Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

DOI 10.1007/s00127-010-0208-0

ORIGINAL PAPER

Role of physical and sedentary activities in the development

of depressive symptoms in early adolescence
Anne Mari Sund Bo Larsson Lars Wichstrm

Received: 22 June 2009 / Accepted: 2 March 2010 / Published online: 1 April 2010
Springer-Verlag 2010

Abstract
Objective To examine whether levels of physical activity
or sedentary activity are risk factors for the development of
depressive symptoms in early adolescence.
Methods A representative sample of 2,464 12- to 15year-old adolescents living in the middle of Norway was
assessed twice, during the years 1998 (T1) and 1999/2000
(T2). The attrition rate was 4.3%. We assessed depressive
symptoms (using the Mood and Feelings Questionnaire,
MFQ) and levels of physical and sedentary activities at
baseline and follow-up. Various potentially confounding
factors, including demographic factors, were assessed at
baseline.
Results The MFQ scores at T1 were cross-sectionally
associated with low levels of vigorous exercise. A possible
buffering effect of vigorous exercise on the relationship
between stressful life events and depression was demonstrated. In longitudinal analysis low levels of vigorous
exercise and high levels of sedentary activities (boys only)
predicted a high score (MFQ C 25) at T2.

A. M. Sund
B. Larsson
Department of Neuroscience, Faculty of Medicine,
Norwegian University of Science and Technology,
7489 Trondheim, Norway
A. M. Sund
St.Olavs University Hospital, Trondheim, Norway
L. Wichstrm
Department of Psychology, Norwegian University of Science
and Technology, 7491 Trondheim, Norway
A. M. Sund (&)
Department of Neuroscience, Medical Faculty, NTNU,
Klostergata 46/48, 7489 Trondheim, Norway
e-mail: Anne.M.Sund@ntnu.no

Conclusions Low levels of vigorous exercise and high

levels of sedentary activities (boys only) constituted independent risk factors for the development of a high level of
depressive symptoms in a 1-year study of young adolescents.
This knowledge should be considered by policy makers,
preventative services, and health-care professionals.
Keywords Vigorous
Sedentary
Physical activity

Depression
Longitudinal
Youth

Introduction
According to the World Health Organization, depression is
the second most important disease in terms of the burden of
disease (disability and mortality) among 15- to 44-year-olds
worldwide [57]. During the few years from early to middle
adolescence, levels of depressive symptoms rise sharply,
particularly among girls [4]. Depressive symptoms in adolescence are often forerunners of adult depression [45].
Levels of physical activity in early childhood are high
and decrease gradually in childhood and further in adolescence [1, 5, 38]. The results of most cross-sectional
studies of adolescents have shown associations between
high levels of vigorous physical activity and low levels of
depressive symptoms [47]. However, other studies have
reported no such relationships [2], or have been restricted
to social functioning [2], to girls [16, 26], to low to moderate levels of activity only among girls [53], or to moderate to vigorous exercising only among boys [19].
Because depressive symptoms can obviously lead to
reduced activity levels, cross-sectional studies can tell us
little about the temporal relationship between depression
and physical activity. Only a few studies have addressed
such relationships longitudinally. In a 2-year follow-up

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study, Motl and collaborators [37] found that changes in

physical activity during leisure time were inversely related
to changes in levels of depressive symptoms, but no sexbased differences emerged. In a study of 15-year-olds in
the USA, participating in a sporting club was inversely
related to the development of depressive symptoms, but
only among boys [16]. In a recent large total-population
study, Wiles [59] found that early adolescents who
undertook the recommended levels of physical activity, i.e.
at least 1 h every day, had less emotional distress 1 year
later than those who undertook less physical activity. In
Norway, Sagatun [46] showed that the hours spent on
physical activity among 15- to 16-year-olds were negatively associated with emotional symptoms and peer
problems 3 years later, but only among boys. Those who
exercised at a moderate level (57 h a week) reported the
lowest emotional stress levels. In two large cross-sectional
school-based studies of young adolescents, high levels of
sedentary behaviour correlated positively with levels of
depressive symptoms [48] and emotional stress [55].
There are probably multiple mechanisms by which
sedentary and exercise behaviours influence depressive
symptoms including both biological pathways and social
and psychological factors. There is solid evidence supporting the roles of negative life events and stress in the
aetiology of depression [51, 52]. Several constitutional and
potentially hard-to-change factors, such as coping styles
[31] and genetics [9], may buffer the negative effects of
stress. It is also possible that lifestyle factors such as
physical activity act as resilience factors mitigating
depression. Supporting evidence was found in a study of
inpatient adolescent girls aged 14 years [8] and in a general
population sample [40]. In both studies, the negative
impact of stressful life events on emotional health declined
as exercise levels increased. However, these studies
included small and non-representative samples of adolescents. In a recent study of young mothers, frequency of
leisure time physical activity was acting as a buffer of the
association between life stress and depressive symptoms
[14]. To the best of our knowledge, this hypothesis has not
yet been tested by specifically addressing depression in a
large representative sample.
While a few longitudinal studies that have investigated
the influence of physical activity on depression in adolescents, the evidence is conflicting [36, 47, 55]. To date, few
studies have included measures of vigorous, non-vigorous
and sedentary activities, and stressful events together with
a wide range of potentially confounding variables in the
assessment of risk factors for the development of high
levels of depressive symptoms among adolescents. A
review of the literature suggests that the following variables might be confounding factors: age [43, 60], sex [47],
family structure [34], socio-economic status (SES) [28,

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Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

60], ethnicity [43, 47, 51], somatic disease [23, 32, 33],
pubertal development [21], body mass index (BMI) [18],
obesity [20] and physical impairment [33].
The aims of the present study were to examine
1.

2.

the cross-sectional and 1-year longitudinal relationships between vigorous exercise, non-vigorous physical
and sedentary activities versus depressive symptoms,
while controlling for possible confounding variables,
including demographic factors, among 12- to 15-yearold Norwegian girls and boys; and
the hypothesis that vigorous exercise moderates the
effects of high levels of stressful life events on levels
of depressive symptoms.

Methods
Procedure
This study was conducted at the schools as part of The
Youth and Mental Health Study, a longitudinal study of
depressive symptoms and disorders in 12- to 15-year-old
school adolescents in two counties in the middle of Norway, South and North Trndelag, during the years 1998
(T1) and 1999/2000 (T2). These areas had a population of
390,000 inhabitants and included one large city, Trondheim, with 150,000 inhabitants. The total population of 12
to 15-year-olds attending 8th and 9th grades in private or
public schools during the autumn of 1998 in South and
North Trndelag was 9,292, 98.5% of whom attended
public schools. The schools are highly integrated, i.e. also
including mildly retarded and physically handicapped
adolescents. Twenty-nine pupils who attended special
schools were not included in the study. In addition, 534
pupils at the smallest schools, e.g. 5.7% of the total population were not included mostly because of practical
reasons. A cluster sampling method was chosen using the
schools as sampling units. This strategy was chosen to
reduce costs (e.g. travelling costs) and to achieve a high
response rate. The schools were drawn with a probability
according to size (proportional allocation) within each
stratum, i.e. for each individual drawn from the total
population sample, all pupils in 8th and 9th grades at the
same schools were selected. This resulted in 22 schools and
2,813 pupils. Twenty-one pupils (0.7%) were not eligible
for the following reasons: admitted to hospital, being
temporarily abroad or lacking sufficient knowledge in
Norwegian language (recently arrived to Norway). Thus, a
total of 2,792 adolescents were eligible for the study.
At each school, a member of the staff was trained and
was responsible for the collection of the written consents
both from the adolescents and the parents and for the data

Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

collection. Of the 2,792 eligible adolescents, 2,464 (88.3%)

participated in the study at T1 (50.8% girls), stratified
according to urbanity and geography: 1: City of Trondheim
(N = 484, 19.5%. 2. Suburbs of Trondheim (N = 432,
17.5%) 3. Coast (N = 405, 16.4%) 4. Inland (N = 1,143,
46.4%).
The Regional Ethics Committee for Medical Research
and the Norwegian Data Inspectorate, the local school
authorities in the two counties, and the school boards
approved the study.
Study sample
At T1, 2,464 adolescents participated (50.5% girls) with a
mean age of 13.7 years (range 12.515.7, SD 0.58) and at
T2 14.9 years (range 13.717.0, SD 0.6). The attrition rate
was 4.2%. Only those adolescents who had participated at
both time points (N = 2,360) were included in the longitudinal analyses of the present study. The average time
between T1 and T2 was 1.1 year (range 0.941.36, SD
0.12) and depended upon follow-up interviews.
Measures at T1
Depressive symptoms
The Mood and Feelings Questionnaire (MFQ) [3]. This is a
34-item questionnaire designed for children and adolescents of 818 years to report depressive symptoms as
specified by the DSM-III Revised criteria [6]. The MFQ
covers affective, melancholic, vegetative, cognitive and
suicidal aspects of depression. The individual is asked to
report his or her feelings during the preceding 2 weeks on a
three-point scale (0 = not true, 1 = sometimes true,
and 2 = true) and the total summed scores range
between 0 and 68. The psychometric properties of the MFQ
have previously been shown to be satisfactory [13], as they
were for the present sample [50]. The MFQ has been used
to screen for depressive symptoms among adolescents in
clinical samples [15] and in the general population [11]. In
the present sample, 18 subjects (0.8%) who had omitted
more than 10% of the items were not included in the
analysis, and the missing values for those with a lower
proportion of omitted items were replaced with the mean
MFQ item score. The total summed scores were used in the
bivariate and linear regression analyses.
Physical and sedentary activities
Short self-reported measures of vigorous physical activity
among young people in mid-adolescence have shown
acceptable validity and reliability [7]. Four questions about
physical activity, modified according to Paffenbarger [41],

433

were used. Vigorous exercise was assessed by asking the

adolescents about the number of hours they exercised
vigorously per week, using five response categories ranging from less than 3 h to more than 14 h (including gym in
school, which represented about 2 h every week). Nonvigorous physical activities (e.g., walking, bicycling,
playing, skateboarding) performed each day were assessed
in four response categories, ranging from less than one
hour to more than four hours. Time spent on sedentary
activities everyday outside school (e.g. homework, reading,
watching TV, games) was assessed in four response categories ranging from less than three hours to more than
six hours. The variables were used as grouping variables
in the bivariate analyses and ordinal scales in the regression
analyses. In addition, the question What do you like to
do? included five response alternatives ranging from
considering oneself being physically sedentary to physically very active. The response on this variable at T1 was
used to validate the other physical activity variables,
showing moderate high correlation with vigorous activity
(r = 0.6, P \ 0.01), but low correlation with non-vigorous
activity (r = 0.16, P \ 0.01) and low negative correlation
with the sedentary variable (r = -0.15, P \ 0.01).
Stressful life events
The adolescents answered a 33-item questionnaire constructed for the purpose of the present study, the Early
Adolescence Stress Questionnaire (EASQ) [51]. In the
EASQ, the sum of stressful life events and chronic stressors
salient to young adolescents, in the school, family, and
social network domains during the previous 12 months are
recorded. The mean number of reported stressful events for
the previous year at T1 was 4.5 (SD 3.6) for the whole
sample, and no significant sex difference was found [51].
In the bivariate and regression analyses, the total sum of
stressful events was used.
A dichotomized variable was used when visualizing the
interaction analyses, i.e. a cutoff was set at five stressful
events. To avoid confounding between stress and depressive symptoms at T2, only events assessed at T1 were used
in the longitudinal analysis.
Pubertal stage
The adolescents completed the Pubertal development scale
[44] (range 14). Most were in the initial (37.5%) or
middle (34.4%) phase of puberty. Girls were significantly
more advanced in their pubertal development than boys
(Z2,226 = -12.5, P \ 0.001). The variable was treated as a
grouping variable in the bivariate analyses and as a continuous variable in the regression analyses.

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Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

BMI

Physical and sedentary activities

Self-reported weight and height data were converted to

Quetlets body mass index [56]. This score was subdivided
into three categories:\10th percentile (BMI \ 16.2 kg/m2),
between the 10th and 90th percentiles (BMI = 16
22.5 kg/m2) and [90th percentile (BMI [ 22.5 kg/m2).
The mean BMI for the whole sample was 19.2 kg/m2
(range 11.838.8, SD = 2.7). The variable was treated as a
grouping variable in the bivariate analyses, and as a
dummy variable or a continuous variable in the regression
analyses.

Questions identical to those asked at T1 regarding selfreported perception of physical activity, vigorous exercise,
non-vigorous physical and sedentary activities and on
impairment the previous year because of somatic illness or
injury.

Somatic health
The adolescents were asked about their current somatic
health with the open-ended question Do you have any
disease? The answers were coded according to the
International Classification of Primary Care criteria [24]
and grouped into none, one, two and three or more diseases. The variable was treated as a grouping variable in
the bivariate analysis and an ordinal scale in the regression
analysis. The reported diseases were predominantly allergy
(24.1%), hay fever (28.1%) and asthma (21.4%).
Physical impairment
The adolescents were asked whether they had reduced (no/
yes) their leisure/sport activities/seeing friends because of
disease/injury or pain during the previous 12 months.
Demographic variables
Age, sex, parental SES, ethnicity and living situation were
included in the analyses. The parental SES was measured
by classifying the mothers and fathers occupations
according to the international classification of occupation,
ISCO-88 [25]. A distinction was made between those
subjects with one or two parents of Norwegian background
and those with a non-Norwegian background. Subjects who
lived with both parents or shared their time equally
between their parents were contrasted with all other
domestic situations.
Measures at T2
Depressive symptoms (MFQ)
At T2, the MFQ was readministered to the adolescents and
the total scores were dichotomized at the 90th percentile to
subdivide the subjects into low and high scorers in the
logistic regression analysis.

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Statistical analysis
The data were analysed with the statistical package for the
social sciences (SPSS), version 15. Correlations between
the continuous data were assessed by the Pearson productmoment coefficient. Student t test or ANOVA/ANCOVA
was used for parametric data and the MannWhitney test
was used for non-parametric data to assess the differences
between groups. Bonferroni corrections were used to adjust
for multiple comparisons in post hoc analyses. Paired t tests
were used for parametric analyses and Wilcoxons test for
paired non-parametric analyses. All tests were two-tailed
and an a level of P \ 0.05 indicated statistical significance.
The assessed variables that showed bivariate relationships with depressive symptom levels at T1, in addition to
demographic variables, were entered into a subsequent
stepwise hierarchical multiple linear regression analysis to
predict depressive symptom scores cross-sectionally.
Hierarchical logistic regression analyses were performed to
investigate whether vigorous exercise, non-vigorous
activities, and sedentary activities, in addition to potentially
confounding factors, predicted levels of depressive symptoms longitudinally.
In the regression analysis, vigorous exercise, non-vigorous activities, sedentary variables, pubertal groups and
somatic health variables were treated as ordinal variables
and were transformed into Z scores, and the scores of the
vigorous exercise variable reversed. The following variables were transformed into dummy variables: sex, SES,
living situation, ethnic group, physical impairment, and
BMI categories. The variables were entered in three steps
with a backward elimination procedure at each step, and
variables with a P value of B0.10 were retained in the
analysis. Step 1 contained variables found to predict
depression in an earlier analysis of the present sample [51].
Step 2 contained all potentially confounding variables, and
step 3 included all variables of major interest. In a fourth
step, potential interaction variables were introduced individually. There were no problems with multicollinearity
between the explaining factors.
In the hierarchical logistic regression analysis, the
HosmerLemeshow test for goodness of fit [22] was used
to predict the likelihood that an individual would be a low
or high scorer on the MFQ at T2.

Z989 =
-5.1***d
Z2,249 = -7.1***d Z1,140 = -4.9**d
n.s.
2.0 (0.9)
1.98 (0.8)
1.99 (0.8)

Z1,105 = -4.5***d Z1,093 =

-2.9**d
Z2,198 = 5.1***d
2.15 (1.0) Z2,315 =
7.6***b
1.93 (0.9)
2.04 (0.9)

n.s.

n.s.

Z1,145 = -2.1*d
Z2,270 = 2.13*d
2.56 (1.1) Z2,280 =
5.2***b
2.20 (0.8)
2.37 (1.0)

t1,182 = -3.7***c
t2,347 = 3.6***a n.s

MFQ the mood and feelings questionnaire

Student t test, bMannWhitney, cPaired t test, dWilcoxon paired test

a

1.83 (0.9) n.s.

Sedentary activities
(14)

* P \ 0.05 ** P \ 0.01 *** P \ 0.001

2.26 (1.0) Z2,267 =

4.4***b
Non-vigorous activities 2.16 (1.0) 2.07 (0.9)
(14)

1.84 (0.8) 1.85 (0.8)

2.60 (1.0) Z2,310 =

9.1***b
2.42 (0.9) 2.24 (0.8)
Vigorous exercise
(15)

t2,330 = 11.3***

10.6 (11.8) 13.4 (11.2) 7.8 (8.5)

Boys
Girls
All
Sex
difference
Boys
mean
(SD)
Girls
mean
(SD)
Sex
difference
Boys
mean
(SD)
Girls
mean
(SD)

10.3 (9.2) 12.4 (10.1) 8.2 (7.4)

The results of variables were examined in successive

ANOVA/ANCOVAs. Interaction effects between sex and
depressive symptom levels and all the other study variables
were examined. Our results showed that depressive
symptom levels at T1 increased significantly with lower
levels of vigorous exercise and higher levels of sedentary

MFQ (064)

Bivariate analyses

All
mean
(SD)

Cross-sectional analysis at T1

All
mean
(SD)

Using identical measures to those used at T1, the adolescents were reassessed 1 year later (T2) with an attrition rate
of 4.3% (N = 105). The adolescents who did not participate at T2 were characterized by having significantly
higher mean total scores on the MFQ at T1 (17.3 vs. 10.4
for the continuing subjects) (t2,442 = 7.13, P \ 0.001)
[52], more frequent non-Norwegian backgrounds [52] and
lower levels of vigorous exercise at T1 (t2,405 = 3.1,
P \ 0.01). No sex, grade, or SES differences between the
two groups were observed. Girls had significantly higher
mean total levels of depressive symptoms at both T1 and T2
than those of boys. Although the mean total MFQ score for
the whole sample did not increase from T1 to T2, a significant difference between the sexes was observed
(P \ 0.001). The girls showed an increase in depressive
symptom levels between the two time points, whereas a
small nonsignificant reduction in symptom levels was
observed among boys (Table 1).
Boys displayed significantly higher levels of vigorous
exercise and non-vigorous physical activities than did girls
at both time points. However, no sex-based difference was
observed for levels of sedentary activities. The whole
sample showed a decline in vigorous exercise and nonvigorous physical activity from T1 to T2. However, the
decline in vigorous exercise among boys was nonsignificant. An increase in level of sedentary activities was
observed for the whole sample (Table 1).

T1T2 differences

Gender differences and changes over the 1-year period

T2

Results

T1

There were few missing data for most of the variables at

T1, ranging from 1 to 3%. The levels of missing data were
higher for physical impairment (11.1%) and the BMI
(13.1%) variables. In the final analyses, 19.7% of the data
had missing values in the cross-sectional regression analysis, and 7.8% in the longitudinal logistic regression
analysis.

Variable

Missing data

435
Table 1 Levels of depressive symptoms on the MFQ, vigorous exercise, non-vigorous physical and sedentary activities for the whole sample and by sex over 1 year in 2,360 Norwegian
adolescents and the results of between-group differences

Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

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Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

Table 2 Mean total MFQ scores with standard deviations within

parenthesis, the results of ANOVAS/ANCOVAs using levels of
vigorous exercise, non- vigorous physical activities, sedentary
Variable

activities, pubertal status, BMI group, number of somatic diseases

and reduced activity levels because of disease/injury as grouping
factors at T1 (N = 2,464)

Categories

Vigorous exercise per week (including gym at school, h) 1. \3

Non- vigorous physical activity per day (h)

Sedentary activities per day (h)

Pubertal group girls

Pubertal group boys

288 13.7 (10.4)

BMI group (kg/m ) Girls

BMI group (kg/m2) boys

Number of medical diseases

1 [ 2, 3, 4***

1,168 11.2 (10.0)

2 [ 3*

3. 710

683 9.2 (8.5)

1 [ 5*

4. 1114

174 8.8 (8.4)

5. [14

79 8.6 (7.1)

1. \1

655 11.5 (9.6)

2. 12

933 10.5 (9.6)

3. 34

498 10.0 (9.4)

4. [4

264 10.1 (9.4)

1. \3

922 10.4 (9.4)

2. 34
3. 56

1,015 10.5 (9.4)

327 11.0 (10.0)

4. [6

116 13.4 (9.5)

1. Prepub

62 10.4 (9.9)

n.s.

F3,2375 = 5.55**

4 [ 1, 2***
4 [ 3*

F3,1201 = 12.41*** 4 [ 1, 2**

2. Beginning- pub

417 11.0 (9.0)

4 [ 3*

3. Mid-pub

528 13.4 (10.4)

3 [ 1, 2*

4. Advanced pub

198 16.0 (10.4)

1. Prepub

228 7.3 (7.0)

2.Beginning-pub

487 8.6 (7.9)

3. Mid- pub

323 8.6 (8.1)

127 11.7 (10.0)

2. 16.222.5

830 12.1 (9.7)

3. [22.5

115 17.4 (11.9)

1. \16.2

100 8.7 (8.7)

2. 16.222.5
3. [22.5

836 8.2 (7.8)

108 8.4 (7.8)

1. None

1,631 10.5 (9.7)

2. One

653 10.4 (8.8)

3. Two

136 13.0 (10.1)

1. No
2. Yes

n.s.

98 8.8. (7.9)

1. \16.2

4. Three or [
Physical impairment

F4,2386 = 10.3***

Bonferroni
posthoc
comparisons

2. 36

4. Advanced pub
2

Mean total MFQ Main effects

Score (SD)

F2,1069 = 14.43*** 3 [ 1, 2***

n.s.

n.s

24 11.7 (11.4)
2,240 10.4 (9.3)

F1,2441 = 24.5***

2 [ 1***

204 13.7 (11.6)

* P \ 0.05 ** P \ 0.01 *** P \ 0.001

activities, with increased pubertal development (only for

girls), higher BMI category (only for girls), and with the
presence of physical impairment some times during the last
year (for details, see Table 2).
Moderate correlations were observed between the
number of stressful events and depressive symptom levels
[(r = 0.50, P \ 0.01) for girls and (r = 0.52, P \ 0.01)
for boys], whereas a nonsignificant relationship with levels
of vigorous exercise was evident for both sexes.

123

Multivariate analysis
Hierarchial multiple linear regression was first employed to
determine if vigorous exercise improved prediction of
depressive symptom levels beyond the main predictors
found in earlier cross-sectional analysis of the present
sample [51] while controlling for potential confounders
(see Table 3). In step 1, the model was significant after
including gender, ethnicity and sum of stressful life events

Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

437

Table 3 The results of hierarchical multiple regression analyses using depressive symptom (MFQ) scores at T1 as an outcome measure
(N = 1,979)
Predictor

sr2 change
(unique) (%)

Unstandardizedcoefficient (B)

Standard
error (SE)

t value

Gendera

4.14

0.33

12.63***

4.4

Ethnic groupb

3.56

1.03

3.44**

0.3

1.25

0.04

28.35***

23.9

Pubertal group

0.42

0.57

2.29*

0.2

BMI [ 22.5 kg/m2

2.12

0.18

3.75***

0.5

Step 1

29.8

Stressful life events

Step 2

30.7

Step 3
Vigorous exercise

Total R2 (%)

31.4
c

0.81

0.18

4.47***

0.7

Two- way interactions

Pubertal group 9 gender

1.43

0.36

3.95***

0.5

BMI [ 22.5 kg/m2 9 gender

4.22

1.14

3.71***

0.5

Vigorous exercise 9 stressful events

0.14

0.50

2.83**

0.3

Reference group: girls

At least one parent Norwegian versus all other non-Norwegian parental groups

The vigorous exercise variable is reversed

* P \ 0.05, ** P \ 0.01, *** P \ 0.001
Before interactions: unique variability = 30.0%, shared variability = 1.2%
Low stress (<=5last year)
20

High stress (>5 last year)

18
16
14
12

MFQ

in the equation, R2 = 0.30, F3,1974 = 280.76, P \ 0.001.

The model improved significantly after including pubertal
group and BMI group in step 2, R2 = 0.307,
F2,1972 = 11.27, P \ 0.001 and vigorous exercise in step 3,
R2 = 0.314, F1,1971 = 19.95, P \ 0.001. (see Table 3
including only significant variables). No effect of nonvigorous physical activities was observed.
Analysis of two-way interactional effects between
pubertal group by sex and BMI group by sex on depressive
symptom levels showed that they remained significant in
the multivariate analysis. For both sexes, an interactional
effect was observed between levels of vigorous exercise
and stressful events, step: R2 = 0.32, F1,1970 = 8.0,
P \ 0.01 (see Table 3). The nature of the interaction
showed that higher levels of vigorous activities were
associated with a stronger reduction in depressive symptoms when the levels of stressful events were high. The
dichotomized stressful event variable was used to visualize
this interaction (Fig. 1).

10
8
6
4
2
0
<3

3-6

7-10

11-14

> 14

hours

hours

hours

hours

hours

Vigorous exercise per week

Longitudinal analyses
To predict group membership, i.e. low versus high scorers
on the MFQ at T2, a hierarchical logistic regression analysis was performed using the dichotomized MFQ variable
at T2 as the dependent variable, while controlling for the
depressive symptom level at T1 and other potentially
confounding variables. The impairment variable at T2 was

Fig. 1 Interaction (P \ 0.01) at T1 showing mean total sum scores of

depressive symptoms (MFQ) as a function of levels of stressful events
(15 vs.[5) last year and hours of vigorous exercise per week among
a representative sample of Norwegian adolescents (N = 1,979)

also included in the first step of the analysis, but emerged

as nonsignificant. Both high levels of sedentary activities
and low levels of vigorous exercise at T1 significantly

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Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

Table 4 The results of hierarchical logistic regression analysis using depressive symptoms, sex, stressful life events, ethnicity, sedentary
activities and vigorous exercise at T1 (N = 2,175) as predictors of severe depressive symptoms (MFQ C 25) 1 year later
Predictor

Unadj OR Exp(B)

95% CI

Adj OR Exp(B)

95% CI

Step 1
MFQ T1

14.49***

10.4520.11

8.58***

5.8212.64

Sex

3.09***

2.284.19

2.42***

1.703.44

Stressful life events T1

1.18***

1.141.22

1.09***

1.051.14

3.75***

2.076.82

3.66***

1.817.42

Step 2
Ethnicity
Step 3
Sedentary activities
Vigorous exercisea

1.20*

1.021.41

1.22*

1.021.47

1.42***

1.201.68

1.23*

1.011.49

1.46*

1.032.06

1.45*

1.002.11

Interaction
Sedentary activities 9 sex

Unadj OR unadjusted odds ratio, Adj OR adjusted odds ratio, CI confidence interval
a

The scores of vigorous exercise reversed

* P \ 0.05, ** P \ 0.01, *** P \ 0.001

predicted the likelihood of being a high scorer

(MFQ C 25) 1 year later. The increment in the model fit
attributed to sedentary activities and levels of vigorous
exercise was significant (v2 = 9.22 df = 1, P \ 0.05). The
result of the HosmerLemeshow test was nonsignificant,
indicating a good model fit (P = 0.98). A significant sex
by sedentary activities interaction effect was also found in
that sedentary activities was significant only for boys in
predicting high scorers (adjusted odds ratio = 1.53; 95%
confidence interval: 1.152.03; Table 4).

Discussion
The overall aim of this study was to examine the relationships between physical and sedentary activities in
regard to depressive symptom levels in cross-sectional and
1-year longitudinal studies of a large, representative sample
of early adolescents in Norway. After we controlled for
possible confounders, low levels of vigorous exercise
remained an independent predictor of depressive symptom
levels in the cross-sectional analysis, a finding consistent
with previous reports [28, 47]. Low levels of vigorous
exercise for the whole sample and high levels of time spent
on sedentary activities among boys were predictors of high
levels of depressive symptoms 1 year later.
This protective effect of vigorous exercise against
depressive symptoms 1 year later, while controlling for
various confounding variables, has seldom been reported.
To the best of our knowledge, the finding that sedentary
activities predict high levels of depressive symptoms
among young adolescent boys has not been shown in earlier research using a longitudinal representative design, and

123

extends the findings of a previous cross-sectional studies

that showed a relationship between low levels of sedentary
activities and psychological well being among adolescents
[55] and with depression and anxiety levels among children
[42]. Although the sizes of the relationships in the present
study were modest, they still indicate how low levels of
vigorous exercise and high levels of sedentary activities
might signal future depressive problems.
A difficulty encountered when interpreting the results of
the cross-sectional analysis is the fact that slower psychomotor activity and lower levels of physical activity among
adolescents might also be an inherent characteristic of a
depressive state. The findings of the present longitudinal
analysis might be explained by a common third factor
related to both activity levels and the emergence of
depressive symptoms.
The mechanisms by which sedentary and exercise
behaviours influence depressive symptoms include both
biological pathways, social and psychological factors.
Levels of monoamines (noradrenalin and serotonin) are
reduced in depression. Possible mechanisms are that the
neurotransmitters increase and that endorphins increase
during hard physical exercise [35]. Theoretically, physical
inactivity might influence the body in the opposite way, by
reducing the levels of these agents and thus precipitating
depressive feelings. A third hypothesis emphasizes the role
played by exercise in regulating stressful signals to the
limbic system and preventing the hypersecretion of cortisol
[54]. A positive effect of exercise on sleep among children
has been reported [17, 49], and might be relevant to the
frequent occurrence of sleep problems during depression.
Psychosocial factors might be related to feelings of
loneliness elicited by sedentary activities, which often take

Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

place in solitude (e.g., playing computer games). The

opposite effect might also occur during vigorous exercise,
which is often undertaken with peers in this age group [58].
Spending time on sedentary activities might take time from
physical activities or time spent with family or friends.
Rumination is a coping style that increases from childhood
to adolescence [10] and is associated with the duration of
depressive symptoms [39] and the onset of depressive
episodes among young adults [27]. Being sedentary might
provoke rumination to a greater extent than does physical
activity. Conversely, exercising might elicit a sense of
mastering the body, an increase in self-esteem and positive
cognitions that counteract the development of depression.
Sex differences
The finding that only girls who were more advanced in
their pubertal development (in the upper ten BMI percentile) having higher levels of depressive symptoms also
disappeared in the longitudinal analysis, showed that these
factors had no lasting effect. No sex-based differences in
the relationships between vigorous activity and depressive
symptom levels were found in the cross-sectional or longitudinal analyses. However, sedentary activities seem to
be more harmful for the mental health of early adolescent
boys than girls in the longitudinal 1-year analysis, which is
consistent with the report by Johnson et al. [26], who noted
that high sedentary activity among girls was related to the
lowest levels of depressive symptoms.
Stressful events
In this study, interactive effects between stressful life
events and vigorous exercise on depressive symptom levels
were identified. Vigorus exercise was associated with a
greater reduction in depressive symptoms when levels of
stressful events were high. Thus, vigorous exercise had a
possible buffering effect on stress. These results provide
support for the stress-buffering effects of excercising;
findings in line with recent results of a study of young
mothers [14].Our findings are also consistent with earlier
research in small clinical [8] and general population samples [40]. In the context of high levels of stress, vigorous
exercising might represent a positive coping strategy
counteracting depression. Thus, exercise could have a
stealing effect, i.e. distracting the adolescent from a
stressful burden. Second, by strengthening the individual
physically, this might have positive effects on thought
processes and concentration, possibly inducing a more
problem-solving strategy towards stressful events. However, these possible interpretations remain to be tested
empirically. The finding in the present study supports the
theory that exercise activities have a buffering effect on the

439

relationship between stressful life events and depression,

but the cross-sectional nature of the findings is open to
alternate interpretations.
Strengths and limitations
All the adolescents participated in compulsory physical
exercise lessons at their schools. The effects of exercising
at some level, compared with no exercise at all, might
therefore have been concealed in the study. Possible confounding factors were measured only at T1 and other
confounding factors may have influenced the results.
However, the fact that non-vigorous physical activities had
no effect suggests that vigorous exercise exerts stronger
protective effects than does being generally active.
Because the dropouts at T2 were likely to be less
physically active than continuing subjects and had higher
MFQ scores at T1, the findings of the longitudinal study
might be biased towards weakened relationships. Whereas
no inferences can be drawn about causality from the
present study, risk factors might be assessed based on the
longitudinal design [29].
Depressive symptoms were measured at only two time
points, 1 year apart. While it is possible that these findings
only mirror mood swings among adolescents, half of the
high scorers at T1 were still high scorers at T2 [52]. We
used a self-reported measure of depressive symptoms, the
MFQ, and these findings are not readily applicable to
depressive disorders.
Measurement of physical activity among young people
is complicated by the cognitive, physiological and other
changes that occur during adolescent development, in
addition to more intermittent patterns of habitual physical
activity in youth [12]. Whereas self-reported measures of
exercise and physical activity may have limited validity in
children, it has been shown that the quality of self-reported
information increases with age [7]. Therefore, it is likely to
be valid for our participants, who had reached junior high
school. A more general question about self-perception of
levels of physical activity also concurred with the quantitative self reports, supporting to some extent the validity of
the measurements in the present study. Still, because of
some ambiguity regarding the questions posed, there might
be some risk for misclassification. Today, importance is
laid on measuring intensity, frequency and duration during
a week including weekends [12]. In the present study, we
asked about total sum of hours spent on exercising, on nonvigorous physical activity and sedentary activities per
week. However, more-objective measures, such as monitoring physical activities based on systematic observations,
accelerometry, pedometri, oxygen uptake or diaries, might
have yielded more valid and reliable information. The
strengths of the present study are the large representative

123

440

sample, the high response rate, the small attrition rate at T2,
and that both physical and sedentary activities were
measured.

Soc Psychiatry Psychiatr Epidemiol (2011) 46:431441

8.

9.

Conclusion
Low levels of vigorous exercise for both sexes and high
levels of sedentary activities for boys emerged as risk
factors for high levels of depressive symptoms at the 1-year
follow-up. Conversely, vigorous exercise possibly moderates the effects of high levels of stressful events on
depressive symptom levels. Increasing vigorous exercise
and reducing sedentary activities might improve the mental
health of adolescents in the general population. This
knowledge should be considered by policy makers, preventative services and health-care professionals.
In a treatment outcome study of adults, exercise was
suggested to be an alternative or adjunct to both psychotherapy and medication for mild to moderate depression
[36]. Very limited research exists on the treatment of
adolescents, with no conclusive evidence for positive
effects of physical activity on depression [30]. Low risk
and readily accepted therapies are required for this age
group. Whether increased levels of vigorous exercise and a
reduction in sedentary activities also reduce depressive
symptom levels in adolescents should be evaluated in
treatment outcome studies.

10.

11.

12.

13.

14.

15.

16.

17.

18.
Acknowledgments This study was supported by grants from the
Research Council of Norway and the National Council for Mental
Health, Norway.
19.

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