心理健康是健康的重要组成部分,身体活动/体育锻炼是提升心理健康的重要途径。本文综述了身体活动/体育锻炼对应激、消极情绪、自尊、认知功能及主观幸福感的影响的相关研究。笔者认为,虽然在研究层面上,该领域的研究尚需对剂量反应效应及调节变量等进行深入探讨,但在实践层面上,已有足够证据支持了身体活动/体育锻炼对心理健康的效益。在提升心理健康的实践中,应给予身体活动/体育锻炼以充分的重视。
Mental health is an important part of health. Physical activity or physical exercise is an important approach to improve mental health. This paper reviewed the literature of psychological benefits (e.g. stress, negative emotions, self-esteem, cognitive function and subjective well-being) of physical activity or physical exercise from 2010 to 2016.The authors suggested although the research in this field needs further study on dose-response effect and moderators, there has been enough evidence to support the effectiveness of physical activity or physical exercise on mental health at the practical level. In the practice of mental health promotion, physical activity or physical exercise should be given more attention.
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1. 引言
世界卫生组织(World Health Organization, WHO)成立之初,就在其《宪章》中明确指出,健康是指身体上,心理上和社会上的完满状态,而不仅是没有疾病和虚弱的现象。1989年,世界卫生组织再次深化了健康的定义,将道德健康纳入,认为健康包括身体健康、心理健康、社会适应良好及道德健康。可见,心理健康是健康的重要组成部分,不容忽视。
在全世界范围内,心理健康都是一个严重的公共健康问题。世界卫生组织预测,到2020年,抑郁将超过癌症,紧随心血管疾病之后,成为第二大致死致残因素(World Health Organization, 2008, 引自Buckworth et al., 2013);不仅如此,心理健康也影响着身体健康,焦虑、抑郁等消极情绪,均可能增加心血管疾病、癌症、II型糖尿病等多种慢性疾病的患病风险。因此,提升心理健康水平,是全世界共同面临的重要课题。
此外,一些采用随机对照试验的研究也支持了身体活动/体育锻炼对应激的积极作用。这些研究发现,对不同人群而言,身体活动/体育锻炼干预能够降低个体感受到的应激水平,改善应激症状(Magalhaes Das Neves, Loots, & van Niekerk, 2014; van der Zwan et al., 2015; von Haaren et al., 2015)。
抑郁已经成为全世界的重要公共卫生问题之一。Kerri (2014)指出,根据世界卫生组织(World Health Organization, WHO)的数据,全球约有3.5亿人经历过抑郁。而且,因为多种原因,抑郁经常未被诊断出,或未得到治疗。依据该报告,我国的抑郁发生率为3.2%,处于较低的水平。然而,Kerri也指出,我国抑郁发病率较低的重要原因可能源于所使用的诊断方法及标准,导致较高的误诊或漏诊率,而非真正的低发生率。
例如,Cao (Cao et al., 2011)对5003名我国11至16岁青少年的横断调查发现,屏幕时间(使用电视、电脑及手机等)是中学生抑郁的风险因素(比数比OR为1.52,95% CI: 1.31~1.76),而高强度的身体活动则是抑郁的保护因子(比数比OR为0.73,95% CI: 0.62~0.85),较长的屏幕时间和高强度身体活动不足是青少年出现多种心理障碍的重要原因。Jonsdottir等(Jonsdottir et al., 2010)对瑞典超过3000名健康护理及社会保险业从业人员进行了为期2年纵向追踪调查。结果也发现,有低强度及中高强度休闲时间身体活动的人群,相比于不活动的人群,抑郁风险更低。此外,Loprinzi (2013)使用2005至2006年美国健康及营养检查抽样调查的数据(2005~2006 National Health and Nutrition Examination Survey),分析了708名65岁以上老年人的身体活动情况(使用加速度计客观测量)与抑郁症状的关系。结果发现,在控制了人口统计学变量及体脂百分比后,小强度的身体活动每增加60分钟/周,抑郁的风险降低20% (比数比OR为0.80,95% CI: 0.67~0.95),类似地,中等强度及高强度的身体活动也能够有效地降低抑郁风险(比数比OR为0.78,95% CI: 0.64~0.94)。上述对不同年龄阶段人群的调查结果均提示,身体活动/体育锻炼是抑郁风险的重要保护因子。
研究者对处于不同年龄阶段的人群,进行了多项横断或纵向追踪调查,探讨身体活动/体育锻炼与焦虑的关系。如Dimech & Seiler (2011)对小学生的纵向追踪调查发现,课外参与团体项目的体育活动能够有效减缓小学生的社会焦虑。而Cao等(Cao et al., 2011)对5003名我国11至16岁青少年的横断调查也发现,屏幕时间(使用电视、电脑及手机等)是诱发中学生焦虑的风险因素(比数比OR为1.36,95% CI: 1.18~1.57)。此外,Brunes等(Brunes, Augestad, & Gudmundsdottir, 2013)针对挪威30,000余名19岁以上成年人的调查,也发现了身体活动与焦虑之间的负向关系。即,与报告身体活动较少的人群相比,报告中高强度身体活动的人群在焦虑量表上的得分更低。而对成年女性而言,身体活动的强度、频率及持续时间均与焦虑障碍的发生风险间呈负向关系。而且,Pasco (Pasco et al., 2011)的一项针对60岁以上老年人(547名被临床诊断为抑郁焦虑障碍,533名诊断为阴性)的横断调查同样发现,身体活动能够有效地减少抑郁焦虑障碍的发生(比数比OR为0.55, 95% CI: 0.32~0.94))。而且,研究者进一步指出,休闲时间的身体活动是总身体活动的重要组成部分,即使控制了无关变量对抑郁焦虑障碍的影响后,休闲时间身体活动也与抑郁焦虑障碍的发生呈负向关系,提示了身体活动尤其是休闲时间身体活动对老年人焦虑的保护作用。上述研究结果提示,对不同年龄阶段的人群而言,身体活动/体育锻炼对焦虑具有减缓和改善的效益。
此外,一些干预研究也支持了身体活动/体育锻炼干预对焦虑的改善作用。如Herring等(Herring et al., 2012)对30名被诊断为广泛性焦虑障碍的久坐少动的中年女性进行为期6周(2次/周)的体育锻炼干预,干预手段包括力量训练和有氧训练。结果发现,与只接受药物治疗的控制组相比,两种形式的体育锻炼干预都能有效地改善担忧的症状。另一些针对其他人群的干预研究也支持了上述结论(杜铭,韩志霞,肖坤鹏,2013; 孟建平,2013)。
而且,Rebar (Rebar et al., 2015)对该领域的8项元分析进行了元分析。结果发现,身体活动对非临床诊断为焦虑障碍的健康人群,也具有减缓作用,但效果较小(SMD = 0.38, 95% CI: −0.66~−0.11)。
认知功能是大脑皮层的高级功能,随年龄的增加,日渐衰退。因此,改善或延缓老年人的认知功能衰退,关系着老年人的心理健康和生活质量。近年来,多项研究表明,身体活动/体育锻炼对老年人的认知功能衰退具有改善或减缓其进程的作用。例如,Boucard等(Boucard et al., 2012)通过一项包括3个年龄阶段(分别为18~28、60~70和70~81岁)成年人的横断调查,检验了身体活动/体育锻炼与老年人执行功能的关系。结果发现,对60岁以上的老年人而言,自我报告的身体活动水平能够负向预测执行功能的衰退,提示了身体活动对认知功能衰退的减缓作用。但这一减缓作用具有选择性,即对抑制功能有效,对转换和刷新功能效果不明显。Huang等(Huang et al., 2014)的研究,也支持了这一结论。他们发现,无论从事何种类型的体育锻炼,参与体育锻炼的老年人的抑制功能均优于不参加体育锻炼的老年人。
此外,一些回溯调查或纵向追踪调查也揭示了身体活动对老年人认知衰退进程的延缓作用。如,Fong等(Fong et al., 2014)的研究发现,自我报告有5年以上,每周至少3次体育锻炼(太极拳或耐力锻炼)的老年人,执行控制功能优于无规律锻炼的老年人。而且,也有研究发现,即使是低强度的身体活动,也能减少老年人认知功能受损的风险(Lee et al., 2014)。此外,即使在控制了人口统计学及疾病情况等变量后,低强度或中等强度的身体活动仍能负向预测老年人的认知功能衰退,如语词流畅性(Wilbur et al., 2012)。
同时,一些纵向干预研究也进一步揭示了身体活动对老年人认知衰退的积极作用。如,对老年人进行规律的身体活动干预能够增加海马的体积,或大脑的激活程度,进而改善老年人的认知功能,如记忆、视觉空间能力、语言、推理及执行功能等(Erickson et al., 2011; Kamegaya et al., 2014; Nishiguchi et al., 2015)。而且,一些研究也发现,身体活动干预对老年人认知功能的改善效益在80岁以上的老年人或初始身体活动状况较差的老年人群中,尤其突出(Barnes et al., 2013; Sink et al., 2015)。在锻炼项目的选择上,已有的少数研究研究提示,技能主导类项目(如太极、有氧舞蹈)的效果优于体能主导类项目(如拉伸训练) (Jeoung, 2014; Lam et al., 2011),开放性项目(如乒乓球)的效果优于闭锁性项目(Dai et al., 2013)。但总体而言,参与不同的身体活动/体育锻炼项目对老年人认知功能效益的差异,还需后续研究的深入探讨。
此外,有两项元分析研究评估了身体活动/体育锻炼对老年人认知功能改善的效果。Sofi (Sofi et al., 2011)纳入了15项针对正常老年人群的前瞻性研究,涉及33,816名参与者,前瞻性时间跨度为1至12年,在这一时期内,共3210名参与者发生了认知衰退。元分析结果表明,高水平的身体活动能够减少认知衰退发生风险的38% (发生率HR为0.62, 95% CI: 0.54~0.70; p < 0.00001),即使是小到中等的身体活动也能减少认知衰退发生风险的35% (发生率HR为0.65, 95% CI: 0.57~0.75; p < 0.00001),明晰了身体活动对认知功能衰退发生风险具有中等程度减缓作用。另一项元分析研究(Smith et al., 2010)纳入了29项针对成年人(18岁以上)的有氧锻炼干预时间超过1个月的随机对照实验,共获得了234个效果量。分析结果表明,有氧锻炼干预对成年人认知功能的多个成分具有中等程度的效果量(注意:g = 0.158; 95% CI: 0.055~0.260, p < 0.003; 执行功能:g = 0.123; 95% CI: 0.021~0.225, p < 0.018; 记忆:g = 0.128; 95% CI: 0.015~0.241, p < 0.026)。
主观幸福感(psychological well being),指人们对其生活质量所做的情感性和认知性的整体评价,受到多方面因素的综合影响。其中,身体活动/体育锻炼是影响因素之一。2011年,英国4位首席医务官员指出,身体活动能够对生活满意感的诸多方面产生积极的影响,如睡眠,积极的情感体验,及生活质量等(转引自Biddle, Mutrie, & Gorely, 2015)。
6.1. 身体活动/体育锻炼对睡眠的影响
人的一生约有三分之一的时间是睡眠时间。失眠是常见的睡眠障碍之一,长期失眠(超过1个月),不仅影响日间活动,也会导致个体情绪低落,降低其生活满意感。在美国睡眠协会(the National Sleep Foundation)提出的改善睡眠的建议中,坚持规律锻炼是建议之一。相关领域的多项研究证据也支持了这一建议。
Wu等(Wu et al., 2015)对4747名我国大学生的身体活动情况、屏幕时间(使用电脑、智能手机等)、心理健康及睡眠情况进行调查。结果发现,约10%的大学生自我报告睡眠状况较差,低身体活动水平和较长的屏幕时间与较差的睡眠状况呈正向关系。类似地,Loprinzi & Cardinal (2011)从美国全国健康和营养检查调查(NHANES, 2005~2006)的数据中,抽取3081份成年人(年龄范围:18至85岁)的数据(身体活动使用加速度计客观测量,睡眠质量采用自我报告)进行分析。结果发现,即使控制了年龄、体脂百分比、健康状况和吸烟状况后,与未达到身体活动推荐标准的成年人相比,达到身体活动推荐标准能够有效地降低日间过度瞌睡的风险(比数比OR为0.65,95% CI:0.44~0.97)。提示了身体活动与睡眠质量以及日间精力的正向关系。
上述横向调查的结果,也得到了纵向追踪调查的支持。如Tsunoda等(Tsunoda et al., 2015)进行了一项间隔近5年的前瞻性研究,包括了4446名日本中老年人(中年人平均45岁,老年人平均65岁)。研究涉及了睡眠持续时间短及主观睡眠不足两种困扰。前瞻性调查结果发现,对中年人而言,参加中高强度及剧烈强度的身体活动,能够有效地预防主观睡眠不足(中高强度比数比OR为0.81,95% CI: 0.67~0.98;剧烈强度比数比OR为0.83,95% CI: 0.71~0.97);而对老年人而言,即使是中低强度的身体活动,也能够对主观睡眠不足产生预防作用(比数比OR为0.58,95% CI: 0.42~0.81);但研究未发现身体活动对睡眠持续时间较短的预防及改善作用。这一研究结果提示了身体活动对主观睡眠质量的正向影响。
此外,一些干预研究也支持了身体活动/体育锻炼干预对睡眠的改善作用。例如,Pa等(Pa et al., 2014)的研究以72名初始身体活动较少,且有主观认知抱怨和睡眠抱怨的社区老年人为参与者,采用4种干预手段(分别为:有氧加认知训练;有氧加教育训练,拉伸加认知训练,拉伸加教育训练),进行为期12周的干预。结果发现,与中高强度的身体活动相比,低强度的身体活动及心理干预对老年人主观睡眠质量的改善效果更优。类似的一些研究也发现了体育锻炼干预对老年人睡眠质量的积极作用(高航,史姣姣,2013;孟建平,2013)。
同时,针对其他人群的纵向干预研究也获得了上述结论。例如,有研究发现,中年女性(平均35岁)的睡眠质量能够通过为期8周的有氧练习得到改善(Gezer & Cakmakci, 2010)。而Kredlow等(Kredlow et al., 2015)对身体活动与睡眠质量研究的元分析也表明,规律的身体锻炼对睡眠时间和睡眠效率具有小的效果量,对入睡时间具有小到中等的效果量,对睡眠质量具有中等的效果量。
此外,一些研究探讨了身体活动与生活质量间的关系。如Bertheussen等(Bertheussen et al., 2011)针对4500名19岁至95岁成年人的横断调查发现,在不同年龄和性别的人群中,身体活动与生活质量(个体对自己的身体、心理及社会功能的主观评价)均呈正向关系。而且,与身体活动与心理健康有关的生活质量的关系相比,身体活动与身体健康有关的生活质量的关系更为密切。同时,研究者发现,在大于65岁的老年人群中,身体活动与心理健康的关系较其他年龄人群更为密切。
郭 璐,毛志雄. 身体活动/体育锻炼的心理健康效益Psychological Benefits of Physical Activity or Physical Exercise[J]. 心理学进展, 2017, 07(12): 1407-1418. http://dx.doi.org/10.12677/AP.2017.712174
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