Executive function moderates the intention-behavior link for physical activity and dietary behavior

Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD)

BACKGROUND

Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment. Little is known about the specific features or processes underpinning education that are health protective. The objective of the current study was to address this gap by examining specific aspects of early education pertaining to student characteristics and experiences, as well as features of the classroom environment, in predicting cardiometabolic health in adulthood.

METHODS

Subjects were 1364 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD, 1991-2009) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE, 2018-2022). Models examined individual education indicators (student social skills, student-teacher relationship quality, and classroom emotional and instructional quality in the period of elementary school and student academic performance between ages 54 months and 15 years) in relation to a composite of cardiometabolic risk in adulthood (ages 26-31), reflecting central adiposity, blood pressure, insulin resistance, inflammation, and dyslipidemia. Models were adjusted for key explanatory factors including socio-demographics, infant characteristics, parental socioeconomic status (SES), and child health status. Follow-up analyses were performed to test potential mediators of early education effects on adult health, including adult SES (educational attainment, household income) and health behaviors (diet quality, activity level, sleep duration, smoking).

RESULTS

In adjusted models, results showed greater student social skills, indexed by a mean of annual teacher ratings between kindergarten and 6th grade, predicted lower cardiometabolic risk in adulthood (β=-0.009, p <.05). In follow-up analyses, results showed the protective effect of student social skills on cardiometabolic risk may be mediated by adult income (β=-0.0014, p <.05) and diet quality (β=-0.0031, p <.05). Effects of the other early education indicators were non-significant (ps > 0.05).

CONCLUSIONS

Findings point to the potential significance of early student social competence as a link to long-term health, possibly via the acquisition of resources needed for the maintenance of health, as well as through engagement in health behaviors supporting healthy eating. However, more research is needed to replicate these findings and to elaborate on the role of early student social competence and the pathways explaining its effects on cardiometabolic health in adulthood.

A biobehavioural and social-structural model of inflammation and executive function in pediatric chronic health conditions

Evidence indicates that pediatric chronic health conditions (CHCs) often impair executive functioning (EF) and impaired EF undermines pediatric CHC management. This bidirectional relationship likely occurs due to biobehavioural and social-structural factors that serve to maintain this feedback loop. Specifically, biobehavioural research suggests that inflammation may sustain a feedback loop that links together increased CHC severity, challenges with EF, and lower engagement in health promoting behaviours. Experiencing social and environmental inequity also maintains pressure on this feedback loop as experiencing inequities is associated with greater inflammation, increased CHC severity, as well as challenges with EF and engagement in health promoting behaviours. Amidst this growing body of research, a model of biobehavioural and social-structural factors that centres inflammation and EF is warranted to better identify individual and structural targets to ameliorate the effects of CHCs on children, families, and society at large. This paper proposes this model, reviews relevant literature, and delineates actionable research and clinical implications.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

Role of Cognitive Control in Psychotherapy: An Integrated Review

Background

Cognitive control (CC), including shifting, updating, and inhibiting functions, may play an integral role in various aspects of psychotherapy; however, research on this is limited. This review aims to link the disparate lines of evidence on CC as they relate to psychotherapy processes, techniques, and outcomes.

Methods

A systematic search of the literature on neuropsychological domains relating to psychotherapy in adults with anxiety/depression yielded 18 eligible studies. The review also uses a narrative format to explore other potential links between CC and psychotherapy that are underinvestigated, and highlights the need for research and application to evidence-based practice of psychotherapy.

Results and conclusions

Findings suggest that CC may predict psychotherapy outcomes and also improve as a function of psychotherapy. Analog sample studies suggest a possible link between CC and techniques for regulation of cognition and emotion, such as reappraisal, mindfulness, and cognitive restructuring. CC may also play an integral role in the regulation of behavior. Study of CC in the context of psychotherapy may potentially explain individual differences in psychotherapy outcomes and mechanisms of action of various psychotherapy techniques and processes. Such an understanding may have possible implications for "best fit" matching clients to therapies and modifying psychological interventions to account for poorer CC abilities. CC may be enhanced through training and further research is warranted on the impact of such training in facilitating better long-term psychotherapy outcomes.

Modern health worries and annoyance from environmental factors are largely unrelated to smoking, alcohol consumption, and physical activity

OBJECTIVE

Modern health worries, as well as environmental annoyance from chemical agents, noise, and electromagnetic exposure are associated with symptom reporting and marked affective-behavioural changes. As promotion and protection of health is a primary characteristic of these conditions, it can be expected that they will be related to less risk behaviour (smoking and alcohol consumption) and more health behaviour (physical activity), both cross-sectionally and longitudinally.

METHODS

Hypotheses were tested in a sample of 2336 individuals participating in T1 and T2 data collection (3 years apart) of the Västerbotten Environmental Health Study, Sweden. Health-related behaviours were assessed using single self-report questions. Smoking was measured on a binary (yes-or-no) scale; frequency of alcohol consumption and physical activity was measured on a 5-point and a 4-point scale, respectively.

RESULTS

Modern health worries showed no cross-sectional association with the three behaviours, whereas annoyance was typically inversely, very weakly, related to smoking and alcohol consumption. Physical activity was significantly positively associated only with chemical annoyance. None of the variables significantly predicted change of behaviours at T2 after controlling for the respective T1 value and demographic variables.

CONCLUSIONS

Individuals with high levels of modern health worries and annoyance from various environmental agents are not clearly characterized by a healthier lifestyle. Perhaps they focus on the alleviation of their existing symptoms; alternatively, somatic symptom distress decreases their cognitive-affective resources necessary for a long-term life style change.

The Insidious Influence of Stress: An Integrated Model of Stress, Executive Control, and Psychopathology

Although exposure to acute stress undoubtedly contributes to psychopathology, most individuals do not develop psychopathology following stress exposure. To explain this, biological, emotional, and cognitive responses to stress have been implicated, but individual differences in executive control (i.e., top-down control of cognition and behavior) measured in response to stress has only recently emerged as a potential factor contributing to psychopathology. In this review, we introduce a model-the integrated model of stress, executive control, and psychopathology-positing how the impairing effects of acute stress on executive control can contribute to psychopathology. We link to research on biological, emotional, and cognitive processes, all of which can be impacted by executive control, to propose a framework for how poorer executive control under conditions of acute stress can contribute to psychopathology. This integrated model is intended to further our understanding of who is more susceptible to the negative consequences of stress.

Executive functioning as a moderator of flossing behaviour among young adults: a temporal self-regulation theory perspective

Background

Flossing among young adults is often infrequent and barriers not completely understood. One explanation concerns the capacity for executive functioning (EF) during the self-regulation of behaviour.

Methods

Using Temporal Self-Regulation Theory (TST) as a framework to explore EF, young adults from Norwegian universities completed a survey that measured monthly flossing frequency, flossing-related intentions and behavioural prepotency (BP), and EF using the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A).

Results

Data from 362 participants were analysed. The TST-model explained a substantial proportion of variance in monthly flossing (R2 = 0.74), and flossing was associated directly with intention and BP, and interactions between intention and both BP and global-EF. Sub-domains of EF were explored using the same model, revealing that behavioural regulation processes, specifically those related to emotional control and shifting between tasks, offered better fit. Simple slopes revealed that moderation effects were only present at lower levels of BP.

Conclusion

EF plays a role in moderating the translation of intentions into flossing behaviour. Specifically, emotional control and task-shifting appear to be influential, and this influence increases when habitual and environmental support (i.e. BP) is reduced. Overcoming EF-barriers may represent a key step in establishing flossing behaviours.

Prospective Effects of Discrimination, Depressive Symptoms, and Cognitive Control Among Mexican-Origin Women

OBJECTIVES

Cognitive control predicts functional independence and cognitive health outcomes, but is yet to be known the extent to which social stress, like discrimination, may diminish cognitive control capacities in Mexican-origin women. We evaluated the prospective associations between everyday and ethnic discrimination on cognitive control and examined the mediating effects of depressive symptoms on these links. We further examined the extent to which associations varied by age and financial strain.

METHODS

We used data from 596 Mexican-origin women (average age = 38.89, standard deviation = 5.74) who participated in a 3-wave longitudinal study spanning 8 years (from 2012 to 2020). Participants completed measures of everyday and ethnic discrimination at Wave 1, depressive symptoms in Waves 1 and 2, and completed computer-based tasks of cognitive control at Wave 3. Self-reported assessments of financial strain were completed at Wave 2. Moderated mediation structural equation models were implemented to test hypotheses.

RESULTS

Depressive symptoms significantly mediated the prospective association between everyday/ethnic discrimination to cognitive control. Higher levels of everyday and ethnic discrimination at baseline were associated with more depressive symptoms at Wave 2, which were then related to poorer cognitive control (i.e., longer reaction time in congruent and/or incongruent trials) at Wave 3. There was no significant moderation of age. Among those with low financial strain, higher levels of everyday discrimination were related to faster response times.

DISCUSSION

Results revealed the long-term consequences of experiences with discrimination on cognitive control that operate through increased depressive symptoms and that may have some subtle differential effects across levels of financial strain.

Associations Among PTSD, Cognitive Functioning, and Health-Promoting Behavior in Post-9/11 Veterans

INTRODUCTION

PTSD is associated with negative health behaviors that increase chronic disease risk, yet health behaviors and their determinants are not well investigated in this context. One understudied mechanism of health behaviors is cognitive functioning. Deficits in cognitive functioning may undermine engagement in health-promoting behavior, thereby increasing the negative impact of PTSD. We tested three hypotheses: (1) Greater PTSD symptom severity is associated with less health-promoting behavior; (2) greater PTSD symptom severity is associated with poorer cognitive functioning across verbal memory, processing speed, attention, and executive functioning domains; and (3) verbal memory and executive functioning exhibit indirect effects on the relationship between PTSD and health-promoting behavior.

MATERIALS AND METHODS

We examined associations between PTSD symptom severity (Clinician-Administered PTSD Scale for DSM-IV), cognitive functioning, and health-promoting behavior (Health-Promoting Lifestyle Profile II) in 124 post-9/11 veterans (average age = 37.82; 85.5% male; 63.7% White; 18.5% Black; 26.6% Hispanic). Cognitive domains examined included verbal memory (California Verbal Learning Test), processing speed (Digit Symbol Coding), attention and working memory (Digit Span), and executive functions (Trail Making Test and Stroop Interference).

RESULTS

Regression analyses indicated that greater PTSD symptom severity was associated with less health-promoting behavior (B = -.0101, SE = 0.0016, P < .0001; R2 = 0.3052). Path analyses revealed that verbal learning and memory partially accounted for this relationship (R2 = 0.037- 0.043; P < .05).

CONCLUSIONS

Therapeutic targeting of these relationships may have implications for the prevention of long-term disease impact in veterans; longitudinal research is needed to elucidate the potential impact on chronic disease.

Executive Functioning, Daily Self-Regulation, and Diabetes Management while Transitioning into Emerging Adulthood

BACKGROUND

Executive functioning (EF) predicts better Type 1 diabetes (T1D) management in the high-risk years after high school, but the daily self-regulation processes involved are unclear.

PURPOSE

To examine whether EF is associated with daily self-regulation that minimizes one's exposure or buffers adverse reactions to daily diabetes problems, and to determine whether these patterns become stronger during the transition out of high school.

METHODS

A measurement burst design with convenience sampling was used. Seniors in high school with T1D (N = 207; 66% female) completed self-report (i.e., Behavioral Rating Inventory of Executive Functioning) and performance measures of EF (i.e., Delis-Kaplan Executive Function System). A 14-day daily diary assessing self-regulation failures, diabetes problems, affect, and indicators of diabetes management was completed at baseline and 1 year later.

RESULTS

Correlations and multilevel modeling were conducted. Lower self-reported EF problems were associated with lower average levels of daily self-regulation failures, and these variables were associated with fewer daily diabetes problems. In contrast, better EF performance was unrelated to average daily self-regulation failures, and was unexpectedly associated with more frequent diabetes problems in year 2. Equally across years, on days participants reported lower than their average levels of daily self-regulation failures, they had fewer diabetes problems, regardless of EF. On days with lower than average diabetes problems, participants reported better diabetes management indicators. EF generally did not buffer daily associations in either year.

CONCLUSIONS

Regardless of EF, promoting daily self-regulation may prevent diabetes problems and promote T1D management in daily life at this high-risk transitional time.

Dissemination, Implementation, and Evaluation of an Effective School-Based Intervention to Promote Physical Activity in Adolescents: A Study Protocol

Adolescents around the world do not engage in sufficient physical activity and the Spanish context is no exception. Understanding the educational context as a complex system, school-based multi-level and multi-component interventions seem to be an effective strategy to reverse this trend. Moreover, a co-creational approach seems to facilitate the mobilization of community partnerships and the engagement of stakeholders in the intervention process. This study aims to describe the dissemination, implementation, and evaluation process of an effective school-based intervention program in another setting using the replicating effective programs framework and a co-participatory approach. This study will be conducted in two Spanish secondary schools located in the region of Aragon (experimental vs. control school) in a sample of adolescents in the second grade (13–14 years old). To evaluate the effectiveness, different health behaviors such as physical activity, sleep, sedentary time with screens, nutrition, and psychosocial variables will be quantitatively measured at baseline and after the implementation of the intervention. Qualitative methods will also be used to better understand the implementation process and the co-creation approach, as well as to provide insights into the sustainability of the intervention program. The current study has the potential to provide strong information about the dissemination, implementation, and evaluation process of school-based programs to promote healthy behaviors among adolescents.

A Study on the Localization of Urban Residents' Recreation: A Moderated Mediation Model Based on Temporal Self-Regulation Theory

The pandemic has resulted in a further reduction in travel distance, recreational radius of destinations and other levels of tourism activity, making "local people traveling locally" a new feature. From the perspective of localization of urban residents' recreation, this paper describes a moderated mediation model based on temporal self-regulation theory. Five representative urban parks in Beijing were selected as study areas, and data collected through a questionnaire were used to discuss the behavioral characteristics of localized recreation and the formation mechanism of sense of place among urban residents in Beijing. The results showed that: (1) connectedness beliefs and temporal valuations positively influenced sense of place, and had a positive indirect effect on sense of place through the mediating role of recreation involvement; (2) recreation benefits positively influenced sense of place; (3) recreation benefits reinforced the direct and mediating role of recreation involvement. Based on these findings, the paper concludes with a discussion of the theoretical value and practical implications, as well as future research directions for park and city management.

Do executive functions predict physical activity behavior? A meta-analysis

BACKGROUND

Executive functions (EFs) are important determinants of health behaviors. In the present study, a meta-analysis was conducted to investigate the relationship between EFs and physical activity (PA) behavior.

METHODS

Systematic searches were carried out in PsycInfo, MEDLINE, and SPORTDiscus databases throughout April 2021. Prospective empirical studies conducted with general healthy populations across the lifespan, which reported the relationship between baseline EFs and later PA behavior were selected.

RESULTS

Eight studies were found eligible. Results of the multilevel meta-analysis revealed a small but significant total effect size for EFs on PA behavior of z = 0.12. High heterogeneity was observed among studies. When potential moderators were tested, residual heterogeneity remained significant and the effects of the moderators were not significant. The effect size dropped when accounted for publication bias.

CONCLUSIONS

Despite limitations, the study provided evidence for EFs' determinant role on PA behavior. More research is however encouraged to inform PA promotion programs that are well-prepared for individual differences in EFs.

Youth pre-pandemic executive function relates to year one COVID-19 difficulties

Introduction

The first year of the COVID-19 pandemic presented a series of stressors that could relate to psychological difficulties in children and adolescents. Executive functioning (EF) supports goal achievement and is associated with life success, and better outcomes following early life adversity. EF is also strongly related to processing speed, another predictor of life outcomes.

Methods

This longitudinal study examined 149 youths' pre-pandemic EF and processing speed abilities as predictors of self-reported emotional, cognitive, and social experiences during the first year of the COVID-19 pandemic. EF and processing speed were measured with a total of 11 behavioral tasks. The COVID-era data was collected during two timepoints, during early (May-July 2020) and mid- (January-March of 2021) pandemic.

Results

Better pre-pandemic EF skills and processing speed abilities predicted more mid-COVID-19 pandemic emotional and cognitive difficulties. On the other hand, better switching (a subcomponent of EF) and processing speed abilities predicted more mid-pandemic social interactions. EF and processing speed abilities did not relate to the well-being reports from the initial months of the pandemic. Our EF - but not processing speed - results were largely maintained when controlling for pre-pandemic mental health burden, socioeconomic status (SES), and gender.

Discussion

Better cognitive abilities may have contributed to worse mid-pandemic functioning by supporting the meta-cognition needed for attending to the chaotic and ever-changing pandemic news and advice, leading to higher stress-induced worry and rumination. Our study highlights a potential downside of higher EF - often largely viewed as a protective factor - in youth.

Using an integrated model of the theory of planned behavior and the temporal self-regulation theory to explain physical activity in patients with coronary heart disease

Background

This study aimed to explore the psychosocial determinants of the physical activity (PA) levels in patients with coronary heart disease (CHD) using an integrated theoretical model based on the theory of planned behavior (TPB) and the temporal self-regulation theory (TST).

Method

This was a prospective study conducted at the Affiliated Hospital of Hangzhou Normal University, Zhejiang, China. A total of 279 patients with CHD [176 men aged 26-89 years, mean (M) = 64.69, standard deviation (SD) = 13.17] were selected under the study inclusion criteria by convenience sampling. The data on attitude, subjective norm (SN), perceived behavioral control (PBC), and intention variables for the TPB model and consideration of future consequences (CFC), habit, and self-control (SC) variables for the TST model were collected 1-2 days before the discharge (Time 1, T1) of the participants, and a telephone follow-up was made to assess the participants' self-reported PA levels 1 week after their discharge (Time 2, T2).

Results

The results revealed that only 39.8% of the patients with CHD met the guidelines' recommendations on PA. The data analyses using structural equation modeling (SEM) in the Mplus 8.3 modeling program showed that, in the simple mediation model, attitude, PBC, and CFC were positively related to the intention to practice guideline-recommended levels of PA but SN was not. In addition, intention was shown to mediate the relationships between attitude, PBC, CFC, and PA levels. Furthermore, based on the moderated mediating model, intention and habit were shown to be positively associated with PA levels but SC was not. Moreover, SC played a significant moderating role between intention and PA levels. However, habit strength did not moderate the relationship between intention and PA levels.

Conclusion

An integration of the TPB and TST models offers a good theoretical tool for understanding PA levels in patients with CHD.

Impact of Non-Pharmacological Interventions on the Mechanisms of Atherosclerosis

Atherosclerosis remains the leading cause of mortality and morbidity worldwide characterized by the deposition of lipids and fibrous elements in the form of atheroma plaques in vascular areas which are hemodynamically overloaded. The global burden of atherosclerotic cardiovascular disease is steadily increasing and is considered the largest known non-infectious pandemic. The management of atherosclerotic cardiovascular disease is increasing the cost of health care worldwide, which is a concern for researchers and physicians and has caused them to strive to find effective long-term strategies to improve the efficiency of treatments by managing conventional risk factors. Primary prevention of atherosclerotic cardiovascular disease is the preferred method to reduce cardiovascular risk. Fasting, a Mediterranean diet, and caloric restriction can be considered useful clinical tools. The protective impact of physical exercise over the cardiovascular system has been studied in recent years with the intention of explaining the mechanisms involved; the increase in heat shock proteins, antioxidant enzymes and regulators of cardiac myocyte proliferation concentration seem to be the molecular and biochemical shifts that are involved. Developing new therapeutic strategies such as vagus nerve stimulation, either to prevent or slow the disease’s onset and progression, will surely have a profound effect on the lives of millions of people.

Individual Differences in Germ Spreading Behaviors Among Children With Attention-Deficit/Hyperactivity Disorder: The Role of Executive Functioning

OBJECTIVE

Infectious diseases, such as coronavirus disease 2019 (COVID-19), are commonly transmitted by respiratory droplets and contact with contaminated surfaces. Individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to be infected with COVID-19 and experience more hospitalizations than individuals without ADHD. The current study investigated the role of ADHD symptomatology and executive functioning (EF) in germ spreading behavior frequency among young children with and without ADHD and parenting responses to these behaviors.

METHODS

Participants included 53 children diagnosed with ADHD and 47 typically developing (TD) children between the ages of 4-5 years (76% male; Mage = 4.62; 86% Hispanic/Latinx). Parents and teachers reported on children's ADHD symptomatology and children completed three EF tasks. Germ spreading behavior frequency (direct contact of hand to face and toy in mouth) and parenting responses (verbal and nonverbal behaviors) were observed during a 5-min parent-child play situation.

RESULTS

Negative binomial regression analyses indicated that both ADHD diagnostic status and poor metacognition predicted both higher rates of toy to mouth (β = 1.94, p < .001; β = 0.03, p = .004) and face touching frequency (β = 0.60, p = .03; β = 0.03, p = .004), respectively. Additionally, poor attention and worse cognitive flexibility only predicted higher rates of toy to mouth frequency (β = 0.09, p < .001; β = -0.04, p = .001), respectively.

CONCLUSIONS

Young children with ADHD are at high risk for spreading germs via putting toys in their mouth and touching their face. Particularly, high levels of inattention and poor EF appear to be associated with higher rates of germ spreading behaviors.

Validity test of the theory of planned behavior in college students’ withdrawal from smartphone dependence

Smartphone usage has brought great convenience to our daily life. However, the detrimental consequences of smartphone dependence also require special attention. Based on the theory of planned behavior (TPB), this study designed a questionnaire to investigate college students’ withdrawal from smartphone dependence. The reliability and validity of the questionnaire were tested. The results showed that the reliability of the questionnaire was good (α = 0.84–0.94). The principal component analysis was conducted, contribution rates of these factors were moderately high (62.06%–82.35%). The validity was verified through confirmatory factor analysis. All the model fit indices were higher than the acceptable standard, which indicated the construct validity of the TPB questionnaire is good. The results of the multi-group structural equation model revealed that the model provided excellent fit to the data in each demographic group. The results of structural equation model presented that, in most demographic groups, students’ attitude, subjective norm, and perceived behavioral control of withdrawal from smartphone dependence positively influenced their behavioral intention. Furthermore, subjective norm was the most effective predictors in each group. However, part of the paths from intention to behavior failed to reach the significant level, and their coefficients are relatively small. This reveals the gap between college students’ withdrawal intention and their actual behavior, and there may be other factors influence the relationship between the two variables.

The Role of Executive Function in the Effectiveness of Multi-Component Interventions Targeting Physical Activity Behavior in Office Workers

A knowledge gap remains in understanding how to improve the intervention effectiveness in office workers targeting physically active (PA) behavior. We aim to identify the modifying effect of executive function (EF) on the intervention effectiveness targeting PA-behaviors, and to verify whether the observed effect varies by Job Demand Control (JDC) categories. This workplace-based intervention study included 245 participants who were randomized into a control group and two intervention arms-promoting physical activity (iPA) group or reducing sedentary behavior (iSED) group. The interventions were conducted through counselling-based cognitive behavioral therapy and team activities over 6 months. PA-behaviors were measured by an accelerometer. EF was assessed by the Trail Making Test-B, Stroop, and n-back test. The JDC categories were measured by the demand control questionnaire. Higher EF level at baseline was significantly associated with the intervention effect on increased sleep time (β-coefficient: 3.33, p = 0.003) and decreased sedentary time (-2.76, p = 0.049) in the iSED-group. Participants with active jobs (high job demands, high control) presented significantly increased light-intensity PA in the iSED-group in comparison to the control group. Among participants with a high level of EF and active jobs, relative to the control group, the iPA-group showed a substantial increase in light-intensity PA (1.58, p = 0.036) and the iSED-group showed a tendency of reducing sedentary behavior (-5.35, p = 0.054). The findings suggest that office workers with a high EF and active jobs may benefit most from an intervention study targeting PA-behaviors.

Healthy eating behaviors and self-control in scarcity: The protective effects of self-compassion

Maintaining healthy eating habits requires self-control and this process can become unsuccessful in certain stressful situations (e.g., economic scarcity). This study tested whether self-compassion can buffer the negative impacts of economic scarcity on healthy eating behaviors and self-control. In the correlational Study 1 (n = 304) based on self-reports, a mediating effect of self-control between economic scarcity and healthy eating behaviors was found in females but not males, and that self-compassion moderated the direct relationship between economic scarcity and healthy eating behaviors in females. No significant moderated mediation effect was found. In Study 2, female participants (n = 113) completed economic scarcity (ES) (or abundance) and self-compassion (SC) (or writing-control (WC)) manipulations and a food-selection task. The ES + WC group chose more high-calorie food than the economic abundance (EA) + WC group and the ES + SC group, and the EA + SC group also selected more high-calorie food compared with the EA + WC group and the ES + SC group. In Study 3 (n = 136), similar manipulations and a dot-mixed task were used to measure self-control, and the ES + SC group showed higher accuracy than the ES + audio-control (AC) group at a trend level. These findings support the protective role of self-compassion in healthy eating behaviors and self-control impairments resulted from economic scarcity, which offer promise for promoting healthy lifestyles among individuals living in scarcity.

The role of environmental cues in sugar-sweetened beverage consumption using a temporal self-regulation theory framework

Sugar-sweetened beverage consumption is related to adverse health outcomes such as obesity and Type 2 diabetes. The present research further examined the utility of the temporal self-regulation theory in predicting sugar-sweetened beverage consumption. In addition, the research aimed to identify salient cues that trigger intake. Two-hundred and eighty-seven participants were recruited using convenience sampling in US and Australian populations. Hierarchical multiple regression analyses were used, and the final model accounted for 27.1% of the variance in consumption, providing partial support for the temporal self-regulation theory (ƒ² = 0.37). Intention accounted for a significant 7.0% of variance (R² = 0.07, p < .001), behavioural prepotency variables (past behaviour, habit, and cues) together combined for an additional 15.1% of variance (R² = 0.15, p < .001), but neither measure of self-regulatory capacity (trait self-control, inhibition) was a significant predictor. No cues emerged as unique predictors, however the findings suggest that consumption may be influenced by a combination of cues across different situations. Behavioural prepotency moderated the intention-behaviour relationship such that as behavioural prepotency increased, the greater the influence intention had on behaviour. Further support for the role of both intention and automatic processes in sugar-sweetened beverage consumption was garnered, but more research is needed to identify when specific cues influence consumption most.

Predicting Physical Activity Behavior by Automatic and Reflective Self-Regulatory Processes

In this study, we examined the interaction of automatic (i.e., automatic affective evaluations) and reflective [i.e., reflective intention and executive functions (EFs)] processes on physical activity (PA) behavior based on dual-process theories. We expected main effects as well as significant interaction effects between automatic associations, intention, and EFs on behavior. In particular, a well-controlled implicit-association-test (IAT) was applied to assess automatic affective evaluation. A prospective study with two points of measurement (N=212 students) was conducted. At t1, age, sex, PA behavior (control variables), automatic associations, EFs (shifting, updating, inhibition), and PA intention (predictors and moderators) were assessed with standardized questionnaires and tests. At t2 (4weeks later), PA behavior (dependent variable) was measured with a standardized questionnaire. A hierarchical multiple linear regression analysis including two- and three-way interactions between IAT results, intention, and EFs on PA behavior was conducted. Results showed that the interactions Intention x Shifting and IAT x Intention x Inhibition were significant. Moderation analyses revealed that participants with higher intentions and lower inhibition values (improved inhibition abilities) showed a negative association between IAT and PA, while those with lower intentions and lower inhibition values showed a positive association between IAT and PA, which was documented in a significant slope difference test between these two groups. Thus, both automatic and reflective processes contribute and interact in predicting PA. As well as fostering more positive affective evaluations towards PA, interventions to strengthen PA intentions and to improve EFs could help to increase PA behavior.

Improving Serious Games to Tackle Childhood Obesity

Childhood obesity has become a global public health issue. Today, there are opportunities to promote health through technological devices such as serious games. Despite the major advancement of this field of research, the use of serious games as a validated intervention in clinical practice requires further clarifications on some methodological aspects. In this perspective article, we report the pros and cons of existing serious games. Besides, we attempt to propose a new methodology of design of a serious game that could help to cope with childhood obesity. The proposed idea consists of a serious game in virtual reality based on enjoyment, movement, education, and executive functioning (EF) training. Longitudinal studies and solid research protocol would certainly ensure consistency and aid interpretation.

Preexisting Executive Function Deficits and Change in Health Behaviors During the COVID-19 Pandemic

BACKGROUND

Executive functions (EF) support engagement in goal-directed behaviors, including several health behaviors. Stressful and cognitively demanding events can disrupt EFs and interfere with health behavior, possibly to a greater extent in those with preexisting EF deficits. This study examined the association between preexisting EF deficits and subsequent negative changes in eating patterns, physical activity, sedentariness, and alcohol/substance use during the COVID-19 pandemic.

METHOD

Participants were 374 young adults in a follow-up study of the longitudinal, multisite Study of Early Child Care and Youth Development (SECCYD). Preexisting EF deficits were assessed with the Barkley Deficits in Executive Function Scales-Short Form, and personally impactful negative changes in four health behaviors (physical activity, unhealthy eating, sedentary time, alcohol/substance use) during the COVID-19 pandemic were subsequently assessed with the Epidemic-Pandemic Impacts Inventory.

RESULTS

In ordered logistic regression models, higher preexisting total EF deficits were associated with greater negative impactful changes in physical activity and unhealthy eating, independent of sociodemographic variables, obesity, and (as relevant) accelerometer-based physical activity and pre-COVID-19 diet quality. Socioeconomic status moderated the association between total EF deficits and impactful change in alcohol/substance use, with EF deficits linked to greater impactful change in alcohol/substance use only in higher socioeconomic strata.

CONCLUSION

Individuals with preexisting EF deficits appear more vulnerable to the negative impact of the COVID-19 pandemic on several key health behaviors. As the pandemic unfolds, strategies may be needed to identify those with EF deficits (e.g., screening tools) and provide them with tailored support for chronic disease risk reduction.

Pilot Trial of Acceptance-Based Behavioral Weight Loss and Neurocognition Among American Indians

Acceptance-based behavioral therapies (ABTs) for obesity may be superior to standard behavioral therapies but have not been adequately tested with American Indians (AIs). Neurocognitive function is also unexamined in relation to behavioral weight loss among AIs despite findings that neurocognition predicts outcomes in general samples, may help explain some of the benefits of ABTs, and may be relevant to marginalized groups. The primary objective of this pilot was to examine the feasibility/acceptability of ABT in an AI sample. Exploratory analyses examined the relationship between neurocognition and weight loss. Forty-eight AI adults with overweight/obesity (ages 43.3 ± 10.3 years, 85% female; baseline body mass index = 36.8 ± 4.4 kg/m²) enrolled in a 6-month open ABT weight loss trial. Feasibility indices, including screening/enrollment, session attendance, retention rates for posttreatment assessments, and program acceptability were examined. Percent weight loss (%WL) was assessed as well as fluid and crystalized neurocognition (National Institutes of Health Toolbox Cognition Battery [NIHTB-CB]). We enrolled 79% of the eligible sample and retained 75% (N = 36) at posttreatment assessments. Program completers lost an average of 5.2 ± 4.9% of initial body weight (d_z = 1.14), whereas intent-to-treat analyses show a mean loss of 4.1 ± 4.7%. Participants reported high satisfaction, effectiveness, and cultural appropriateness. Exploratory analyses of neurocognitive domains suggested that crystalized cognition was higher among completers, and higher baseline cognitive flexibility predicted greater %WL (β = .34, p = .05). ABT resulted in clinically significant weight loss in an AI sample. A controlled trial of ABT in a larger, more diverse sample is warranted to determine whether (a) the findings are robust, generalizable, and/or superior to other treatments and (b) neurocognitive factors moderate outcomes.

Cognitive Function and Functional Mobility Predict Exercise Adherence in Older Adults Who Fall

INTRODUCTION

Strength and balance exercises prevent falls. Yet, exercise adherence is often low. To maximize the benefit of exercise on falls prevention, we aimed to identify baseline cognitive and mobility factors that predict adherence to the Otago Exercise Program (OEP) - a home-based exercise program proven to prevent falls.

METHODS

We conducted a secondary longitudinal analysis of data from a randomized clinical trial (RCT) (OEP compared with usual care) among 172 participants who were assigned to the OEP intervention of the RCT. Adherence to the OEP was calculated as a percent score (i.e., [frequency of strength and balance retraining session per week/3 strength and balance retraining sessions per week] × 100). Executive function (i.e., mental flexibility) was measured using the Trail Making Tests (Part A and B: TMT B - TMT A) and the Digit Symbol Substitution Test (DSST). Short-term memory and encoding was measured using the Verbal Digits Forward test. Executive function (i.e., inhibition and working memory) was measured using the Stroop Color-Word Test and the Verbal Digits Forward minus Verbal Digits Backward test. Mobility was assessed using the Short Performance Physical Battery and the Timed Up and Go test. We used general estimation equations analysis to determine the predictors of adherence to the OEP.

RESULTS

Better set shifting (β = -0.06, z = -2.43, [SE = 0.02] p = 0.018] predicted greater OEP adherence. Greater attention and short-term memory (β = -6.99, z = -2.37 [SE = 2.95]) predicted poorer OEP adherence. Response inhibition, processing speed, working memory, and mobility assessed by the SPPB were not associated with adherence. Poorer baseline Timed Up and Go (β = 1.48 z = 1.94, [SE = 0.76]; p < 0.001), predicted better OEP adherence.

CONCLUSION

Specific cognitive processes (i.e., executive function of set shifting, attention, and short-term memory) and functional mobility predicted exercise adherence. Further research needs to explore the pathways that explain why better attention and short-term memory predicted lower adherence and why poorer functional mobility led to better OEP adherence.

A 'case-mix' approach to understand adherence trajectories for a falls prevention exercise intervention: A longitudinal cohort study

OBJECTIVE

We identified adherence-based case-mixes from participants' longitudinal adherence to falls prevention exercise interventions over 12 months. Second, we identified modifiable baseline predictors (cognition, mobility and functional status) based on participants' case-mix adherence trajectories.

STUDY DESIGN AND OUTCOME MEASURES

This study was a 12-month longitudinal secondary analysis of data from 172 participants who received the Otago Exercise Program (OEP) in a randomized controlled trial. Adherence to the OEP was ascertained monthly via self-report. Case-mixes, groups of individuals who followed similar adherence trajectories, were visually defined using 12-month longitudinal trajectories; we used latent class growth modeling. Baseline predictors of adherence were examined for the following categories: 1) cognition, 2) mobility and 3) functional status.

RESULTS

Four distinct case-mixes were identified. The "non-adherent" case-mix (18 %) was distinguished by a non-adherent and decreasing adherence trajectory over time. The "low adherence" case-mix (45 %) did not have complete adherence or consistent adherence over the 12-month follow-up. The "moderate adherence" case-mix (27 %) was characterized by a stable (i.e., non-variable) adherence trajectory with a slightly increasing pattern at midpoint. The "high adherence" case-mix (10 %) demonstrated consistent and high adherence over the 12-month follow-up. For individuals with "moderate adherence", the Digit Symbol Substitution Test (DSST) significantly predicted adherence (relative risk ratio (RRR) = 1.12 (0.95 CI: 1.0-1.26); p = 0.049). For individuals with "high adherence", the Digits Forward minus Digits Backward (RRR = 0.43 (0.95 CI: 0.23-0.79); p = 0.002) and Instrumental Activities of Daily Living (RRR = 0.36 (0.95 CI: 0.16-0.81); p = 0.01) significantly predicted adherence.

CONCLUSIONS

Cognitive profile and activities of daily living at baseline may predict the longitudinal pattern of adherence.

Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series

PURPOSE

Despite varied treatment effects, weight recidivism is common and typically associated with the abandonment of prescribed weight management strategies. Literature suggests that difficulty with weight management is associated with deficits in executive functioning, in particular cognitive flexibility and response inhibition, the neurocognitive processes that are involved in goal-directed behaviours, such as dietary adherence. These processes are overlooked by mainstream weight loss programmes. The aim of the study was to assess the effectiveness of a cognitive remediation-enabled cognitive behaviour therapy (CR-CBT) in addressing the neurocognitive, psychological and behavioural correlates of weight loss. It was hypothesised that CR-CBT would improve cognitive flexibility and response inhibition, reduce binge eating, aid weight loss and improve metabolic health.

METHODS

Four adults with obesity (body mass index > 30 kg/m²) received 7 weeks of manualised CR-CBT and were assessed via a case series analysis at baseline, end of treatment and 3-month follow-up. Treatment included 3 weekly 90-min group-based behaviour weight loss sessions for 3 weeks, followed by twice-weekly 50-min individualised CR-CBT sessions for 4 weeks.

RESULTS

Cognitive remediation-enabled cognitive behaviour therapy produced improvements in response inhibition and cognitive flexibility, and reductions in binge eating frequency, weight, and metabolic health readings between baseline and 3-month follow-up.

CONCLUSIONS

This is the first study to assess the effectiveness of CR-CBT in the treatment of obesity. Preliminary indications of treatment success are discussed with respect to study limitations. In light of these results, we recommend further investigation via a randomised control trial (RCT).

LEVEL OF EVIDENCE

Level IV, case series.

Effects of adaptive and non-adaptive three-week executive control training on interference control: Evidence from the N2, CRN, and ERN

The current pilot study investigated if interference control can be improved by a three-week at-home training comprising a flanker and a n-back task in healthy adults, thus exploring the training's suitability for future clinical application, i.e. as a treatment augmentation for psychological disorders. As training gains are assumed to be modulated by the amount of mismatch between task demands and brain resources, an adaptive and a non-adaptive training were contrasted in separate experiments. In the adaptive training, task difficulty was continuously adapted to participants' performance. In the non-adaptive training procedure, task difficulty remained stable on the lowest difficulty level. As deficits in interference control in psychological disorders often predominantly manifest on the electrophysiological level, the impact of the training procedures on medio-frontal negativities (N2, CRN, ERN) was investigated in addition to behavioral measures. The adaptive training led to significant improvements in interference control, as reflected in reduced response times and error rates in incompatible trials. This was accompanied by specific and complementary changes in medio-frontal negativities: After the adaptive training the N2 in incompatible trials was larger and the CRN in incompatible trials was reduced. The non-adaptive training procedure led to generally faster response times but also an increased error rate, indicating a speed-accuracy trade-off. This was accompanied by global changes to medio-frontal negativities irrespective of compatibility, possibly indicating task disengagement. Taken together, the current studies demonstrate that an adaptive training procedure can improve interference control thereby opening up possible clinical applications.

Serial-multiple mediation of enjoyment and intention on the relationship between creativity and physical activity

The purpose of the present study was to examine a serial-multiple mediation of physical activity (PA) enjoyment and PA intention in the relationship between creativity and PA level (i.e., moderate-to-vigorous PA). A total of 298 undergraduate and graduate students completed a self-reported questionnaire evaluating creativity, PA enjoyment, PA intention, and PA level. Data analysis was conducted using descriptive statistics, Pearson correlation coefficient, ordinary least-squares regression analysis, and bootstrap methodology. Based on the research findings, both PA enjoyment (β = 0.06; 95% CI [0.003, 0.12]) and PA intention (β = 0.08; 95% CI [0.03, 0.13]) were found to be a mediator of the relationship between creativity and PA level, respectively. Moreover, the serial-multiple mediation of PA enjoyment and PA intention in the relationship between creativity and PA level was statistically significant (β = 0.02; 95% CI [0.01, 0.04]). These findings underscore the importance of shaping both cognitive and affective functions for PA promotion and provide additional support for a neurocognitive affect-related model in the PA domain. In order to guide best practices for PA promotion programs aimed at positively influencing cognition and affect, future PA interventions should develop evidence-based strategies that routinely evaluate cognitive as well as affective responses to PA.

Predicting the Students' Brain Executive Functions Based on Their Acculturation in Multicultural High Schools

Background: Executive functions as a group of complex mental processes and cognitive abilities necessary for our goal-directed behavior to control the skills. Acculturation is a process in which an individual acquires and adjusts to a new cultural environment. Objectives: The present study aimed to predict the ethnically diverse students’ brain executive functions based on their acculturation. Methods: In this correlational survey study, 1,019 high school students in the city of Kabodar Ahang, a multicultural city in Hamedan Province, are investigated. In total, 280 bilingual as ethnically diverse students were selected using a relative stratified random method. The Behavior Rating Inventory of Executive Functions (BRIEF) and Marin acculturation scale were used to collect data. The Pearson correlation coefficient, multiple regression, and step-by-step regression were employed to collect the data. Results: There is a positive association between acculturation and brain functions and inhibition components, task completion, working memory, and organization (P ≤ 0.001). In other words, increased students' acculturation leads to fostered brain executive functions in subscales of inhibition, task completion, working memory, and mental organization. Also, the multiple regression indicated that acculturation can predict 30% of the students' brain function variance. Conclusions: Teachers working in multicultural regions can use the findings of the present study to gain an appropriate understanding about students' individual differences according to their capacity of executive functions and organizing the process of learning based on their working memory and the complexity of the task.

Cognitive Training: Associations and Implications for Weight Management and Translational Research

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.

Mental contrasting with implementation intentions increases study time for university students

BACKGROUND

Goal setting is a core aspect of human behaviour that drives action. The intention to achieve one's goals, however, does not necessarily translate into desired outcomes. Although the mental contrasting with implementation intentions (MCII) strategy has demonstrated strong efficacy, limited investigations have been conducted in a university academic goal-setting context.

AIMS

The current study sought to investigate the efficacy of MCII in facilitating academic goal attainment in university students.

METHOD

Fifty-eight students from Macquarie University, Australia, were randomly allocated to either MCII or stress management training, and were assessed on their progress towards the target goal of increased hours of study four weeks later. Goal attainment scaling (GAS) facilitated the generation of tailored specific goals and was the primary outcome measure.

RESULTS

An analysis of covariance indicated that students trained in MCII achieved significantly better goal outcomes than those trained in stress management for both broad (p = .038) and course- or unit-specific (p = .005) study goals.

CONCLUSIONS

Results highlight the efficacy of using MCII and GAS in combination to promote increased study time for university students.

Influence of a Planning Intervention on Physical Activity Behavior: the Moderating Role of Intentions and Executive Functions in a Randomized Controlled Trial

Background

Planning and executive functions (EFs; inhibition, updating, shifting) are self-regulatory variables that help people to become and stay physically active. The aim of this study was to examine how and for whom a planning intervention affects physical activity (PA) behavior in the short term. Therefore, the mediating role of planning and the moderating role of intentions and EFs for the planning–behavior link were examined.

Method

In a randomized control trial with two treatment groups (planning group vs. control group) and two points of measurement (t1 and t2, 1 week apart), n = 200 students participated in both measurements. At t1, participants filled in standardized questionnaires assessing PA behavior, intention, and planning. Computer-based tests assessed the following EFs: inhibition, updating, and shifting. At t2, planning and PA behavior were measured again. Moderated mediation analyses were conducted.

Results

A significant increase in PA between t1 and t2 was found for the planning group compared with the control group. Furthermore, planning cognitions significantly mediated the effect of the planning group on behavior and intention, as well as the EF updating moderated the association between planning and behavior. Forming plans was particularly beneficial for participants with high intentions and lower updating performance.

Conclusion

Planning enhances PA behavior, particularly when PA intention is high. Poor performance in updating can be compensated by planning since encouraging people to generate plans might facilitate automatic enactment of the behavior.

C-Reactive Protein as a Possible Predictor of Trail-Making Performance in Individuals with Psychiatric Disorders

Cognitive dysfunction is a prominent feature of psychiatric disorders. Studies have shown that systemic low-grade inflammation is crucial in the development of cognitive deficits across psychiatric disorders. The aim of this study was to further examine the role of inflammation and inflammatory mediators in cognitive function in psychiatric disorders. This study included 364 inpatients (53% females) with International Classification of Diseases (ICD)-10 F3 (affective disorders) and F4 (neurotic, stress-related, and somatoform disorders) diagnoses. The mean age was 52 years (22 to 69 years) and the median body mass index was 27.6. Cognitive function was assessed with the Color–Word Interference Test after Stroop and the Trail-Making Test A/B. Multiple linear regression models were calculated to assess the predictive value of C-reactive protein and the kynurenine/tryptophan ratio on cognitive function controlling for age, sex, education, premorbid verbal intelligence quotient, illness duration, depressive symptoms, and obesity-related parameters (e.g., body mass index, high-density lipoprotein). Our data confirm that in patients with psychiatric disorders, C-reactive protein serum concentration is a relevant and important predictor of Trail-Making Test B performance, measuring cognitive flexibility. The effect size of this association did not change much after adding clinical and metabolic variables into the regression model. The kynurenine/tryptophan ratio was not related to cognitive test scores. The involvement of C-reactive protein as a peripheral inflammatory marker in cognitive flexibility and psychomotor processing speed in psychiatric illness can be concluded.

Episodic future thinking, delay discounting, and exercise during weight loss maintenance: The PACE trial

OBJECTIVES

Weight loss maintenance (WLM) is the next major challenge in obesity treatment. While most individuals who lose weight intend to keep their weight off, weight regain is common. Temporal Self-Regulation Theory posits that whether intentions lead to behavior depends on self-regulatory capacity, including delay discounting (DD; the tendency to discount a larger future reward in favor of a smaller immediate reward). Episodic Future Thinking (EFT; mental imagery of a future event for which a health goal is important) may improve DD and promote behavior change. Described herein is a trial protocol designed to examine whether EFT improves DD within the context of weight loss maintenance.

METHOD

Participants who lose ≥5% of initial body weight in an online behavioral weight loss intervention will be randomly assigned to a standard weight loss maintenance program (WLM-STD) or a weight loss maintenance program plus EFT (WLM + EFT). Both interventions involve periodic phone and in-person treatment sessions. Participants in WLM + EFT will engage in daily EFT training via smartphone. To control for contact, participants in WLM-STD will engage in daily Healthy Thinking (reviewing strategies for weight management) on their smartphone. Our primary hypothesis is that WLM + EFT will yield better improvements in DD compared to WLM-STD. We will also explore whether DD mediates the relationship between intervention allocation and physical activity (secondary outcome). Weight and contextual variables will be explored.

CONCLUSIONS

This study is the first to test whether EFT improves DD within the context of weight loss maintenance; results from this experimental medicine approach could have important implications for understanding the impact of both EFT and DD on sustained behavior change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Linking Grazing to Inhibition and Goal-Directed Behaviour in Obesity With and Without Eating Disorder Features

Recent models of obesity and eating behaviour have implicated both automatic responding to food-related cues and executive functioning in driving dietary choice. This study aimed to relate grazing severity to high weight with and without significant eating disorder features via the effects of inhibition and degree of goal-directed behaviour, in persons with obesity with and without significant eating disorder features compared to healthy controls. Forty-four participants with obesity (43.1% endorsing marked eating disorder features), and 43 healthy-weight age- and sex-matched participants (N = 87; 67.8% female, age = 28.57 (8.70; 18.18–58.34) years, BMI = 29.18 (7.80; 18.65–51.95) kg/m2) completed demographic and eating disorder-related questionnaires, a neuropsychological task of inhibition and an instrumental decision-making task. Bootstrapped serial mediation analyses were performed to examine the effect of group on grazing via goal-directed behaviour and inhibition. While significant differences existed between the groups in terms of inhibition, goal-directed behaviour and grazing severity, the effect of group on grazing severity was not found to be mediated by the degree of behavioural goal-directedness and inhibition. Therefore, :in persons with obesity with or without eating disorder symptoms, putative relationships between a reduced inhibitory profile and/or behaviour that is less flexible and goal-directed and eating behaviours such as grazing, remain unclear.

Chronic versus recent expressive suppression burdens are differentially associated with cognitive performance among older adults

Introduction: Expressive suppression (ES; suppression of affective behavior) has been shown to have a deleterious impact on subsequently administered tests of executive functions (EF), threatening validity, and reliability of EF assessment. Past research has shown that recent ES (i.e., across 24 hours prior to testing) and chronic ES (i.e., across 2 weeks prior to testing) have differential impact on test performance. The present study compared the association of chronic vs. recent ES with speed vs. accuracy of performance on tests of EF and tests of lower-order processes.

METHOD

Participants were 255 community-dwelling older adults aged 60 and older. Participants completed timed subtests of the Delis-Kaplan Executive Function System and the Burden of State Emotion Regulation Questionnaire.

RESULTS

Hierarchical linear regressions examined the contributions of chronic vs. recent ES to test performance. Recent ES was related to scores of both speed and accuracy on EF tests. The association between recent ES and EF errors held beyond covariates (i.e., chronic ES, demographics, depression, and general cognitive status). In contrast, the association between recent ES and EF speed was fully explained by EF error scores. Chronic ES was associated only with speed of performance and only on lower-order tasks, but this relationship did not survive correction for cognitive, psychiatric, and demographic factors.

CONCLUSIONS

Recent ES appears to be a risk factor for EF lapses. Chronic ES, while related to performance speed, seems to also relate to several other cognitive, psychiatric, and demographic factors, which themselves explain slower information processing.

Acute high-intensity interval training improves motor skill acquisition

BACKGROUND

It is well established that acute exercise improves cognitive function. However, less is known about the effects of exercise on motor skill acquisition. Therefore, this study investigated the effects of acute high-intensity interval training (HIIT) on motor skill acquisition.

METHODS

Sixty individuals (27 males, 33 females) between 18 and 40 years of age participated in two testing sessions separated by one week. During visit 1, participants performed one block of a continuous tracking, force control task to establish baseline ability. Participants were then randomized to either an aerobic-only HIIT group (HIIT-A), an aerobic/resistance HIIT group (HIIT-AR), or a resting control group. Both exercise groups performed a 20-minute, digital versatile disc (DVD)-delivered HIIT exercise protocol during visit 2. Following exercise or rest, all participants performed five blocks of the same force control task to assess skill acquisition.

RESULTS

On visit 2, the HIIT-A group had a significantly lower total performance error (E) compared to the control group (P<0.05). Both exercise groups (HIIT-A and HIIT-AR) had a significantly lower peak amplitude error (PE) following exercise compared to the control group (P<0.05). No significant group differences were observed for temporal error (TE). Additionally, no significant differences were observed between the exercise groups (P>0.05).

CONCLUSIONS

These findings suggest that acute HIIT-A improves motor skill acquisition compared to rest. Furthermore, improvements in acquisition appeared to be a result of improved spatial accuracy. Therefore, performing HIIT-A prior to practicing a motor task may help reduce total error during the motor skill acquisition phase.

Executive Functioning as a Predictor of Weight Loss and Physical Activity Outcomes

BACKGROUND

Executive functioning, which is fundamental for carrying out goal-directed behaviors, may be an underappreciated predictor of outcomes in lifestyle modification programs for adults with obesity.

PURPOSE

This study tested the hypotheses that higher levels of baseline executive functioning would predict greater weight loss and physical activity after 6 months of behavioral treatment.

METHODS

Participants (N = 320) were recruited from the community and provided with 16 treatment sessions. Executive functioning was measured with the tower task component of the Delis-Kaplan Executive Function System (D-KEFS). At months 0 and 6, weight was measured in the clinic and physical activity was measured with tri-axial accelerometers.

RESULTS

Baseline D-KEFS achievement score, rule violations, and completion time significantly predicted weight loss at 6 months. For example, among participants without any rule violations (n = 162), weight loss averaged 11.0%, while those with rule violations (n = 158) averaged 8.7% weight loss. Rule violations also significantly predicted physical activity at 6 months. Among participants without any rule violations, physical activity at 6 months averaged 169.8 min/week, versus 127.2 min/week among those with rule violations.

CONCLUSIONS

Particular aspects of executive functioning may predict the relative ease or difficulty of changing eating and exercise-related behaviors, albeit with small effect sizes. This study is the first to our knowledge to detect a predictive relationship between components of executive functioning and objectively measured physical activity in adult lifestyle modification, and one of the first to predict weight loss in adults using an objective measure of executive functioning.

CLINICALTRIALS.GOV REGISTRATION NUMBER

NCT02363010.

Association of self-reported executive function and mood with executive function task performance across adult populations

Executive function (EF) impacts behavior associated with health outcomes. EF can be measured using self-report and/or performance measures, but the correlations between these types of measures are mixed in the extant literature. This study examined self-report and performance-based measures of EF using data from 6 studies, including community and clinical populations (410 participants, ages 19-80, 71% female). Partial correlations revealed significant relationships between performance on the Trail making, Delay Discounting, and Stop Signal tasks with self-reported EF (p < .006 after controlling for age). Mood scores were significantly related to all self-reported domains of EF (p < .0001), and mood and EF scores were correlated over time. When also controlling for mood, correlations between delay discounting and stop signal tasks with self-reported EF remained significant (p < .006). Finally, examining EF scores in participants with and without clinically elevated mood scores showed a wider distribution of self-reported EF scores among those with clinically elevated mood symptoms than among those without. We conclude that self-reported EF is associated with tasks measuring delay discounting and response inhibition in our large, heterogenous population and that assessing EF may be particularly important for those with high levels of mood symptoms.

The role of executive functioning on the intention-behaviour relationship of health behaviours: a temporal self-regulatory perspective

OBJECTIVE

The current study employed the Temporal Self-Regulation theory (TST) to determine if self-regulatory capacity and prepotent behaviour moderate the relationship between intention and health behaviours (i.e., physical activity, and healthy eating) in college students.

DESIGN

220 students were surveyed across two time points to assess past/intended behaviour (Time 1) and follow-up behaviour (Time 2).

MAIN OUTCOME MEASURES

To address limitations in previous research, self-regulatory capacity was assessed using an ecologically valid rating scale (Barkley Deficits in Executive Functioning Scale). Multi-item assessment measures were utilised for physical activity (International Physical Activity Questionnaire) and healthy eating (All-Day Screener) behaviours.

RESULTS

A link between intention and follow-up behaviour was established and executive functioning (EF) and past behaviours were positively associated with follow-up behaviour. EF had no unique moderation effects on health behaviours, but combinations of Low, Moderate, and High levels of past behaviour and EF demonstrated moderation for physical activity and healthy eating.

CONCLUSION

This study demonstrated the utility of the TST in predicting health behaviour and emphasised the mutual necessity of EF and past behaviour in understanding the intention-behaviour relationship. Findings can be used to formulate studies and interventions that reduce barriers to health behaviours, therefore, lessening the need for high self-regulatory abilities.

Determining the Optimal Outcome Measures for Studying the Social Determinants of Health

Americans have significantly poorer health outcomes and shorter longevity than citizens of other industrialized nations. Poverty is a major driver of these poor health outcomes in the United States. Innovative anti-poverty policies may help reduce economic malaise thereby increasing the health and longevity of the most vulnerable Americans. However, there is no consensus framework for studying the health impacts of anti-poverty social policies. In this paper, we describe a case study in which leading global experts systematically: (1) developed a conceptual model that outlines the potential pathways through which a social policy influences health, (2) fits outcome measures to this conceptual model, and (3) estimates an optimal time frame for collection of the selected outcome measures. This systematic process, called the Delphi method, has the potential to produce estimates more quickly and with less bias than might be achieved through expert panel discussions alone. Our case study is a multi-component randomized-controlled trial (RCT) of a workforce policy called MyGoals for Healthy Aging.

Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications

AIM

Motivation to take up and maintain a healthy lifestyle is key to diabetes prevention and management. Motivations are driven by factors on the psychological, biological and environmental levels, which have each been studied extensively in various lines of research over the past 25 years. Here, we analyse and reflect on current and emerging knowledge on motivation in relation to lifestyle behaviours, with a focus on people with diabetes or obesity. Structured according to psychological, (neuro-)biological and broader environmental levels, we provide a scoping review of the literature and highlight frameworks used to structure motivational concepts. Results are then put in perspective of applicability in (clinical) practice.

RESULTS

Over the past 25 years, research focusing on motivation has grown exponentially. Social-cognitive and self-determination theories have driven research on the key motivational concepts 'self-efficacy' and 'self-determination'. Neuro-cognitive research has provided insights in the processes that are involved across various layers of a complex cortical network of motivation, reward and cognitive control. On an environmental - more upstream - level, motivations are influenced by characteristics in the built, social, economic and policy environments at various scales, which have provided entry points for environmental approaches influencing behaviour.

CONCLUSIONS

Current evidence shows that motivation is strongly related to a person's self-efficacy and capability to initiate and maintain healthy choices, and to a health climate that supports autonomous choices. Some approaches targeting motivations have been shown to be promising, but more research is warranted to sustainably reduce the burden of diabetes in individuals and populations.