Aerobic Exercise Training Reduces Overt Anger Expression Among Overweight Children

1. Aerobic Exercise Training Reduces Overt Anger Expression Among Overweight Children Joseph Tkacz, M.S. Colleen Boyle, M.S. Catherine L. Davis, Ph.D. Georgia Prevention Institute Department of Pediatrics Medical College of Georgia

2. Introduction • Hostility has been linked with cardiovascular risk in adolescents(Raikkonen, Matthews, & Salomon 2003)and adults (Niaura et al., 2002) • Anger is defined as the emotional aspect of hostility(Kubzansky et. al, 2005) • There is evidence that links anger to cardiovascular problems in adults(See review by Everson-Rose, 2005) • In children, high anger emotionality predicts externalizing problem behaviors(Rydell, Berlin, and Bohlin, 2003)

3. Anger Expression • The expression of anger has usually been categorized on the following dimensions: • Anger expressed outwardly • Anger turned inward • Anger controlled (Siegel, 1986; Spielberger, 1996; Armstead et al. 2002)

4. Effects of Exercise on Mood • It is documented that regular exercise (Dunn et al., 2001)and even a single bout of exercise (Bartholomew et al., 2005)can have positive benefits on mood and the psychological well-being of adults • The effects of exercise on anger in children are not as well understood

5. Purpose and Hypothesis • The purpose of the present study was to experimentally investigate the effects of regular aerobic exercise on anger expression in children • H1: Children assigned to an exercise program would report improved anger scores in comparison to controls

6. Methods • Sample consisted of 139 obese, sedentary children • Recruited from local elementary schools in the Augusta area • Age range 7-11 • BMI Percentile >= 85 • Excluded data for subjects who did not attend posttest • 1 child on antipsychotic medication was excluded

7. Methods Cont.

8. Table 1. Sample Characteristics

9. After School Exercise Program • Every day after school for 15 weeks • Transportation provided (school bus) • Vigorous aerobic activities: walking, jogging, tag games, running games, jump rope, basketball, soccer(Gutin et al., 1999) • Competition, skill deemphasized • Token economy incentives for goals: • Attend at least 4 days/week • Average heart rate over 150 bpm each day • Approximately 1 staff member per 9 children

10. Play Research Gymnasium 3184 sq ft with basketball court, vinyl coated concrete floor, divider curtain, padding, and auditory baffles to reduce echo.

12. Pediatric Anger Expression Scale • 15 item self-report of anger styles in children(Jacobs et al., 1989) • Yields 3 factor analysis derived scales: • Anger In: the holding in and possible denial of anger (Cronbach’s α = 0.77) • Anger Out: anger is openly expressed, potentially including hostile and aggressive behavior (α = 0.77) • Anger Control: maintaining control of anger reactions and an attempt to successfully resolve the conflict or frustration with a more cognitive and less impulsive approach (α = 0.67) • Anger Expression Score: Summary score (α = 0.60) (Anger in + Anger out) / Anger Control

13. The Pediatric Anger Expression Scale 1. I control my temper. C hardly-ever  sometimes  often 2. I show my anger. O hardly-ever  sometimes  often 3. I hold my anger in. I hardly-ever  sometimes  often 4. I talk to someone until I feel better. C hardly-ever  sometimes  often 5. I do things like slam doors. O hardly-ever  sometimes  often 6. I hide my anger. I hardly-ever  sometimes  often 7. I keep my cool. C hardly-ever  sometimes  often 8. I attack whatever it is that makes me very angry. O  hardly-ever  sometimes  often 9. I get mad inside but I don’t show it. I hardly-ever  sometimes  often 10. I do something totally different until I calm down. C  hardly-ever  sometimes  often 11. I say mean things. O hardly-ever  sometimes  often 12. I can stop myself from losing my temper.I hardly-ever  sometimes  often 13. I try to calmly settle the problem. C hardly-ever  sometimes  often 14. I lose my temper. O hardly-ever  sometimes  often 15. I’m afraid to show my anger. I hardly-ever  sometimes  often Scales: O = Anger Out I = Anger In C = Anger Control

14. Data Analysis • Exercise vs. control conditions compared via t-tests • Children on ADHD meds (n = 6) were included • Excluding these children did not affect results

15. Res Exercise Pre Post Diff. Anger In 10.1 (2.4) 9.8 (2.4) -0.28 (2.5) Anger Out 8.3 (2.5) 7.7 (2.2) -0.61 (2.4) Anger Control 10.9 (2.3) 11.0 (2.4) 0.10 (2.5) Anger Exp. 7.5 (3.1) 6.5 (3.3) -1.00 (3.5)

16. ults Control Pre Post Diff. Sig. 9.4 (2.2) 9.5 (2.0) 0.12 (2.3)ns 8.3 (2.4) 9.0 (2.6) 0.76 (3.2)p = .007 10.7 (2.2) 10.8 (2.2) 0.10 (2.2)ns 6.9 (4.4) 7.7 (3.5) 0.79 (5.0)p = .02

17. Mean Change Scores

18. Discussion • The primary hypothesis was partially supported: • Children assigned to the exercise classes showed significant decreases at post test for the Anger Out and summary Anger Expression scales, compared to controls who increased • There were no differences between groups on the Anger Control and Anger In scales

19. Regular aerobic exercise may reduce or prevent the increase in anger expression among overweight, sedentary children • Results are consistent with previous literature showing beneficial effects of exercise on mood and emotional states in adults (Dunn et al., 2005)

20. Possible Mechanisms • Trait and state anger have been associated with frontal lobe activity(Harmon-Jones & Sigelman, 2001; Dougherty et al., 1999) • These results are consistent with our prior work showing improved executive function (inhibition, self control) in overweight, sedentary children due to exercise(Tomporowski, Davis, & Gregoski, 2005) • Exercise buffers stress by modulating 5-HT and NE brain systems (Dishman et al., 2006)

21. Clinical Implications • Compared to traditional methods of anger reduction, exercise is inexpensive, relatively simple, and promotes general good health NIH Funding • This study was supported by grants: RO1 DK60692 & RO1 DK70922 (Davis)