Abstract
BACKGROUND: Physical activity (PA) and sedentary behavior (SB) are movement behaviors that have been associated with mental health. Evidence suggests that replacing SB with PA may influence mental disorders. This study aimed to evaluate the effects of replacing time spent in SB with moderate-intensity PA (MPA) and vigorous-intensity (VPA) on the symptoms of anxiety and depression among college students. METHODS: This cross-sectional study used data from a multicenter survey conducted among undergraduate students from eight public universities in Brazil. Data were collected between October 2021 and February 2022 using an online questionnaire sent via email. The outcomes were anxiety and depression symptoms, assessed using the Depression, Anxiety, and Stress Scale-21. Exposure to SB was evaluated by the total sitting time and PA level, considering the type of exercise, weekly frequency, and duration in minutes. Subsequently, PA was classified according to its intensity. The explanatory variable was adherence to the 24-hour movement guidelines, assessed by combining the time spent in SB and PA. Based on this, three groups were formed: (1) complete adherence, (2) partial adherence, and (3) non-adherence. An isotemporal substitution logistic model was used to assess the effects of the different SB, MPA, and VPA periods on mental health. RESULTS: A total of 8,059 young adults participated in the study, with a mean age of 23.9 years (SD: ± 6.28). Most students reported spending more than 9 h/day in SB (55.09%), and 48.28% were physically inactive. The multivariate analysis revealed an association between non-adherence to movement guidelines and mental health (p < 0.001), showing a dose-response gradient. Students who did not adhere to the guidelines were more likely to have symptoms of anxiety [OR: 1.89 (95% CI: 1.67-2.14)] and depression [OR: 2.49 (95% CI: 2.19-2.82)]. Furthermore, in the isotemporal analysis, replacing SB with equivalent amounts of time in MPA and VPA reduced the odds of mental disorder symptoms in all models evaluated. CONCLUSION: Replacing SB with equivalent quantities of MPA or VPA reduces the odds of symptoms of anxiety and depression. Therefore, it is essential to develop public policies that encourage increased PA levels and reduced SB in university environments to promote mental health and improve the physical health of students with mental disorder symptoms.