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ObjectiveTo synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations.DesignUmbrella review.Data sourcesTwelve electronic databases were searched for eligible studies published from inception to 1 January 2022.Eligibility criteria for selecting studiesSystematic reviews with meta-analyses of randomised controlled trials designed to increase physical activity in an adult population and that assessed depression, anxiety or psychological distress were eligible. Study selection was undertaken in duplicate by two independent reviewers.ResultsNinety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=−0.43, IQR=−0.66 to –0.27), anxiety (median effect size=−0.42, IQR=−0.66 to –0.26) and psychological distress (effect size=−0.60, 95% CI −0.78 to –0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions.Conclusion and relevancePhysical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.PROSPERO registration numberCRD42021292710.

Chatbots (also known as conversational agents and virtual assistants) offer the potential to deliver healthcare in an efficient, appealing and personalised manner. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of chatbot interventions designed to improve physical activity, diet and sleep. Electronic databases were searched for randomised and non-randomised controlled trials, and pre-post trials that evaluated chatbot interventions targeting physical activity, diet and/or sleep, published before 1 September 2022. Outcomes were total physical activity, steps, moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption, sleep quality and sleep duration. Standardised mean differences (SMD) were calculated to compare intervention effects. Subgroup analyses were conducted to assess chatbot type, intervention type, duration, output and use of artificial intelligence. Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment tool. Nineteen trials were included. Sample sizes ranged between 25–958, and mean participant age ranged between 9–71 years. Most interventions (n = 15, 79%) targeted physical activity, and most trials had a low-quality rating (n = 14, 74%). Meta-analysis results showed significant effects (all p < 0.05) of chatbots for increasing total physical activity (SMD = 0.28 [95% CI = 0.16, 0.40]), daily steps (SMD = 0.28 [95% CI = 0.17, 0.39]), MVPA (SMD = 0.53 [95% CI = 0.24, 0.83]), fruit and vegetable consumption (SMD = 0.59 [95% CI = 0.25, 0.93]), sleep duration (SMD = 0.44 [95% CI = 0.32, 0.55]) and sleep quality (SMD = 0.50 [95% CI = 0.09, 0.90]). Subgroup analyses showed that text-based, and artificial intelligence chatbots were more efficacious than speech/voice chatbots for fruit and vegetable consumption, and multicomponent interventions were more efficacious than chatbot-only interventions for sleep duration and sleep quality (all p < 0.05). Findings from this systematic review and meta-analysis indicate that chatbot interventions are efficacious for increasing physical activity, fruit and vegetable consumption, sleep duration and sleep quality. Chatbot interventions were efficacious across a range of populations and age groups, with both short- and longer-term interventions, and chatbot only and multicomponent interventions being efficacious.

ObjectiveTo evaluate systematic reviews of randomised controlled trials (RCTs) on the effects of exercise on general cognition, memory and executive function across all populations and ages.MethodsSystematic reviews and meta-analyses of RCTs evaluating the effects of exercise on general cognition, memory and executive function were eligible. Data extraction and risk of bias scoring were conducted in duplicate. The A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was used to assess the risk of bias. Effect sizes were pooled using random effects models and reported as standardised mean differences (SMD). Subgroup analyses were conducted for participant and intervention characteristics.General cognition, memory and executive function.Data sourcesCINAHL, The Cochrane Library, Embase, MEDLINE via OVID, Emcare, ProQuest Central, ProQuest Nursing and Allied Health Source, PsycINFO, Scopus, Sport Discus and Web of Science.Results133 systematic reviews (2,724 RCTs and 258 279 participants) were included. Exercise significantly improved general cognition (SMD=0.42), memory (SMD=0.26) and executive function (SMD=0.24). Memory and executive function improvements from exercise were greater for children and adolescents than for adults and older adults. Those with attention-deficit/hyperactivity disorder exhibited greater improvement in executive function than other populations. Effects were generally larger for low- and moderate-intensity interventions. Shorter interventions (1–3 months) and exergames (video games that require physical movement) had the largest effects on general cognition and memory. Findings remained statistically significant after excluding reviews rated as low and critically low quality.ConclusionsThese findings provide strong evidence that exercise, even light intensity, benefits general cognition, memory and executive function across all populations, reinforcing exercise as an essential, inclusive recommendation for optimising cognitive health.Trial registration numberPROSPERO ID: CRD42023468991.

Background Children and adolescents’ physical inactivity is a global problem. Financial incentives are increasingly utilised to support children’s participation in sport, with programs introduced in multiple jurisdictions globally, however few programs have comprehensive evaluations. This study used a Delphi methodology to develop evaluation recommendations for an existing population-wide financial incentive program based in South Australia. Methods A three-round Delphi study was conducted from October 2022 to April 2023. A diverse range of stakeholders including end-users, government representatives, academics/researchers, and Non-Government Organisation representatives participated in the Delphi panel. Round 1 focussed on the perceived importance of various evaluation components, including reach, process, and effectiveness. Round 2 focussed on identifying evaluation approaches and tools, while Round 3 determined methodological priorities and timeframes. A consensus level of ≥ 70% was set a priori (rating 6 or 7 on 7-point scale). Round 3 results were used to formulate evaluation recommendations. Results Sixty-seven stakeholders agreed to participate, with an average response rate of 76% (87%; 73% and 67% for each round, respectively). All evaluation components gained consensus in Round 1. In Round 2, consensus was gained on 14 evaluation measures, including measuring the cost of sport, awareness of the program amongst eligible families, and reasons for non-participation, with evaluation methods generated for each measure. Round 3 results determined participants’ preferred methods of evaluation and informed the development of evaluation recommendations. Recommended evaluation methods included mixed method approaches for provider and user process evaluations and measuring program awareness using an epidemiological survey. Conclusion This Delphi study sought the views and opinions from diverse stakeholders to create evaluation recommendations for a population-wide sports voucher program. Results suggested that a comprehensive evaluation strategy is needed to understand the reach, effectiveness, and impact of the program. Additionally, there was a consensus on reallocating program funds for this evaluation.

Mental health disorders affect 15% of youth aged 10–19 years globally, typically emerging before age 15. While school-based peer-led programs show promise in improving physical health behaviours by leveraging existing social networks, reducing stigma, and demonstrating high implementation feasibility, their effectiveness for mental health outcomes remains unclear. This systematic review examined controlled trials of school-based, peer-led lifestyle interventions (physical activity, diet, or sleep) reporting mental health outcomes in adolescents aged 10–19 years. Six electronic databases were searched up to March 28, 2024. Seven studies met inclusion criteria, encompassing 7,060 adolescents from 151 schools across the UK, USA, Canada, and Norway. Interventions varied in frequency and duration, with six focusing on physical activity and one on diet. Meta-analyses revealed no significant effects for psychological difficulties (MD = 0.60, 95% CI -3.52 to 4.72; p  = 0.32, k = 2), self-efficacy for physical activity (SMD = 0.18, 95% CI -3.08 to 3.44; p  = 0.61, k = 2), or wellbeing (SMD = 0.0, 95% CI -2.94 to 2.94; p  = 1.0, k = 2). These findings, while requiring cautious interpretation, highlight the pressing need for more comprehensive and rigorous research to better understand the impact of peer-led interventions on mental health outcomes.

Abstract In recent years, metabolomics, the systematic study of small-molecule metabolites in biological samples, has yielded fresh insights into the molecular determinants of pulmonary diseases and critical illness. The purpose of this article is to orient the reader to this emerging field by discussing the fundamental tenets underlying metabolomics research, the tools and techniques that serve as foundational methodologies, and the various statistical approaches to analysis of metabolomics datasets. We present several examples of metabolomics applied to pulmonary and critical care medicine to illustrate the potential of this avenue of research to deepen our understanding of pathophysiology. We conclude by reviewing recent advances in the field and future research directions that stand to further the goal of personalizing medicine to improve patient care.

Waterlogging occurs because of poor soil drainage and/or excessive rainfall and is a serious abiotic stress affecting plant growth because of declining oxygen supplied to submerged tissues. Although cucumber (Cucumis sativus L.) is sensitive to waterlogging, its ability to generate adventitious roots facilitates gas diffusion and increases plant survival when oxygen concentrations are low. To understand the physiological responses to waterlogging, a 10-day waterlogging experiment was conducted. The objective of this study was to measure the photosynthetic and key metabolites of cucumber plants under waterlogging conditions for 10 days. Plants were also harvested at the end of 10 days and analyzed for plant height (ht), leaf number and area, fresh mass (FM), dry mass (DM), chlorophyll (Chl), carotenoid (CAR), proline, and soluble sugars. Results indicated that cucumber plants subjected to the 10-day waterlogging stress conditions were stunted, had fewer leaves, and decreased leaf area, FM, and DM. There were differences in physiological performance, Chl, CAR, proline, and soluble sugars. Overall, waterlogging stress decreased net photosynthesis (A), having a negative effect on biomass accumulation. However, these decreases were also dependent on other factors, such as plant size, morphology, and water use efficiency (WUE) that played a role in the overall metabolism of the plant.

Soilless production systems (i.e hydroponics, aeroponics, aquaponics) have become commonplace in urban settings and controlled environments. They are efficient nutrient recyclers, space savers, and water conservers. However, they lack high levels of biological richness in the root microbiome when compared to soil production systems, which may affect plant health and nutrient uptake. To address this issue and incorporate more sustainable practices, beneficial microorganisms (i.e. Trichoderma spp., Bacillus sp.) can be added in the form of biofertilizers. However, many factors affect impacts of microorganisms and their interactions with plants. In this experiment, Black Summer Pac Choi ( Brassica rapa var. Chinensis) was grown for two trials in a Deep-Water system (DWS) or a Nutrient Film Technique system (NFT) with commercial biofertilizers containing Trichoderma spp., Bacillus amyloliquefaciens , a combination of both, and a control. Plant physiology, nutrient composition, and nutrient uptake efficiency (NUE) were generally negatively affected by Trichoderma spp. both growing systems, indicating that Trichoderma may not be recommended for hydroponic production. However, Bacillus amyloliquefaciens showed promise as an effective biofertilizer in the NFT systems and had a positive influence on NUE in DWS.

Importance Low levels of physical activity during hospitalization are thought to contribute to a range of poor outcomes for patients. Using wearable activity trackers during hospitalization may help improve patient activity, sedentary behavior, and other outcomes. Objective To evaluate the association of interventions that use wearable activity trackers during hospitalization with patient physical activity, sedentary behavior, clinical outcomes, and hospital efficiency outcomes. Data Sources OVID MEDLINE, CINAHL, Embase, EmCare, PEDro, SportDiscuss, and Scopus databases were searched from inception to March 2022. The Cochrane Central Register for Controlled trials, ClinicalTrials.gov, and World Health Organization Clinical Trials Registry were also searched for registered protocols. No language restrictions were imposed. Study Selection Randomized clinical trials and nonrandomized clinical trials of interventions that used wearable activity trackers to increase physical activity or reduce sedentary behavior in adults (aged 18 years or older) who were hospitalized were included. Data Extraction and Synthesis Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Main Outcomes and Measures The primary outcomes were objectively measured physical activity or sedentary behavior. Secondary outcomes included clinical outcomes (eg, physical function, pain, mental health), and hospital efficiency outcomes (eg, length of stay, readmission). Results Fifteen studies with a total of 1911 participants were included, representing various surgical cohorts (4 studies), stroke rehabilitation (3 studies), orthopedic rehabilitation (3 studies), mixed rehabilitation (3 studies), and mixed medical (2 studies). All studies were included in meta-analyses. There was a significant association between wearable activity tracker interventions with higher overall physical activity (standardized mean difference, 0.35; 95% CI, 0.15 to 0.54;I2 = 72%;P < .002) and less sedentary behavior (mean difference, −35.46 min/d; 95% CI, −57.43 to −13.48 min/d;I2 = 0;P = .002), and a significant association between wearable activity tracker interventions with improvements in physical function (standardized mean difference, 0.27; 95% CI, 0.08 to 0.46;I2 = 0;P = .006) compared with usual care. There was no significant association between wearable activity tracker interventions with pain, mental health, length of stay, or readmission risk. Conclusions and Relevance In this systematic review and meta-analysis, interventions that used wearable activity trackers with patients who are hospitalized were associated with higher physical activity levels, less sedentary behavior, and better physical functioning compared with usual care.