Mental Health and Physical Activity 2 (2009) 55–64

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Mental Health and Physical Activity

journal homepage: www.elsevier.com/locate/menpa

Associations of multiple physical activity domains with mental well-being

Ester Cerin a, *, Eva Leslie b, Takemi Sugiyama c, Neville Owen c
a
Institute of Human Performance, The University of Hong Kong, 111-113 Pokfulam Rd, Hong Kong
b
School of Psychology, Deakin University, Geelong, Australia
c
Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Objective: Physical activity (PA) has consistent associations with mental well-being, but studies have
Received 9 July 2009 focused primarily on leisure-time activity, and there has been little attention to the roles of other activity
Received in revised form domains (household, occupational and transport). We examined the dose–response relationships of PA
14 September 2009
dimensions (frequency, amount and volume) with mental well-being for all four PA domains. We also
Accepted 14 September 2009
assessed the interaction effects of gender, age, body weight status, and PA domains.
Method: In 2003–2004, two surveys collected data on PA, socio-demographics, height and weight,
Keywords:
perceived neighborhood attributes, barriers to PA, and physical and mental well-being from 2194
SF-12
Adults Australian adults. Generalized linear models with restricted cubic splines identified the dose–response
Demographic characteristics relationships of PA domains with mental well-being; the interactive effects of PA domains, age, gender
Body mass index and weight status; and the confounding effects of poor mental or physical health as barriers to PA.
Dose–response relationship Results: Leisure-time PA was independently linearly related to mental well-being in most demographic
groups. Stronger effects were observed for vigorous-intensity leisure-time PA. Poor health as a barrier to
PA explained only a small portion of the relationships of PA with mental well-being. The magnitude and
direction of the effects of household, occupational and transport PA depended on age, gender, weight
status and/or participation in other PA domains.
Conclusions: Individual physical capacities and characteristics, and level of discretionary choice are likely
determinants of the effects of PA on mental well-being. Strategies aimed at increasing PA for mental
health benefits need to take these diverse and sometimes counterintuitive effects into account.
Ó 2009 Elsevier Ltd. All rights reserved.

1. Introduction well-being. This is particularly true for PA domains other than

Mental well-being is a protective factor for psychiatric disorders
(Gill, Butterworth, Rodgers, & Mackinnon, 2007), coronary heart
disease (Stansfeld & Marmot, 2002) and an indicator of good quality
of life (Pressman & Cohen, 2005). Results from cross-sectional
(Kruger, Bowles, Jones, Ainsworth, & Kohl, 2007), prospective (e.g.,
Brown, Ford, Burton, Marshall, & Dobson, 2005; Tessier et al., 2007;
Wiles, Haase, Gallacher, Lawlor, & Lewis, 2007), and experimental
studies provide sufficient evidence to conclude that regular
participation in physical activity (PA) is predictive of higher levels of
mental well-being (Bize, Johnson, & Plotnikoff, 2007; Teychenne,
Ball, & Salmon, 2008b). Nevertheless, many questions remain
unanswered. For instance, little is known about the magnitude and
functional shape (linear or curvilinear) of the relationships of the
dimensions of PA (frequency, duration, and intensity) with mental
* Corresponding author. fax: þ852 2818 8042.
E-mail address: ecerin@hku.hk (E. Cerin).
leisure-time PA (Kim, Shin, Nam, Choi, & Kim, 2008; Teychenne
et al., 2008b): namely, household, occupational and transport PA. It
is also unknown how these other domains of PA might interact with
leisure-time activity in the context of mental well-being. Addi-
tionally, there is a dearth of findings on the moderating effects of
socio-demographic variables on the relationships between specific
aspects of PA and mental well-being in a general population
(Tessier et al., 2007).
1.1. Physical activity domains and mental well-being
Most studies have examined the associations of composite,
mixed-domain (e.g., Bernaards et al., 2006; Kruger et al., 2007) or
leisure-time (e.g., Brown et al., 2005; Bültmann et al., 2002; Tessier
et al., 2007; Thorsen et al., 2005; Wendel-Vos, Schuit, Tijhuis, &
Kromhout, 2004) PA measures with mental well-being. Notably,
some measures of leisure-time PA have included active commuting
to work (e.g., Thorsen et al., 2005; Wendel-Vos et al., 2004) and
household activities (Wendel-Vos et al., 2004), making it difficult to

1755-2966/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.mhpa.2009.09.004
56 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64
ascertain the effects of leisure-time PA, independent of other PA
domains. Research on time use and mental well-being indicate that
it is particularly important to examine these independent effects,
because different types of activities can evoke different affective
reactions (Robinson & Godbey, 1999). For example, several studies
found household chores to be associated with more negative
psychological sequelae than are work and leisure-time activity
(Robinson & Godbey, 1999). Leisure-time activities such as exer-
cising for recreational or health purposes and socializing can
reduce the need for recovery after a day at work, while housework
had no impact on the need for recovery (Sonnentag & Zijlstra,
2006). In general, leisure-time activities yielded the most positive
psychological outcomes, followed by travel, work, and, lastly,
household activities (Robinson & Godbey, 1999). Differences in
psychological reactions to the different domains of PA are thought
to be determined by the degree of intrinsic motivation and self-
determination associated with participation in a specific activity,
and the amount of physical and psychological resources available to
accomplish the activity (Sonnentag, 2001).
Only two studies have examined the distinct effects of all four
domains of PA (leisure, household, occupational, and transport) on
mental health, but these were in specific rather than general adult
populations, and related to depression rather than to general
psychological well-being (McKercher et al., 2009; Teychenne, Ball,
& Salmon, 2008a). Leisure activity was the only PA domain that was
associated with lower odds of depressive symptoms in women
(Teychenne et al., 2008a). McKercher et al. (2009) also found
inverse associations between depression and leisure-time PA in
young Australian adults and reported a positive association
between occupational PA and prevalence of depression.
There is some evidence that the effects of participation in
a particular PA domain on mental well-being may depend on the
level of participation in other PA domains. For example, engage-
ment in vigorous leisure-time PA was found to be associated with
psychological benefits in workers with sedentary jobs, but not in
those with active jobs (Bernaards et al., 2006). Typical household
chores require moderate-intensity activity (Gunn et al., 2002) and
may yield better psychological outcomes in those with low levels of
occupational PA who, accounting for the level of occupational
stress, are likely to feel less physically-fatigued from their job than
their more active counterparts. To date, no study has examined the
interactive effects of participation in various PA domains on mental
well-being.
1.2. Physical activity and mental well-being:
socio-demographic moderators
Identifying the moderating effects of key socio-demographic
characteristics is important for devising effective PA interventions
targeting psychological well-being. Several studies have reported
associations between PA and mental well-being, stratified by
gender (e.g., Bernaards et al., 2006; Kim et al., 2008; Ströhle et al.,
2007; Wendel-Vos et al., 2004). These findings are mixed and
inconclusive, with some studies reporting no gender differences
(e.g., Bernaards et al., 2006; Stubbe, de Moor, Boomsma, & de Geus,
2007) or only minimal gender differences (e.g., Tessier et al., 2007),
and others finding stronger associations in men (e.g., Bültmann
et al., 2002; Kim et al., 2008) or in women (Tessier et al., 2007).
Given these inconsistent findings, it is important to continue
exploring the moderating effects of gender, particularly in relation
to PA domains other than leisure-time (household, occupational,
and transport) which have not been well-studied.
Few studies have examined the moderating effects of age on the
relationships between PA and mental well-being. Contrasting
findings have been reported within the same study for different
mental well-being outcomes (Ströhle et al., 2007) and across
studies for similar outcomes (e.g., Stubbe et al., 2007). Age is
a strong correlate of participation in specific PA domains. For
example, younger adults tend to report higher levels of active
transport (Owen et al., 2007) and leisure-time PA (Leslie et al.,
2004), while older adults report higher levels of participation in
gardening and yard work (Australian Bureau of Statistics, 2009).
Age is also negatively associated with the capacity to engage in
strenuous activities (McArdle, Katch, & Katch, 1995), and to some
aspects of psychological well-being (Pawlikowska et al., 1994). It is
thus plausible to expect moderating effects of age on the relation-
ships between specific PA domains and mental well-being.
Body mass index (BMI) is another potential moderator of the
effects of PA on mental well-being. For example, BMI has been
identified as a significant correlate of many perceived barriers to
regular participation in PA, including time constraints, and moti-
vational and social barriers (Cerin et al., in press). PA may thus yield
less positive psychological benefits for overweight and obese than
for normal-weight adults. Such differential effects may be partic-
ularly pronounced for household, occupational, and transport
domains, as they offer a limited range of activities and settings that
may be outside the ‘comfort zone’ of overweight/obese persons,
while leisure-time activities can provide scope for discretionary
choice in relation to activity–intensity and greater individual flex-
ibility. A recent study using a global domain-unspecific PA measure
did not provide support for a moderating effect of BMI (Kruger
et al., 2007). In contrast, a study focusing on leisure-time PA found
more stable and pervasive positive effects of PA changes on changes
in aspects of mental well-being among normal-weight than among
heavier women (Wolin, Glynn, Colditz, Lee, & Kawachi, 2007).
Nevertheless, it remains unclear whether BMI is an effect modifier
of the associations of specific PA domains with mental well-being.
Here, we examine the potential independent and interactive
effects of four distinct PA domains (leisure, household, occupa-
tional, and transport) on psychological well-being. Specifically, we
examine the shape of the dose–response relationship of the weekly
frequency, amount (frequency * duration), and volume
(amount  intensity) dimensions of the four PA domains with
mental well-being. The interactive effects of gender, age, BMI, and
PA domains were also examined. Additionally, to partly address the
possibility of reverse causality (i.e., poor mental health influencing
PA rather than the opposite), we estimated the confounding effects
of not engaging in PA due to poor mental or physical health.
2. Methods
2.1. Participants and procedure
Data from the Physical Activity in Localities and Community
Environments (PLACE) study, conducted in 2003–2004 in Adelaide,
Australia were used. The primary aim was to examine the associ-
ations of characteristics of the built environment with residents’ PA.
A stratified two-stage cluster sampling design was used to recruit
2650 English-speaking adults, aged 20–65, residing in private
dwellings and able to walk without assistance. Households were
randomly selected from residential addresses within 32 neighbor-
hoods comprising 154 Census Collection Districts (CCD; the
smallest administrative unit used by the Australia Bureau of
Statistics). Neighborhood selection was based on their objectively-
measured walkability and socio-economic status (SES), primarily
defined as their median household income (see Cerin, Leslie, Owen,
& Bauman, 2008; Du Toit, Cerin, & Leslie, 2005 for details). Groups
of eight neighborhoods represented each of the following four area
strata: high walkable/high SES, low walkable/high SES, high walk-
able/low SES, and low walkable/low SES (Cerin et al., 2008).
 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64 57

Stratification by area walkability and SES was conducted to help 2.2. Measures
maximize the variance of variables that are associated with walk-
ability (e.g., transport PA) and SES (e.g., participation in leisure-time 2.2.1. Socio-demographic and other personal characteristics
and occupational PA; environmental aesthetics; traffic and crime Participants reported gender, age, educational attainment, living
safety). At the same time, this strategy was likely to increase the arrangements, employment status, annual household income,
variance of mental well-being as it is associated with traffic and number of children (18 years) in the household, household size,
crime safety and environmental aesthetics (Leslie & Cerin, 2008). height and weight, number of motorized vehicles in the household,
Households within the selected neighborhoods were sent an weekly hours spent at work, and daily hours spent commuting to
introductory letter, a questionnaire, a token gratuity, a consent and from work. Poor (physical or mental) health as a reason for not
form, and a reply-paid envelope. In households with more than one engaging in PA was measured on a 5-point scale (ranging from
eligible participant, the person with the most recent birthday was never to very often), using an item from Hovell et al.’s (1989) scale.
invited to take part in the study. Thank-you letters and a lottery- As the main outcome of this paper was measured in the second
based incentive were sent to those who returned a completed survey, computation of BMI was based on data reported in the
questionnaire. The study was approved by an institutional human second survey.
research ethics committee. Details about the recruitment proce-
dure are reported elsewhere (Du Toit et al., 2005). 2.2.2. Neighborhood characteristics
Two surveys, six months apart, were mailed to the participants. Several neighborhood characteristics were considered as possible
These included questions about socio-demographic characteristics, confounders of the relationships of PA with mental well-being. These
perceived environment, barriers to participation in PA (first included area-level SES (a CCD median household income adjusted
survey), height and weight, PA and time spent sitting (first and for household size) and perceived neighborhood aesthetics, safety
second survey), and physical and mental well-being (second from crime and traffic. Perceived neighborhood characteristics were
survey). The overall response rate as a proportion of invitation measured using the Australian version of the Neighborhood Envi-
letters sent to selected addresses was 11.5%. The low response rate ronment Walkability Scale (NEWS-AU), which has good reliability
was partly attributable to the spatial nature of the survey that and validity (Cerin et al., 2008). Items of the NEWS-AU were rated on
sampled households rather than individuals. Based on Census data, a 4-point Likert scale (strongly disagree to strongly agree).
we estimated that over 25% of the selected households might have
been ineligible due to not meeting the age criteria. Over 74% of 2.2.3. Physical activity and sedentary time
those known to be contacted completed the first survey, and 83% of The long version of the International Physical Activity Ques-
the first-survey participants completed the second survey tionnaire (IPAQ; Craig et al., 2003) was used to measure leisure-
(N ¼ 2194). The socio-demographic characteristics of the 2194 time (walking, moderate, and vigorous), household (moderate and
participants included in this study are shown in Table 1. vigorous outdoors, and moderate indoor), occupational (walking,
moderate, and vigorous), and transport PA (cycling and walking),
and sitting time. Participants reported the frequency (number of
Table 1
Socio-demographics and environmental attributes of the study sample (N ¼ 2194). days) and duration (hours and minutes per day) of each type of PA
undertaken in the last seven days. For the sitting variables, they
Characteristic Estimate Characteristic Estimate
reported the average hours and minutes they spent sitting on
Male, % 36.0 Married/de facto 56.0
a week day and weekend day. IPAQ has been shown to have
relationship, %
Missing values 0.4 Missing values 1.4 comparable reliability and validity to other self-report measures of
PA (Craig et al., 2003). Only data from the second survey, measured
Children in household, % 29.3 Body mass index, 26.4 (6.1)
concurrently to that of mental well-being, was used in the present
M (SD)
Missing values 1.4 Missing values, % 5.5 analyses.
Several PA variables were created using data from the IPAQ.
Employed, % 62.7 Work [h/wk], M (SD) 25.0 (20.3)
Missing values 2.2 Missing values, % 12.5
These were frequency and amount, and volume of PA by domain.
Frequency was operationalized as the sum of the days per week
Educational Commuting [h/day], 0.4 (0.7)
spent in activities falling under a specific domain. The hypothetical
attainment, % M (SD)
Year 10 or less 23.0 Missing values, % 8.3 range of frequency for occupational, household, and leisure-time
Year 12 or equivalent 29.3 No. motor vehicles, 1.6 (1.0) PA was 0–21, while that for transportation PA was 0–14. Total time
M (SD) (frequency  duration) was operationalized as the sum of the
Tertiary 46.3 Missing values, % 2.4 weekly hours spent doing domain-specific activities. Total volume
Missing values 1.4
(frequency  duration  intensity) was defined as the sum of hours
Annual household CCD household per week spent in domain-specific activities weighted by a corre-
income, % income (wk), %
sponding multiple of the resting metabolic rate (MET) as specified
<AU$ 31,200 34.1 <AU$ 600 32.5
AU$ 31,200–77,999 41.5 AU$ 600–999 31.4 in the IPAQ scoring protocol (www.ipaq.ki.se/scoring.pdf). Finally,
AU$ >77,999 20.3 >AU$ 999 36.1 to obtain a more-detailed perspective on the potential effects of PA
Missing values 1.4 Missing values 0.0 on mental well-being, weekly hours spent on specific subcategories
Age, M (SD), years 46.3 (12.0) CCD household 2.3 (0.4) of PA by domain (e.g., leisure-time walking, moderate, and vigorous
size, M (SD) PA) were also computed and entered as separate predictors in the
Missing values, % 4.8 Missing values, % 0.0 models of mental well-being. Participants’ total sitting time (in
Household size, M (SD) 2.4 (1.3) Neigh. crime, M (SD) 1.7 (0.3) hours per week) was estimated as specified in the IPAQ scoring
Missing values, % 3.0 Missing values, % 1.0 protocol.
Neigh. aesthetics, M (SD) 3.1 (0.6) Neigh. traffic hazards, 2.4 (0.7)
M (SD) 2.2.4. Physical and mental well-being
Missing values, % 1.0 Missing values, % 1.0 The 12-item Short Form Health Survey (SF-12; Ware, Kosinski, &
h ¼ hours; wk ¼ week; AU$ ¼ Australian dollars; Neigh. ¼ neighborhood; Keller, 1996) with weights from the Australian National Survey was
CCD ¼ census collection district. used to measure physical and mental well-being. It assesses general
58 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64
self-rated health, physical and psychological symptoms, and limi-
tations in daily activities due to mental and physical ill health over
the previous four weeks. The SF-12 provides composite mental and
physical health summary scores ranging from 0 to 100, with higher
scores indicative of higher levels of well-being. The composite
mental health summary score (MCS-12) was the primary outcome
variable in this study. A study on a representative Australian adult
population showed that the MCS-12 is a valid measure of mental
health in epidemiological research (Gill et al., 2007).
2.3. Data analyses
2.3.1. Associations of PA domains with mental well-being
Separate generalized linear regression models (GLM), with appro-
priate variance and link functions, were estimated for frequency,
amount (h/wk) and volume (MET-h/wk) of participation in PA domains
as predictors of mental well-being (MCS-12). Z-values associated with
the regression coefficients of the PA variables were compared to
ascertain whether the addition of PA duration and intensity contrib-
uted to the explanation of mental well-being over and above PA
frequency and PA amount, respectively. Models examining the inde-
pendent effects of subcategories of activities falling within specific PA
domains (e.g., moderate and vigorous occupational PA) were also
evaluated. The shapes of the dose–response relationships of PA
domains with mental well-being were estimated using restricted cubic
splines (Harrell, 2001). A spline is a smoothly joined piecewise function
that can describe very complex non-linear relationships. Cubic spline
regression uses a predictor composed of a linear and a cubic term. If the
cubic term is not statistically significant, the data provide support for
a linear rather than non-linear relationship. Models were adjusted for
gender, age, educational attainment, employment status, individual
and CCD-level household income and size, living arrangements (single;
married/de facto), children in the household (none; one or more),
number of motorized vehicles in the household, total weekly sitting
time, perceived neighborhood environmental aesthetics, perceived
traffic and crime safety, hours of work, commuting time, physical
health score, and BMI.
2.3.2. Reverse causation explaining the relationship between PA
domains and mental well-being
To examine the extent to which eventual associations of PA
domains with mental well-being were attributable to not being
able to engage in PA because of poor health (rather than PA having
a beneficial effect on mental health), a method for the quantifica-
tion of confounding effects was employed (MacKinnon, 2008). This
involved (1) computing the difference between the regression
coefficients of a PA variable adjusted and unadjusted for poor
health as a barrier to participation in PA; and (2) testing whether
the difference was statistically significant. The difference between
the regression coefficients indicates the amount of the association
of a specific PA domain with mental well-being due to non-
participation in PA because of poor health (reverse causation). The
regression coefficient of PA adjusted for the poor health barrier
quantifies the direct effect of PA on mental well-being. The distri-
bution of the difference between regression coefficients is usually
skewed. Hence, significance testing was conducted using boot-
strapping re-sampling techniques (MacKinnon, 2008). A con-
founding effect is declared statistical significant if the 95%
bootstrap-based confidence intervals of the difference between
regression coefficients exclude zero. Cluster bootstrapping and
bias-corrected confidence intervals were employed. Adjustment for
the eventual confounding effects of self-reported poor health as
a barrier to PA and physical health status can also help to partly
address the problem of common-source bias (Macleod et al., 2002),
here referring to the possibility that participants with depressive
symptoms tended to give negatively-biased reports about a range
of health behaviors (e.g., engagement in PA) and well-being indi-
cators (e.g., poor general and mental health).
2.3.3. Interactive effects of PA domains, gender, age, and BMI
Two-way interaction terms of PA domains (e.g., leisure-time by
occupational PA frequency) were added to the main-effect GLMs
(adjusted for poor health as a barrier to participation in PA) to
examine whether the association of a specific PA domain on mental
well-being depended on the level of PA in another domain. The
moderating effects of age, gender, and BMI were examined by adding
appropriate two- (age, gender, or BMI by PA variable) and three-way
interaction terms (e.g., age by gender by PA variable) to the GLMs
described above. The three-way interaction terms examined
whether interaction effects of PA domains differed across socio-
demographic subgroups. Post-hoc probing of significant interaction
terms was conducted by determining the values of the moderator
(age, gender, BMI, other PA domain) for which a PA variable had
significant positive or negative associations with mental well-being.
To assist the interpretation of findings from the analyses of inter-
action effects, differences in PA variables across levels of each socio-
demographic moderator (age, gender and BMI) were also examined
using GLMs. For all main and interaction terms, a significance level of
0.05 was adopted. All GLMs used Huber–White estimators of stan-
dard errors, accounting for the clustering effects arising from the
sampling design. The percentage of respondents with missing data
on at least one of the variables was greater than 5%, so analyses were
conducted on the original dataset as well as on 10 multiple imputed
datasets using Multivariate Imputation by Chained Equations
(MICE; Royston, 2004). The results based on multiple imputations
yielded slightly smaller standard errors due to the increase in
sample size. Only the imputation-based results are reported. All
analyses were conducted in Stata 9.2 (Stata Corp, 2006).
Accounting for clustering effects due to the sampling design, the
study had 80% power to detect very small three-way interaction
effects explaining as little as 0.6% of the outcome variance. No
probability-level adjustment for multiple testing was employed in
this study. This is because our aim was to examine the independent
effect of each theoretically-plausible factor or interaction of factors
in its own right, while probability corrections, such as Bonferroni’s,
test the null hypothesis that none of the factors or interaction
effects contribute to the explanation of the outcome. In this regard,
most contemporary statisticians maintain that probability-level
adjustments should not be used when assessing evidence about
specific hypotheses (Perneger, 1998).
3. Results
Table 1 shows the socio-demographic and environmental attri-
butes of the study sample. Table 2 shows the descriptive statistics for
the PA and well-being variables by gender, age group, weight status
and for the total sample. The sample average mental well-being
score was comparable to that of Australian adults (close to mean
standardized T score of 50). Participants spent most of the week in
sedentary (sitting) behaviors, followed by household, occupational,
transport, and leisure-time PA. Significant between-gender and age-
group differences were found in all PA domains (Table 2). Weight
status (BMI) was related to all PA domains except for occupational
PA. Age was related to both mental and physical well-being.
3.1. Associations of PA domains with mental
well-being: main effects
Models A in Tables 3 and 4 report the estimates of the main
effects of PA on mental well-being before controlling for poor
 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64 59

Table 2
Descriptive statistics for physical activity and well-being indicators for the whole sample and by socio-demographic groups.

Variable M (SD) Median (IQR) Means

Gender Age group Weight status

Male (a) Female (b) 18–35 (a) 36–50 (b) 51–65 (c) NW (a) OW (b) OB (c)
Mental well-being 49.6 (9.9) 53.0 (13.1) 50.1 49.4 47.7b,c 48.9a,c 51.3a,b 49.6 49.9 49.3
Physical well-being 49.4 (9.8) 52.9 (12.4) 50.0b 49.1a 52.3b,c 50.0a,c 47.5a,b 51.4b,c 49.2a,c 45.4a,b
Total sitting time (h/wk) 40.0 (22.2) 35.0 (26.0) 41.3b 38.5a 40.9c 39.5 38.9a 38.4c 40.1 41.1a

Occupational PA
Frequency (max: 21) 3.0 (4.8) 0.0 (5.0) 3.7b 2.6a 3.1c 3.7 2.5a,b 3.1 3.1 2.9
Amount (h/wk) 7.3 (13.9) 0.0 (6.5) 9.5b 6.0a 6.7b,c 9.2a,c 5.7a,b 7.1 7.4 7.3
Volume (MET-h/wk) 33.8 (68.9) 0.0 (29.2) 46.4b 26.8a 30.0b,c 43.8a,c 26.9a,b 32.5 35.5 34.3
Walking (h/wk) 2.7 (6.0) 0.0 (1.3) 3.1b 2.5a 2.6 3.4c 2.3b 2.8 2.7 2.8
Moderate (h/wk) 2.8 (5.9) 0.0 (1.7) 3.7b 2.4a 2.9c 3.5c 2.2a,b 2.9 2.8 2.8
Vigorous (h/wk) 1.7 (4.8) 0.0 (0.0) 2.7b 1.1a 1.3b 2.3a,c 1.3b 1.5 2.0 1.8

Household PA
Frequency (max: 21) 5.8 (4.7) 5.0 (6.0) 4.5b 6.6a 5.3b,c 5.8a 6.1a 5.8 6.0c 5.7b
Amount (h/wk) 9.4 (10.9) 5.0 (11.0) 7.1b 10.7a 8.1b,c 9.5a 10.0a 7.6b 10.2a 9.7
Volume (MET-h/wk) 35.6 (42.9) 19.0 (41.0) 29.0b 39.3a 30.5b,c 35.6a 38.2a 33.0b 39.1a 35.9a
Moderate indoor (h/wk) 4.4 (5.7) 2.0 (5.5) 2.4b 5.6a 3.8b,c 4.6a 4.6a 4.1b 4.6a 4.9
Moderate outdoor (h/wk) 3.4 (4.9) 1.5 (3.7) 2.8b 3.8a 3.0c 3.4 3.6a 3.3 3.7 3.3
Vigorous outdoor (h/wk) 1.6 (3.9) 0.0 (1.0) 1.9b 1.4a 1.3 1.5 1.8 1.4b 2.0a,c 1.4b

Transport PA
Frequency (max: 14) 3.3 (3.0) 3.0 (5.0) 3.6b 3.1a 3.5b 3.1a 3.4 3.5c 3.2 2.9a
Amount (h/wk) 2.9 (4.3) 1.3 (3.5) 3.1b 2.7a 2.9 2.7 3.0 3.1c 2.8 2.4a
Volume (MET-h/wk) 10.4 (16.7) 4.4 (12.4) 11.8b 9.6a 10.5 10.3 10.5 11.3c 10.2 8.8a
Walking (h/wk) 2.5 (3.9) 1.0 (3.0) 2.6 2.4 2.5 2.3 2.7 2.7c 2.5 2.1a
Cycling (h/wk) 0.4 (1.6) 0.0 (0.0) 0.6b 0.3a 0.4 0.5c 0.3b 0.4 0.4 0.3

Leisure-time PA
Frequency (max: 21) 3.0 (3.8) 2.0 (5.0) 3.1 3.0 3.0 2.9 3.1 3.4b,c 2.9a,c 2.3a,b
Amount (h/wk) 2.9 (4.3) 1.5 (4.0) 3.1b 2.7a 2.7 2.7 3.1 3.3b,c 2.8a,c 2.1a,b
Volume (MET-h/wk) 5.0 (17.3) 13.0 (21.0) 14.4b 12.1a 13.5 12.6 13.0 15.3b,c 12.3a,c 8.9a,b
Walking (h/wk) 1.6 (2.8) 0.5 (2.0) 1.7 1.5 1.2c 1.3 2.0a 1.7c 1.6 1.3a
Moderate (h/wk) 0.6 (1.8) 0.0 (0.3) 0.7 0.6 0.6 0.7 0.7 0.8c 0.6 0.5a
Vigorous (h/wk) 0.7 (1.8) 0.0 (0.0) 0.8b 0.6a 0.9c 0.7 0.5a 0.9b,c 0.6a,c 0.4a,b

d ¼ days; h ¼ hours; wk ¼ week; SD ¼ standard deviation; IQR ¼ interquartile range; PA ¼ physical activity; NW ¼ normal-weight (BMI <25.0 kg/m2); OW ¼ overweight (BMI
25.0–29.9 kg/m2); OB ¼ obese (BMI 30.0 kg/m2); Superscripts a, b, c: Mean statistically significantly different to that of category a, b, c (p < .05).

health as a barrier to participation in PA. The independent (linear
and non-linear) associations of frequency, amount, and volume of
household, transport, and occupational PA were not statistically
significant. Only leisure-time PA was consistently independently
positively associated with mental well-being in a linear fashion. For
instance, a difference of 1 h/wk in amount of leisure-time PA was
predictive of a difference of 0.19 (95% CI: 0.10, 0.28) points on the
MCS-12 (Table 3). All dimensions of leisure-time PA independently
contributed to mental well-being. In fact, frequency of leisure-time
PA had the weakest (z ¼ 2.05), while volume the strongest
(z ¼ 4.53), association with mental well-being (Table 3). A model
examining the independent effects of each subcategory of PA
domain (Table 4; Model A) indicated that vigorous-intensity PA was
the only type of leisure-time PA to be positively associated with
mental well-being. This model also revealed a negative but weak
independent effect of vigorous-intensity outdoor household PA.
3.2. Associations of PA domains with mental well-being:
confounding effects of poor health as a barrier to participation in PA
Models B in Tables 3 and 4 report the estimates of the main
effects of PA on mental health adjusted for self-reported poor
health as a barrier to participation in PA. Bootstrap-based (BB)
analyses revealed that poor health as a barrier partly explained the
positive associations of PA with mental well-being. The confound-
ing effect of poor health as a barrier was 0.020 (BB 95% CI: 0.002,
0.040) points on the MCS-12 by unit of PA frequency (day/wk),
accounting for 18% of the total effect of frequency of leisure-time
PA. Significant confounding effects were observed with respect to
leisure-time PA amount (0.025; BB 95% CI: 0.009, 0.045; 13.4% of
total effect), leisure-time PA volume (0.005; BB 95% CI: 0.002,
0.009; 12.8% of total effect), and vigorous leisure-time PA (0.044; BB
95% CI: 0.012, 0.083; 16.0% of total effect). Poor health as a barrier to
PA suppressed the effect of moderate-intensity outdoor household
PA (0.011; BB 95% CI: 0.024, 0.002; decreasing the total effect
by 12.9%), which, after accounting for this confounder, became
statistically significant (Table 4; Model B).
3.3. Interactive effects of BMI
Several significant two- and three-way interaction effects were
found (Tables 3 and 4). The association between transport PA
frequency and mental well-being depended on BMI and was
significantly negative only in obese participants (b ¼ 0.323; 95%
CI: 0.652, 0.001; p ¼ .050; Table 3). Further analyses revealed
that amount of transport-related walking (b ¼ 0.273; 95% CI:
0.534, 0.011; p ¼ .041; Table 4), but not cycling, was negatively
associated with the MCS-12 score in obese. BMI was also a moder-
ator of the interaction effects of household and leisure-time PA
(Table 3). Specifically, among normal-weight respondents, frequency,
amount, and volume of leisure-time PA were positively related with
mental well-being in those with average and below-average levels
of household PA. These relationships were not significant in those
with above-average levels of household PA [i.e., 0.10 SD above the
average household PA frequency; 0.46 SD above the average
household PA amount; and 0.39 SD above the average household PA
60 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64

Table 3
Associations of physical activity frequency, amount, and volume in occupational, transport, household and leisure domains with mental well-being: main and interaction
effects.

PA variable Models A Models B

b (95% CI) z b (95% CI) z

Main effects
Frequency (d/wk)
Occupational PA 0.009 (0.098, 0.080) 0.20 0.021 (0.111, 0.070) 0.44
Transport PA 0.022 (0.175, 0.131) 0.28 0.040 (0.196, 0.117) 0.50
Household PA 0.003 (0.085, 0.091) 0.07 0.011 (0.071, 0.095) 0.28
Leisure-time PA 0.114a (0.005, 0.222) 2.05 0.094 (0.012, 0.201) 1.74

Amount (h/wk)
Occupational PA 0.006 (0.023, 0.035) 0.40 0.004 (0.026, 0.033) 0.26
Transport PA 0.015 (0.120, 0.089) 0.29 0.017 (0.118, 0.085) 0.32
Household PA 0.014 (0.055,0.026) 0.70 0.004 (0.044, 0.035) 0.21
Leisure PA 0.187c (0.098, 0.275) 4.12 0.162c (0.073, 0.250) 3.59

Volume (MET-h/wk)
Occupational PA <0.001 (0.005, 0.006) 0.16 <0.001 (0.006, 0.006) 0.01
Transport PA 0.003 (0.030, 0.024) 0.22 0.034 (0.030, 0.023) 0.25
Household PA 0.005 (0.015, 0.005) 0.94 0.002 (0.012, 0.007) 0.48
Leisure PA 0.039c (0.022, 0.056) 4.53 0.034c (0.017, 0.050) 3.94

Interaction effects
Frequency (d/wk)
BMI by transport PA
Normal-weight vs. obese 0.387a (0.002, 0.773) 1.97
Age by household PA by leisure-time PA 0.001a (<0.001, 0.002) 2.45
BMI by household PA by leisure-time PA
Normal-weight vs. overweight 0.047a (0.009, 0.085) 2.41
Normal weigh vs. obese 0.066b (0.022, 0.111) 2.91
Gender by household PA by occupational PA 0.029a (0.001, 0.057) 2.04

Amount (h/wk)
Age by household PA 0.004b (0.001, 0.007) 2.78
BMI by household PA by leisure-time PA
Normal-weight vs. overweight 2  104a (8  105, 4  104) 2.03
Normal-weight vs. obese 2  104a (8  105, 4  104) 2.43

Volume (METh/wk)
Age by household PA 1  103b (4  104, 2  103) 3.09
Age by occupational PA 6  104a (7  105, 1  103) 2.19
BMI by household PA by leisure-time PA
Normal-weight vs. obese 1  105a (1  105, 2  105) 1.98

d ¼ days; h ¼ hours; wk ¼ week; PA ¼ physical activity; b ¼ unstandardized regression coefficients; CI ¼ 95% confidence intervals; Models A and B ¼ unadjusted and adjusted
for poor health as a barrier to participation in PA, respectively; ap < .05; bp < .01; cp < .001.

Table 4
Associations of physical activity domain and type with mental well-being: main and interaction effects.

PA variable (h/wk) Model A Models B

b (95% CI) z b (95% CI) z

Main effects
Occupation – walking 0.026 (0.051, 0.103) 0.66 0.028 (0.050, 0.107) 0.71
Occupation – moderate 0.037 (0.054, 0.128) 0.80 0.033 (0.056, 0.122) 0.74
Occupation – vigorous 0.058 (0.163, 0.046) 1.10 0.062 (0.168, 0.044) 1.14
Transport – cycling 0.020 (0.268, 0.228) 0.16 0.013 (0.281, 0.255) 0.10
Transport – walking 0.005 (0.118, 0.102) 0.10 0.010 (0.122, 0.103) 0.17
Household – moderate outdoor 0.081 (0.010, 0.171) 1.75 0.093a (0.003, 0.183) 2.02
Household – vigorous outdoor 0.123a (0.231, 0.016) 2.25 0.123a (0.227, 0.018) 2.30
Household – moderate indoor 0.047 (0.137, 0.043) 1.03 0.032 (0.120, 0.056) 0.71
Leisure – walking 0.110 (0.024, 0.243) 1.61 0.092 (0.037, 0.220) 1.40
Leisure – moderate 0.215 (0.017, 0.442) 1.86 0.191 (0.036, 0.418) 1.65
Leisure – vigorous 0.275b (0.087, 0.464) 2.86 0.232a (0.044, 0.419) 2.41

Interaction effects
Age by occupational – vigorous 0.012b (0.003, 0.020) 2.89
Age by household– vigorous outdoor 0.012a (0.003, 0.021) 2.56
Age by household – moderate outdoor 0.010b (0.004, 0.016) 3.08
BMI (obese vs. normal) by transport – walking 0.331a (0.619, 0.044) 2.26

h ¼ hours; wk ¼ week; PA ¼ physical activity; b ¼ unstandardized regression coefficients; 95% CI ¼ 95% confidence intervals; Models A and B ¼ unadjusted and adjusted for
poor health as a barrier to participation in PA, respectively; ap < .05; bp < .01; cp < .001.
 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64
volume]. Amount and volume of household PA were not related to
mental well-being at any leisure-time PA level. However, frequency
of household PA showed a negative effect on mental well-being at
above-average frequency of leisure-time PA (1.32 SD). In over-
weight respondents, frequency, amount and volume of leisure-time
PA were positively related to mental well-being at all household PA
levels. In this subsample, household PA was not independently
related to mental well-being and its effects did not depend on
leisure-time PA. In obese respondents, the effects of frequency,
amount, and volume of leisure-time PA were not statistically
significant and did not depend on housework level. In contrast, in
the same group of participants, the effects of household PA
frequency and amount depended on leisure-time PA. Positive
associations of household PA frequency and amount with mental
well-being were observed at higher levels of leisure-time PA only
(0.1 SD above the average frequency; 1.4 SD above the average
amount).
3.4. Interactive effects of gender
Gender was a significant moderator of the interaction effect of
household and occupational PA frequency (Table 3). In men,
household and occupational PA frequencies were not associated
with mental well-being and their effect did not depend on the
other PA domain. In women, frequency of occupational PA was
negatively related with mental well-being but only at higher
frequency of housework (1.15 SD above the average frequency).
Also, frequency of household PA was negatively related to mental
well-being at higher levels of occupational PA (2.2 SD above the
average frequency).
3.5. Interactive effects of age
Age moderated the interaction effect of household and
leisure-time PA frequency (Table 3). In participants aged 1 SD
above the sample mean (45.5 yrs þ 12 yrs ¼ 57.5), frequency of
leisure-time PA was not associated with mental well-being. In
contrast, in younger participants (1 SD below the mean: 33.5 yrs)
frequency of leisure-time PA was positively associated with
mental well-being, but only if household PA frequency was not
0.23 SD above the sample average (i.e., 4 times weekly). Similar
findings were observed for respondents of average age
(45.5 yrs). Household PA frequency was not related with mental
health in average-age participants. It was predictive of poorer
mental well-being in younger respondents with above-average
frequency of leisure-time PA (0.23 SD above the average
frequency), while in older respondents (1 SD above the sample
mean) it was predictive of better mental well-being but only at
above-average frequency of leisure-time PA (0.34 SD above the
average frequency). Age also moderated the independent effects
of household PA amount and volume, and volume of occupa-
tional PA. Amount and volume of household PA had a negative
effect on mental well-being only in participants aged 40 or less,
while it had no effect in others. Further analyses revealed that
amount of outdoor, but not indoor, household PA interacted with
age (Table 4). Moderate-intensity outdoor household PA was
positively related with mental health in older respondents only
(0.15 SD above the average age). Vigorous-intensity outdoor
household PA was negatively associated with mental well-being
in all participants but those aged 50 and over. Volume of occu-
pational PA was negatively related with mental well-being in
those aged 30 or less. This age-dependent association was due to
the amount of vigorous-intensity occupational PA but not to
other components of occupational PA (Table 4).
61
4. Discussion
We identified independent and interactive effects of four PA
domains (leisure, household, occupational and transport) on
mental well-being. The focus of previous studies has been primarily
on the leisure-time domain (Bize et al., 2007). Our findings confirm
that leisure-time activity is an important ingredient of the mental
health-PA equation for most segments of an adult population.
However, they also suggest that physical activities in other domains
play an important role. The associations of these PA domains with
mental well-being appear to differ substantially across socio-
demographic groups and depend on the level of participation in
other PA domains. We discuss these findings in detail below.
4.1. Leisure-time PA
In general, we found positive linear associations of weekly
frequency, amount, and volume of leisure-time PA with mental
well-being. The strongest relationship was observed for volume
and the weakest for frequency of leisure-time PA. Additionally, after
adjustment for other PA domains, vigorous-intensity PA was the
only type of leisure-time PA to be independently associated with
mental well-being. These findings are concordant with those of
recent studies (Mutrie & Hannah, 2007; Teychenne et al., 2008a;
Vuillemin et al., 2005), suggesting higher doses of leisure-time PA
provide greater mental health benefits.
Several theories have been proposed to explain the associations
between PA dose, especially intensity, and mental well-being. The
inverted-U and inverted-J hypotheses postulate that moderately-
vigorous-intensity activities yield optimal psychological effects,
while light-intensity activities are insufficient to produce effects, and
very high intensity is either ineffective or detrimental (Berger & Motl,
2000). The present study provides partial support for these
hypotheses, as only vigorous leisure-time PA was significantly related
to mental well-being, but a linear rather than curvilinear relationship
was observed between volume of leisure-time PA and mental well-
being. Also, the inverted-U and inverted-J hypotheses focus on
average population effects and consider specific dose–response
relationships to be generalizable to the entire population. Our find-
ings instead suggest that there are important inter-individual varia-
tions in responses to leisure-time PA. This is in line with a recently-
proposed theoretical framework which postulates that psychological
reactions to PA vary as a function of individuals’ cognitive responses
and preferences (Ekkekakis, Hall, & Petruzzello, 2005).
Personal (age and BMI) and situational (participation in
household PA) characteristics were found to influence the associ-
ations of leisure-time PA with mental well-being. Frequency of
leisure-time PA was positively associated with mental well-being in
those below 57 years of age, only if their reported average or below-
average frequency of household PA. In contrast, older participants
showed no effects of leisure-time PA frequency on mental well-
being. These differences are likely to be due to varying levels of time
pressure experienced by different age groups. Older adults, for
example, spend less time working and caring for their family than
do their younger counterparts (Brown, Cerin, & Warner-Smith,
2008; Gauthier & Smeeding, 2003). Thus, they can schedule leisure
activities based on their personal preferences rather than fitting
them into their busy schedules. Because adults under-55 years have
limited, usually suboptimal, time for leisure activities, they may
benefit from increases in leisure-time PA frequency if these do not
add to time pressures or result in excessive depletion of physical
resources.
BMI was a significant modifier of the relationships between
leisure-time PA and mental well-being. All dimensions of leisure-
time PA were positively associated with mental well-being in
62 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64
normal-weight respondents with average or below-average levels
of household PA. These positive effects were not observed in
normal-weight respondents with high levels of household PA, nor
in obese respondents (irrespective of the level of other PA
domains). While in those of normal-weight, the lack of such
a relationship may be due to mental and physical fatigue resulting
from household activities, among those who are obese, it is more
likely to be due to lack of enjoyment of PA and feelings of physical
discomfort associated with exercising (Cerin et al., in press; Ekke-
kakis et al., 2005). Similarly, Wolin et al. (2007) observed more
consistent positive associations between changes in PA and mental
well-being in normal-weight than obese women.
Interestingly, a positive association of mental well-being with
leisure-time PA, irrespective of the level of other PA domains, was
found in overweight respondents. These seemingly counterintui-
tive finding may be in part attributed to the limited validity of BMI
as a measure of adiposity. It is possible that a portion of the
respondents classified as overweight had high lean and low fat
mass, which is typical of many active, physically-fit individuals
(Jonnalagadda, Skinner, & Moore, 2004). Also, substantial misclas-
sification of normal-weight men, but not women, into the over-
weight category has been reported and attributed to greater lean
mass in men (Kennedy, Shea, & Sun, 2009). More-muscular, more
physically-fit males would be likely tolerate higher volumes of PA
and enjoy PA more than their lighter, but not necessarily leaner,
male and female counterparts. Our finding could also be partly due
to the fact that, in general, overweight respondents participated in
lower levels of leisure-time PA than normal-weight respondents.
Hence, their leisure-time PA might have not reached sufficient
levels of frequency, intensity or duration that, together with other
PA domains, would have impacted on feelings of time pressure and
fatigue.
4.2. Household PA
Significant independent effects of dimensions (frequency,
amount, volume and type) of household PA with mental well-being
were observed in respondents with specific socio-demographic
characteristics and activity patterns. No association of household
PA frequency with mental well-being was found in men. In
contrast, women with high frequency of occupational PA were
negatively affected by higher frequency of household PA. These
effects might be explained by gender differences in household PA
participation (higher in women) and capacity to tolerate high levels
of PA. In this regard, studies on the time use of Australian adults
reported that women spent almost twice as much time on house-
hold chores as men (Australian Bureau of Statistics, 2009; Brown
et al., 2008), which is argued to contribute to their reported higher
levels of time-pressure stress and negative psychological reactions
to this type of activity (Brown et al., 2008). Mutrie and Hannah
(2007) also found household PA to be positively related to
depression in women but not men.
Age played a prominent role in determining the magnitude and
direction of the effects of household PA. While household PA ten-
ded to be negatively related to mental well-being in younger
respondents, it showed a positive effect in older respondents. This
was particularly true for outdoor household PA (e.g., gardening and
yard work). Older adults enjoy and engage in gardening activities
more than do their younger counterparts. While for many older
adults gardening is a discretionary activity, there is evidence that
younger adults tend to classify it under the category of committed
time, which thus may yield poorer psychological outcomes than
free-time activities (Australian Bureau of Statistics, 2009).
The association of household PA with mental well-being also
depended on the respondents’ weight status, the level of other PA
domains, and the dimension of household PA. While volume of
household PA was not a significant independent predictor of
mental health for any of the BMI categories, frequency and amount
of household PA were significant predictors. Frequency of house-
hold PA showed a negative association in normal-weight partici-
pants with above-average leisure-time PA, indicating possible
time-pressure effects. In contrast, obese respondents reporting
higher frequency and amount of household PA had better mental
outcomes, but only if they were simultaneously engaging in above-
average levels of leisure-time PA. It is possible that this particular
sub-set of participants provided socially-desirable answers or
represented persons with high level of enjoyment of PA allowing
them to overcome the barriers imposed by excessive weight.
4.3. Occupational PA
In general, occupational PA was unrelated to mental well-being.
However, negative associations were found in young respondents
and women with high levels of participation in household PA,
suggesting that the effect of occupational PA might depend on
personal preferences regarding this type of activity or the amount
of physical resources invested in other activities. Similar findings
were reported in a recent study whereby young Australian women
showed positive associations between depression and occupational
PA as measured by the IPAQ (McKercher et al., 2009). Also, analo-
gously to our study, vigorous occupational PA was found to be
negatively associated with mental well-being in male adults
(Kim et al., 2008).
4.4. Transport PA
Transport PA was unrelated to mental well-being in all demo-
graphic groups with the exception of obese respondents for whom
larger amounts of walking for transport were predictive of poorer
mental well-being. Obese people may experience higher levels of
physical discomfort when walking for (often non-discretionary)
utilitarian purposes in a warm Mediterranean climate, typical of the
area where the study was conducted (Adelaide, Australia). In
contrast, other domains of PA (household, occupational, and
leisure-time) allow for greater flexibility in the regulation or choice
of conditions and type of activity to better suit individual
preferences.
4.5. Study limitations
Study limitations include the cross-sectional design, which does
not allow causal relationships to be inferred from the associations
that we report. To partially account for this problem we estimated
the potential confounding effects of not engaging in PA due to poor
mental or physical health, and found that they explained only up to
16% of the effects of amount and volume of leisure-time PA on
mental well-being. Yet, it is possible that controlling for this con-
founding effect did not completely abolish common-source biases,
as reporting tendencies cannot be measured precisely (Macleod
et al., 2002). In such case, the estimated magnitude of associations
between PA and mental well-being might be inflated. Future
studies using prospective designs could examine the relationships
of changes in PA across multiple domains with mental health
indices. A further limitation is the low response rate, which was
partly due to the sampling design. Nevertheless, the study sample is
likely to be representative of the target population as the observed
levels of PA, mental and physical well-being, and overweight and
obesity were similar to those obtained from population-represen-
tative samples (Cerin et al., in press). We did not adjust for smoking
status and alcohol consumption. However, we adjusted for
 E. Cerin et al. / Mental Health and Physical Activity 2 (2009) 55–64
self-reported physical well-being as measured by the SF-12, which
is a reliable correlate of smoking and drinking status (Riise, Moen, &
Nortvedt, 2003). This study was based on self-report measures
known to be less precise than objective measures. Hence, the
reported associations are likely biased.
5. Conclusions
Our findings indicate that the potential effects of PA on mental
well-being can depend on personal characteristics, activity domain,
and participation in other PA domains. As observed in leisure
studies and time-use research, leisure-time PA yielded positive
psychological outcomes in most demographic groups. The effects
were proportional to the dose of PA and were greater for high-
intensity activities. Other forms of PA were either unrelated or
negatively related with mental well-being, depending on the level
of participation in other activities and personal characteristics.
Personal characteristics and participation in other PA domains,
indicative of available physical resources, were also critical in
determining not only the magnitude but also the direction of the
relationship of household PA with mental well-being. Population
health strategies aimed at increasing PA need to take these diverse
and sometimes opposite effects of PA on mental well-being into
account. Finally, although this study did not specifically measure
level of discretion in activity and activity preferences, it is specu-
lated that these may play a significant role in determining the
associations of PA with mental well-being. It rests on future studies
to determine whether and to what extent this is the case.
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