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van der Veer A, Madern T, van Lenthe FJ. Tunneling, cognitive load and time orientation and their relations with dietary behavior of people experiencing financial scarcity - an AI-assisted scoping review elaborating on scarcity theory. Int J Behav Nutr Phys Act 2024; 21:26. [PMID: 38439067 PMCID: PMC10910771 DOI: 10.1186/s12966-024-01576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The concept of a financial scarcity mindset has raised much attention as an explanation for poor decision-making and dysfunctional behavior. It has been suggested that financial scarcity could also impair dietary behavior, through a decline in self-control. Underlying cognitive mechanisms of tunneling (directing attention to financial issues and neglecting other demands), cognitive load (a tax on mental bandwidth interfering with executive functioning) and time orientation (a shift towards a present time horizon, versus a future time horizon) may explain the association between financial scarcity and self-control related dietary behavior. The current scoping review gathers recent evidence on how these mechanisms affect dietary behavior of people experiencing financial scarcity. It builds on a theoretical framework based on insights from behavioral economics and health psychology. METHODS A literature search was executed in six online databases, which resulted in 9.975 papers. Search terms were tunneling, cognitive load and time orientation, financial scarcity, and dietary behavior. Screening was performed with ASReview, an AI-ranking tool. In total, 14 papers were included in the scoping review. We used PRISMA-ScR guidelines for reporting. RESULTS Limited evidence indicates that a scarcity mindset could increase tunneling, through attentional narrowing on costs of food, which then directly impacts dietary behavior. A scarcity mindset involves experiencing financial stress, which can be understood as cognitive load. Cognitive load decreases attentional capacity, which could impair self-control in dietary choices. Financial scarcity is related to a present time orientation, which affects dietary choices by shifting priorities and decreasing motivation for healthy dietary behavior. CONCLUSIONS A scarcity mindset affects dietary behavior in different ways. Tunneling and a shift in time orientation are indicative of an attentional redirection, which can be seen as more adaptive to the situation. These may be processes indirectly affecting self-control capacity. Cognitive load could decrease self-control capacity needed for healthy dietary behavior because it consumes mental bandwidth. How a changing time orientation when experiencing financial scarcity relates to motivation for self-control in dietary behavior is a promising theme for further inquiry.
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Affiliation(s)
- Annemarieke van der Veer
- Research Group of Debt and Debt Collection, University of Applied Sciences Utrecht, Utrecht, PO Box 85397, 3508 AJ, The Netherlands.
| | - Tamara Madern
- Research Group of Debt and Debt Collection, University of Applied Sciences Utrecht, Utrecht, PO Box 85397, 3508 AJ, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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Yang M, Su J. Love Matters: The Effect of Mating Motive on Female Food Choice. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:969-979. [PMID: 38155337 DOI: 10.1007/s10508-023-02768-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
The prevalence of obesity has been increasing globally in recent decades. Behind the phenomenon, high-fat food consumption has been conceived as an important driver. In the current study, we explored whether mating motive caused an effect on female food choice as well as the psychological mechanism underlying it. In Study 1, we recruited 64 participants from a university and asked them to complete a mating prime, after which they would finish a food choice task in which food with different flavors were shown. In Study 2, we replicated Study 1 with a different mating priming method and examined the mediating role of body shaping desire on the relation between mating motive and female food choice. Results showed that: (1) The salience of mating motive decreased female's high-fat food choice but increased male's high-fat food choice; (2) the effect of mating motive in females was robust and more salient for sweet food rather than salty food; and (3) the body shaping desire partially mediated the effect of mating motive on female food choice.
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Affiliation(s)
- Mengyan Yang
- School of Psychology, Nanjing Normal University, Gulou District, 122 Ninghai Road, Nanjing, 210024, China
| | - Jinlong Su
- School of Psychology, Nanjing Normal University, Gulou District, 122 Ninghai Road, Nanjing, 210024, China.
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Wijaya EA, Solek P, Rachmadi D, Rahayuningsih SE, Tarigan R, Hilmanto D. Effect of Executive Function on Health-Related Quality of Life in Children with Chronic Kidney Disease. Int J Nephrol Renovasc Dis 2024; 17:17-28. [PMID: 38223907 PMCID: PMC10785681 DOI: 10.2147/ijnrd.s428657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction As the highest function in the brain that regulates our daily activity, executive dysfunction might affect someone's health-related quality of life (HRQoL), especially in those with chronic diseases, including chronic kidney disease (CKD). Neurocognitive functions, including intelligence quotient (IQ) and executive function can be affected through various mechanisms in CKD. However, there was still no specific study regarding how IQ and executive function might affect HRQoL in children with CKD. Purpose To assess Executive Function's impact on HRQoL and to find association between treatment modalities and CKD stages with HRQoL in children with CKD. Methods A cross sectional study was conducted at Pediatric Nephrology Clinic at Hasan Sadikin General Hospital, Bandung, Indonesia from September 2022 to April 2023. We included 38 children whose age range were 6-16 years 11 months old with CKD stage III - V. Assessment tools used were: BRIEF questionnaire for executive function; WISC III tool for IQ; PedsQLTM questionnaire generic module for HRQoL. Data was analyzed using SPSS ver. 26.0. Results Total number of samples was 38. Complete examinations were done on 30 patients. Eight other patients did not undergo the IQ test. There was a negative correlation between executive function components scores (GEC, BRI, MI) with HRQoL scores on parents' proxy in all domains. We found no correlation between HRQoL and IQ scores, but we found a correlation between IQ and CKD stage. There was a significant difference in HRQoL from the children's perspective among the three modalities; children who underwent conservative treatment were having the best HRQoL scores. Conclusion Interventions to improve executive function of children with CKD should be done to improve their HRQoL in the future. Early diagnosis and treatment of CKD should be done at the earliest to improve neurocognitive function and HRQoL.
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Affiliation(s)
- Elrika Anastasia Wijaya
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Purboyo Solek
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dedi Rachmadi
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Sri Endah Rahayuningsih
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rodman Tarigan
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dany Hilmanto
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Kleineidam L, Stark M, Riedel-Heller SG, Pabst A, Schmiedek F, Streit F, Rietschel M, Klinger-König J, Grabe HJ, Erhardt A, Gelbrich G, Schmidt B, Berger K, Wagner M. The assessment of cognitive function in the German National Cohort (NAKO) - Associations of demographics and psychiatric symptoms with cognitive test performance. World J Biol Psychiatry 2023; 24:909-923. [PMID: 35175181 DOI: 10.1080/15622975.2021.2011408] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the cognitive test battery of the German National Cohort (NAKO), a population-based mega cohort of 205,000 randomly selected participants, and to examine associations with demographic variables and selected psychiatric and neurological conditions. METHODS Initial data from 96,401 participants providing data on the cognitive performance measured by a brief cognitive test battery (12-word list recall task, semantic fluency, Stroop test, digit span backwards) was examined. Test results were summarised in cognitive domain scores using exploratory and confirmatory factor analyses. Associations with sociodemographic and psychiatric factors were analysed using linear regression and generalised additive models. RESULTS Cognitive test results were best represented by two domain scores reflecting memory and executive functions. Lower cognitive functions were associated with increasing age and male sex. Higher education and absence of childhood trauma were associated with better cognitive function. Moderate to severe levels of anxiety and depression, and a history of stroke, were related to lower cognitive function with a stronger effect on executive function as compared to memory. Some associations with cognition differed by German language proficiency. CONCLUSIONS The NAKO cognitive test battery and the derived cognitive domain scores for memory and executive function are sensitive measures of cognition.
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Affiliation(s)
- Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Melina Stark
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Florian Schmiedek
- Department of Education and Human Development, DIPF | Leibniz Institute for Research and Information in Education, Frankfurt am Main, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig University Giessen, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Wuerzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Kong KL, Anzman-Frasca S, Burgess B, Serwatka C, White HI, Holmbeck K. Systematic Review of General Parenting Intervention Impacts on Child Weight as a Secondary Outcome. Child Obes 2023; 19:293-308. [PMID: 35925814 PMCID: PMC10316528 DOI: 10.1089/chi.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
General parenting interventions have improved parent-child relationships and child behavior, with emerging evidence that they may also reduce prevalence of pediatric overweight/obesity. We conducted a systematic review on interventions that were designed to promote positive parenting and examined child weight post-hoc. We searched for studies published through January 2022 that promoted positive parenting among parents of children ages 0-18 years and reported effects on body weight as an ancillary outcome, with no intervention content focused on energy balance (e.g., feeding, physical activity). This search was carried out within ClinicalTrials.gov, ISRCTN Registry, PubMed, PsycINFO, Web of Science, and Connected Papers. Studies were imported into EndNote X9 and assessed independently by two investigators. In total, 753 clinical trials and 723 publications were assessed, and six publications met inclusion criteria. All cohorts were low-income and interventions targeted expectant mothers up through parents of adolescents. Follow-ups occurred when participants were between 2 and 25 years. Significant improvements in weight-related outcomes were observed across all studies for the intervention arm as a whole or for certain subgroups, and reasons underlying these gains tended to differ by participants' age. The magnitude of effect sizes ranged from medium to large. Interventions focused on general positive parenting are efficacious at lowering risk of overweight/obesity without focusing on physical health. Promoting attachments among infants, restructuring a toddler's home environment, praising preschoolers, and communicating with adolescents may optimize weight outcomes in parenting interventions adapted for obesity prevention.
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Affiliation(s)
- Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stephanie Anzman-Frasca
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Brenda Burgess
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Catherine Serwatka
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
| | - Hope I White
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Katherine Holmbeck
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Neuroscience Program, Bucknell University, Lewisburg, PA, USA
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Nelson TD, Stice E. Contextualizing the Neural Vulnerabilities Model of Obesity. Nutrients 2023; 15:2988. [PMID: 37447312 DOI: 10.3390/nu15132988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
In recent years, investigators have focused on neural vulnerability factors that increase the risk of unhealthy weight gain, which has provided a useful organizing structure for obesity neuroscience research. However, this framework, and much of the research it has informed, has given limited attention to contextual factors that may interact with key vulnerabilities to impact eating behaviors and weight gain. To fill this gap, we propose a Contextualized Neural Vulnerabilities Model of Obesity, extending the existing theory to more intentionally incorporate contextual factors that are hypothesized to interact with neural vulnerabilities in shaping eating behaviors and weight trajectories. We begin by providing an overview of the Neural Vulnerabilities Model of Obesity, and briefly review supporting evidence. Next, we suggest opportunities to add contextual considerations to the model, including incorporating environmental and developmental context, emphasizing how contextual factors may interact with neural vulnerabilities to impact eating and weight. We then synthesize earlier models and new extensions to describe a Contextualized Neural Vulnerabilities Model of Obesity with three interacting components-food reward sensitivity, top-down regulation, and environmental factors-all within a developmental framework that highlights adolescence as a key period. Finally, we propose critical research questions arising from the framework, as well as opportunities to inform novel interventions.
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Affiliation(s)
- Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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McGrath AB, Weinstock J, Cloutier R, Christensen M, Taylor DJ, Henderson CE. Examination of college student health behaviors and self-reported executive functions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:639-649. [PMID: 33830875 DOI: 10.1080/07448481.2021.1904951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/24/2021] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Objective: Emerging adulthood is characterized by maturation of executive functions (EF) and changes in health behaviors (HB). Interestingly, EF are bi-directionally related to many specific HB; yet how EF performs in relation to overall patterns of HB engagement is unclear. Groupings of HB and the relationship between these HB groupings and EF were examined. PARTICIPANTS Full-time college students were recruited from three large Mid- and Southwest universities (N = 1,387). METHODS Online self-report questionnaires assessing demographics, HB, and EF were completed. RESULTS Latent class analysis of HB revealed three classes: (1) High Substance Use, (2) Moderately Healthy, (3) Healthy. In general, the Healthy class had significantly greater EF compared to no significant differences between the other two classes. CONCLUSIONS Collective engagement in HB is associated with EF. Interventions targeting both HB and EF simultaneously may be most efficacious.
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Affiliation(s)
- Andrew B McGrath
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | | | - Renee Cloutier
- Department of Psychology, University of North Texas, Denton, TX, USA
- Methodology Center, Pennsylvania State University, University Park, PA, USA
| | | | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Craig E Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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Szabo-Reed AN, Martin LE, Savage CR, Washburn RA, Donnelly JE. Pre-post intervention exploring cognitive function and relationships with weight loss, intervention adherence and dropout. Health Psychol Behav Med 2023; 11:2162528. [PMID: 36632603 PMCID: PMC9828788 DOI: 10.1080/21642850.2022.2162528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the association between baseline cognitive function, intervention dropout, adherence and 3-month weight loss (WL) when controlling for confounding demographic variables. Methods 107 (Mage = 40.9 yrs.), BMI in the overweight and obese range (BMI = 35.6 kg/m2), men (N = 17) and women (N = 90) completed a 3-month WL intervention. Participants attended weekly behavioral sessions, comply with a reduced calorie diet, and complete 100 min of physical activity (PA)/wk. Cognitive function tasks at baseline included Flanker (attention), Stroop (executive control) and working memory, demographics, body weight and cardiovascular fitness were assessed at baseline. Session attendance, adherence to PA and diet were recorded weekly. Results Baseline attention was positively correlated with age (p < .05), education (p < .05), attendance (p < .05), diet (p < .05) and PA (p < .05). Baseline executive control (p < .05) and working memory (p < .05) were each associated with % WL. Baseline executive control (p < .01) and working memory (p < .001) were also each associated with education. ANOVA indicated that baseline attention (p < .01) was associated with WL, specifically for comparing those who achieved 5-10% WL (p < .01) and those who achieved greater than 10% WL (p < .01) to those who dropped. Significance Results suggest that stronger baseline attention is associated with completion of a 3-mo. WL intervention. Executive control and working memory are associated with amount of WL achieved. NCT registration US NIH Clinical Trials, NCT01664715.
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Affiliation(s)
- Amanda N. Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, USA, Amanda N. Szabo-Reed Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas, KS66160, USA
| | - Laura E. Martin
- Department of Population Health, University of Kansas Medical Center, Kansas, KS, USA
| | - Cary R. Savage
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas, KS, USA
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Henneghan AM, Van Dyk KM, Ackerman RA, Paolillo EW, Moore RC. Assessing cancer-related cognitive function in the context of everyday life using ecological mobile cognitive testing: A protocol for a prospective quantitative study. Digit Health 2023; 9:20552076231194944. [PMID: 37588154 PMCID: PMC10426293 DOI: 10.1177/20552076231194944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Objective Millions of cancer survivors are at risk for cancer-related cognitive impairment (CRCI), yet accurate and accessible assessments of cognitive functioning remain limited. Ecological mobile cognitive testing (EMCT) could offer a solution. This paper presents the protocol for a study that aims to (1) establish the reliability and validity of EMCT to assess CRCI in breast cancer survivors, and (2) prospectively evaluate within-person processes (and interactions) among context, mood, and behavior that explain cognitive variability, everyday functioning, and quality of life of cancer survivors. Methods Participants will include breast cancer survivors (>21 years old) who are within 5 years of completing chemotherapy treatment. Participants will complete two virtual visits (baseline, follow-up) 2 months apart to assess self-reported cognitive symptoms and cognitive performance, sociodemographic characteristics, clinical history, everyday functioning, and quality of life. Between virtual visits, EMCT will be used to sample cognitive functioning every other day (28 times total). We will use linear mixed-effect regressions and single-level multiple regression models to analyze the data. Results We anticipate a minimum of 124 breast cancer survivors enrolling and completing data collection. Study results will be published in peer-reviewed scientific journals. Conclusions Our findings will have broad implications for assessing CRCI in an ecologically valid and person-centered way using EMCT. We aim to provide this protocol to aid researchers who would like to apply this approach to their studies.
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Affiliation(s)
| | - Kathleen M Van Dyk
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, CA, USA
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Fox KR, Vannatta K, Jackson JL. Difficulties With Executive Function Are Associated With Risky Health Behaviors Among Young Adult Congenital Heart Defect Survivors. J Cardiovasc Nurs 2023; 38:60-69. [PMID: 36037294 PMCID: PMC9771948 DOI: 10.1097/jcn.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adults with congenital heart defects (CHDs) have an increased risk for cardiovascular complications, but few are in optimal cardiovascular health. Executive function deficits, which are elevated among CHD survivors, may contribute to engagement in behaviors that increase cardiovascular risk. OBJECTIVE The aim of this study was to identify the association between executive function and the health risk behaviors of tobacco use, saturated fat intake, and insufficient physical activity among young adults with CHDs. METHODS Young adults with CHDs completed the Behavior Rating Inventory of Executive Function-Adult Version, which yields composite and 9 individual domain scores (eg, inhibition, working memory). Participants also completed self-report measures of tobacco use, saturated fat intake, and physical activity. Linear and logistic regression models determined the association between executive function and risky health behaviors, adjusting for demographic factors, disease status, and emotional distress. RESULTS One in 10 young adults with CHDs reported clinically significant difficulties with global executive function. Difficulties with global executive function were associated with increased tobacco use ( P = .018) and greater saturated fat intake ( P = .015) but not insufficient physical activity ( P = .902). Difficulties with inhibition were specifically associated with increased tobacco use ( P = .003) and greater saturated fat intake ( P = .007), and problems with self-monitoring were associated with increased tobacco use ( P = .017). CONCLUSIONS Executive function difficulties are associated with self-reported engagement in health risk behaviors among young adults with CHDs. Health behavior interventions for adult CHD survivors may require additional modifications that consider executive function problems, particularly difficulties with inhibition.
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Robinson E, Jones A, Marty L. The role of health-based food choice motives in explaining the relationship between lower socioeconomic position and higher BMI in UK and US adults. Int J Obes (Lond) 2022; 46:1818-1824. [PMID: 35864310 PMCID: PMC7613617 DOI: 10.1038/s41366-022-01190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022]
Abstract
Background/Objectives Lower socioeconomic position (SEP) is associated with increased risk of higher BMI and developing obesity. No research to date has directly examined whether SEP differences in health-based food choice motives or executive function explain why lower SEP is associated with higher BMI. Subjects/Methods We analysed observational data from large samples of UK (N = 4130) and US (N = 1898) adults which included measures of SEP (education level, household income and subjective social status) and self-reported BMI. Participants also completed validated self-report measures on the extent to which their day-to-day food choices were motivated by health and weight control, as well as completing computerized tasks measuring inhibitory control (Stroop task) and working memory (Digit span task). Results Across both UK and US adults, the relationship between indicators of lower SEP and higher BMI were consistently explained by participants from lower SEP backgrounds reporting being less motivated by health when making food choices, which accounted for 18–28% of the association between lower SEP and higher BMI. There was no evidence that measures of executive function explained associations between SEP and BMI or moderated relations between food choice motives and higher BMI. Conclusions SEP differences in health-based food choice motives may play an important role in explaining why lower SEP is associated with an increased risk of higher BMI.
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Affiliation(s)
- Eric Robinson
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Andrew Jones
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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12
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Neural Processing of Health Information and Hypertension Self-Management in African Americans. Nurs Res 2022; 71:303-312. [PMID: 35302958 PMCID: PMC9246902 DOI: 10.1097/nnr.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Uncontrolled blood pressure (BP) rates are persistently high among African Americans with hypertension. Although self-management is critical to controlling BP, little is known about the brain-behavior connections underlying the processing of health information and the performance of self-management activities. OBJECTIVES In this pilot study, we explored the associations among neural processing of two types of health information and a set of self-management cognitive processes (self-efficacy, activation, decision-making, and hypertension knowledge) and behaviors (physical activity, dietary intake, and medication taking) and health status indicators (BP, health-related quality of life, anxiety, and depression). METHODS Using a descriptive cross-sectional design, 16 African Americans with uncontrolled hypertension (mean age = 57.5 years, 68.8% women) underwent functional magnetic resonance imaging to assess activation of two neural networks, the task-positive network and the default mode network, and a region in the ventromedial prefrontal cortex associated with emotion-focused and analytic-focused health information. Participants completed self-reports and clinical assessments of self-management processes, behaviors, and health status indicators. RESULTS Our hypothesis that neural processing associated with different types of health information would correlate with self-management cognitive processes and behaviors and health status indicators was only partially supported. Home diastolic BP was positively associated with ventromedial prefrontal cortex activation ( r = .536, p = .09); no other associations were found among the neural markers and self-management or health status variables. Expected relationships were found among the self-management processes and behaviors and health status indicators. DISCUSSION To advance our understanding of the neural processes underlying health information processing and chronic illness self-management, future studies are needed that use larger samples with more heterogeneous populations and additional neuroimaging techniques.
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Acar-Burkay S, Cristian DC. Cognitive underpinnings of COVID-19 vaccine hesitancy. Soc Sci Med 2022; 301:114911. [PMID: 35395612 PMCID: PMC8920576 DOI: 10.1016/j.socscimed.2022.114911] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/28/2022] [Accepted: 03/12/2022] [Indexed: 10/31/2022]
Abstract
RATIONALE Vaccines save lives. Despite the undisputed value of vaccination, vaccine hesitancy continues to be a major global challenge, particularly throughout the COVID-19 global pandemic. Since vaccination decisions are counter-intuitive and cognitively demanding, we propose that vaccine hesitancy is associated with executive function-a group of high-level cognitive skills including attentional control, working memory, inhibition, self-regulation, cognitive flexibility, and strategic planning. OBJECTIVE We set out to test (i) whether vaccine hesitancy is driven by individual differences in executive function beyond established socio-demographic factors (e.g., education, political orientation, gender, ethnicity, age, religiosity) and depressed mood, and (ii) whether this relationship is exacerbated by situational stress. METHODS Two studies were conducted with U.S. residents. Using a cross-sectional design, Study 1 examined the associations between executive function, socio-demographic factors, COVID-19 conspiracy beliefs, trust in health authorities, and COVID-19 vaccine hesitancy. Using an experimental design, Study 2 focused solely on unvaccinated individuals and tested the interactive effect of executive function and stress on willingness to receive a COVID-19 vaccine. We used ordinal logistic regressions to analyze the data. RESULTS Individual differences in executive function predicted participants' COVID-19 conspiracy beliefs, trust in health authorities, and their willingness to vaccinate against COVID-19. Importantly, the unique contribution of executive function to vaccine hesitancy could not be explained by socio-demographic factors or depressed mood. Furthermore, Study 2 revealed that weaker executive function had detrimental effects on COVID-19 vaccine acceptance and trust in health authorities mainly under heightened stress. CONCLUSIONS Individual differences in executive function and situational stress jointly impact COVID-19 vaccination decisions and need to be considered together when designing health communications aimed at reducing COVID-19 vaccine hesitancy. Interventions that lower stress and promote trust have the potential to increase vaccine acceptance, especially for individuals with weaker executive function.
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14
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Tomaso CC, James T, Nelson JM, Espy KA, Nelson TD. Longitudinal associations between executive control and body mass index across childhood. Pediatr Obes 2022; 17:e12866. [PMID: 34725959 PMCID: PMC8923908 DOI: 10.1111/ijpo.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Childhood obesity remains a prevalent public health concern. Executive control, a set of higher-order cognitive abilities for directing attention and behaviour, has been identified as a malleable factor potentially related to weight outcomes in youth. However, the directionality of this relationship remains unclear. OBJECTIVES This study examined reciprocal associations between three executive control components-inhibitory control, working memory and flexible shifting-and BMI (body mass index) percentile during childhood. METHODS At four points throughout elementary school, a community sample (N = 294) completed executive control tasks and had their height and weight objectively measured. Controlling for sex and socioeconomic risk status, random intercept cross-lagged panel models were tested. RESULTS Better inhibitory control performance predicted lower subsequent BMI at each timepoint, and better working memory and flexible shifting performance in grade three both predicted lower subsequent BMI in grade 4. However, BMI did not predict subsequent executive control performance at any timepoint. CONCLUSIONS Executive control abilities, including automatic response modulation, being able to hold and manipulate mental information, and being able to make flexible mental transitions, may be protective against weight problems, particularly in middle childhood when these abilities have had more time to mature and children begin to gain more independence.
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Affiliation(s)
- Cara C. Tomaso
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Tiffany James
- Office of Research and Economic Development, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Jennifer M. Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA,Office of Research and Economic Development, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Kimberly A. Espy
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA,Department of Psychiatry and Behavioral Science, University of Texas Health Science Center at San Antonio, Long School of Medicine, San Antonio, Texas, USA
| | - Timothy D. Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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15
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Becker JH, Feldman JM, Arora A, Busse PJ, Wisnivesky JP, Federman AD. Cognition, symptom perception, and medication non-adherence in older adults with asthma. J Asthma 2022; 59:607-615. [PMID: 33249956 PMCID: PMC8180526 DOI: 10.1080/02770903.2020.1856867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is highly prevalent in elderly asthmatics and is associated with worse asthma self-management (SM) and outcomes. CI may also explain why older adults may under-perceive asthma symptoms. We hypothesized that CI would be associated with low medication adherence and asthma symptom under-perception (ASP). We also hypothesized that ASP would mediate the relationship between CI and medication adherence. METHODS Participants of this longitudinal cohort study were asthmatics (N = 334) ≥60 years (51% Hispanic, 25% Black). Cognitive measures assessed general cognition, attention, processing speed, executive functioning, memory, and language. Measures of SM were self-reported and electronically measured adherence to controller medications. ASP was assessed for 6 weeks by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter, followed by PEF blows. Participants were blinded to actual PEF values. Percentage of time that participants were in the over-perception zone was calculated as an average. RESULTS In regression analyses, those with impairments in memory and general cognition had lower odds ratios (OR) for self-reported non-adherence (OR: 0.96, 95% CI 0.93 - 0.98 & OR: 0.90, 95% CI 0.83 - 0.96, respectively). CI was not associated with electronically measured non-adherence or ASP. In structural equation modeling, while CI was associated with adherence (β = 0.04, SE = 0.021, p = 0.04), ASP did not mediate this relationship. CONCLUSIONS While results confirmed the importance of cognition in asthma SM, these findings were not linked to ASP. Future analyses are needed to understand the role of confounding factors.
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Affiliation(s)
- Jacqueline H. Becker
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Arushi Arora
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paula J. Busse
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P. Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;,Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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16
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Kusi-Mensah K, Nuamah ND, Wemakor S, Agorinya J, Seidu R, Martyn-Dickens C, Bateman A. Assessment Tools for Executive Function and Adaptive Function Following Brain Pathology Among Children in Developing Country Contexts: a Scoping Review of Current Tools. Neuropsychol Rev 2021; 32:459-482. [PMID: 34870774 PMCID: PMC9381467 DOI: 10.1007/s11065-021-09529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022]
Abstract
Several tools have been developed to assess executive function (EFs) and adaptive functioning, although in mainly Western populations. Information on tools for low-and-middle-income country children is scanty. A scoping review of such instruments was therefore undertaken. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis- Scoping Review extension (PRISMA-ScR) checklist (Tricco et al., in Annals of Internal Medicine 169(7), 467–473, 2018). A search was made for primary research papers of all study designs that focused on development or adaptation of EF or adaptive function tools in low-and-middle-income countries, published between 1st January 1894 to 15th September 2020. 14 bibliographic databases were searched, including several non-English databases and the data were independently charted by at least 2 reviewers. The search strategy identified 5675 eligible abstracts, which was pruned down to 570 full text articles. These full-text articles were then manually screened for eligibility with 51 being eligible. 41 unique tools coming in 49 versions were reviewed. Of these, the Behaviour Rating Inventory of Executive Functioning (BRIEF- multiple versions), Wisconsin Card Sorting Test (WCST), Go/No-go and the Rey-Osterrieth complex figure (ROCF) had the most validations undertaken for EF tests. For adaptive functions, the tools with the most validation studies were the Vineland Adaptive Behaviour Scales (VABS- multiple versions) and the Child Function Impairment Rating Scale (CFIRS- first edition). There is a fair assortment of tests available that have either been developed or adapted for use among children in developing countries but with limited range of validation studies. However, their psychometric adequacy for this population was beyond the scope of this paper.
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Affiliation(s)
- Kwabena Kusi-Mensah
- Department of Psychiatry, University of Cambridge, Clifford Allbutt Building Cambridge Biomedical Campus CB2 OAH, Cambridge, UK. .,Komfo Anokye Teaching Hospital, P. O. Box 1934, Kumasi, Ghana.
| | | | - Stephen Wemakor
- Department of Psychiatry, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, 48109, MI, USA
| | | | | | | | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Clifford Allbutt Building Cambridge Biomedical Campus CB2 OAH, Cambridge, UK.,School of Health and Social Care, University of Essex, Colchester, UK
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17
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Savikangas T, Törmäkangas T, Tirkkonen A, Alen M, Fielding RA, Kivipelto M, Rantalainen T, Stigsdotter Neely A, Sipilä S. The effects of a physical and cognitive training intervention vs. physical training alone on older adults' physical activity: A randomized controlled trial with extended follow-up during COVID-19. PLoS One 2021; 16:e0258559. [PMID: 34644357 PMCID: PMC8513828 DOI: 10.1371/journal.pone.0258559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Executive functions underlie self-regulation and are thus important for physical activity and adaptation to new situations. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted physical activity at baseline, after six (6m) and twelve months (12m) of the interventions, one-year post-intervention follow-up and an extended follow-up during COVID-19 lockdown. METHODS Data from a single-blinded, parallel-group randomized controlled trial (PASSWORD-study, ISRCTN52388040) were utilized. Participants were 70-85 years old community-dwelling men and women from Jyväskylä, Finland. PT (n = 159) included supervised resistance, walking and balance training, home-exercises and self-administered moderate activity. PTCT (n = 155) included PT and cognitive training targeting executive functions on a computer program. Physical activity was assessed with a one-item, seven-scale question. Executive functions were assessed with color-word Stroop, Trail Making Test (TMT) B-A and Letter Fluency. Changes in physical activity were modeled with multinomial logistic models and the impact of executive functions on physical activity with latent change score models. RESULTS No significant group-by-time interaction was observed for physical activity (p>0.1). The subjects were likely to select an activity category higher than baseline throughout the study (pooled data: B = 0.720-1.614, p<0.001-0.046). Higher baseline Stroop predicted higher physical activity through all subsequent time-points (pooled data: B = 0.011-0.013, p = 0.015-0.030). Higher baseline TMT B-A predicted higher physical activity at 6m (pooled data: B = 0.007, p = 0.006) and during COVID-19 (B = 0.005, p = 0.030). In the PT group, higher baseline Letter Fluency predicted higher physical activity at 12m (B = -0.028, p = 0.030) and follow-up (B = -0.042, p = 0.002). CONCLUSIONS Cognitive training did not have additive effects over physical training alone on physical activity, but multicomponent training and higher executive function at baseline may support adaptation to and maintenance of a physically active lifestyle among older adults.
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Affiliation(s)
- Tiina Savikangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Törmäkangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Tirkkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Roger A. Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, United States of America
| | - Miia Kivipelto
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Timo Rantalainen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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18
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Targeting executive function for weight loss in adults with overweight or obesity. Physiol Behav 2021; 240:113540. [PMID: 34331958 DOI: 10.1016/j.physbeh.2021.113540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
Obesity is associated with a multitude of negative health sequalae. Behavioral weight loss (BWL) is currently the recommended behavioral treatment for obesity; however, it is not effective for approximately half of the individuals who participate. BWL requires individuals to carry out many tasks requiring executive function (EF; i.e., higher order cognitive functions such as planning and problem solving) in order to be successful. Growing research supports that lower EF may be associated with attenuated weight loss following BWL, and targeting EF in treatment could improve outcomes. This paper aims to describe the rationale for the development of Novel Executive Function Training for Obesity (NEXT), which adapts Compensatory Cognitive Training to be delivered in conjunction with BWL. We summarize evidence relating EF to obesity and reduced weight loss following BWL, as well as the past success of cognitive training on EF. Then we describe the treatment model for NEXT followed by initial data suggesting that NEXT is feasible and acceptable and may impact EF and weight. Obesity treatments incorporating cognitive training, especially those that train compensatory strategies, may improve weight-loss outcomes and provide a more durable treatment than traditional interventions, but larger randomized control trials are necessary.
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19
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Marty L, Franzon C, Jones A, Robinson E. Socioeconomic position, energy labelling and portion size selection: An online study comparing calorie and physical activity calorie equivalent (PACE) labelling in UK adults. Appetite 2021; 166:105437. [PMID: 34126162 PMCID: PMC8385415 DOI: 10.1016/j.appet.2021.105437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/13/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
Limited research has examined the impact of energy labelling on portion size selection. It is also unclear whether physical activity calorie equivalent (PACE) is more effective than standard kilocalorie (kcal) energy labelling in promoting healthier dietary behaviour and whether effectiveness varies based on socioeconomic position (SEP). In the present online study, 1667 UK adults of lower and higher SEP made virtual portion size selections for 18 common main meal foods under one of four conditions: kcal labelling only, PACE labelling only, kcal and PACE labelling, no labelling. Contrary to predictions, participants in the kcal labelling condition (+55 kcal, p < 0.001) chose larger portion sizes compared to the no labelling condition, whereas the PACE labelling (−17 kcal, p = 0.065) and no labelling condition did not significantly differ. The presence of PACE information on labels was associated with selection of significantly smaller portions when compared to labels that only included kcal information. Effects of labels on portion size selection were not moderated by participant SEP in primary analyses. The present study of virtual portion size selections suggests that kcal labelling resulted in larger portion size selections than no labelling, but this counter-intuitive effect was attenuated when kcal and PACE labelling were combined. Further research examining the impact of PACE labelling on real-world food selection in participants of lower and higher SEP is now warranted.
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Affiliation(s)
- Lucile Marty
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France.
| | - Caterina Franzon
- Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Andrew Jones
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Eric Robinson
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
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20
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Lo SL, Gearhardt AN, Fredericks EM, Katz B, Sturza J, Kaciroti N, Gonzalez R, Hunter CM, Sonneville K, Chaudhry K, Lumeng JC, Miller AL. Targeted self-regulation interventions in low-income children: Clinical trial results and implications for health behavior change. J Exp Child Psychol 2021; 208:105157. [PMID: 33910138 DOI: 10.1016/j.jecp.2021.105157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Self-regulation, known as the ability to harness cognitive, emotional, and motivational resources to achieve goals, is hypothesized to contribute to health behaviors across the lifespan. Enhancing self-regulation early in life may increase positive health outcomes. During pre-adolescence, children assume increased autonomy in health behaviors (e.g., eating; physical activity), many of which involve self-regulation. This article presents results from a clinical trial (NCT03060863) that used a factorial design to test behavioral interventions designed to enhance self-regulation, specifically targeting executive functioning, emotion regulation, future-oriented thinking, and approach biases. Participants were 118 children (9-12 years of age, M = 10.2 years) who had a history of living in poverty. They were randomized to receive up to four interventions that were delivered via home visits. Self-regulation was assayed using behavioral tasks, observations, interviews, and parent- and child-report surveys. Results were that self-regulation targets were reliably assessed and that interventions were delivered with high fidelity. Intervention effect sizes were very small to moderate (d range = .02-.65, median = .14), and most were not statistically significant. Intercorrelation analyses indicated that associations between measures within each target varied based on the self-regulation target evaluated. Results are discussed with regard to the role of self-regulation-focused interventions in child health promotion. Implications of findings are reviewed for informing next steps in behavioral self-regulation interventions among children from low-income backgrounds.
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Affiliation(s)
- Sharon L Lo
- School of Graduate Psychology, Pacific University, Hillsboro, OR 97123, USA; School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Benjamin Katz
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA 24061, USA
| | - Julie Sturza
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Niko Kaciroti
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard Gonzalez
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kendrin Sonneville
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kiren Chaudhry
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Julie C Lumeng
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alison L Miller
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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21
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Houston E, Fadardi JS, Harawa NT, Argueta C, Mukherjee S. Individualized Web-Based Attention Training With Evidence-Based Counseling to Address HIV Treatment Adherence and Psychological Distress: Exploratory Cohort Study. JMIR Ment Health 2021; 8:e18328. [PMID: 33507152 PMCID: PMC7878104 DOI: 10.2196/18328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders. OBJECTIVE The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes. METHODS Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers. RESULTS Of the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants' attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0. CONCLUSIONS Our findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.
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Affiliation(s)
- Eric Houston
- Claremont Graduate University, Claremont, CA, United States.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Nina T Harawa
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Chris Argueta
- California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Sukrit Mukherjee
- Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
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22
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Szabo-Reed AN, Donnelly JE. Cognitive Training: Associations and Implications for Weight Management and Translational Research. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021; 6. [PMID: 34017915 DOI: 10.1249/tjx.0000000000000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Behavioral weight loss programs combining energy restriction and increased physical activity (PA) are generally successful in producing clinically significant weight loss (≥5%) over 3-6 mos. However, weight maintenance (≥ 2 yrs.) continues to be problematic, due in part to an inability of individuals to continue adherence to diet and PA recommendations. It is hypothesized that neurocognitive processes, specifically executive functions (EFs, i.e., inhibition, working memory, mental flexibility), underlie self-regulation, self-efficacy, and are essential for the adoption and maintenance of health behaviors. Behavioral weight loss programs generally attempt to improve self-regulation; however, these skills are difficult to implement long-term. Strengthening EFs through cognitive training may improve weight maintenance by improving self-efficacy and self-regulation, resulting in improved program attendance and improved adherence to dietary and PA recommendations. Although randomized trials have not been conducted to specifically evaluate this hypothesis, results from the available literature suggest the potential for cognitive training to improve weight maintenance.
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Affiliation(s)
- Amanda N Szabo-Reed
- Department of Weight Management, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Joseph E Donnelly
- Department of Weight Management, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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23
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Nelson TD, James TD, Nelson JM, Johnson AB, Mason WA, Yaroch AL, Espy KA. Associations between specific components of executive control and eating behaviors in adolescence: A study using objective and subjective measures. Appetite 2020; 154:104784. [PMID: 32579972 PMCID: PMC7442726 DOI: 10.1016/j.appet.2020.104784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/24/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022]
Abstract
A growing literature suggests that executive control (EC; also known as "executive functioning" or "EF") in adolescence may play an important role in the development of key health behaviors, including eating behaviors. However, existing literature has significant limitations in the conceptualization and measurement of EC. The current study aims to address these limitations by employing a multidimensional approach to conceptualizing and measuring adolescent EC, including both objective and subjective measures covering multiple components of EC, and examining links with specific eating behaviors. A community sample of adolescents (N = 208; mean age = 14.5 years) completed a battery of performance-based neuropsychological tasks assessing specific components of EC (i.e., working memory, inhibitory control, flexible shifting), a norm-referenced questionnaire covering problems with specific components of EC in daily life, and a measure assessing key eating behaviors (i.e., uncontrolled eating, emotional eating, cognitive restraint). Objectively-measured adolescent working memory was significantly and uniquely associated with cognitive restraint, with stronger working memory associated with less cognitive restraint. No other associations between performance-based EC tasks and eating behaviors were found. In contrast, using subjective reports of EC, problems with inhibitory control were associated with greater uncontrolled eating, and problems with flexible shifting were associated with greater emotional eating. The results suggest links between specific aspects of EC and specific eating behaviors in adolescence, as well as the potential importance of context for understanding the role of EC in eating behavior. Given evidence that EC is modifiable, the findings have potential implications for novel interventions addressing eating behaviors by targeting EC.
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Affiliation(s)
| | - Tiffany D James
- University of Nebraska-Lincoln, Office of Research and Economic Development, USA
| | - Jennifer Mize Nelson
- University of Nebraska-Lincoln, Department of Psychology, USA; University of Nebraska-Lincoln, Office of Research and Economic Development, USA
| | - Anna B Johnson
- University of Nebraska-Lincoln, Department of Psychology, USA
| | - W Alex Mason
- Boys Town, Child and Family Translational Research Center (formerly the National Research Institute), USA
| | | | - Kimberly Andrews Espy
- University of Texas at San Antonio, Department of Psychology, USA; UT Health San Antonio, Long School of Medicine, Department of Psychiatry and Behavioral Science, USA
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Barha CK, Falck RS, Skou ST, Liu-Ambrose T. Personalising exercise recommendations for healthy cognition and mobility in ageing: time to consider one's pre-existing function and genotype (Part 2). Br J Sports Med 2020; 55:301-303. [PMID: 33023881 DOI: 10.1136/bjsports-2020-102865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Cindy K Barha
- Physical Therapy, Facutly of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Physical Therapy, Facutly of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Teresa Liu-Ambrose
- Physical Therapy, Facutly of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Relationship between self-care adherence, time perspective, readiness to change and executive function in patients with heart failure. J Behav Med 2020; 43:1-11. [DOI: 10.1007/s10865-019-00080-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/06/2019] [Indexed: 12/13/2022]
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Szabo‐Reed AN, Martin LE, Hu J, Yeh H, Powell J, Lepping RJ, Patrician TM, Breslin FJ, Donnelly JE, Savage CR. Modeling interactions between brain function, diet adherence behaviors, and weight loss success. Obes Sci Pract 2020; 6:282-292. [PMID: 32523717 PMCID: PMC7278911 DOI: 10.1002/osp4.403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Obesity is linked to altered activation in reward and control brain circuitry; however, the associated brain activity related to successful or unsuccessful weight loss (WL) is unclear. METHODS Adults with obesity (N = 75) completed a baseline functional magnetic resonance imaging (fMRI) scan before entering a WL intervention (ie,3-month diet and physical activity [PA] program). We conducted an exploratory analysis to identify the contributions of baseline brain activation, adherence behavior patterns, and the associated connections to WL at the conclusion of a 3-month WL intervention. Food cue-reactivity brain regions were functionally identified using fMRI to index brain activation to food vs nonfood cues. Food consumption, PA, and class attendance were collected weekly during the 3-month intervention. RESULTS The left middle frontal gyrus (L-MFG, BA 46) and right middle frontal gyrus (R-MFG; BA 9) were positively activated when viewing food compared with nonfood images. Structural equation modeling with bootstrapping was used to investigate a hypothesized path model and revealed the following significant paths: (1) attendance to 3-month WL, (2) R-MFG to attendance, and (3) indirect effects of R-MFG through attendance on WL. CONCLUSION Findings suggest that brain activation to appetitive food cues predicts future WL through mediating session attendance, diet, and PA. This study contributes to the growing evidence of the importance of food cue reactivity and self-regulation brain regions and their impact on WL outcomes.
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Affiliation(s)
- Amanda N. Szabo‐Reed
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | - Laura E. Martin
- Department of Population Health HealthUniversity of Kansas Medical CenterKansas CityKansas
- Hoglund Brain Imaging CenterUniversity of Kansas Medical CenterKansas CityKansas
| | - Jinxiang Hu
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Hung‐Wen Yeh
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Joshua Powell
- Graduate School of Social WorkUniversity of DenverDenverColorado
| | - Rebecca J. Lepping
- Hoglund Brain Imaging CenterUniversity of Kansas Medical CenterKansas CityKansas
| | - Trisha M. Patrician
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Florance J. Breslin
- Center for Brain, Biology and BehaviorUniversity of Nebraska‐LincolnLincolnNebraska
| | - Joseph E. Donnelly
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | - Cary R. Savage
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
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Marty L, Jones A, Robinson E. Socioeconomic position and the impact of increasing availability of lower energy meals vs. menu energy labelling on food choice: two randomized controlled trials in a virtual fast-food restaurant. Int J Behav Nutr Phys Act 2020; 17:10. [PMID: 32005255 PMCID: PMC6995045 DOI: 10.1186/s12966-020-0922-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. There is a lack of evidence on the effectiveness and SEP equity of structural-based (e.g. increasing availability of lower energy options) and information provision (e.g. menu energy labelling) interventions on food choice. METHODS Across two online experiments, participants of lower and higher SEP made meal choices in a novel virtual fast-food restaurant. To be eligible to take part, participants were required to be UK residents, aged 18 or above, fluent in English, have access to a computer with an internet connection and have no dietary restrictions. Participants were randomized to one of four conditions in a 2 × 2 between-subjects design: menu energy labelling present vs. absent and increased availability of lower energy options (75% of menu options lower energy) vs. baseline availability (25% of menu options lower energy). Participants also completed measures of executive function and food choice motives. RESULTS The analysis of pooled data from both studies (n = 1743) showed that increasing the availability of lower energy options resulted in participants ordering meals with significantly less energy on average (- 71 kcal, p < 0.001, partial η2 = 0.024) and this effect was observed irrespective of participant SEP. Menu labelling had no significant effect on energy ordered (- 18 kcal, p = 0.116, partial η2 = 0.001) in participants from both higher and lower SEP. Furthermore, we found no evidence that executive function or food choice motives moderated the effect of increasing lower energy menu options or energy labelling on total energy ordered. CONCLUSIONS In a virtual fast-food environment, energy labelling was ineffective in reducing total energy ordered for both higher and lower SEP participants. Increasing the availability of lower energy options had an equitable effect, reducing total energy ordered in participants from higher and lower SEP. TRIAL REGISTRATION Study protocols and analysis plans were pre-registered on the Open Science Framework (https://osf.io/ajcr6/).
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Affiliation(s)
- Lucile Marty
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Andrew Jones
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Eric Robinson
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
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Gaalema DE, Dube S, Potter A, Elliott RJ, Mahoney K, Sigmon SC, Higgins ST, Ades PA. The effect of executive function on adherence with a cardiac secondary prevention program and its interaction with an incentive-based intervention. Prev Med 2019; 128:105865. [PMID: 31662210 PMCID: PMC6939881 DOI: 10.1016/j.ypmed.2019.105865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/20/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022]
Abstract
Participation in secondary prevention programs such as cardiac rehabilitation (CR) reduces morbidity, mortality, and hospitalizations while improving quality of life. Executive function (EF) is a complex set of cognitive abilities that control and regulate behavior. EF predicts many health-related behaviors, but how EF interacts with interventions to improve treatment adherence is not well understood. The objective of this study is to examine if EF predicts CR treatment adherence and how EF interacts with an intervention to improve adherence. Data were collected from 2013 to 2018 in Vermont, USA. 130 Medicaid-enrolled individuals who had experienced a qualifying cardiac event were enrolled in a controlled clinical trial and randomized 1:1 to receive financial incentives for completing secondary prevention sessions or to usual care. In this secondary analysis, effects of EF on CR adherence (defined as completing ≥30/36 sessions) were examined in 112 participants (57 usual care, 55 intervention) who completed an EF battery. Delay-discounting, a measure of impulsivity, predicted CR adherence (p = 0.01) and interacted with the incentive intervention, such that those who exhibited greater discounting of future rewards benefitted more from the intervention than those who discounted less (F(1, 104) = 5.23, p = 0.02). Better cognitive flexibility, measured with the trail-making-task, also predicted CR adherence (p = 0.02). While EF has been associated with adherence to a variety of treatment regimens, this interaction between an incentive-based intervention to promote treatment adherence and EF is novel. This work illustrates the value of considering individual differences in EF when designing and implementing interventions to promote health-related behavior change.
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Affiliation(s)
- Diann E Gaalema
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America.
| | - Sarahjane Dube
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | - Alexandra Potter
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | | | | | - Stacey C Sigmon
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | - Stephen T Higgins
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | - Philip A Ades
- University of Vermont, United States of America; University of Vermont Medical Center, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
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Favieri F, Forte G, Casagrande M. The Executive Functions in Overweight and Obesity: A Systematic Review of Neuropsychological Cross-Sectional and Longitudinal Studies. Front Psychol 2019; 10:2126. [PMID: 31616340 PMCID: PMC6764464 DOI: 10.3389/fpsyg.2019.02126] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background: The increasing incidence of people affected by overweight or obesity is a significant health problem. The knowledge of the factors which influences the inappropriate eating behaviors causing excessive body fat is an essential goal for the research. Overweight and obesity are significant risk factors for many health diseases, such as cardiovascular problems, diabetes. Recently, many studies have focused on the relationship between body weight and cognitive processes. Objectives: This systematic review is aimed to investigate the existence and the nature of the relationship between excessive body weight (overweight/obesity) and executive functions, analyzing cross-sectional, and longitudinal studies in order to verify the evidence of a possible causality between these variables. Methods: The review was carried out according to the PRISMA-Statement, through systematic searches in the scientific databases PubMed, Medline, PsychInfo, and PsycArticles. The studies selected examined performance on executive tasks by participants with overweight or obesity, aged between 5 and 70 years. Studies examining eating disorders or obesity resulting from other medical problems were excluded. Furthermore, the results of studies using a cross-sectional design and those using a longitudinal one were separately investigated. Results: Sixty-three cross-sectional studies and twenty-eight longitudinal studies that met our inclusion and exclusion criteria were analyzed. The results confirmed the presence of a relation between executive functions and overweight/obesity, although the directionality of this relation was not clear; nor did any single executive function emerge as being more involved than others in this relation. Despite this, there was evidence of a reciprocal influence between executive functions and overweight/obesity. Conclusions: This systematic review underlines the presence of a relationship between executive functions and overweight/obesity. Moreover, it seems to suggest a bidirectional trend in this relationship that could be the cause of the failure of interventions for weight reduction. The results of this review highlight the importance of a theoretical model able to consider all the main variables of interest, with the aim to structuring integrated approaches to solve the overweight/obesity problems.
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Affiliation(s)
- Francesca Favieri
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Forte
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Maria Casagrande
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Webel AR, Schreiner N, Salata RA, Friedman J, Jack AI, Sattar A, Fresco DM, Rodriguez M, Moore S. The Effect of an HIV Self-Management Intervention on Neurocognitive Behavioral Processing. West J Nurs Res 2019; 41:990-1008. [PMID: 30654713 PMCID: PMC6570548 DOI: 10.1177/0193945918823347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People living with HIV (PLHIV) are increasingly diagnosed with comorbidities which require increasing self-management. We examined the effect of a self-management intervention on neurocognitive behavioral processing. Twenty-nine PLHIV completed a two-group, 3-month randomized clinical trial testing a self-management intervention to improve physical activity and dietary intake. At baseline and 3 months later, everyone completed validated assessments of physical, diet, and neurocognitive processing (functional magnetic resonance imaging [fMRI]-derived network analyses). We used linear mixed effects modeling with a random intercept to examine the effect of the intervention. The intervention improved healthy eating (p = .08) but did not improve other self-management behaviors. There was a significant effect of the intervention on several aspects of neurocognitive processing including in the task positive network (TPN) differentiation (p = .047) and an increase in the default mode network (DMN) differentiation (p = .10). Self-management interventions may influence neurocognitive processing in PLHIV, but those changes were not associated with positive changes in self-management behavior.
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Affiliation(s)
- Allison R Webel
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Nathaniel Schreiner
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Robert A Salata
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- 2 University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA
| | - Jared Friedman
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Anthony I Jack
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Abdus Sattar
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Margaret Rodriguez
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley Moore
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Crandall A, Cheung A, Young A, Hooper AP. Theory-Based Predictors of Mindfulness Meditation Mobile App Usage: A Survey and Cohort Study. JMIR Mhealth Uhealth 2019; 7:e10794. [PMID: 30900992 PMCID: PMC6450472 DOI: 10.2196/10794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/30/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background Mindfulness meditation has become increasingly popular over the last few years, due in part to the increase in mobile apps incorporating the practice. Although studies have demonstrated the potential of mindfulness meditation to positively impact health, little has been uncovered about what predicts engagement in mindfulness meditation. Understanding the predictors of mindfulness meditation may help practitioners and phone app developers improve intervention strategies and app experience. Objective The purpose of this study was to use the Theory of Planned Behavior and Temporal Self-Regulation Theory to determine factors predicting mindfulness meditation mobile app use. Methods The sample consisted of 85 undergraduate students with no prior mindfulness meditation experience. During their first laboratory visit, participants completed tasks to measure their executive functioning and a survey to measure Theory of Planned Behavior constructs about mindfulness meditation. Over the following 2 weeks, participants logged the days and minutes that they practiced mindfulness meditation using a phone app. Hierarchical regression modeling was used to analyze the data. Results After controlling for demographic factors, participant subjective norms (beta=14.51, P=.001) and intentions (beta=36.12, P=.001) were predictive of the number of minutes practicing mindfulness. Participant executive functioning did not predict mindfulness meditation practice, nor did it moderate the link between intentions and mindfulness meditation practice. Participant attitudes (beta=0.44, P<.001) and perceived control (beta=0.42, P=.002) were positively associated with intentions to practice mindfulness. Conclusions These results suggest that among college student populations, the Theory of Planned Behavior may be useful in predicting the use of mindfulness meditation phone apps. However, participant executive functioning was not a predictor or moderator of mindfulness practice, and Temporal Self-Regulation Theory may be less useful for explaining mindfulness meditation behaviors using phone apps over a short period of time among college students. The results have implications for public health professionals, suggesting that a focus on subjective norms and intentions may promote mindfulness meditation practice using phone apps.
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Affiliation(s)
- AliceAnn Crandall
- Brigham Young University, Department of Public Health, Provo, UT, United States
| | - Aaron Cheung
- Brigham Young University, Department of Public Health, Provo, UT, United States
| | - Ashley Young
- Brigham Young University, Department of Public Health, Provo, UT, United States
| | - Audrey P Hooper
- Brigham Young University, Department of Public Health, Provo, UT, United States
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Nelson TD, Mize Nelson J, Alex Mason W, Tomaso CC, Kozikowski CB, Andrews Espy K. Executive Control and Adolescent Health: Toward A Conceptual Framework. ADOLESCENT RESEARCH REVIEW 2019; 4:31-43. [PMID: 30886888 PMCID: PMC6419957 DOI: 10.1007/s40894-018-0094-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/09/2018] [Indexed: 05/25/2023]
Abstract
Executive control is a set of cognitive abilities that may impact a variety of adolescent health behaviors and outcomes; however, research on executive control as a contributor to the physical health of youth is relatively limited. Therefore, the current article explores the possible role of executive control in adolescent health by reviewing relevant literature and proposing a conceptual framework to guide future research in this area. The development of executive control from preschool through adolescence is described, with particular attention to executive control in the unique health context of adolescence. A new conceptual model is proposed, focusing on how executive control may play a critical role in supporting health in adolescence and beyond through the mechanisms of attentional, behavioral, and emotional control. Literature exploring associations between youth executive control and key health behaviors (including diet, physical activity, sleep and substance use) is reviewed. Researchers and clinicians are encouraged to consider executive control as an important cross-cutting contributor to health during adolescence and beyond and to incorporate this construct into longitudinal studies of health.
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Affiliation(s)
| | - Jennifer Mize Nelson
- Department of Psychology, University of Nebraska-Lincoln
- Office of Research, University of Nebraska-Lincoln
| | - W Alex Mason
- Boys Town Child and Family Translational Research Center (formerly the National Research Institute)
| | - Cara C Tomaso
- Department of Psychology, University of Nebraska-Lincoln
| | | | - Kimberly Andrews Espy
- University of Texas at San Antonio
- Department of Psychology, University of Nebraska-Lincoln
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Nyongesa MK, Ssewanyana D, Mutua AM, Chongwo E, Scerif G, Newton CRJC, Abubakar A. Assessing Executive Function in Adolescence: A Scoping Review of Existing Measures and Their Psychometric Robustness. Front Psychol 2019; 10:311. [PMID: 30881324 PMCID: PMC6405510 DOI: 10.3389/fpsyg.2019.00311] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background: There is much research examining adolescents' executive function (EF) but there is little information about tools that measure EF, in particular preference of use, their reliability and validity. This information is important as to help both researchers and practitioners select the most relevant and reliable measure of EF to use with adolescents in their context. Aims: We conducted a scoping review to: (a) identify the measures of EF that have been used in studies conducted among adolescents in the past 15 years; (b) identify the most frequently used measures of EF; and (c) establish the psychometric robustness of existing EF measures used with adolescents. Methods: We searched three bibliographic databases (PsycINFO, Ovid Medline, and Web of Science) using key terms "Adolescents," "Executive Functions," and "measures". The search covered research articles published between 1st January 2002 and 31st July 2017. Results: We identified a total of 338 individual measures of EF from 705 eligible studies. The vast majority of these studies (95%) were conducted in high income countries. Of the identified measures, 10 were the most used frequently, with a cumulative percent frequency accounting for nearly half (44%) the frequency of usage of all reported measures of EF. These are: Digit Span (count = 160), Trail Making Test (count = 158), Behavior Rating Inventory of Executive Function (count = 148), Wisconsin Card Sorting Test (count = 140), Verbal Fluency Tasks (count = 88), Stroop Color-Word Test (count = 78), Classical Stroop Task (count = 63), Color-Word Interference Test from Delis-Kaplan battery (count = 62), Rey-Osterrieth Complex Figure Test (count = 62), and Original Continuous Performance Test (count = 58). In terms of paradigms, tasks from Span (count = 235), Stroop (count = 216), Trails (count = 171), Card sorting (count = 166), Continuous performance (count = 99), and Tower (count = 94) paradigms were frequently used. Only 48 studies out of the included 705 reported the reliability and/or validity of measures of EF used with adolescents, but limited to studies in high income countries. Conclusion: We conclude that there is a wide array of measures for assessing EF among adolescents. Ten of these measures are frequently used. However, the evidence of psychometric robustness of measures of EF used with adolescents remains limited to support the validity of their usage across different contexts.
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Affiliation(s)
- Moses K. Nyongesa
- Neuroassement Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Derrick Ssewanyana
- Neuroassement Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - Agnes M. Mutua
- Neuroassement Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Esther Chongwo
- Neuroassement Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Charles R. J. C. Newton
- Neuroassement Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amina Abubakar
- Neuroassement Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Institute for Human Development, Aga Khan University Hospital, Nairobi, Kenya
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Powell LH, Appelhans BM, Ventrelle J, Karavolos K, March ML, Ong JC, Fitzpatrick SL, Normand P, Dawar R, Kazlauskaite R. Development of a lifestyle intervention for the metabolic syndrome: Discovery through proof-of-concept. Health Psychol 2018; 37:929-939. [PMID: 30234352 PMCID: PMC6589338 DOI: 10.1037/hea0000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim was to describe the early phases of the progressive development of a lifestyle treatment for sustained remission of the metabolic syndrome (MetS) using the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development as a guide. METHODS Early discovery and design phases produced a 3-component (diet, physical activity, stress), group-based lifestyle treatment with an intensive 6-month phase followed by monthly, participant-led maintenance meetings. In the proof-of-concept phase, 26 participants with the MetS (age 53 ± 7 years, 77% female, and 65% ethnic minority) were recruited in a quasi-experimental design to determine if treatment could achieve the prespecified benchmark of MetS remission in ≥50% at 2.5 years. Exploratory outcomes focused on MetS components, weight, and patient-centered benefits on energy/vitality and psychosocial status. RESULTS MetS remission was achieved in 53.8% after a median of 2.5 years. At 2.5 years, an increase of +15.4% reported eating ≥3 servings of vegetables/day, +7.7% engaged in ≥150 minutes of moderate-to-vigorous physical activity/week; and +11.5% reported experiencing no depression in the past 2 weeks. Weight loss ≥5% was achieved by 38.5%, and energy/vitality, negative affect, and social support improved. Median group attendance over 2.5 years was 73.8%. CONCLUSIONS It is plausible that this lifestyle program can produce a remission in the MetS, sustained through 2.5 years. After refinements to enhance precision and strength, progression to feasibility pilot testing and a randomized clinical trial will determine its efficacy as a cost-effective lifestyle option for managing the MetS in the current health care system. (PsycINFO Database Record
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Affiliation(s)
- Lynda H. Powell
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Bradley M. Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jennifer Ventrelle
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Michelle L. March
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Jason C. Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Patricia Normand
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Rebecca Dawar
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
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Reimann Z, Miller JR, Dahle KM, Hooper AP, Young AM, Goates MC, Magnusson BM, Crandall A. Executive functions and health behaviors associated with the leading causes of death in the United States: A systematic review. J Health Psychol 2018; 25:186-196. [DOI: 10.1177/1359105318800829] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Research indicates that executive functioning may predict health behavior. This systematic review provides an overview of the relationship between domains of executive functioning and health behaviors associated with the leading causes of death in the United States. A total of 114 articles met the inclusion criteria (adult sample, published in English between 1990 and November 2016) and were reviewed and synthesized. Results indicated that although many studies had mixed findings, at least one executive function component was associated with every health behavior. Based on these results, health professionals should consider the role of executive functions in behavior change interventions.
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Abstract
OBJECTIVE Although numerous studies have documented the effects of sleep loss on executive control (EC) and related abilities, research examining the impact of early EC on subsequent sleep problems is lacking. Therefore, the current study reports on a longitudinal investigation of EC in preschool as a predictor of sleep-wake problems and daytime sleepiness in early adolescence. PARTICIPANTS The participants were 141 children (48.6% female) recruited from the community for a longitudinal study spanning preschool through early adolescence, with an oversampling for high sociodemographic risk (34.1% based on eligibility for public medical insurance, free or reduced lunch status, or family income-to-needs below the federal poverty line). METHODS Participants completed a battery of developmentally appropriate tasks assessing major aspects of EC (working memory, inhibitory control, flexible shifting) during a laboratory visit at age 4 years, 6 months. Participants also completed a follow-up session in early adolescence (between ages 11 years and 13.5 years; mean age = 11.82 years, SD = .62 years), during which they completed self-report measures of sleep-wake problems and daytime sleepiness. RESULTS Structural equation modeling results indicate that preschool EC (represented by a single latent construct) significantly negatively predicted both sleep-wake problems and daytime sleepiness in early adolescence, with poorer EC predicting greater subsequent sleep problems. CONCLUSIONS Poorer EC abilities during the critical period of preschool may be a risk factor for later sleep problems in adolescence. Given that EC appears to be modifiable, early interventions to promote EC development may help prevent subsequent sleep problems and promote long-term health trajectories.
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Affiliation(s)
- Timothy D Nelson
- a Department of Psychology , University of Nebraska-Lincoln , Lincoln , Nebraska
| | - Katherine M Kidwell
- a Department of Psychology , University of Nebraska-Lincoln , Lincoln , Nebraska
| | - Maren Hankey
- a Department of Psychology , University of Nebraska-Lincoln , Lincoln , Nebraska
| | - Jennifer Mize Nelson
- a Department of Psychology , University of Nebraska-Lincoln , Lincoln , Nebraska
- b Office of Research, University of Nebraska-Lincoln , Lincoln , Nebraska
| | - Kimberly Andrews Espy
- a Department of Psychology , University of Nebraska-Lincoln , Lincoln , Nebraska
- c Department of Psychology , University of Arizona , Tucson , Arizona
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Caldwell AE, Masters KS, Peters JC, Bryan AD, Grigsby J, Hooker SA, Wyatt HR, Hill JO. Harnessing centred identity transformation to reduce executive function burden for maintenance of health behaviour change: the Maintain IT model. Health Psychol Rev 2018; 12:231-253. [PMID: 29402182 PMCID: PMC6124500 DOI: 10.1080/17437199.2018.1437551] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 02/02/2018] [Indexed: 01/12/2023]
Abstract
The inability to produce sustainable lifestyle modifications (e.g., physical activity, healthy diet) remains a major barrier to reducing morbidity and mortality from prevalent, preventable conditions. The objective of this paper is to present a model that builds on and extends foundational theory and research to suggest novel approaches that may help to produce lasting behaviour change. The model aims to integrate factors not typically examined together in order to elucidate potential processes underlying a shift from behaviour initiation to long-term maintenance. The central premise of the Maintain IT model builds on approaches demonstrating that in-tact executive function (EF) is critical for health behaviour initiation, for more complex behaviours beyond initiation, and in unsupportive environments and circumstances, but successful recruitment of EF is effortful and prone to error. Enduring changes are more likely if the underlying cognitive processes can become less effortful (non-conscious, automatic). The Maintain IT model posits that a centred identity transformation is one path leading to less effortful processing and facilitating successful recruitment of EF when necessary over the long term, increasing the sustainability of health behaviour change. A conceptual overview of the literature supporting the utility of this integrative model, future directions, and anticipated challenges are presented.
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Affiliation(s)
- Ann E. Caldwell
- Colorado Nutrition Obesity Research Center, University of Colorado, Anschutz Medical Campus
| | - Kevin S. Masters
- Colorado Nutrition Obesity Research Center, University of Colorado, Anschutz Medical Campus
- Department of Psychology, University of Colorado, Denver
| | - John C. Peters
- Colorado Nutrition Obesity Research Center, University of Colorado, Anschutz Medical Campus
- Department of Medicine, University of Colorado, Anschutz Medical Campus
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado, Boulder
| | - Jim Grigsby
- Department of Psychology, University of Colorado, Denver
- Department of Medicine, University of Colorado, Anschutz Medical Campus
| | | | - Holly R. Wyatt
- Colorado Nutrition Obesity Research Center, University of Colorado, Anschutz Medical Campus
- Department of Medicine, University of Colorado, Anschutz Medical Campus
| | - James O. Hill
- Colorado Nutrition Obesity Research Center, University of Colorado, Anschutz Medical Campus
- Department of Medicine, University of Colorado, Anschutz Medical Campus
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus
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Last BS, Lawson GM, Breiner K, Steinberg L, Farah MJ. Childhood socioeconomic status and executive function in childhood and beyond. PLoS One 2018; 13:e0202964. [PMID: 30142188 PMCID: PMC6108482 DOI: 10.1371/journal.pone.0202964] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022] Open
Abstract
Socioeconomic status (SES) predicts health, wellbeing, and cognitive ability, including executive function (EF). A body of recent work has shown that childhood SES is positively related to EF, but it is not known whether this disparity grows, diminishes or holds steady over development, from childhood through adulthood. We examined the association between childhood SES and EF in a sample ranging from 9–25 years of age, with six canonical EF tasks. Analyzing all of the tasks together and in functionally defined groups, we found positive relations between SES and EF, and the relations did not vary by age. Analyzing the tasks separately, SES was positively associated with performance in some but not all EF measures, depending on the covariates used, again without varying by age. These results add to a growing body of evidence that childhood SES is associated with EF abilities, and contribute novel evidence concerning the persistence of this association into early adulthood.
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Affiliation(s)
- Briana S. Last
- Department of Psychology, The University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Gwen M. Lawson
- Department of Psychology, The University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kaitlyn Breiner
- Department of Psychology, The University of California—Los Angeles, Los Angeles, California, United States of America
| | - Laurence Steinberg
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Martha J. Farah
- Department of Psychology, The University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Dassen FCM, Houben K, Allom V, Jansen A. Self-regulation and obesity: the role of executive function and delay discounting in the prediction of weight loss. J Behav Med 2018; 41:806-818. [PMID: 29802535 PMCID: PMC6209053 DOI: 10.1007/s10865-018-9940-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/18/2018] [Indexed: 12/15/2022]
Abstract
Obesity rates are rising worldwide. Executive function and delay discounting have been hypothesized to play important roles in the self-regulation of behavior, and may explain variance in weight loss treatment success. First, we compared individuals with obesity (n = 82) to healthy weight controls (n = 71) on behavioral and self-report measures of executive function (working memory, inhibition and shifting) and delay discounting. Secondly, the individuals with obesity took part in a multidisciplinary weight loss program and we examined whether executive function and delay discounting predicted weight change. Individuals with obesity displayed weaker general and food-specific inhibition, and weaker self-reported executive function. Better behavioral working memory and better self-reported inhibition skills in daily life were predictive of greater weight loss. As findings are correlational, future studies should investigate the causal relationship between executive function and weight loss, and test whether intervening on executive function will lead to better prevention and treatment of obesity.
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Affiliation(s)
- Fania C M Dassen
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Katrijn Houben
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Vanessa Allom
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Anita Jansen
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Hayes JF, Eichen DM, Barch DM, Wilfley DE. Executive function in childhood obesity: Promising intervention strategies to optimize treatment outcomes. Appetite 2018; 124:10-23. [PMID: 28554851 PMCID: PMC5702584 DOI: 10.1016/j.appet.2017.05.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022]
Abstract
Executive functions (EFs) are hypothesized to play a role in the development and maintenance of obesity due to their role in self-regulatory processes that manage energy-balance behaviors. Children with obesity have well-documented deficits in EF, which may impede effectiveness of current, evidence-based treatments. This review examines top-down EF processes (e.g., inhibitory control, working memory, cognitive flexibility), as well as bottom-up automatic processes that interact with EFs (e.g., attentional bias, delay discounting) and their relation to weight-loss treatment success in children. It then evaluates EF-related interventions that may improve treatment response. Empirical studies that included an intervention purported to affect EF processes as well as pre-post measurements of EF and/or relative weight in populations ages 19 or younger with overweight/obesity were reviewed. Findings indicate that poorer EF may hinder treatment response. Moreover, there is preliminary evidence that behavioral weight loss intervention and physical activity may positively affect EF and that improvements in EF are related to enhanced weight loss. Finally, novel intervention strategies, such as computer training of core EFs, attention modification programs, and episodic future thinking, show promise in influencing both EFs and EF-related skills and weight. Further research is needed to provide more conclusive evidence of the efficacy of these interventions and additional applications and settings should be considered.
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Affiliation(s)
- Jacqueline F Hayes
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, United States.
| | - Dawn M Eichen
- University of California, San Diego, 9500 Gilman Drive #0874, La Jolla, CA 92093, United States
| | - Deanna M Barch
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, United States
| | - Denise E Wilfley
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, United States
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Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 3:CD009728. [PMID: 29499084 PMCID: PMC5865125 DOI: 10.1002/14651858.cd009728.pub4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
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Affiliation(s)
- Anne Martin
- University of EdinburghCentre for Population Health SciencesMedical School, Teviot PlaceEdinburghUKEH8 9AG
- University of GlasgowMRC/CSO Social and Public Health Sciences Unit200 Renfield StreetGlasgowUKG2 3QB
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghEH8 8AQUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
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Hunter JA, Hollands GJ, Couturier DL, Marteau TM. Effect of snack-food proximity on intake in general population samples with higher and lower cognitive resource. Appetite 2018; 121:337-347. [PMID: 29183701 PMCID: PMC5768324 DOI: 10.1016/j.appet.2017.11.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/18/2017] [Accepted: 11/18/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Placing snack-food further away from people consistently decreases its consumption ("proximity effect"). However, given diet-related health inequalities, it is important to know whether interventions that alter food proximity have potential to change behaviour regardless of cognitive resource (capacity for self-control). This is often lower in those in lower socio-economic positions, who also tend to have less healthy diet-related behaviours. Study 1 aims to replicate the proximity effect in a general population sample and estimate whether trait-level cognitive resource moderates the effect. In a stronger test, Study 2 investigates whether the effect is similar regardless of manipulated state-level cognitive resource. METHOD Participants were recruited into two laboratory studies (Study 1: n = 159; Study 2: n = 246). A bowl of an unhealthy snack was positioned near (20 cm) or far (70 cm) from the participant, as randomised. In Study 2, participants were further randomised to a cognitive load intervention. The pre-specified primary outcome was the proportion of participants taking any of the snack. RESULTS Significantly fewer participants took the snack when far compared with near in Study 2 (57.7% vs 70.7%, β = -1.63, p = 0.020), but not in Study 1 (53.8% vs 63.3%, X2 = 1.12, p = 0.289). Removing participants who moved the bowl (i.e. who did not adhere to protocol), increased the effect-sizes: Study 1: 39.3% vs 63.9%, X2 = 6.43, p = 0.011; Study 2: 56.0% vs 73.9%, β = -2.46, p = 0.003. Effects were not moderated by cognitive resource. CONCLUSIONS These studies provide the most robust evidence to date that placing food further away reduces likelihood of consumption in general population samples, an effect unlikely to be moderated by cognitive resource. This indicates potential for interventions altering food proximity to contribute to addressing health inequalities, but requires testing in real-world settings. TRIAL REGISTRATION Both studies were registered with ISRCTN (Study 1 reference no.: ISRCTN46995850, Study 2 reference no.: ISRCTN14239872).
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Affiliation(s)
- Jennifer A Hunter
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
| | - Dominique-Laurent Couturier
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
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Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 1:CD009728. [PMID: 29376563 PMCID: PMC6491168 DOI: 10.1002/14651858.cd009728.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
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Affiliation(s)
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEDINBURGHUKEH8 8AQ
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Heinitz S, Reinhardt M, Piaggi P, Weise CM, Diaz E, Stinson EJ, Venti C, Votruba SB, Wassermann EM, Alonso-Alonso M, Krakoff J, Gluck ME. Neuromodulation directed at the prefrontal cortex of subjects with obesity reduces snack food intake and hunger in a randomized trial. Am J Clin Nutr 2017; 106:1347-1357. [PMID: 29046305 PMCID: PMC5698839 DOI: 10.3945/ajcn.117.158089] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/12/2017] [Indexed: 01/08/2023] Open
Abstract
Background: Obesity is associated with reduced activation in the left dorsolateral prefrontal cortex (DLPFC), a region of the brain that plays a key role in the support of self-regulatory aspects of eating behavior and inhibitory control. Transcranial direct current stimulation (tDCS) is a noninvasive technique used to modulate brain activity.Objectives: We tested whether repeated anodal tDCS targeted at the left DLPFC (compared with sham tDCS) has an immediate effect on eating behavior during ad libitum food intake, resulting in weight change, and whether it might influence longer-term food intake-related appetite ratings in individuals with obesity.Design: In a randomized parallel-design study combining inpatient and outpatient assessments over 31 d, 23 individuals with obesity [12 men; mean ± SD body mass index (BMI; in kg/m2): 39.3 ± 8.42] received 15 sessions of anodal (i.e., enhancing cortical activity) or sham tDCS aimed at the left DLPFC. Ad libitum food intake was assessed through the use of a vending machine paradigm and snack food taste tests (SFTTs). Appetite was evaluated with a visual analog scale (VAS). Body weight was measured. We examined the effect of short-term (i.e., 3 sessions) and long-term (i.e., 15 sessions) tDCS on these variables.Results: Relative to sham tDCS, short-term anodal tDCS did not influence ad libitum intake of food from the vending machines. Accordingly, no effect on short-term or 4-wk weight change was observed. In the anodal tDCS group, compared with the sham group, VAS ratings for hunger and the urge to eat declined significantly more (P = 0.01 and P = 0.05, respectively), and total energy intake during an SFTT was relatively lower in satiated individuals (P = 0.01), after long-term tDCS.Conclusions: Short-term anodal tDCS of the left DLPFC did not have an immediate effect on ad libitum food intake or thereby weight change, relative to sham tDCS. Hunger and snack food intake were reduced only after a longer period of anodal tDCS in individuals with obesity. This trial was registered at clinicaltrials.gov as NCT00739362.
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Affiliation(s)
- Sascha Heinitz
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | | | - Paolo Piaggi
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | | | - Enrique Diaz
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Emma J Stinson
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Colleen Venti
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Susanne B Votruba
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and
| | - Miguel Alonso-Alonso
- Laboratory of Bariatric and Nutritional Neuroscience, Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Marci E Gluck
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ;
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Effects of Moderate Exercise on Cortical Resilience: A Transcranial Magnetic Stimulation Study Targeting the Dorsolateral Prefrontal Cortex. Psychosom Med 2017; 79:143-152. [PMID: 27359179 DOI: 10.1097/psy.0000000000000361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The beneficial effects of exercise on the brain regions that support cognitive control and memory are well documented. However, examination of the capacity of acute exercise to promote cortical resilience-the ability to recover from temporary pertubation-has been largely unexplored. The present study sought to determine whether single session of moderate-intensity aerobic exercise can accelerate recovery of inhibitory control centers in the dorsolateral prefrontal cortex after transient perturbation via continuous theta burst stimulation (cTBS). METHODS In a within-participants experimental design, 28 female participants aged 18 to 26 years (mean [standard deviation] = 20.32 [1.79] years) completed a session each of moderate-intensity and very light-intensity exercise, in a randomized order. Before each exercise session, participants received active cTBS to the left dorsolateral prefrontal cortex. A Stroop task was used to quantify both the initial perturbation and subsequent recovery effects on inhibitory control. RESULTS Results revealed a significant exercise condition (moderate-intensity exercise, very light-intensity exercise) by time (prestimulation, poststimulation, postexercise) interaction (F(2,52) = 5.93, p = .005, d = 0.38). Specifically, the proportion of the cTBS-induced decrement in inhibition restored at 40 minutes postexercise was significantly higher after a bout of moderate-intensity exercise (101.26%) compared with very light-intensity exercise (18.36%; t(27) = -2.17, p = .039, d = -.57, 95% confidence interval = -161.40 to -4.40). CONCLUSION These findings support the hypothesis that exercise promotes cortical resilience, specifically in relation to the brain regions that support inhibitory control. The resilience-promoting effects of exercise have empirical and theoretical implications for how we conceptualize the neuroprotective effects of exercise.
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Pfeffer I, Strobach T. Executive Functions, Trait Self-Control, and the Intention-Behavior Gap in Physical Activity Behavior. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2017; 39:277-292. [PMID: 29064317 DOI: 10.1123/jsep.2017-0112] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many people fail to translate their physical activity intentions into behavior. This intention-behavior gap can be explained by (a) explicit trait self-control, (b) implicit executive functions, and (c) their interactions. In 118 participants, the intention-behavior gap was measured in a prospective design. Trait self-control was assessed via self-report questionnaires, whereas executive functioning was measured with test performance in inhibition, updating, and shifting at baseline. Regression analysis showed that (a) higher trait self-control predicts a smaller intention-behavior gap; (b) updating performance is related with this gap; and (c) behavior in tests on inhibition, updating, and shifting moderate the relation between the trait self-control and the intention-behavior gap. The present study showed that the complex pattern that modulates the relation between intended and realized physical activity behavior includes trait self-control, executive functions, as well as the combination of these cognitive components supporting dual-process approaches of self-control including implicit and explicit processing components.
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Toglia J, Lahav O, Ben Ari E, Kizony R. Adult Age and Cultural Differences in Performance on the Weekly Calendar Planning Activity (WCPA). Am J Occup Ther 2017; 71:7105270010p1-7105270010p8. [DOI: 10.5014/ajot.2016.020073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We compared performance on a cognitively demanding task, the Weekly Calendar Planning Activity, of participants in three age groups and two countries (United States and Israel).
METHOD. A sample of 375 U.S. and 433 Israeli healthy adults participated. During the activity, participants were observed for speed, accuracy, strategy use, and efficiency.
RESULTS. Accuracy scores were similar in both countries; however, Israeli participants were slower and less efficient (p < .05). The younger and middle-aged Israeli groups were more strategic and the older Israeli group followed fewer rules than the corresponding U.S. groups (p < .05). Older participants in both countries were less accurate, efficient, and strategic than younger participants (p < .05).
CONCLUSION. Limited strategy use and poor time allocation may contribute to difficulty managing cognitively demanding activities for older adults and may also be influenced by culture. Practitioners should consider these factors when screening people for occupational performance difficulties.
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Affiliation(s)
- Joan Toglia
- Joan Toglia, PhD, OTR/L, FAOTA, is Dean, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY;
| | - Orit Lahav
- Orit Lahav, PhD, OT, is Deputy Director, Occupational Therapy Department, Ono Academic College, Kiryat Ono, Israel
| | - Eynat Ben Ari
- Eynat Ben Ari, PhD, OTR, is Faculty, Department of Occupational Therapy, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Kizony
- Rachel Kizony, PhD, OT, is Senior Lecturer, Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel, and Research Occupational Therapist, Department of Occupational Therapy, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
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Case K, Guo Y, Nixon SJ, Muller K, Huo T, Prather R, Morris H, Stoner D, Shenkman E. Exploring the Role of Executive Functioning Capacity in Patient Activation and Health Outcomes Among Medicaid Members With Multiple Comorbidities. Med Care Res Rev 2017; 76:444-461. [DOI: 10.1177/1077558717709419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient activation, the perceived capacity to manage one’s health, is positively associated with better health outcomes and lower costs. Underlying characteristics influencing patient activation are not completely understood leading to gaps in intervention strategies designed to improve patient activation. We suggest that variability in executive functioning influences patient activation and ultimately has an impact on health outcomes. To examine this hypothesis, 440 chronically ill Medicaid enrollees completed measures of executive functioning, patient activation, and health-related quality of life. Mediation analyses revealed that executive functioning: (a) directly affected patient activation and mental health-related quality of life, (b) indirectly affected mental health-related quality of life through patient activation, and (c) was unrelated to physical health-related quality of life. These data indicate that further study of the relationships among neurocognitive processes, patient activation, and health-related quality of life is needed and reinforces previous work demonstrating the association between patient activation and self-reported outcomes.
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Affiliation(s)
| | - Yi Guo
- University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | - Dena Stoner
- Department of State Health Services, Austin, TX, USA
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