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Background The salutary effects of resistance exercise training (RET) are well established, including increased strength and function; however, less is known regarding the effects of RET on mental health outcomes. Aerobic exercise has well-documented positive effects on anxiety, but a quantitative synthesis of RET effects on anxiety is needed. Objectives To estimate the population effect size for resistance exercise training (RET) effects on anxiety and to determine whether variables of logical, theoretical, and/or prior empirical relation to anxiety moderate the overall effect. Methods Thirty-one effects were derived from 16 articles published before February 2017, located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Trials involved 922 participants (mean age = 43 ± 21 years, 68% female/32% male) and included both randomization to RET ( n  = 486) or a non-active control condition ( n  = 436), and a validated anxiety outcome measured at baseline, mid-, and/or post-intervention. Hedges’ d effect sizes were computed and random effects models were used for all analyses. Meta-regression quantified the extent to which participant and trial characteristics moderated the mean effect. Results RET significantly reduced anxiety symptoms (Δ = 0.31, 95% CI 0.17–0.44; z  = 4.43; p  < 0.001). Significant heterogeneity was not indicated ( Q T (30) = 40.5, p  > 0.09; I 2  = 28.3%, 95% CI 10.17–42.81); sampling error accounted for 77.7% of observed variance. Larger effects were found among healthy participants (Δ = 0.50, 95% CI 0.22–0.78) compared to participants with a physical or mental illness (Δ = 0.19, 95% CI 0.06–0.31, z  = 2.16, p  < 0.04). Effect sizes did not significantly vary according to sex ( β  = −0.31), age ( β  = −0.10), control condition ( β  = 0.08), program length ( β  = 0.07), session duration ( β  = 0.08), frequency ( β  = −0.10), intensity ( β  = −0.18), anxiety recall time frame ( β  = 0.21), or whether strength significantly improved ( β  = 0.19) (all p  ≥ 0.06). Conclusions RET significantly improves anxiety symptoms among both healthy participants and participants with a physical or mental illness. Improvements were not moderated by sex, or based on features of RET. Future trials should compare RET to other empirically-supported therapies for anxiety.

Chronic resistance exercise training (RET) is largely understudied as a treatment intervention for anxiety disorders. Expectations may play a role in the effect of RET on anxiety and mood responses. Exploring placebo effects in chronic interventions is imperative to understanding the influence of expectations on psychological responses to chronic RET. This study quantified the associations between expectations of psychological outcomes of exercise (EPOE) and observed anxiety symptom and mood state responses to chronic RET among young adults with and without Analogue Generalized Anxiety Disorder (AGAD). An eight-week RET intervention was implemented among 54 young adults (25.8 ± 5y). 26 were randomized to the intervention group and 28 to waitlist (WL). Anxiety symptoms and mood state responses were measured pre and post RET and EPOE were measured at baseline. Spearman’s rho quantified associations between baseline expectations and anxiety and mood responses. There were no significant associations in the RET sample between EPOE and experienced psychological responses (all rho = -0.41 to -0.07, all p  > 0.005). Preliminary findings suggest that the mental health benefits of chronic RET were independent of placebo effects, notwithstanding the potential limitations of small sample size and the non-mode-specific measure of expectations. Future research should explore the associations of mode-specific EPOE in larger sample sizes.

This trial quantified the effects of ecologically-valid resistance exercise training (RET) on anxiety and worry symptoms among young adults. Young adults not meeting criteria for subclinical, or analogue Generalized Anxiety Disorder (AGAD) were randomized to an eight-week RET intervention, or eight-week wait-list. AGAD status was determined using validated cut-scores for both the Psychiatric Diagnostic Screening Questionnaire-Generalized Anxiety Disorder subscale (≥ 6) and Penn State Worry Questionnaire (≥ 45). The primary outcome was anxiety symptoms measured with the Trait Anxiety subscale of the State-Trait Anxiety Inventory. The RET was designed according to World Health Organization and American College of Sports Medicine guidelines. RM-ANCOVA examined differences between RET and wait-list over time. Significant interactions were decomposed with simple effects analysis. Hedges’ d effect sizes quantified magnitude of differences in change between RET and wait-list. Twenty-eight participants (64% female) fully engaged in the trial (mean age: 26.0 ± 6.2y, RET: n = 14; Wait-list: n = 14). A significant group X time interaction was found for anxiety symptoms (F (3,66)  = 3.60, p  ≤ 0.019; d  = 0.85, 95%CI: 0.06 to 1.63). RET significantly reduced anxiety symptoms from baseline to post-intervention (mean difference =  − 7.89, p  ≤ 0.001). No significant interaction was found for worry (F (3,69)  = 0.79, p  ≥ 0.50; d  =  − 0.22, 95%CI: − 0.96 to 0.53). Ecologically-valid RET significantly improves anxiety symptoms among young adults. Trial Registration : Clinicaltrials.gov Identifier: NCT04116944, 07/10/2019.

To estimate the effect of pharmacotherapy on PTSD, anxiety, and depression among combat veterans; to determine whether the effects varied according to patient and intervention characteristics; and to examine differential effects of pharmacotherapy on outcomes. Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science databases were searched through November 2014. Searches resulted in eighteen double-blind, placebo controlled trials of 773 combat veterans diagnosed with PTSD and included only validated pre- and post-intervention PTSD and anxiety or depression measures. Authors extracted data on effect sizes, moderators, and study quality. Hedges' d effect sizes were computed and random effects models estimated sampling error and population variance. The Johnson-Neyman procedure identified the critical points in significant interactions to define regions of significance. Pharmacotherapy significantly reduced (Δ, 95%CI) PTSD (0.38, 0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52, 0.35-0.70). The effects of SSRIs and tricyclic antidepressants on PTSD were greater than other medications independent of treatment duration. The effect of SSRIs and tricyclic antidepressants were greater than other medications up to 5.2 and 13.6 weeks for anxiety and depression, respectively. The magnitude of the effect of pharmacotherapy on concurrently-measured PTSD, anxiety, and depression did not significantly differ. Pharmacotherapy reduced PTSD, anxiety, and depressive symptoms in combat veterans. The effects of SSRIs and tricyclic antidepressants were greater for PTSD and occurred quicker for anxiety and depression than other medications.

The role of expectations in psychological responses to acute resistance exercise (RE) is largely unknown. This study quantified associations between expectations regarding psychological responses to exercise and observed state anxiety and mood responses after acute RE among adults with and without Analogue Generalized Anxiety Disorder (AGAD). Acute RE was nested into week one of an eight-week RCT of RE among 56 young adults with AGAD ( n  = 25) and non-AGAD ( n  = 31). 23 young adults were randomized to the intervention group and 33 to seated quiet rest. State anxiety and mood were measured pre and 10 min-post acute RE or seated quiet rest (QR). Expectations were measured pre acute RE or QR. Spearman’s rho quantified associations between expectations and mood responses. There were no associations in the acute RE sample between expectations of psychological outcomes and experienced psychological outcomes (all rho : -0.05 to 0.16) and the QR sample (all rho : -0.07 to 0.22). The measurement of Expected Psychological Outcomes of Exercise (EPOE) was not specific to RE modality alone, possibly influencing participants’ responses. These preliminary findings suggest that post-acute RE mood responses are independent from expectations of psychological outcomes, which is paramount when promoting RE as a potential treatment/therapeutic option to improve mood. Future research should focus on expectations of psychological responses specifically to acute and chronic RE.

Background Globally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviors (STBs), PSSP effectiveness does not easily translate to school settings. Adolescents’ perspectives on PSSP are particularly important for (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, yet there is a gap in understanding adolescents’ experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesize adolescents’ perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Methods The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The protocol was guided by the seven-stage process for meta-ethnography proposed by Noblit and Hare. Searches of PsycINFO, MEDLINE, Web of Science, CINAHL, ERIC, Scopus, and study reference lists will identify peer-reviewed studies. Gray literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesized in line with Noblit and Hare’s stages and evaluated using the Critical Appraisal Skills Program (CASP) checklist. Discussion To our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents’ perspectives on engaging with PSSP interventions. Understanding adolescents’ experiences of engaging with PSSP will impact the field of PSSP in several ways by (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields. Systematic review registration PROSPERO CRD42022319424.

Background Depression is a prevalent, debilitating, and often recurrent mood disorder for which successful first-line treatments remains limited. The purpose of this study was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status among Irish adults, using two existing datasets, The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study. Methods The two selected databases were pooled ( n  = 10,122), and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms. Data collection were conducted in 2010–2011. Results Significantly higher depressive symptoms were reported by females (7.11 ± 7.87) than males (5.74 ± 6.86; p  < 0.001). Following adjustment for age, sex, BMI, and dataset, meeting the PA guidelines was associated with 44.7% (95%CI: 35.0 to 52.9; p  < 0.001) lower odds of elevated depressive symptoms. Compared to the low PA tertile, the middle and high PA tertiles were associated with 25.2% (95%CI: 8.7 to 38.6; p  < 0.01) and 50.8% (95%CI: 40.7 to 59.2; p  < 0.001) lower odds of elevated depressive symptoms, respectively. Conclusion Meeting the PA guidelines is associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.

Background Anxiety is an adaptive response to an objective or perceived threat; however, when symptoms become severe and chronic it that can become a maladaptive anxiety disorder. Limited evidence suggests that physical activity may be associated with prevention against anxiety. This study uses data from The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study to investigate cross-sectional associations between physical activity and anxiety symptoms and status among Irish adults. Methods Both datasets were harmonized ( n  = 7874). The short form International Physical Activity Questionnaire measured physical activity. Participants were classified as meeting World Health Organization physical activity guidelines (≥150 min weekly of moderate intensity physical activity, ≥75 min weekly of vigorous intensity physical activity, or ≥ 600 MET-minutes) or not. They were also divided into three groups based on weekly MET-minutes of moderate-to-vigorous physical activity (Low: 0–599; Moderate: 600–1199; High: ≥1200), and three groups based on weekly minutes of walking (Low: 0–209; Moderate: 210–419; High: 420+). Anxiety symptoms were measured by the Hospital Anxiety and Depression Scale with a score of ≥8 indicating anxiety. Binomial logistic regression, adjusted for relevant confounders examined physical activity–anxiety associations. Results Females had higher rates of anxiety than males (28.0% vs 20.0%; p  < 0.001). Following adjustment for relevant covariates, meeting physical activity guidelines was associated with 13.5% (95% CI: 2.0–23.7; p  = 0.023) lower odds of anxiety. Moderate and High physical activity were associated with 13.5% (− 11.0–32.6; p  = 0.254) and 13.6% (1.4–4.2; p  = 0.030) lower odds of anxiety compared to Low physical activity, respectively. Moderate and High walking were associated with 2.1% (− 14.5–16.3; p  = 0.789) and 5.1% (− 9.3–17.6; p  = 0.467) lower odds of anxiety compared to Low walking, respectively. Conclusion Meeting physical activity guidelines is associated with lower odds of anxiety, but the strength of associations did not increase considerably with increased physical activity levels.

BackgroundMechanisms underlying exercise-induced mood enhancement are not well understood, but it is plausible that adaptive changes in attention to emotional stimuli underlie this effect. Thus, this study examined the effects of acute aerobic exercise on eye-tracking metrics while participants viewed emotionally expressive faces.MethodsThirty-four adults (18 women) aged 21.1 ± 1.4 years completed two counterbalanced 30-min conditions: vigorous running or seated rest. Eye tracking occurred pre- and 20-min post-condition. Participants viewed positive (n = 15), negative (n = 15), and neutral (n = 15) emotional facial expressions from the NimStim repository. Fixation duration, longest fixation, number of fixations, and scan path length were analyzed using repeated measures ANOVAs.ResultsExercise improved mood, but had no effect on the dependent measures (all 3-way interactions p > 0.66). However, a main effect of emotionally expressive content for fixation duration (p = 0.04, η = 0.10) and a marginally significant effect for longest fixation (p = 0.06, ηp2 = 0.09) were detected, such that fixation duration and longest fixation were greatest for faces expressing positive emotions.ConclusionThese preliminary findings indicated that acute exercise did not alter the processing of expressive faces as indexed by eye-tracking metrics of attention. However, eye tracking effectively detected processing patterns indicative of a pleasure bias while viewing emotional facial expressions.

Background Many adults with major depressive disorder (MDD) do not engage in treatment and may also not respond when current frontline treatments are completed. Resistance exercise training (RET) is an understudied behavioral treatment option, which may help with MDD management through improving cerebral blood flow that is commonly impaired in adults with MDD. The purpose of this study is to use gold-standard research methods to determine the validity (clinical efficacy) of RET for treating MDD and to determine potential cerebrovascular pathways through which RET might improve MDD symptoms. Methods This study will be a randomized controlled trial of 200 adults with DSM-5-diagnosed MDD of at least mild severity. Participants will be randomized to 16 weeks of twice-weekly RET at either guidelines-based high dose (60% one-repetition maximum initial load; n  = 100) or a low-dose/SHAM (30% one-repetition maximum initial load; n  = 100) progressive, upper- and lower-body program using resistance machines. The primary clinical outcomes of this trial are depressive symptom severity, assessed via clinician-rated GRID-Hamilton Depression Rating Scale and self-reported Quick Inventory of Depressive Symptomatology. Secondary outcomes that will examine potential mediators are cerebral blood flow (via cerebral blood velocity and pulsatility) and self-efficacy (via New General Self-Efficacy Scale and RET Task Self-Efficacy). Group differences will be evaluated during assessment visits at weeks 0 (Baseline), 8, 16 (Post-Intervention), 26, and 52. Additional analyses will explore predictors of treatment success and participants’ maintenance of the RET past the active intervention. Discussion RET is an understudied behavioral treatment for MDD. This randomized controlled trial will critically build on previous studies by using a large sample size, rigorously examining potential (provocative, plausible) biological and psychological mechanisms of RET’s hypothesized antidepressant effects, and determining potential persistent effects with short- and long-term follow-up assessments. If clinical efficacy is confirmed, RET would be added as a highly translatable, accessible, low-cost alternative treatment option for individuals with MDD. Further effectiveness and implementation research would be required if efficacy is confirmed in this trial. Trial registration This trial is registered on ClinicaTrials.gov (ID: NCT06110897; October 20th, 2023; https://clinicaltrials.gov/study/NCT06110897 ).