Sprint Interval Training and Continuous Aerobic Exercise Training Have Similar Effects on Exercise Motivation and Affective Responses to Exercise in Patients With Major Depressive Disorders: A Randomized Controlled Trial

Effectiveness of short sprint interval training in women with major depressive disorder: a proof-of-concept study

Background

High-intensity intermittent training has emerged as an option for treating major depressive disorder (MDD). However, short sprint training (sSIT), an efficient HIIT modality, has not been tested yet for this purpose. The sSIT has been proven to induce the same metabolic adaptations, with the advantage of promoting lower muscle fatigue than other HIIT protocols.

Methods

Seventeen adult women diagnosed with moderate/severe MDD were randomly allocated into a sSIT group (n=9) or a control condition (n=8). The sSIT group completed, over two weeks, six 6-10-min sessions which consisted of 3-12 "all out" sprints of 5 s interspersed with low-intensity recovery of 30-45 s. The week before and after the intervention, both groups were evaluated with the Hamilton Depression Rating Scale of 21-itens (HAM-D21), and for physical fitness and incidental physical activity.

Results

The sSIT group exhibited significant improvements for HAM-D21 scores (24.6±8.2 vs. 16.8±10.1), maximum aerobic power (140±15 vs. 155±15 W), countermovement jump (13.0±3.4 vs. 14.9±3.1 cm), % of body fatness (32.4±4.4 vs. 29.3±3.8%), and 4-days number of steps (13,626±11,309 vs. 16,643±15,371) after the training period when compared to the control group.

Conclusion

Less than 1 hour of a sSIT protocol over two weeks have demonstrated to reduce depressive symptoms, while improving aerobic fitness and body composition, and increasing incidental physical activity in a sample of women diagnosed with MDD.

The Role of Gut Microbiota, Nutrition, and Physical Activity in Depression and Obesity-Interdependent Mechanisms/Co-Occurrence

Obesity and depression are interdependent pathological disorders with strong inflammatory effects commonly found worldwide. They determine the health status of the population and cause key problems in terms of morbidity and mortality. The role of gut microbiota and its composition in the treatment of obesity and psychological factors is increasingly emphasized. Published research suggests that prebiotic, probiotic, or symbiotic preparations can effectively intervene in obesity treatment and mood-dysregulation alleviation. Thus, this literature review aims to highlight the role of intestinal microbiota in treating depression and obesity. An additional purpose is to indicate probiotics, including psychobiotics and prebiotics, potentially beneficial in supporting the treatment of these two diseases.

High-intensity interval training ameliorates chronic unpredictable mild stress-induced depressive behaviors via HDAC2-BDNF signaling in the ventral hippocampus

Major depressive disorder (MDD) is a devastating psychiatric disease, and current therapies could not well meet the demand for MDD treatment. Exercise benefits mental illness, and notably, exercise has been recommended as an alternative option for MDD treatment in some countries. However, the paradigm and intensity of exercise for MDD treatment has yet to be determined. High-intensity interval training (HIIT) is a potent and time-efficient type of exercise training and has gained popularity in recent years. In this study, we exposed the mice to chronic unpredictable mild stress (CUMS) and found HIIT exerted substantial antidepressant effect. Moreover, HIIT further enhanced the antidepressant effect of fluoxetine, a classic antidepressant in the clinic, confirming the antidepressant role of HIIT. HIIT significantly reversed the CUMS-induced upregulations in HDAC2 mRNA and protein level in the ventral hippocampus. We also found HIIT rescued the CUMS-induced downregulation in the expression of brain-derived neurotrophic factor (BDNF) and HDAC2 overexpression counteracted the HIIT-induced increase in BDNF level. More importantly, both virus-mediated HDAC2 overexpression and microinfusion of TrkB-Fc, a BDNF scavenger, in the ventral hippocampus abolished the antidepressant effect of HIIT. Together, our results strongly demonstrate that HIIT attenuates depressive behaviors, probably via HDAC2-BDNF signaling pathway and reveal that HIIT may serve as an alternative option for MDD treatment.

The CRAVE and ARGE scales for motivation states for physical activity and sedentarism: Brazilian Portuguese translation and single-item versions

Motivation states for physical activity and sedentarism potentially vary from moment to moment. The CRAVE scale (Cravings for Rest and Volitional Energy Expenditure) was developed to assess transient wants and desires to move. Three studies were conducted with the aims of: (1) translating and validating the scale in Brazilian Portuguese, (2) examining changes with exercise, and (3) determining the best single-item for Move and Rest subscales for English and Portuguese. In Study 1, six bilingual speakers translated the scale into Brazilian Portuguese [named Anseios por Repouso e Gastos com Energia (ARGE)]. The ARGE had good content validity coefficients across three dimensions (0.89-0.91), as determined by three independent, bilingual referees. 1,168 participants (mean age = 30.6, SD = 12.2) from across Brazil completed an online version of the ARGE. An Exploratory Factor Analysis found two clear, oblique, and inversely related factors (Move and Rest; GFI = 1.00, RMSR = 0.03). Reliability was good (Cronbach α's: 0.93 and 0.92). Two models of the scale (10 vs. 13 items) were compared with Confirmatory Factor Analysis. The previously validated version using 10 scored items (GFI = 1.00, RMSEA = 0.07, RMSR = 0.02) outperformed the version scored with 13 items. State anxiety and exercise behavior had small associations with Move and Rest (-0.20 to 0.26). In Study 2, ARGE Move scores had high correspondence post-session (ICC = 0.83) for 9 women performing short Sprint Interval Training (sSIT; 6 sessions). Large, but non-significant, effects were detected for changes in motivation states with sSIT. In Study 3, IRT analyses found that for the United States sample, "be physically active" and "be still" were the most representative items for Move and Rest, respectively, while for the Brazil sample they were "exert my muscles" and "be a couch potato." Overall, it was found that: (A) the ARGE scale demonstrated good psychometric properties, (B) the original scoring (with 10 items) resulted in the best model, (C) it had small associations with exercise behavior, and (D) the subscales were reduced to single items that varied by country, indicating potential cultural differences in the concept of motivation states for physical activity.

Does Exercise Modality Matter Affectively? Contrasting Type and Sequence of Moderate-Intensity Continuous Training Versus High-Intensity Interval Training in a Randomized Within-Subject Study

Over the past two decades, affective determinants of exercise behavior have received increasing attention in research on health promotion and prevention. To date, however, little is known about changes in affective exercise determinants during multi-week training programs in insufficiently active individuals. This applies in particular to the currently discussed advantages and disadvantages of high-intensity interval training (HIIT) compared with moderate-intensity continuous training (MICT) with regard to the affective experience of these two training types (e.g., reduced monotony vs. more aversive response during HIIT), which is important for exercise adherence. Referring to the Affect and Health Behavior Framework (AHBF), this within-subject study investigated changes in affective exercise determinants as a function of training type and sequence consisting of MICT and HIIT. Forty insufficiently active healthy adults (M _age = 27 ± 6 years; 72% women) underwent two 6-week training periods in a randomized sequence (MICT - HIIT vs. HIIT - MICT) within 15 weeks. Pre-post questionnaires and in-situ measurements, during and after a standardized vigorous-intensity continuous exercise session (VICE), were used to assess affective attitude, intrinsic motivation, in-task affective valence, as well as post-exercise enjoyment. These four affect-related constructs were collected before, between, and after the two training periods. Mixed models revealed a significant effect for training sequence (p = 0.011) - but not for training type (p = 0.045; non-significant after Bonferroni alpha adjustment) - on changes in in-task affective valence in favor of the MICT - HIIT sequence. Moreover, no significant training type or sequence effects were found for the constructs of reflective processing: exercise enjoyment, affective attitude, and intrinsic motivation. Therefore, individual-based training recommendations should consider the effects of variety and training sequence to develop tailored interventions that lead to more positive affective experiences - in particular during exercise - and promote the maintenance of exercise behavior in previously inactive individuals.

The efficacy of exercise interventions for all types of inpatients across mental health settings: A systematic review and meta-analysis of 47 studies

This systematic review and meta-analysis investigated the benefits, safety and adherence of exercise interventions delivered in inpatient mental health settings, quantified the number of exercise trials that provided support to maintain engagement in exercise post-discharge, and reported patient feedback towards exercise interventions. Major databases were searched from inception to 22.06.2022 for intervention studies investigating exercise in mental health inpatient settings. Study quality was assessed using Cochrane and ROBINS-1 checklists. Fifty-six papers were included from 47 trials (including 34 RCTs), bias was high. Exercise improved depression (Standardised mean difference = -0.416; 95% Confidence interval -0.787 to -0.045, N = 15) compared to non-exercise comparators amongst people with a range of mental illnesses, with further (albeit limited) evidence suggesting a role of exercise in cardiorespiratory fitness and various other physical health parameters and ameliorating psychiatric symptoms. No serious exercise-related adverse events were noted, attendance was ≥80% in most trials, and exercise was perceived as enjoyable and useful. Five trials offered patients post-discharge support to continue exercise, with varying success. In conclusion, exercise interventions may have therapeutic benefits in inpatient mental health settings. More high-quality trials are needed to determine optimal parameters, and future research should investigate systems to support patients to maintain exercise engagement once discharged.

Intervention of Physical Activity for University Students with Anxiety and Depression during the COVID-19 Pandemic Prevention and Control Period: A Systematic Review and Meta-Analysis

(1) Background: Although physical activity has been widely recognized as an effective way to improve anxiety and depression, we lack a systematic summary of research on improving anxiety and depression during the COVID-19 pandemic. The study aims to systematically analyze how physical activity impacts on this situation in college students during COVID-19. (2) Methods: Both Chinese and English databases (PubMed the Cochrane Library, EMBASE, Web of Science, Scopus, Chinese National Knowledge Infrastructure, Wanfang) were analyzed. All the randomized controlled trials (RCTs) about physical activity intervention for this were included. We received eight eligible RCT experiments before the retrieval time (4 October 2022) in the meta-analysis. (3) Results: Physical activity benefits for college students with significant anxiety were (SMD = -0.50; 95% CI = -0.83 to -0.17; I² = 84%; p < 0.001; Z = 2.98;) and depression (SMD = -0.62; 95% CI = -0.99 to -0.25; I² = 80.7%; p < 0.001; Z = 3.27). Subgroup analyses showed physical activity of different intensities significantly impacted on improving college students' depression and anxiety, but physical activity of 6 < 9 Mets intensity had a greater effect on anxiety than on depression. Interventions of eight weeks or less performed better than those of over eight weeks while interventions less than four times per week had a significant effect on improving the situation. The overall effect of a single intervention of 30 min was more effective than one of over 60 min. (4) Conclusion: Physical activities can effectively improve the situation of anxiety and depression for college students during the COVID-19 pandemic. However, a higher quality RCT experiment is needed to prove it.

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

BACKGROUND

The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders.

OBJECTIVE

The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders.

METHODS

The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome.

RESULTS

A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind-body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind-body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms.

CONCLUSION

Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind-body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence. Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).

A Rapid Review of Randomized Trials Assessing the Effects of High-Intensity Interval Training on Depressive Symptoms in People with Mental Illness

OBJECTIVE

to systematically search for randomized controlled trials comparing the effects of high-intensity interval training (HIIT) protocols vs. control without exercise or other exercise protocols, in patients with mental disorders experiencing depressive symptoms, and to provide some guidance based on the current HIIT literature to improve further interventions.

METHODS

we searched for relevant studies, published by 18 August 2022 on PubMed, Embase, PsycINFO and SPORTDiscus databases, that used a HIIT protocol, involving adults (≥18 years) with a diagnosis of a mental disorder, participating in a HIIT or a control condition, and assessed for depressive symptoms.

RESULTS

Four studies accounting for 108 participants (n HIIT = 55; n comparison groups = 53) met the inclusion criteria. Three out of the four studies included found significant improvements of depressive symptoms after 12 days to 8 weeks of intervention. However, there were no differences to other forms of low-to-moderate continuous exercise in 2/3 studies.

CONCLUSIONS

The limited evidence suggests the effectiveness of HIIT interventions for improving depressive symptoms in people with mental illness. However, HIIT was not superior to other exercise treatments, although a trend for its superiority may be recognized. A number of methodological issues should be considered in further interventions to better characterize and identify the most efficient HIIT modalities for the treatment of depressive symptoms in these patients.

Molecular Mechanisms of Exercise and Healthspan

Healthspan is the period of our life without major debilitating diseases. In the modern world where unhealthy lifestyle choices and chronic diseases taper the healthspan, which lead to an enormous economic burden, finding ways to promote healthspan becomes a pressing goal of the scientific community. Exercise, one of humanity's most ancient and effective lifestyle interventions, appears to be at the center of the solution since it can both treat and prevent the occurrence of many chronic diseases. Here, we will review the current evidence and opinions about regular exercise promoting healthspan through enhancing the functionality of our organ systems and preventing diseases.

Affective Responses to Both Climbing and Nordic Walking Exercise Are Associated With Intermediate-Term Increases in Physical Activity in Patients With Anxiety and Posttraumatic Stress Disorder - A Randomized Longitudinal Controlled Clinical Pilot Trial

BACKGROUND

Exercise programs have shown anxiolytic effects in psychiatric patients. Adherence to exercise programs and subsequent long-term lifestyle change is influenced by acute affective responses of the exercise programs. This research aimed to assess acute affective responses of two different exercise modalities compared to a non-exercise control program and its effects on persisting physical activity behavior change.

METHODS

Sixty-six outpatients diagnosed with an anxiety disorder or posttraumatic stress disorder were randomly allocated to one of three groups in a randomized longitudinal controlled clinical pilot trial: climbing (n = 26), nordic walking (n = 19), social contact control (n = 21). Affective responses were assessed pre, during, and post activity. General physical activity behavior was recorded prior to participation in the program, post program, and at follow-ups three and six months after the program.

RESULTS

Multilevel modeling analyzes of 1,066 individual data points revealed increases in affective valence in the exercise sessions compared to the social contact sessions. State anxiety decreased in the climbing group compared to the social contact group. Physical activity behavior was increased immediately following the program as well as at six months follow-up in both exercise groups. A larger increase in affective valence during and after the sessions was associated with higher physical activity post program.

CONCLUSIONS

Climbing and conventional nordic walking exercise sessions revealed positive affective changes in outpatients indicating therapeutic potential of both modalities for acute emotion regulation. In accordance with theoretical models of human behavior change, it was judged that the experience of a more pleasant affective state following the exercise sessions induced more persisting effects on physical activity behavior after the exercise programs.

TRIAL REGISTRATION

https://www.clinicaltrials.gov/ct2/show/NCT03758599, identifier: NCT03758599.

[Enjoying Sports and Movement in Mental Illness]

Enjoying Sports and Movement in Mental Illness Abstract. Sports and exercise therapy is an effective complemant in the treatment of major depression. The recommendations of at least 150 minutes of moderate or 75 minutes of intensive physical activity per week should be met to achieve positive effects of physical activity. In addition, individual needs and the physical health conditions must be considered in the planning and implementation, so that exercise will be enjoyed in the long term.

Study protocol for a pilot high-intensity interval training intervention in inpatient mental health settings: a two-part study using a randomised controlled trial and naturalistic study design

BACKGROUND

Severe mental illnesses (SMI), including schizophrenia spectrum disorder, bipolar disorder and major depressive disorder, are associated with physical health comorbidities and premature mortality. Physical activity and structured exercise have a beneficial impact on cardiometabolic risk and ameliorate mental health symptomology and cognition. This protocol describes a feasibility study for a high-intensity interval training (HIIT) intervention among inpatients with SMI, to improve their physical and mental health.

METHODS

The feasibility study follows a two-part design owing to COVID-19-related adaptations to project design: (a) a non-blinded randomised controlled trial (RCT) of 12 weeks of bicycle-based HIIT, delivered twice weekly in a face-to-face, one-to-one setting, compared to treatment as usual (TAU) and (b) a naturalistic study of inpatient HIIT; eligible participants will be invited to two sessions of HIIT per week, delivered by the research team remotely or in person. Additionally, participants in the naturalistic study may use the bike to conduct self-directed sessions of their chosen length and intensity. We will measure the feasibility and acceptability of the HIIT intervention as primary outcomes, alongside secondary and tertiary outcomes evaluating the physical, mental and cognitive effects of HIIT. The study aims to recruit 40 patients to the RCT and 6-8 patients to the naturalistic design.

DISCUSSION

Exercise is a modifiable lifestyle barrier that can reverse cardiometabolic disease risk. If HIIT is found to be feasible and acceptable in inpatients with SMI, there would be scope for large-scale work to evaluate the clinical, cost and implementation effectiveness of HIIT in inpatient mental health settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03959735 . Registered June 22, 2019.

Cognitive effectiveness of high-intensity interval training for individuals with methamphetamine dependence: a study protocol for randomised controlled trial

INTRODUCTION

Cognitive deficit is a common syndrome of methamphetamine (MA) dependence. It is related to decision-making, control ability, and social functioning. High-intensity interval training (HIIT) is a training technique that requires people to work out at full intensity during a short period. Many studies have already shown the potential effects of HIIT on cognitive functions. The purpose of this trial is to evaluate the cognitive effects of HIIT on individuals with MA dependence.

METHODS AND ANALYSIS

A total of 240 individuals with MA dependence will be randomly assigned to the HIIT group, moderate-intensity continuous training (MICT) group and control (CON) group. HIIT will consist of a 24-min HIIT exercise on a treadmill. MICT will consist of a 1-h body-mind exercise. CON will be their traditional intervention. The experimental period will be 12 months with 3 interventions weekly for the first 6 months and follow-up for the next 6 months. All subjects will be given cognitive tests at baseline, after intervention and at follow-up. Cognitive performances will be compared by a mixed-model analysis for repeated measures.

DISCUSSION

HIIT training may reduce illicit drug cravings amongst individuals with MA dependence; hence, HIIT may have a good effect on the cognitive functions, such as memory and executive function, of individuals with MA dependence.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000032492 . Registered on April 30, 2020 ( http://www.chictr.org.cn/edit.aspx?pid=52127&htm=4 ).

Comparison of the printed and online administration of the Behavioral Regulation in Exercise Questionnaire (BREQ-2)

OBJECTIVE

To compare the traditional printed form of the Behavioral Regulation in Exercise Questionnaire with a proposed online form in terms of validity, reliability, and applicability.

METHODS

A crossover design study was conducted with 157 undergraduate students. Half of the sample answered the printed questionnaire first and then answered the online questionnaire 7 days later, while the other half of the sample did the inverse. Cronbach's alpha was used to analyze the internal consistency of both the online and printed questionnaires. The construct validity was analyzed by confirmatory factor analysis, using a weighted least square mean and adjusted variance estimation and oblique rotation. The quality of the model was tested with fit indices.

RESULTS

The confirmatory factor analysis showed the 19-item structure with five factors: χ2 of 230.718; degrees of freedom of 142; χ2/degrees of freedom of 1.625; comparative fit index of 0.978 and root mean square error of approximation of 0.073. All items presented factorial loads above 0.5. There was also excellent consistency between the formats of administration in all dimensions, with Cronbach's alpha values above 0.70. The stability between the formats of administration varied between 0.78 (95%CI: 0.69-0.85) and 0.84 (95%CI: 0.77-0.89), suggesting desirable confidence between both formats of administration.

CONCLUSION

The five-factor model of the online Behavioral Regulation in Exercise Questionnaire shows internal consistency both in terms of the scale dimensions as well as in terms of the total items.

Neurophysiological Stress Response and Mood Changes Induced by High-Intensity Interval Training: A Pilot Study

This pilot study, conducted in advance of a future definitive randomized controlled trial, aimed to investigate the feasibility of using a HIIT-based intervention to induce neurophysiological stress responses that could be associated with possible changes in mood. Twenty-five active male college students with an average age of 21.7 ± 2.1 years, weight 72.6 ± 8.4 kg, height 177 ± 6.1 cm, and BMI: 23.1 ± 1.4 kg/m² took part in this quasi-experimental pilot study in which they were evaluated in two different sessions. In the first session, subjects performed a graded exercise test to determine the cycling power output corresponding to VO_2peak. The second session consisted of (a) pre-intervention assessment (collection of blood samples for measuring plasma corticotropin and cortisol levels, and application of POMS questionnaire to evaluate mood states); (b) exercise intervention (10 × 1-min of cycling at VO_2peak power output); (c) post-intervention assessment, and (d) 30-min post-intervention evaluation. Significant post-exercise increases in corticotropin and cortisol plasma levels were observed whereas mood states decreased significantly at this assessment time-point. However, a significant increase in mood was found 30-min after exercise. Finally, significant relationships between increases in stress hormones concentrations and changes in mood states after intense exercise were observed. In conclusion, our HIIT-based intervention was feasible to deliver and acceptable to participants. A single bout of HIIT induced acute changes in mood states that seems to be associated with hypothalamic-pituitary-adrenal axis activation.

Perspectives on implementing HIIT interventions for service users in inpatient mental health settings: A qualitative study investigating patient, carer and staff attitudes

BACKGROUND

High intensity interval training (HIIT) may have beneficial effects among people living with severe mental illness (SMI), however there remains an absence of information on attitudes of key stakeholders (e.g. family carers, healthcare professionals) towards offering HIIT interventions in psychiatric inpatient settings. This study sought to qualitatively investigate, in inpatients with SMI, carer and staff groups, perspectives on implementing HIIT interventions for patient groups in inpatient settings.

METHODS

Seven focus groups and one individual interview were conducted. These included three focus groups held with inpatients with SMI (n=13), two held with carers (n=15), and two held with healthcare professionals working in inpatient settings (n=11). An additional individual interview was conducted with one patient participant.

RESULTS

Two key themes emerged from the data, across all participants, that reflected the 'Positivity' in the application of HIIT interventions in psychiatric inpatient settings with beliefs that it would help patients feel more relaxed, build their fitness, and provide a break from the monotony of ward environments. The second theme related to 'Implementation concerns', that reflected subthemes about i) patient motivation, ii) patient safety and iii) practical logistical factors, including having access to the right sports clothing and staff availability.

LIMITATIONS

Investigations were limited to one mental health service provider and participants might already be those with an interest in exercise-based interventions.

CONCLUSIONS

HIIT interventions for SMI inpatients were perceived positively by key stakeholders. However, individual and organisational barriers to successful implementation are identified and should be addressed in advance.

The effect of menstrual cycle and exercise intensity on psychological and physiological responses in healthy eumenorrheic women

Psychological responses such as affect, mood, motivation, anxiety are important considerations for exercise adherence. A large body of evidence indicates that exercise intensity is a controllable variable capable of increasing positive feelings. Investigations thus far, however, have not considered that the higher incidence of negative psychological responses in women could be due to physiological particularities of the menstrual cycle (MC). This project investigates the effect of MC phases and exercise intensity on psychophysiological responses in fourteen healthy, eumenorrheic and physically active women. Measuring psychophysiological responses before, during and after exercise, participants completed two exercise bouts of 15 min above and below the anaerobic threshold in the follicular phase (FP) and the luteal phase (LP) of the MC. Lower levels of depression and hostility and higher levels of vigor, affect and motivation were observed during exercise in the FP. Exercise at moderate intensity elicited more positive psychological responses compared to high-intensity exercise, highlighted by findings that affect and rating of perceived exertion were worse in the LP without changes in physiological responses. These findings suggest no effect of MC on physiological responses, but psychological responses are impaired in the LP, worsening particularly during exercise at high intensity.

Working out the worries: A randomized controlled trial of high intensity interval training in generalized anxiety disorder

BACKGROUND

Aerobic exercise (AE) demonstrated an overall medium treatment effect in anxiety disorders (AD) but there is evidence for an "intensity-response" relationship. High intensity interval training (HIIT) was highly effective on a range of (mental) health parameters. However, so far no randomised-controlled trial (RCT) investigated the efficacy of HIIT in AD.

METHODS

33 patients with generalized anxiety disorder (GAD) were randomly assigned to 12-day HIIT or a training of lower intensity (LIT). Anxiety, comorbid depression, stress-related bodily symptoms and perceived control over anxiety related stimuli (PC) were assessed at baseline, post-training and 30 days after baseline by using the Penn State Worry Questionnaire (PSWQ), the Hamilton Inventories for Anxiety and Depression (Ham-A, Ham-D), the Screening for Somatoform Symptoms-7 (SOMS-7) and the Anxiety Control Questionnaire (ACQ-R).

RESULTS

Both interventions showed moderate or large effects on all clinical measures. However, effects for HIIT were generally about twice as high as for LIT. PC negatively correlated with GAD severity in the whole sample at baseline but an association of training-induced changes in PC and worrying were exclusively detectable in HIIT.

CONCLUSION

HIIT was highly effective and fast acting in GAD. Therefore, it may complement first-line treatment approaches in this condition.

H″IT″ting the Barriers for Exercising during Social Isolation

Aerobic exercise is traditionally recommended to improve general health and prevent many non-communicable diseases. However, the measures adopted to control the novel Coronavirus (COVID-19) outbreak culminated with closing of exercise facilities and fitness centers and, as a primary consequence, impaired aerobic exercise practice. This contributed to an increase in risk factors associated with physical inactivity such as insulin resistance, high blood pressure, low-grade inflammation, weight gain, and mental health problems. The scenario is worrisome, and it is important to propose alternatives for exercise practice during the COVID-19 pandemic. Interval training (IT) emerges as an exercise mode that might be feasible, low-cost, and potentially safe to be performed in many different places. IT consists of interspersing relative brief bouts of high-intensity exercise with recovery periods and promotes similar or greater health benefits when compared to moderate-intensity continuous exercise. Among the different types of IT, sprint interval training and "Tabata protocols" might be particularly useful during social isolation. These protocols can be controlled and performed without the need of complex equipment and can be adapted to different places, including domestic environments. In this article, we present variations of IT as possible alternatives to cope physical inactivity during COVID-19 pandemics with a focus on its practical applications. The protocols suggested can be performed without the need of specialized equipment or facilities, in a time-efficient manner, and aiming to prevent detraining or even improve physical fitness and general health.

The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls.

METHODS

The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up.

DISCUSSION

Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD.

TRIAL REGISTRATION

ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.

Is improved fitness following a 12-week exercise program associated with decreased symptom severity, better wellbeing, and fewer sleep complaints in patients with major depressive disorders? A secondary analysis of a randomized controlled trial

Major depressive disorder (MDD) is one of the most burdensome disorders worldwide. While exercise training in patients with MDD contributes to clinically relevant improvements in cardiorespiratory fitness, whether and to what degree changes in cardiorespiratory fitness impact depressive symptom severity has not yet been addressed systematically in prior research. The purpose of our study was threefold. Firstly, to examine whether baseline levels and improvements in objectively assessed VO₂max and subjectively perceived fitness predicted endpoint levels and change in depressive symptoms, wellbeing and sleep. Secondly, to determine whether exercise modality (sprint interval training [SIT]) versus continuous aerobic exercise training [CAT]) predicted depressive symptoms, wellbeing and sleep. Thirdly, whether the affective responses during and following exercise predicted depressive symptoms, wellbeing and sleep. All measurements were taken in a sample of inpatients diagnosed with MDD. The sample consisted of 53 participants (41 women and 12 men, M_age = 36.3 years, SD = 11.3) with unipolar depression who were randomly assigned to SIT and CAT. Data were assessed at baseline and after four weeks of exercise training (including three weekly 35 min sessions). Multiple linear regression analyses showed that improvements in VO₂max were associated with fewer depressive symptoms, better mental wellbeing, and better sleep after completion of the intervention. Additionally, improvements in perceived fitness were associated with fewer dysfunctional sleep-related cognitions and higher mental toughness post-intervention. Improvements in VO2max and perceived fitness were also associated with favorable changes in depressive symptoms, mental wellbeing, and sleep. More research is needed to find out which fitness tests are most time- and cost-efficient in a clinical setting and most acceptable for psychiatric patients.