This article is the second in a six-part series, covering “The Big 6:” the six key modifiable health behaviours that play a critical role in both the physical and mental health for youth, now and in the long-term [1,2]. These six factors are dietary intake, physical activity, sleep, sedentary recreational screen time, alcohol use and tobacco/e-cigarette use. See the first installment of this blog series, on dietary intake, here.
In one of the largest school-based prevention clinical trials in Australia, the Health4Life program found significant associations between each of the Big 6 and depression, anxiety, and psychological distress symptoms in adolescents [1-3].
This blog post will cover the physical activity component of The Big Six and how it impacts youth wellbeing.
Physical activity and mental health in youth
Adolescence is a crucial stage of growth, during which teenagers undergo rapid psychological and physical development. A deeper understanding of mental health has led to a renewed perspective on the role of physical exercise, prompting further exploration of its benefits. As the driving force of our society’s future, teenagers require a well-rounded education that prioritises both physical fitness and psychological wellbeing. The Australian 24-Hour Movement Guidelines recommend that young people aged 13-17 year-old engage in at least 60 minutes of moderate-to-vigorous intensity physical activity (MVPA) every day. Yet only 7.9% of 13 to 17-year-olds actually meet these guidelines [4].
A 2023 study published in Mental Health and Physical Activity, found that higher daily MVPA at age 11 was linked to fewer depressive symptoms in females, and an increase in MVPA between ages 11 and 13 was associated with reduced depressive symptoms in males. Higher MVPA also predicted lower emotional difficulties in females and reduced hyperactivity in both sexes [5]. The findings highlight the importance of promoting physical activity in early adolescence and how it can support mental health and behaviour.
The Big 6: Physical activity
The 2023 study conducted using the Health4Life data investigated associations between the Big 6 health behaviours and mental health among adolescents in Australia [1,3].
For physical activity, the study found that:
- The lowest mental disorder symptoms were found in adolescents who engaged in six days of MVPA (for 60 minutes or more per day) in a typical week.
- Compared to teens who reported zero days of at least 60 minutes of MVPA, the adolescents who engaged in the aforementioned physical activity had a 12% lower average anxiety score, 37% lower depression score, and 30% lower psychological distress score.
How does the Health4Life program target physical activity?
The key behaviour change techniques incorporated into the Health4Life cartoon modules use an effective ‘peer-to-peer’ learning approach providing students with evidence-based facts about the Big 6 risk behaviours, improving resistance skills, modifying existing norms, developing life skills (e.g., decision-making, problem-solving, coping skills, self-control), self-regulatory skills (e.g., goal setting, self-monitoring, decision-making), and increasing autonomous motivation. Importantly, the cartoons aim to demonstrate the associations and interrelations between multiple health behaviours, for example, how increasing physical activity can improve sleep. As the story lines develop, questions and interactive activities are included to help consolidate the information students have learnt, and to empower them to apply skills learnt in real life.
Here are some examples of the cartoon storyline, where two characters discuss doing more physical activity that they enjoy:
Here is an example of a multiple-choice activity (which occur throughout the cartoons):
The program helps students identify physical activities that they enjoy, and makes multiple suggestions, from dancing to martial arts. ‘Stop & Think’ activities are also embedded into each lesson to assess and consolidate learning.
The Health4Life program is the first online health education program teaching year 7-8 secondary school students about these Big 6 health behaviours. The program is aligned with the Australian Health and Physical Education curriculum and the NSW Personal Development, Health and Physical Education syllabus and requires no teacher training and minimal preparation for all class and homework activities. Read more about Health4Life here.
Author: Francesca Wallis. With expert review by researchers at the Matilda Centre for Research in Mental Health and Substance Use.
References:
[1] S. Smout, L. A. Gardner, N. Newton, and K. E. Champion, “Dose–response associations between modifiable lifestyle behaviours and anxiety, depression and psychological distress symptoms in early adolescence,” Australian and New Zealand Journal of Public Health, vol. 47, no. 1, p. 100010, Feb. 2023, doi: https://doi.org/10.1016/j.anzjph.2022.100010.[2] Teesson M, Champion KE, Newton NC, et al, “Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians.” BMJ Open 2020;10:e035662. doi: 10.1136/bmjopen-2019-035662
[3] S. Smout and L. Gardner, “The big six modifiable factors for youth mental health,” InSight+, 2023. https://insightplus.mja.com.au/2023/17/the-big-six-modifiable-factors-for-youth-mental-health/
[4] Be You, “Physical activity and mental health,” Beyou.edu.au, 2024. https://beyou.edu.au/resources/fact-sheets/wellbeing-and-stress-management/physical-activity-and-mental-health
[5] J. N. Booth et al., “Associations between physical activity and mental health and behavior in early adolescence,” Mental Health and Physical Activity, vol. 24, no. 24, p. 100497, Nov. 2022, doi: https://doi.org/10.1016/j.mhpa.2022.100497.
