Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial

Target mechanisms of mindfulness-based programmes and practices: a scoping review

QUESTION

Mindfulness-based programmes (MBPs) and practices have demonstrated effects in mental health and well-being, yet questions regarding the target mechanisms that drive change across the population remain unresolved.

STUDY SELECTION AND ANALYSIS

Five databases were searched for randomised controlled trials that evaluate the indirect effects (IEs) of an MBP or mindfulness practice in relation to mental health and well-being outcomes through psychological mechanisms.

FINDINGS

27 eligible studies were identified, with only four exploring mechanisms in the context of specific mindfulness practices. Significant IEs were reported for mindfulness skills, decentering and attitudes of mindfulness (eg, self-compassion) across different outcomes, population samples, mental health strategies and active comparators. Evidence gap maps and requirements for testing and reporting IEs are provided to help guide future work.

CONCLUSIONS

Mindfulness skills, decentering and attitudes of mindfulness may be key intervention targets for addressing the mental health of whole populations. However, future work needs to address significant knowledge gaps regarding the evidence for alternative mechanisms (eg, attention and awareness) in relation to unique outcomes (eg, well-being), mental health strategies (ie, promotion) and active comparators. High-quality trials, with powered multivariate mediation analyses that meet key requirements, will be needed to advance this area of work.

TRIAL REGISTRATION NUMBER

10.17605/OSF.IO/NY2AH.

Potential strategies for supporting mental health and mitigating the risk of burnout among healthcare professionals: insights from the COVID-19 pandemic

Healthcare professionals (HCPs) experienced prolonged stressful conditions during the coronavirus disease 2019 pandemic, and the global situation (particularly in the United Kingdom) meant that they continue to sustain mental stress related to the subsequent cost-of-living and healthcare budgeting crises. The psychological toll on HCPs may lead to increased staff attrition, adversely impacting the quality of patient care and work security. To help mitigate this psychological impact, the current evidence is strongly supportive of healthcare providers consistently adopting programmes fostering improvement in coping and resilience, facilitating healthy lifestyle, and allocating some resources for therapeutic strategies (e.g. cognitive behavioural therapy-based strategies and other strategies specified to trauma-related issues) which can be delivered by trained professionals. We stress that some approaches are not a one-size-fits-all strategy, and we also highlight the need to encourage treatment-seeking among those who need it. These strategies are highly relevant to healthcare employers and policymakers to support all HCPs in settings marked by prolonged periods of stress. The investment in these strategies are expected not only to reduce staff attrition in the long-term, but are likely to add to the cost-effectiveness of overall healthcare budgetary allocation.

Changes in Mental Health Symptoms as a Predictor of Cannabis Coping Motives and Consequences: Examining the Impact of COVID-19 Among College Students

Objective

Cannabis use is common among college students and many students use cannabis to cope with negative affect. The COVID-19 pandemic was a particularly stressful time for college students. Subsequently, the present study compared college students who reported increases in anxiety/depression symptoms since COVID-19 stay at home orders to those who reported no change in anxiety/depression symptoms on cannabis coping motives, use frequency, and negative consequences. Specifically, we examined whether self-reported changes (i.e., group that indicated increases) in poor mental health during COVID-19 were associated with problematic cannabis use via higher cannabis coping motives.

Method

College students (analytic n = 291) completed an online survey for research credit regarding their personal mental health, COVID-19 stressors, and cannabis use behaviors.

Results

Individuals who reported increased depressive symptoms (57.4% of the current sample) due to COVID-19 (as compared to individuals whose depressive symptoms remained the same) reported significantly higher cannabis coping motives (d = .79) as well as more cannabis consequences (d = .37). Further, students who reported increased (61.5% of the current sample) anxiety symptoms (as compared to those whose anxiety symptoms stayed the same) also reported significantly higher cannabis coping motives (d = .47). Moreover, we found that students who reported an increase in depressive/anxiety symptoms reported more cannabis consequences via higher endorsement of cannabis coping motives while controlling for gender, cannabis use frequency, and past-week anxiety/depressive symptoms.

Discussion

Providing resources for substance-free coping strategies to manage the mental health impact of COVID-19 may be extremely useful for this population.

Physical Activity and Physical and Mental Health in Middle-Aged Adults with Down Syndrome

Background

Adults with Down syndrome have an increased risk of aging-related physical and mental health conditions and experience them at an earlier age than the general population. There is a need to investigate modifiable lifestyle factors that may reduce risk for these conditions.

Method

The present study investigated the associations between physical activity (i.e., sedentary behavior and moderate-to-vigorous activity) assessed via accelerometer across 7 days and caregiver-reported physical and mental health of 66 non-demented middle-aged adults with Down Syndrome aged 25-55 years (52% female).

Results

Regression analyses indicated that more time spent in moderate intensity physical activity was associated with less risk of sleep apnea (b = -.031 p = .004) and endocrine/metabolic conditions (b = -.046 p = .009), and lower total number of physical health conditions (b = -.110 p =.016) and anxiety disorders (b = -.021 p =.049) after controlling for relevant sociodemographics. After also adjusting for BMI, the association between time spent in moderate intensity physical activity and sleep apnea (b=-.035, p = .002), endocrine/metabolic conditions (b=-.033, p = .045) and total physical health (b=-.091, p =.026) remained significant Unexpectedly, time spent in sedentary behavior was negatively associated with musculoskeletal conditions (b=-.017, p = .044).

Conclusion

Findings indicate important associations between physical activity in everyday life and the physical and mental health of adults with Down syndrome. Social policies and interventions aimed at reducing time spent sitting around (i.e., sedentary behavior) and encouraging moderate-to-vigorous activity may be a low-burden and low-cost mechanism for fostering healthy physical and mental aging in the Down syndrome population.

Exploring Meditation Profiles and Predictors in Nursing Students

Background: Nursing students face unique academic and clinical workloads linked to increased stress. Previous studies indicate formal and informal mindfulness meditation provide stress-reducing benefits. This practice aligns with holistic nursing core values of self-care and self-reflection; little is known about meditation practice in nursing students. Objectives: Our study aimed to describe meditation practice and predictors in pre-licensure nursing students. Design: Cross-sectional, multi-site. Methods: Qualtrics surveys queried individual demographics, personal meditation and exercise habits, and indicators of wellbeing. Results: Of 417 participants, 65% (n  =  271) reported at least one type of meditation practice. Prayer/spiritual activities were most prevalent (almost 70%), followed by breathing exercises (41%). Meditators reported good or excellent self-rated health status or engaged in exercise (p < .05). Meditators also reported more self-compassion, happiness, and satisfaction with life, and perceived less stress than non-meditators (p < .05). Of all factors studied, only engaging in exercise significantly predicted practicing meditation (OR = 2.05, 95%CI 1.10-3.82). Conclusion: Nursing students who engage in meditation report signs of health and well-being and utilize holistic methods such as prayer and breathing. The intrinsic motivation to engage in healthy habits such as exercise may also help students engage in mindfulness meditation and is an important finding for nursing educators.

Enjoying nature, exercise, social interaction, and affect: A daily diary study

This study investigated the pathways linking daily nature enjoyment to affect by testing whether the associations would be fully explained by exercise and social interaction. Participants (N = 782; 55.6% female; age 25-74, Mage = 47.9) from the Midlife in the United States (MIDUS) refresher study completed surveys across 8 days. Multilevel models indicated that enjoying nature with others tended to predict affect at the within-person level, while enjoying nature alone did not. However, enjoying nature alone did predict affect at the between-person level. Lastly, many of these associations remained, even while controlling for exercise and social interaction.

The Impact of Leisure Activities on the Mental Health of Older Adults: The Mediating Effect of Social Support and Perceived Stress

As the aging continues, China has become the country with the largest older population. In order to ensure the well-being of older adults in their later years, the whole society is increasingly concerned about the mental health of older adults. In 2019, we conduct a questionnaire survey in Shaanxi Province. Stratified random sampling is used to select three representative cities, and 677 samples are selected from the survey results for research. By using the structural equation model, we aim to reveal the mechanism of leisure activities' influence on mental health of the older adults and verify whether social support and perceived stress play a mediating role. The study finds that the older adults' leisure activities have no significant direct impact on mental health. Social support has a significant mediating effect between leisure activities and mental health of the older adults. Leisure activities indirectly affect the mental health of the older adults through social support, and participation in leisure activities can improve the social support of the older adults, thus improving the mental health level of the older adults. Perceived stress plays a significant mediating role between leisure activities and mental health of the older adults. By participating in leisure activities, the perceived stress of the older adults will be reduced, thus improving their mental health. Social support and perceived stress play a sufficient mediating role in the influence of leisure activities on mental health.

Home Garden With Eco-Healing Functions Benefiting Mental Health and Biodiversity During and After the COVID-19 Pandemic: A Scoping Review

The COVID-19 pandemic has led to tremendous impacts on human lives and society, which are not only because of negative effects on people's mental health due to isolation policies and physical distance for mitigating the spread of SARS-CoV-2, but also because the incident post-acute sequelae of the coronavirus will cause mental disorders. A green environment is a health resource, which cannot only benefit human physical and mental health, but also increases biodiversity, contributes to flood mitigation, and cools urban areas. A home garden, as a kind of small green space, can provide ecosystem services with eco-healing functions in reducing mental stress during the isolation period of the COVID-19 pandemic through the garden itself and physical activities in it. Such an eco-healing approach within a mini-therapeutic landscape can also benefit biodiversity by enhancing plant diversity in residence and increasing biodiversity at a large scale. In this article, we propose a conceptual framework describing a home garden as "ecological medicine" with healing functions to improve mental health, as well as indirectly enhancing urban biodiversity. A home garden, as a mini-type of green landscape with biodiversity content, allows people to get close with nature so that it can promote comfortable and natural feelings during the pandemic. Furthermore, such an eco-healing home garden approach benefiting urban biodiversity can meet the challenges in maintaining environmental and mental health in post COVID-19 pandemic recovery, as well as preparing unknown next-surge risks with potential isolation regulations.

Evaluation of a Motivation-Based Intervention to Reduce Health Risk Behaviors among Black Primary Care Patients with Adverse Childhood Experiences

BACKGROUND

Considerable evidence suggests that greater attention should be paid to the impact of trauma among low-income, racial/ethnic minority patients living in urban communities. The goal of this article is to evaluate a 2-session, motivational intervention designed to motivate a change in health risk behaviors among low-income, self-identified Black/African American patients with adverse childhood experiences (ACEs).

METHODS

Qualitative self-reported data described helpful aspects of the intervention and those that could be improved. Eligible participants with 1 or more ACEs being seen in a community-based clinic were interviewed by a mental health clinician researcher for 2 in-person sessions scheduled 1 month apart. Content analysis was performed using a general inductive approach to identify core themes.

RESULTS

In total, 36 of 40 participants completed both sessions, with the majority reporting a high rate of satisfaction. Participants emphasized the importance of talking with a trained professional who could listen without judgment, understand patient challenges, clarify patient goals, and facilitate behavior change plans. Suggestions for improvement included modifying structure and content, enhancing clinic environment, improving linkages to behavioral health, and increasing communication and collaboration with clinicians.

CONCLUSION

Participant evaluation data gathered for this study suggest that through the practice of asking, listening, and accepting, clinicians can help patients who have been exposed to childhood adversity better understand themselves and promote healthy coping behaviors. This study provides preliminary data on the needs of underserved patients that can be utilized to develop and deliver health promotion interventions using a trauma-informed approach in community-based clinics.

Knowledge and Habits of Exercise in Medical Students

Objective. To examine the exercise habits, knowledge, and self-efficacy of incoming medical students. Methods. Mixed-methods study consisting of (1) cross-sectional surveys and (2) qualitative key-informant interviews. (1) International Physical Activity Questionnaire (IPAQ), American Adult's Knowledge of Exercise Recommendations Survey (AAKERS), and Self-Efficacy for Exercise Scale (SEES) to assess student's physical activity level, knowledge of exercise recommendations, and self-efficacy for exercise. (2) Scripted questions explored exercise habits, sources of exercise knowledge, attitude toward exercise. Results. (1) Results of IPAQ classified students as 50% having high, 40% moderate, and 10% low levels of physical activity (n = 132). AAKERS demonstrated a mean total score of 16.2/20 (n = 130) (81% correct), similar to the national average (mean = 16/20) (n = 2002). SEES mean score of 48.5/90 (n = 128) is similar to previous studies (mean = 48.6/90, 52.75/90). (2) Interviews revealed that most students have a consistent exercise routine. Few students received formal education in exercise (10%), while the rest cited either peers, sports, or internet as primary sources of exercise knowledge. Less than half stated they would be comfortable designing an exercise routine for patients. Conclusions. Incoming medical students live an active lifestyle but have limited knowledge and formal training in exercise. Student's knowledge is predominantly self-taught from independent resources.

Meditation and Cardiovascular Health in the US

The 2017 American Heart Association Scientific Statement on meditation and cardiovascular risk suggested that meditation may be considered as an adjunct to guideline-directed cardiovascular risk-reduction interventions. Meditation could potentially increase physical and mental relaxation, leading to improved outcomes after a major cardiovascular event. We hypothesized that meditation is associated with lower cardiovascular risk in the US general population. Using data from the 2012 and 2017 National Health Interview Survey, we identified all patients with hypercholesterolemia, systemic hypertension (SH), diabetes mellitus (DM), stroke, and coronary artery disease (CAD), as well as those who reported that they meditate. Multivariable logistic regression analyses were performed to evaluate the association between meditation and risk of hypercholesterolemia, SH, DM, stroke, and CAD, adjusting for potential confounders. Of 61,267 the National Health Interview Survey participants, 5,851 (9.6%) participated in some form of meditation. After adjusting for age, gender, body mass index, race, marital status, cigarette smoking, sleeping duration, and depression, meditation was independently associated with a lower prevalence of hypercholesterolemia (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.54 to 0.79; p = 0.001), SH (OR 0.86; 95% CI 0.75 to 0.99; p = 0.04), diabetes (OR 0.70; 95% CI 0.59 to 0.84; p = 0.0001), stroke (OR 0.76; 95% CI 0.58 to 0.99; p = 0.04), or CAD (OR 0.51; 95% CI 0.39 to 0.66; p <0.001), compared with those who did not meditate. In conclusion, using a large national database, we found that meditation is associated with a lower prevalence of cardiovascular risks factors and disease.

Mindfulness meditation and exercise both improve sleep quality: Secondary analysis of a randomized controlled trial of community dwelling adults

OBJECTIVES

To assess the benefits of training in mindfulness-based stress reduction (MBSR) or moderate intensity exercise (EX) for improving sleep quality.

DESIGN

Randomized controlled trial.

SETTING

Outpatient, community-based.

PARTICIPANTS

Healthy adults (n = 413) aged 30-69 who did not regularly exercise or practice meditation, and who had no known prior sleep problems.

INTERVENTIONS

1) 8-weeks of MBSR training; 2) matched EX training; or 3) wait-list control.

MEASUREMENTS

The Pittsburgh Sleep Quality Index (PSQI) was administered at baseline and at 1, 3, 5, and 7-month follow-up visits.

ANALYSIS

Total PSQI scores and three PSQI factors (perceived sleep quality; daily disturbance, sleep efficiency) were assessed using linear mixed effects regression models for longitudinal data.

RESULTS

Compared to controls, PSQI global scores improved significantly for EX (mean change -0.98 points [95% CI -1.56, -0.41] p = 0.001) and marginally for MBSR (-0.53 [-1.10, 0.04] p = 0.07). The perceived sleep quality factor improved for both EX (-0.18 [-0.30, -0.07] p = 0.002) and MBSR (-0.12 [-0.24, -0.01] p = 0.035). The daily disturbance factor improved slightly more for MBSR (-0.13 [-0.22, -0.033] p = 0.008) than EX (-0.09 [-0.19, 0.004] p = 0.06). The sleep efficiency factor did not improve after MBSR (0.08 [-0.045, 0.21] p = 0.2) or EX (-0.07 [-0.20, 0.06] p = 0.3). Improvements in the sleep quality were sustained over 7 months for both groups.

CONCLUSIONS

Training in MBSR and EX produced small but statistically significant and sustained improvements in sleep quality. For EX participants, this improvement was due primarily to improvements in perceived sleep quality. For MBSR, the decrease in daily disturbance was more important.

Human needs in COVID-19 isolation

To reduce the spread of COVID-19, the World Health Organization and the majority of governments have recommended that the entire human population should ‘stay-at-home’. A significant proportion of the population live alone or are vulnerable to mental health problems yet, in the vast majority of cases, individuals in social isolation have no access to mental healthcare. The only resource is people themselves using self-help, self-medication and self-care. During prolonged COVID-19 isolation, an in-built system of homeostasis can help rebalance activity, thought and feeling. Increased physical activity enables a reset of physical and mental well-being. During periods of lockdown, it is recommended that exercise should be as vigorously promoted as social distancing itself.

Mindfulness versus Physical Exercise: Effects of Two Recovery Strategies on Mental Health, Stress and Immunoglobulin A during Lunch Breaks. A Randomized Controlled Trial

This research analyses the effects of mindfulness meditation (MM) and physical exercise (PE), practised as daily recovery activities during lunch breaks, on perceived stress, general mental health, and immunoglobin A (IgA). A three-armed randomized controlled trial with 94 employees was conducted for five weeks including two follow-up sessions after one and six months. Daily practice lasted 30 min maximum. Perceived stress and general mental health questionnaires and saliva samples were used. There were significant differences in time factor comparing pre- and post-test of Perceived Stress Questionnaire (PSQ) both for PE [Mdiff = 0.10, SE = 0.03, p = 0.03], and for MM [Mdiff = 0.09, SE = 0.03, p = 0.03]. Moreover, there were significant differences of interaction factor when comparing MM vs. PE in total score at pre-post [F = −2.62 (6, 168.84), p = 0.02, ω² = 0.09], favoring PE with medium and high effect sizes. Regarding General Health Questionnaire (GHQ) variable, practicing MM showed significant effects in time factor compared to pre-Fup2. No significant differences were found for IgA. Thus, practicing both MM and PE as recovery strategies during lunch breaks could reduce perceived stress after five weeks of practice, with better results for PE. Moreover, practicing MM could improve mental health with effects for 6 months.

Influence of Prolonged Visual Display Terminal Use and Exercise on Physical and Mental Conditions of Internet Staff in Hangzhou, China

To examine the effects of prolonged visual display terminal (VDT) working hours and exercise frequency on VDT-related symptoms, we recruited 944 Chinese internet staff for the study. A self-administered questionnaire survey was used to obtain the hours of daily VDT work, exercise frequency, and the physical and mental health of the participants. The daily VDT working time of participants was 8.7 hours. Musculoskeletal pain and eye complaints were prevalent, and the participants had poor mental health status. When daily VDT operation time was more than 11 hours, VDT-related symptoms, including backache (odds ratios (OR) = 3.59), wrist pain (OR = 1.88), hip pain (OR = 2.42), dry eyes (OR = 2.22), and ocular soreness (OR = 2.16) were more likely to occur, and an increased risk of serious occupational stress (OR = 6.75) and job burnout (OR = 2.66) was found in internet workers. Compared with those who never exercised, appropriate exercise frequency (three times per week) was helpful to relieve pain in the shoulders (OR = 0.28), neck (OR = 0.45), back (OR = 0.30), lower back (OR = 0.25), and wrists (OR = 0.38), as well as to prevent vision loss (OR = 0.33) and job burnout (OR = 0.42). Therefore, avoiding excessive VDT exposure and performing moderate exercise could protect the physical and mental health of internet staff from the adverse effects of VDT.

Differential Reduction of IP-10 and C-Reactive Protein via Aerobic Exercise or Mindfulness-Based Stress-Reduction Training in a Large Randomized Controlled Trial

Exercise and meditation improve health and well-being, potentially through decreasing systemic inflammation. In this study, healthy adults (N = 413) were randomized to 8 weeks of training in aerobic exercise, matched mindfulness-based stress reduction, or wait-list control. Three inflammation-related biomarkers (C-reactive protein, interleukin-6, and interferon-gamma-inducible protein-10) were assessed preintervention, directly postintervention, and 17 weeks later. Within-group analyses found that exercise participants had decreased serum interferon-gamma-inducible protein-10 postintervention and 17 weeks later, whereas C-reactive protein was lower in mindfulness-based stress-reduction participants 17 weeks postintervention only. Self-reported physical activity or amount of meditation practice did not predict biomarker changes. This study suggests that (a) training in aerobic exercise can lower interferon-gamma-inducible protein-10, a chemokine associated with interferon activity and illness, and (b) training in mindfulness meditation may have a delayed effect on C-reactive protein, an important inflammatory biomarker. The findings highlight the likelihood of multiple, distinct pathways underlying the health-promoting effects of these lifestyle interventions.

Predictors of Mindfulness Meditation and Exercise Practice, from MEPARI-2, a randomized controlled trial

Objectives

Health-supporting behaviors can be challenging to initiate and maintain. Data from the MEPARI-2 randomized trial were used to assess predictors of sustained exercise and meditation practice.

Methods

Adults aged 30 to 69 years not exercising regularly and without prior meditation training were randomized to 8-week trainings in mindfulness meditation, moderate intensity exercise, or observational control, and monitored for 8 months. Exercise participants reported day-to-day minutes of moderate and vigorous activity; mindfulness meditation participants reported minutes of informal and formal practice. Demographic characteristics and psychosocial factors were assessed as predictors of practice. Growth mixture modeling was used to identify higher and lower practice subgroups.

Results

413 participants (75.8% female; mean (SD) age 49.7 (11.6) years) were randomized to exercise (137), mindfulness meditation (138), or control (138), with 390 (95%) completing the study. Seventy-nine percent of exercisers and 62% of meditators reported ≥150 minutes/week practice for at least half of the 37 weeks monitored. Self-reported minutes of mindfulness meditation and/or exercise practice were significantly (p<0.01) predicted by baseline levels of: general mental health, self-efficacy, perceived stress, depressive symptoms, openness, neuroticism, physical activity, smoking status, and number of social contacts. Growth mixture modeling identified subsets of people with moderate (100-200 min/week) and high (300-450 min/week) levels of self-reported practice for both mindfulness meditation (62% moderate; 38% high) and exercise (71% moderate; 29% high).

Conclusions

In this sample, participants randomized to behavioral trainings reported high levels of practice sustained over 37 weeks. Baseline psychosocial measures predicted practice levels in expected directions.

Feeling Loved: A Novel Brief Self-Report Health Measure

CONTEXT

There is need for a short validated self-report instrument for assessing the feeling of being loved. The Feeling Loved instrument asks: "Do you feel loved?" and "How loved do you feel?" as well as "Do you love yourself?" and "How much do you love yourself?" with 100 mm visual analogue scales assessing the continuous response options.

OBJECTIVE

To assess convergent and discriminant validity and to explore psychometric structure for this novel self-report measure.

DESIGN

Convergent validity comparators include: general mental health, perceived social support, perceived stress, depressive symptoms, and positive/negative emotion. Discriminant validity comparators include: gender, age, ethnicity, socioeconomic status, and body mass index. Latent class analysis techniques explore psychometric structure.

SETTING

Baseline evaluation for a randomized controlled trial.

PARTICIPANTS

Community-recruited adults in Madison, Wisconsin.

INTERVENTION

This validation study is based on pre-intervention data.

MAIN OUTCOME MEASURES

Strength of correlation with comparators is used to assess convergence and discrimination. Goodness-of-fit indicators assess latent class models.

RESULTS

Of n = 412 respondents, 92% answered positively to both Yes/No questions, and 59% self-rated ≥75/100 on both 0-to-100 VAS scales. Supporting convergent validity, highly significant (p < 0.001) Spearman's rho=ρ correlations of a summed Feeling Loved score were: mental health (ρ = 0.49); social support (ρ = 0.46); perceived stress (ρ = -0.46), depressive symptoms (ρ = -0.31), and both positive (ρ = 0.50) and negative (ρ = -0.43) emotion. Significant associations were also found for personality indicators. Supporting discriminant validity, Feeling Loved scores did not correlate significantly with physical health (ρ = -0.08), body mass index (ρ = 0.01), age (ρ = 0.06), or income (ρ = 0.07) (p values all ≥ 0.12). Latent class analysis models suggested a 3-class structure, with strong goodness-of-fit indicators.