS, Daniels SR, Crawford PB, Sabry ZI, Liu K. Decline in physical activity in black girls and white girls during adolescence. N Engl J Med 2002; 347: 709-715
• 16 Kovacs M. The Children’s Depression Inventory (CDI). Psychopharmacol Bull 21: 995-998
• 17 Kriska A, Delahanty L, Edelstein S, Amodei N, Chadwick J, Copeland K, Galvin B, El ghormli L, Haymond M, Kelsey M, Lassiter C, Mayer-Davis E, Milaszewski K, Syme A. Sedentary behavior and physical activity in youth with recent onset of type 2 diabetes. Pediatrics 2013; 131: e850-e856
• 18 Lewinsohn PM, Clarke GN, Seeley JR, Rohde P. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 1994; 33: 809-818
• 19 Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220-229
• 20 Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291-303
• 21 Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970; 45: 13-23
• 22 Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
• 23 Nadeau KJ, Anderson BJ, Berg EG, Chiang JL, Chou H, Copeland KC, Hannon TS, Huang TT, Lynch JL, Powell J, Sellers E, Tamborlane WV, Zeitler P. Youth-onset type 2 diabetes consensus report: Current status, challenges, and priorities. Diabetes Care 2016; 39: 1635-1642
• 24 Nader PR, Bradley RH, Houts RM, McRitchie SL, O'Brien M. Moderate-to-vigorous physical activity from ages 9–15 years. JAMA 2008; 300: 295-305
• 25 Norman AC, Drinkard B, McDuffie JR, Ghorbani S, Yanoff LB, Yanovski JA. Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents. Pediatrics 2005; 115: e690-e696
• 26 Radloff LS. The CES-D scale: A self report depression scale for research in the general population. 1977; Appl Psychol Meas 385-401
• 27 Roberts MD, Drinkard B, Ranzenhofer LM, Salaita CG, Sebring NG, Brady SM, Pinchbeck C, Hoehl J, Yanoff LB, Savastano DM, Han JC, Yanovski JA. Prediction of maximal oxygen uptake by bioelectrical impedance analysis in overweight adolescents. J Sports Med Phys Fitness 2009; 49: 240-245
• 28 Roshanaei-Moghaddam B, Katon WJ, Russo J. The longitudinal effects of depression on physical activity. Gen Hosp Psychiatry 2009; 31: 306-315
• 29 Shomaker LB, Kelly NR, Pickworth CK, Cassidy OL, Radin RM, Shank LM, Vannucci A, Thompson KA, Armaiz-Flores SA, Brady SM, Demidowich AP, Galescu OA, Courville AB, Olsen C, Chen KY, Stice E, Tanofsky-Kraff M, Yanovski JA. A randomized controlled trial to prevent depression and ameliorate insulin resistance in adolescent girls at risk for type 2 diabetes. Ann Behav Med 2016; 50: 762-774
• 30 Shomaker LB, Kelly NR, Radin RM, Cassidy OL, Shank LM, Brady SM, Demidowich AP, Olsen CH, Chen KY, Stice E, Tanofsky-Kraff M, Yanovski JA. Prevention of insulin resistance in adolescents at risk for type 2 diabetes with depressive symptoms: 1-year follow-up of a randomized trial. Depress Anxiety 2017; 34: 866-876
• 31 Shomaker LB, Tanofsky-Kraff M, Zocca JM, Field SE, Drinkard B, Yanovski JA. Depressive symptoms and cardiorespiratory fitness in obese adolescents. J Adolesc Health 2012; 50: 87-92
• 32 Speilberger CD, Gorscuh RL, Lushene REI. Manual for the State-Trait Anxiety Inventory. California: Consulting Psychologists Press; 1970
• 33 Titchener K, Wong QJ. A weighty issue: Explaining the association between body mass index and appearance-based social anxiety. Eat Behav 2015; 16: 13-16
• 34 Zanoveli JM, Morais H, Dias IC, Schreiber AK, Souza CP, Cunha JM. Depression associated with diabetes: from pathophysiology to treatment. Curr Diabetes Rev 2016; 12: 165-178
• 35 U.S . Department of Health and Human Services. Physical Activity Guidelines for Americans; 2^nd edition Available from: https://health.gov/paguidelines/second-edition/