Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER) of the BraveNet practice-based research network: Results of the chronic pain cohort

Background

An increasing number of clinics are providing integrative medicine for chronic pain, creating a need for real-world, practice-based research. Our purpose was to conduct a multi-site prospective, practice-based, observational evaluation of patient reported outcomes in chronic pain patients.

Methods

This study took place at seventeen BraveNet Practice Based Research Network integrative medicine clinics. Chronic pain patients receiving personalized, integrative medicine interventions at BraveNet clinics were eligible. Participants completed the Patient Reported Outcomes Measurement Information System-29, Perceived Stress Scale-4, and the Patient Activation Measure at the index/baseline visit and at 2, 4, 6, and 12 months. Diagnostic and billing codes were extracted data from patients' health records. Linear mixed-model and multi-variate analyses evaluated changes from index visit through 12 months.

Results

A total of 4883 patients enrolled, 3658 qualified and 967 of them endorsed chronic pain, completed at least two outcomes at 2 time points, had evaluable electronic health record data, and had at least one integrative medicine visit during the study period. Participants had a mean age of 51.6 years (SD 13.88) and were mostly white (81.8 %), female (78.3 %), educated (≥ college degree: 70.1 %). Significant improvements were observed on all 7 Patient Reported Outcomes Measurement Information System subscales, Perceived Stress Scale, and Patient Activation Measure scores at 12 months.

Conclusions

Chronic pain patients receiving care at integrative medicine clinics reported significant improvement over time in multiple domains of pain and quality of life. Future research with more sites and a common set of outcomes would further guide clinical practice.

Trial Registration

Clinical Trials.gov NCT01754038.

A comparative assessment of yogasana and karate training on cardio-autonomic function in adolescents: An empirical study

INTRODUCTION

Scientific findings reveal regular practice of traditional mind body exercises may reduce the invasion of chronic stressors and regain psychophysiological balance. This neuroautonomic relationship is assessed through several electrophysiological tools Heart Rate Variability (HRV) being one such measure. The present study compares the long-term cardio autonomic effects of yogasana - the physical aspect of yoga and another eminent but unexplored mind-body martial art form- karate.

METHOD

90 male school going subjects - 30 experienced yoga (age: 15.5 ± 1.83 yrs); 30 karate (age: 15.23 ± 2.07 yrs) practitioners and 30 active age-gender matched controls (age: 15.46 ± 1.77 yrs) were conveniently sampled, after effect size calculation. Time and frequency domain HRV was compared using One-way ANOVA followed by LSD Post Hoc Test after normality distribution of the data was checked.

RESULTS

High frequency power normalized unit (HF nu) showed significantly higher values among yoga practitioners (45.18 ± 16.00 nu) followed by karate practitioners (43.21 ± 18.14 nu) compared to the active control group (32.90 ± 15.76). The Low frequency normalized unit (LF nu) was at (53.90 ± 18.64 nu) and LF/HF Ratio at (1.40 ± 1.10) in the yoga group showed significantly lowest values.

CONCLUSIONS

Yogasana maintains stable parasympathetic dominance through its postures and steady breathing patternology, while karate practitioners being stress resilient show low sympathetic-vagal tone with a steady heart brain wellbeing.

The impact of physical activity on adolescent mental health status: the mediating effect of school adaptation

Objective

This study was designed to examine the mental health status of Chinese adolescents, investigate the effects of adolescent physical activity on mental health status, and verify the mediating effect of school adaptation.

Methods

A survey and analysis were conducted on 9,701 high school students in Shandong Province using the Physical Activity Questionnaire for Adolescents (PAQ-A), the School Social Behavior Scale-2 (SSBS-2), and the Symptom Checklist-90 (SCL-90) self-rating scale. The overall status of adolescent mental health was analyzed, regression modeling along with structural equation modeling was used to test whether school adaptation played a mediating role.

Results

The structural equation model was validated as a good fit (GFI = 0.950, RMSEA = 0.048, CFI = 0.972, NFI = 0.970, SRMR = 0.077). Physical activity was significantly and positively correlated with mental health status (β = -0.691, p < 0.001), school adaptation (β = 1.153, p < 0.001), and school adaptation was significantly and positively correlated with mental health status (β = -0.287, p < 0.001). The direct effect of physical activity on mental health status was 0.011 and the indirect effect of physical activity on school adaptation and school adaptation on mental health status was 0.024.

Conclusion

Physical activity was positively related to mental health status, with physical activity significantly and positively predicting mental health status; school adaptation was significantly and positively related to physical activity and mental health status, with school adaptation mediating between physical activity and mental health status.

Comparing the impacts of different exercise interventions on patients with type 2 diabetes mellitus: a literature review and meta-analysis

Objective

Exercise interventions are a recommended method of diabetes management through which patients can achieve blood glucose control, increase muscle volume, and improve insulin sensitivity, while also improving blood lipids, blood pressure, and cardiovascular health. A few studies on the effects of physical exercise on diabetic patients have been published in recent years. This article focuses on exploring evidence on which exercise interventions generate which effects in diabetic patients, namely, high-intensity interval training (HIIT), method training (MT), aerobic exercise training (AET), resistance training (RT), and combined training (CBT).

Methods

Randomized controlled trials (RCTs) that focused on the effects of exercise interventions on blood glucose and blood lipids of patients with type 2 diabetes mellitus were reviewed. A network meta-analysis was performed to compare the effects of the five exercise interventions in diabetic patients, namely the impacts on glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). The study was strictly conducted following the PRISMA Protocol, and the Cochrane Risk of Bias Assessment Tool 2.0 was used to objectively evaluate the risk of bias in the implementation of the study.

Results

This review included 25 RCTs in total, with 1,711 subjects. Meta-analysis suggests that, compared with conventional therapeutic treatment, exercise interventions can reduce blood glucose indexes, namely HbA1c, FBG, TC, TG, HDL, and LDL. RT and AET have been shown to reduce TC; HIIT, MT, AET, and CBT have been shown to improve HDL; and HIIT, MT, AET, and CBT have been shown to improve HDL. The MT and RT exercise types can reduce LDL. Evidence also suggests that MT can lower HbA1c, TG, and LDL levels, and RT lowers cholesterol levels. HIIT exercise appears to improve FBG and HDL levels.

Conclusion

The five types of exercise generate different effects on the key clinical dimensions of diabetes. MT seems to be the optimal choice to improve HbA1c, TG levels, and LDL, while HIIT improves FBG and HDL levels, whereas RT exercise appears to be the optimal exercise to lower cholesterol levels.

A mixed-methods investigation of COVID-19 pandemic-specific stress in college students

OBJECTIVE

To identify pandemic-specific stressors among college students and compare patterns of stressors in samples obtained during early and chronic phases of the pandemic.

METHOD

Different undergraduate student samples from a Southeastern university completed an online survey in Spring 2020 (early pandemic; N = 673) and Fall 2020 (chronic pandemic; N = 439). This repeated cross-sectional survey study used a mixed methods triangulation design to validate and expand on quantitative findings using qualitative data.

RESULTS

Quantitative and qualitative analyses revealed 13 pandemic stressor domains, with academics and lifestyle adjustment among the most stressful in both samples, and more stressful in the chronic pandemic sample. Non-freshmen, female, and first-generation college students were at greater risk for pandemic stress.

CONCLUSIONS

As college students continue to experience stressors related to COVID-19 and encounter future crises, colleges and universities must adapt to meet their unique needs specific to the context.

Research on the extension of respiratory interaction modalities in virtual reality technology and innovative methods for healing anxiety disorders

The timely alleviation and healing of anxiety is crucial for preventing anxiety disorders. This study explores innovative digital approaches for anxiety relief by integrating virtual reality (VR) and multimodal interaction theories and technologies with psychodrama therapy and breathing therapy from psychology. The research proposes an innovative method of breathing interaction based on olfactory interaction modalities and designs breathing interaction semantics aimed at anxiety healing through three types of breathing therapy. Using the Unreal Engine, VR gamified scenarios and interaction logic for levels were constructed, leading to the development of a multimodal immersive software interaction system and a prototype for VR hardware interaction that extends the breathing interaction modality. The effectiveness of the system for anxiety relief was validated through an EEG experiment involving 38 participants, supported by analysis of Topographic Maps, Band-Power Reports, ERP analysis, and qualitative data from the USE scale. This research confirms that the innovative integration of VR and breathing interaction modalities is effective for anxiety therapy, aiding users in promptly alleviating anxiety and simplifying the psychological healing process.

Long-term effects of yoga-based practices on neural, cognitive, psychological, and physiological outcomes in adults: a scoping review and evidence map

BACKGROUND

Compared with short-term practices, long-term yoga might promote differential qualitative and quantitative outcomes. Following JBI's and PRISMA-ScR guidelines, this scoping review followed an apriori and systematic protocol to document the long-term effects of yoga on neural, cognitive, psychological, and physiological outcomes, provide evidence maps for each yoga component, and summarize results identifying knowledge gaps and promising directions.

METHODS

Four databases (PubMed, Cochrane, LILACS, and PubPsych) were last searched in March 2023. Studies were included if they evaluated adults with > 1 year of practice, specified yoga-based practice(s) of interest, measured neural, cognitive, psychological, and/or physiological outcomes, were written in English, Spanish, or Portuguese, presented original data, and mentioned search terms in the title/abstract. Evidence maps for each yoga component followed a 4-level structure of outcome category, method, study design and literature size. Qualitative summaries followed the same structure, to facilitate information retrieval.

RESULTS

Out of 2270 screened studies, 65 were included (meditative studies = 36, predominantly postural studies = 25, breathing practice studies = 8). Physiologicaland neural outcomes were the most common, followed by psychological and cognitive outcomes. Although heterogeneous, neural results reveal structural and functional changes related to sensorimotor, interoceptive, emotion regulation, and executive functions. Physiologically, most studies have associated long-term practice with parasympathetic-driven autonomic, hormonal and immune responses, but some studies revealed sympathetic-driven or mixed responses, maybe due to the specific technique or individual differences. Psychological outcomes included lower levels of negative affect, psychopathological symptoms, and emotional reactivity. Cognitive measures have shown improved memory/cognition for older adults, but mixed or null effects for other constructs. Commonly, however, long-term practitioners demonstrated improved neural or physiological efficiency while performing cognitive tasks.

CONCLUSIONS

Future research should provide clear descriptions of the investigated yoga practice, employ more experimental paradigms, and refine statistical reports and models. We encourage researchers to work with specific overarching theoretical frameworks to refine research predictions, such as the neurovisceral integration model or predictive coding models; to consider motivational, cultural, and contextual factors that might influence long-term outcomes; and to develop systematic reviews and meta-analyses as next steps of evidence summary.

The effects of an acute Tai Chi on emotional memory and prefrontal cortex activation: a fNIRS study

Objective

Acute exercise has the potential to influence emotional memory and cortical hemodynamics, but the specific effects depend on the type of exercise. This study aimed to determine whether acute Tai Chi practice enhances emotional memory and prefrontal cortex activation compared to cycling and a control condition.

Methods

Using a within-subjects crossover design, 36 healthy university students completed three interventions: Tai Chi, cycling, and a resting control condition. Emotional memory performance was assessed before and after each intervention, and cortical hemodynamics were measured using functional near-infrared spectroscopy (fNIRS). The correlation between oxyhemoglobin (Oxy-Hb) concentration in the prefrontal cortex and emotional memory accuracy was analyzed.

Results

Compared to cycling and the control group, the Tai Chi intervention showed: (1) a significantly higher accuracy of positive emotional memory; (2) a greater increase in Oxy-Hb concentration in the left dorsolateral prefrontal cortex (L-DLPFC) during positive emotional memory tasks; (3) a stronger positive correlation between Oxy-Hb concentration in the L-DLPFC and emotional memory accuracy. In contrast, cycling improved positive emotional memory accuracy to a lesser extent, while the control group showed no significant changes.

Conclusion

Tai Chi, compared to cycling and rest, significantly enhanced positive emotional memory and L-DLPFC activation. These findings highlight the unique potential of Tai Chi to improve emotional memory through increased cortical activation, suggesting its effectiveness as a cognitive-emotional intervention.

Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments

Background

Diabetes-related cognitive impairment is increasingly recognized as a significant complication, profoundly impacting patients' quality of life. This review aims to examine the pathophysiological mechanisms, clinical manifestations, risk factors, assessment and diagnosis, management strategies, and future research directions of cognitive impairment in diabetes.

Methodology

A comprehensive literature search was conducted using PubMed, Medline, and other medical databases to identify, review, and evaluate published articles on cognitive impairment in diabetes. The search focused on studies examining pathophysiology, clinical presentations, risk factors, diagnostic approaches, and management strategies.

Results

The review of current literature revealed that chronic hyperglycemia, insulin resistance, and vascular factors are major contributing factors to cognitive deficits in diabetes. Clinical manifestations include impairments in attention, memory, executive function, visuospatial abilities, and language. Risk factors encompass disease duration, glycemic control, presence of complications, age, education level, and comorbidities. Assessment tools include cognitive screening instruments, neuropsychological testing, and neuroimaging techniques. Management strategies involve glycemic control optimization, lifestyle modifications, cognitive training, and pharmacological interventions.

Conclusion

This review highlights the significant prevalence and impact of cognitive impairment in diabetes, resulting from complex metabolic and vascular disturbances. Early detection and multifaceted interventions are crucial for preserving cognitive function and improving patient outcomes. Future research should focus on neuroprotective strategies, biomarker identification, and personalized approaches. Collaborative efforts between clinicians and researchers are essential to effectively address this growing healthcare challenge and enhance the quality of life for individuals with diabetes-related cognitive impairment.

The Effect of Diaphragmatic Breathing as a Complementary Therapeutic Strategy in Stress of Children and Teenagers 6-18 Years Old

BACKGROUND

Few studies are reported on interventions that have been carried out in children and adolescents using diaphragmatic breathing (DB) together with methods like counseling, muscle relaxation, therapeutic exercise, and music therapy.

OBJECTIVE

The goal of the review is to evaluate the effectiveness of DB as complementary therapy in the stress of the pediatric population (6-18 years old).

METHODS

Detailed research was carried out in the current literature to find relevant studies published from 2010 to October 2024 in PubMed and Cochrane Library. Thirteen studies that fulfilled the inclusion criteria were included in the study. Nine studies involved obese and overweight pediatric populations and the other four involved pediatric patients.

RESULTS

The interventions comprised two 8-week studies in an obese pediatric population, seven studies in healthy children and adolescents with normal weight. The studies were based on DB, muscle relaxation, nutrition, counseling, music therapy, and slow breathing exercises. The participants in the intervention group improved in comparison to those in the control group in terms of stress and depression in most included studies, in terms of school performance in two studies, in terms of better family relationships in one study, and showed improvement in anthropometric indicators in two studies. In four studies that involved pediatric patients, stress and fear of medical procedures were reduced.

CONCLUSIONS

DB can effectively contribute on its own or in combination with other therapeutic methods to improving physiological and psychological indicators in the pediatric population. It is useful to integrate stress management programs that include DB training as clinical practice in primary healthcare and in school schedules for elementary and high-school students.

The psychosomatic impact of Yoga in medical education: a systematic review and meta-analysis

Non-clinical approaches such as meditation, yoga, and mindfulness are popular traditional therapeutical interventions adopted by many educational institutions to improve the physical and mental well-being of learners. This study aimed to evaluate the effectiveness of yoga intervention in improving cardiopulmonary parameters such as blood pressure, heart rate, pulmonary function tests and psychosomatic symptoms such as depression, anxiety and stress in medical and dental students. Using the PRISMA protocol, a search from databases such as PubMed, Scopus, and Embase resulted in 304 relevant articles. After screening the title and abstracts, 47 papers were analyzed thoroughly and included in the qualitative analysis. 18 articles with homogenous statistical data on physiology and psychological parameters were included for meta-analysis. In comparison to the control group, the study showed a significant reduction of systolic blood pressure (SBP: 6.82 mmHg, z = -3.06, p = 0.002), diastolic blood pressure (DBP: 2.92 mmHg, z = -2.22, p = 0.03), and heart rate (HR: 2.55 beats/min, z = -2.77, p = 0.006). Additionally, data from 4 studies yielded a significant overall effect of a stress reduction of 0.77 on standardized assessments due to the yoga intervention (z = 5.29, p < 0.0001). Lastly, the results also showed a significant (z = -2.52, p = 0.01) reduction of 1.2 in standardized anxiety tests in intervention group compared to the control. The findings offer promising prospects for medical educators globally, encouraging them to consider reformation and policymaking in medical curricula to enhance academic success and improve the overall quality of life for medical students worldwide.

Promoting workplace psychological wellbeing through Yoga and Tai Chi classes in female university employees

Introduction

Academic environments are known for their high demands, often resulting in significant distress among employees. Thus, identifying effective intervention strategies to mitigate workplace stress is essential. The present study aims to evaluate the potential benefits of mind-body interventions (i.e., Yoga and Tai Chi) on the psychological wellbeing and perceived mental and physical health of female university employees.

Methods

A total of 166 female university employees and faculty members participated in 10 sessions of Tai Chi or Yoga. They completed self-report questionnaires assessing ruminative thoughts, somatic anxiety, general distress, perceived physical and mental health, and assertive and cooperative behaviors before and after the 10 Tai Chi/Yoga sessions. Additionally, participants completed a state anxiety questionnaire before and after Tai Chi/Yoga second and second-to-last lessons.

Results

Results showed significant differences between scores pre and post Tai Chi and Yoga programs, with lower ruminative thoughts (p = 0.007), lower somatic anxiety (p < 0.001), and higher perceived mental health (p = 0.038) at the end of the programs (i.e., after 10 sessions) compared to the beginning. Moreover, significant differences were found in state anxiety scores, with a reduction in state anxiety at the end of the second (p < 0.001) and second-to-last (p < 0.001) lessons compared to the start.

Conclusion

Our findings highlight the potential positive impact of Tai Chi and Yoga programs on the psychological wellbeing and perceived mental health of female university employees. Immediate reductions in state anxiety following single sessions further underscore the potential of these practices for short-term stress relief. Overall, the results support the implementation of mind-body practices in workplace settings to promote a healthier work environment.

The effects of Baduanjin exercise on the psychological condition and heart rate variability of sports-disadvantaged college students: A randomised trial

OBJECTIVE

To investigate the effects of a 16-week Baduanjin exercise programme on the psychological status and heart rate variability (HRV) of college students in a sports-disadvantaged group, offering a theoretical basis for the potential of Baduanjin exercise to improve mental health.

TRIAL DESIGN

This prospective study enrolled 93 college students from Wuyi University, exempt from the National Standards for Students' Physical Health due to illness or disability. The participants were divided into a control group (n = 47) and an experimental group (n = 46). Over 16 weeks, the experimental group engaged in the Baduanjin exercise, whereas the control group did not participate in regular physical training.

METHODS

We assessed the Symptom Checklist-90-Revised (SCL-90-R, the primary outcome) scores and HRV (time domain and frequency domain indices, the secondary outcomes) of all participants both before and after the 16-week programme.

RESULTS

(1) Post-16 weeks of Baduanjin exercise, a statistically significant difference was observed in the SCL-90-R scores between the control and experimental groups (P < 0.01, P < 0.05). Notably, the scores for interpersonal sensitivity, depression, anxiety, psychoticism, and other factors (predominantly relating to sleep and diet) were significantly lower in the experimental group (t = 4.234, 2.616, 3.450, 2.226, 3.980, P < 0.01, P < 0.05). (2) Following the exercise regimen, the experimental group showed a substantial decrease in heart rate, low-frequency (LF) power, and the LF/high-frequency ratio (LF/HF ratio), and a significant increase in HF compared with the control group (t = 2.358, 4.528, - 2.595, P < 0.05 P < 0.01).

CONCLUSION

Sixteen weeks of Baduanjin exercise may substantially enhance HRV, potentially aiding in balancing sympathetic-vagal nerve activity and thus contributing to the regulation of mental health.

Feasibility of a custom-tailored, evidence-based, theory-informed, intervention to prevent burnout and reduce stress for healthcare professionals: protocol for a single-arm trial

BACKGROUND

Healthcare professionals face high levels of occupational stress, time pressure, workload, and poor organizational support. This makes them particularly vulnerable to burnout. The COVID-19 pandemic has further exacerbated this situation. This single-arm, multicenter, mixed-methods feasibility study pilots the LAGOM program: A tailored, evidence-based intervention to prevent burnout and reduce stress among healthcare professionals.

METHODS

Participants will include healthcare professionals (N = 30) working at Charité-Universitätsmedizin Berlin and Immanuel Hospital, Berlin. LAGOM focuses on support for individual behavior change and personal resources and also addresses the organizational level. The intervention´s feasibility will be evaluated through a non-randomized feasibility trial with a mixed methods process evaluation. The exploratory primary study aims are to assess the acceptability and feasibility of the (1) evaluation procedures and of the (2) intervention content and structure using study records, standardized questionnaires, protocol checklists, and diaries. Exploratory effectiveness analysis will take place as well. Further, semi-structured interviews (n = 3 to 6) and electrophysiological measurements (n = 20) will be conducted.

DISCUSSION

Custom-tailored, well-implemented multi-level interventions are needed to prevent burnout and reduce stress among healthcare professionals. Long-term strategies are warranted to sustainably implement effective programs. This feasibility study helps to refine trial procedures and content of the LAGOM program for a randomized controlled trial to evaluate the intervention's effectiveness.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00032014 , registered 17th October 2023.

Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial

BACKGROUND

The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances.

METHODS

Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).

RESULTS

Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity.

CONCLUSION

The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.

Effects of Tai Chi and Qigong on Heart Rate Variability: A Systematic Review and Meta-Analysis

Background:

Intervention studies examining meditative movement (MM) often demonstrate benefits on physiological and psychological health. A potential mechanism associated with these outcomes is heart rate variability (HRV), an important neurophysiological biomarker of optimal and resilient health and functioning.

Objective:

We aimed to synthesize existing literature on the effects of two related forms of MM, Tai Chi (TC) and Qigong (QG) on HRV parameters in adult populations.

Methods:

Following PRISMA guidelines and Cochrane Collaboration recommendations, four databases (MEDLINE, Google Scholar, Academic Search Premier, and PubMed) were searched for articles (through December 15, 2023) that included TC and/or movement-based QG intervention versus any control condition (active or inactive) and reported at least one HRV outcome. Two reviewers independently completed study selection, data extraction, and risk-of-bias assessment.

Results:

We identified 148 for potential inclusion. After removing 61 duplicates, 87 full-text reviews yielded 23 articles, and 16 qualified for meta-analysis based on common HRV outcomes. Meta-analyses indicated a significant overall effect of TC/QG interventions on high-frequency power and standard deviation of the beat-to-beat intervals (SDNN), two critical HRV parameters, compared with control conditions: for HF power, standardized mean difference (SMD) = 0.29, P = 0.003, 95% Confidence interval (CI) [0.10, 0.48]; heterogeneity: I 2 = 46%, χ2 (8) = 14.89, P = 0.06; and for SDNN: SMD = 0.83, P = 0.02, 95% CI [0.16, 1.51]; heterogeneity: I 2 = 90%, χ2 (7) = 71.62, P < 0.001. Other HRV parameters did not demonstrate significant changes upon meta-analyses, but overall effect sizes showed a trend toward the expected direction.

Conclusion:

Based on the strength of the evidence, we conclude TC/QG interventions may shift HRV parameters toward improved health status and resilience. In addition, we offer suggestions to improve the design and measurement of future TC/QG research interventions exploring HRV.

A custom tailored, evidence-based, theory-informed intervention for healthcare professionals to prevent burnout (LAGOM): study protocol for a pragmatic randomized controlled trial

BACKGROUND

Healthcare professionals in hospitals are exposed to a high level of professional stress, time pressure, workload, and often times poor organizational support. This makes them especially susceptible to burnout. In this pragmatic randomized controlled trial, we test the hypothesis that participation in a 9-week program (LAGOM) that was designed in close collaboration with healthcare professionals, incorporating both individual and organizational aspects reduces emotional exhaustion in healthcare professionals (primary outcome).

METHODS

Eighty four nurses and physicians working at the Charité - Universitätsmedizin Berlin and the Immanuel Hospital Berlin are automatically randomized to the LAGOM program (n = 42) or to usual care (n = 42) in a one-to-one allocation rate. The primary outcome emotional exhaustion is measured by the Maslach Burnout Inventory-Human Services Survey at baseline, post-intervention, and 1-month follow-up via an online survey. Secondary outcomes include depersonalization, personal accomplishment, subjective stress, mental well-being, self-care, self-efficacy, working conditions, mindfulness, and adverse events. Electrophysiological measures for heart rate variation analysis are captured. The PRECIS-2 tool is used to characterize the degree of pragmatism in our trial. Data analysis and primary intention-to-treat analysis using repeated measures analysis of variance are performed blind to intervention allocation. Per-protocol, subgroup, and secondary outcome analyses are conducted exploratively. An advisory board consisting of various stakeholders accompanies the study process.

DISCUSSION

If LAGOM proves to be effective in reducing symptoms of burnout, the program could make an important contribution to tackling the problem of the very high burnout rates among healthcare professionals and become an integral part of preventive services offered by hospitals.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00034060. Registered 31 May 2024.

Effects of different traditional Chinese exercise for knee osteoarthritis patients: A network meta-analysis of randomized controlled trials

BACKGROUND

The most popular traditional Chinese exercise (TCE) techniques include Tai Chi, Yijinjing, Baduanjin, Wuqinxi, and Qigong. Exercise is advised as a primary treatment for knee osteoarthritis (KOA) according to clinical standards. According to several studies, TCE may be an effective way to help people with KOA manage their pain, stiffness, and physical function. Which TCE therapy is the most effective and whose particular usefulness is still debatable. The network meta-analysis (NMA) method is used in this study to evaluate and compare the effects of various TCE therapies on KOA patients.

METHODS

We will search PubMed, Embase, Scopus, Cochrane Library, Web of Science, the China National Knowledge Infrastructure, Wanfang, the Chinese Scientific Journal Database (VIP), and the China Biology Medical Literature Database (CBM) for randomized controlled trials reporting TCE therapy for KOA patients published before October 25, 2023. The Stata 16.0 program will compare the effectiveness of various TCE therapies on KOA patients using conventional pairwise and NMA.

RESULTS

The final 29 studies included 15 articles on Tai Chi, 7 articles on Baduanjin, 4 articles on Wuqinxi, and 3 articles on Yijinjing. Tai Chi was first for the effect sizes of VAS scores, WOMAC pain scores, and WOMAC available scores, while Baduanjin was ranked top for WOMAC stiffness scores. Research should continue to be conducted on the effect of Qigong on KOA intervention.

CONCLUSIONS

This NMA will help determine the best TCE treatment for KOA and offer evidence-based bias for clinical decision-making.

Effects of Vibroacoustic Stimulation on Psychological, Physiological, and Cognitive Stress

Global stress is widespread in today's post-pandemic world of political and economic uncertainty. Vibroacoustic technology is a vibrotactile intervention with multiple uses, but its impact on stress lacks interpretation. This research assessed if the vibroacoustic technology of a Vibroacoustic Sound Massage (VSM) can reduce psychological, physiological, and cognitive stress. The Perceived Stress Scale (PSS-10) and electrocardiogram (ECG) and electroencephalogram (EEG) biosignals were used to quantify results. Participants were divided into Low-Stress and High-Stress groups. The ECG results show VSM increased parasympathetic activity for all participants, with the Low-Stress group being more affected. The EEG results indicate increased concentration, reduced arousal, and increased relaxation, with participant well-being non-significantly affected, though variability in this metric was homogenised after VSM. Together, these results validate VSM as an effective support tool for stress management; however, further research is required.

Improved Sympathetic Activity With Short-Term Effects of Yoga in Young Adults

The purpose of this study was to clarify the heart rate variability (HRV) transition after a single yoga program. Participants were 22 females who were healthy university students and had never practiced yoga before. They practiced yoga while recording their HRV. Heart rate (HR), high frequency (HF; 0.15-0.4 Hz) as parasympathetic and low frequency (LF; 0.04-0.15 Hz) components were extracted, and then the LF/HF ratio as sympathetic and normalized units of HF HFnu = HF/(LF + HF) as parasympathetic modulation in autonomic activity were calculated. HR and HRV indices after yoga were divided into four 5-minute periods (after 5, 10, 15, and 20 minutes) and compared before yoga. HR and LF/HF at all periods after yoga were significantly lower than before yoga (P < .01, all). HF after yoga was not significantly changed, but HFnu after 5, 10, and 15 minutes was significantly higher than before yoga (P < .01, <.01, and =.02, respectively). The short-term effects of yoga on HRV implied a decrease in sympathetic modulation and a relative increase in parasympathetic modulation. Therefore, yoga may be used as a fast-acting alternative therapy to significantly improve sympathetic activity.

Effects of 12 weeks of functional training vs. Muay Thai on cardiac autonomic modulation and hemodynamic parameters in older adults: a randomized clinical trial

BACKGROUND

The elevated blood pressure (BP) and lower cardiac autonomic modulation (CAM) are associated with higher morbidity mortality risk among older adults. Although exercise is an important intervention for cardiovascular promotion, it is unclear whether combat sports training could benefit cardiovascular outcomes as much as autonomic in this population. This study compared the effects of 12 weeks of Muay Thai (MT) training against functional training (FT) on CAM and hemodynamic parameters in older adults.

METHODS

The sample consisted of 50 older adults (41 women; 66.0 ± 5.3 years old), who were equaly randomized into FT (n = 25) and MT (n = 25) intervention groups. CAM was measured by 30-min rest heart rate variability. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and resting heart rate (RHR) were measured using an automatic oscillometric device. Pulse pressure (PP) and the double product (DP) were also calculated. The interventions were carried out three times a week, with 60-min length per session, during 12 consecutive weeks. The intensity of the interventions was measured using the subjective perception of exertion scale and by accelerometer. Two-factor repeated measures analysis of covariance was used for groups comparison, considering intervention group and body mass as factors. The 95% confidence interval of the difference (95%CIdif) was also calculated and the effect size was measured using partial eta squared (η2p).

RESULTS

CAM indices did not show significant changes across moments and intervention groups. In hemodynamic parameters, only in DBP was there an effect of the moment (F1,39 = 8.206; P = 0.007; η2p = 0.174, large) and interaction effect between group*moment (F1,39 = 7.950; P = 0.008; η2p = 0.169, large). Specifically, the MT group at the post-training moment showed lower DBP (P = 0.010; 95%CIdif = -13.3; -1.89) in relation to the FT group. Furthermore, the MT group showed a decrease in DBP during training (P = 0.002; 95%CIdif = -10.3; -2.6). Also, an increase in training intensity was also found over the 12 weeks in FT, with no difference between the groups.

CONCLUSION

After 12 weeks of MT practice there was a reduction in DBP compared to FT in older adults.

TRIAL REGISTRATION

NCT03919968 Registration date: 01/02/2019.

Adolescent mental health interventions: a narrative review of the positive effects of physical activity and implementation strategies

INTRODUCTION

The psychological well-being of adolescents is a global concern due to increasing societal pressures and mental health issues. Physical activity is known to enhance physical health and has potential benefits for mental health, including reducing symptoms of anxiety and depression, boosting self-esteem, and improving social skills. This narrative review explores how physical activity can serve as an intervention to help adolescents manage psychological stress and prevent mental health issues.

METHODS

An extensive literature search was conducted using databases such as PubMed, PsycINFO, Web of Science, and Scopus. Keywords included "adolescent mental health," "physical activity," "psychological intervention," "types of exercise," "anxiety," "depression," "self-esteem," "social skills," and "emotional regulation." Studies were included based on relevance, peer-reviewed status, and involvement of adolescent populations. Data were extracted and analyzed qualitatively, focusing on the psychological impacts of different types of physical activity. Sixty one articles were eventually included.

RESULTS AND CONCLUSION

The review identified multiple studies highlighting the positive effects of various physical activities on adolescent mental health. Aerobic exercises were found to improve mood and cognitive function, strength training reduced depressive symptoms and increased self-efficacy, team sports enhanced social skills and a sense of community, and mind-body practices like yoga and tai chi improved stress management and emotional regulation. The findings suggest that physical activity can play a significant role in promoting adolescent mental health. Implementation strategies in school and community settings, including integrating physical activity into school curricula, offering diverse activity options, training professional instructors, encouraging family and community involvement, and regular monitoring and evaluation, are recommended. Future research should address limitations such as sample diversity and long-term effects. This narrative review underscores the importance of physical activity in enhancing adolescent mental health. Effective implementation strategies and multi-sector collaboration are essential for maximizing the benefits of physical activity interventions.

The Effect of Stress-Reducing Interventions on Heart Rate Variability in Cardiovascular Disease: A Systematic Review and Meta-Analysis

Stress is recognized as a significant trigger and exacerbator of various medical conditions, particularly in the field of cardiovascular disease (CVD). Given that heart rate variability (HRV) offers insight into the functioning of the autonomic nervous system and has been identified as a predictive factor for increased cardiovascular mortality, exploring the correlation between stress and HRV is pertinent. We systematically reviewed trials where researchers investigated the effects of stress-reducing interventions on biomarkers and time-domain/frequency-domain parameters of HRV in CVD. Eligible studies underwent meta-analysis utilizing a random-effects model. The meta-analysis showed overall beneficial effects of stress-reducing interventions on HRV for the standard deviation of Normal-to-Normal intervals (SDNN) in short-term and 24 h assessments, as well as for the low-frequency power (LF) in short-term assessment. Overall effect sizes were notably high and showed significant p-values (short-term SDNN: MD = 6.43, p = 0.01; 24 h SDNN: MD = 10.92, p = 0.004; short-term LF: MD = 160.11, p < 0.001). Our findings highlight the significant impact of stress-reducing interventions in modulating HRV by influencing short-term SDNN and LF parameters, as well as the 24 h assessment of SDNN. These results emphasize the importance of stress-reducing measures in lowering the risk of further progression in CVD and improving patient outcomes.

Home Anxiety Assessment and Influencing Factors among Adolescent Athletes in Yantai City

OBJECTIVE

To understand the prevalence of home-related anxiety among adolescent athletes during the novel coronavirus pandemic and to ascertain the factors influencing this anxiety.

METHODS

We employed cluster sampling to select 1150 adolescent athletes (aged 8-18 years) from six sports training schools in Yantai City, Shandong Province. Mental health status was assessed and recorded. Chi-square tests and multivariable logistic regression were used to analyze the factors contributing to athletes' anxiety.

RESULTS

The survey revealed a COVID-19 infection rate of 38.23% (437 individuals) with an anxiety score of 40.98 ± 8.20 and an anxiety detection rate of 11.29% (129 individuals) during the COVID-19 epidemic. Female athletes exhibited a higher anxiety rate of 14.40% compared to 8.40% in male athletes. Multivariate analysis identified female gender as a risk factor for anxiety (OR = 1.64), while participation in aquatics emerged as a protective factor (OR = 0.24, 95% CI: 1.08-2.48). Professional training duration exceeding three years increased anxiety risk (OR = 3.05, 95% CI: 1.67-5.58), as did not seeking help during difficulties (OR = 2.59, 95% CI: 1.33-5.01). Interestingly, parental care was linked to increased anxiety risk (OR = 2.44, 95% CI 1.34-4.44), while care from friends was protective (OR = 0.60, 95% CI: 0.36-1.01), which was possibly due to the pressure associated with parental expectations.

CONCLUSIONS

Adolescent athletes, particularly females and those with extended training durations, exhibit a heightened susceptibility to anxiety. This study also highlights that athletes who proactively seek assistance during challenging situations tend to experience lower anxiety levels. Additionally, a lack of COVID-19 infection and the involvement of concerned parents contribute to reduced anxiety among these young athletes.

Effectiveness of Resistance Band Use in Conjunction With Tai Chi Among Older Adults With Prefrailty to Improve Functional Fitness, Quality of Life, and Heart Rate Variability

PURPOSE

The current randomized controlled trial aimed to bolster the physical fitness of prefrail older adults, potentially delaying their need for admission to care facilities and enhancing their overall well-being.

METHOD

The experimental group received a physical fitness intervention comprising resistance band use and tai chi three times per week for 12 weeks, whereas the control group received frailty-related health education. Thirty-four male participants completed the study.

RESULTS

A total of seven items had statistically significant differences at 12- and 16-week posttest, respectively: frailty index (p = 0.03; p = 0.03); Instrumental Activities of Daily Living Scale (p < 0.001; p < 0.001); and physical fitness, back (p < 0.001; p < 0.001); physical fitness, arm curl (p = 0.02; p < 0.001); physical activity (p < 0.001; p = 0.009); quality of life, physiological (p = 0.04; p < 0.001); and heart rate variability (p < 0.001; p < 0.001).

CONCLUSION

Results revealed substantial improvements in physical fitness, frailty conditions, self-care abilities, and quality of life, but not balance or lower limb flexibility, for the experimental group. Therefore, exercise interventions may effectively improve prefrail older adults' quality of life. [Journal of Gerontological Nursing, 50(5), 19-26.].

Yoga and Cardiovascular Diseases - A Mechanistic Review

Yoga is an ancient Indian practice that involves the mind and body. It is a combination of physical exercises and postures with a focus on deep breathing and meditation. Yoga thereby promotes a healthy lifestyle which is one of the key factors in the prevention of various cardiovascular diseases. The practice of yoga might hence be effective in preventing the onset of these diseases. Yoga exerts its beneficial effects by favorable modulation of the autonomic system, reduction in oxidative stress, decreased inflammatory stress, improved endothelial function, and epigenetic changes. These changes might contribute not only to the prevention of cardiovascular diseases but also to delaying and preventing the onset of various modifiable cardiovascular risk factors. This review aims to delineate the possible mechanisms of the effect of yoga on cardiovascular health and its potential beneficial effects.

The application of virtual reality meditation and mind-body exercises among older adults

Virtual reality (VR)-based mindfulness is a promising method to improve the health of older adults. Therefore, many attempts have been made to explore the application of VR-based mindfulness, such as VR meditation and mind-body exercises, in older adults. Generally, current studies indicate the heavy reliance on apparatus for implementing VR-based mindfulness interventions. In VR meditation, the crucial apparatus is VR headsets. In VR mind-body exercises, three essential components are required: motion capture sensors, main consoles, and display screens. In the aspect of health promotion, VR meditation is an effective method for improving mental health, pain, and quality of life in older adults. VR mind-body exercises contribute to increasing the mental health and physical function of older adults. Furthermore, VR mind-body exercises may be combined with other forms of exercise as a mixed method to promote the health of older adults. VR-based mindfulness interventions enhance the meditation and mind-body exercises experience for older adults while improving accessibility. However, their implementation still encounters a series of challenges, such as cost, technical anxiety, and apparatus-related issues. Additionally, we recommend future research to examine the optimal exercise dose for VR mind-body exercises to maximize their health benefits.

Acute effects of different Tai Chi practice protocols on cardiac autonomic modulation

Tai Chi serves as an effective exercise modality for enhancing autonomic regulation. However, a majority of existing studies have employed the single routine (SR) protocol as the basis for health interventions. The extent to which the gong routine application (GRA) protocol achieves similar levels of exercise load stimulation as traditional single practice routines remains uncertain. Therefore, this study the distinct characteristics of autonomic load stimulation in these different protocols, thus providing a biological foundation to support the development of Tai Chi health promotion intervention programs. we recruited a cohort of forty-five university students to participate in the 15 min GRA protocol and SR protocol. We collected heart rate and heart rate variability indicators during periods of rest, GRA protocol, and SR protocol utilizing the Polar Scale. Additionally, we assessed the mental state of the participants using the BFS State of Mind Scale. In summary, the autonomic load is lower in the GRA protocol compared to the SR protocol, with lower sympathetic activity but higher parasympathetic activity in the former. Results are specific to college students, additional research is necessary to extend support for frail older adults. It is advised to incorporate GRA protocol alongside SR protocol in Tai Chi instruction. This approach is likely to enhance Tai Chi skills and yield greater health benefits.

The effects of mind-body exercise on anxiety and depression in older adults: a systematic review and network meta-analysis

Background

Limited research directly compares the clinical effects of different types of mind-body exercises on anxiety and depression in older adults. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that meet the inclusion criteria to explore the intervention effects of five different types of mind-body exercises in improving anxiety and depression in older adults.

Methods

We followed the PRISMA-NMA guidelines and conducted searches in the Web of Science, PubMed, the Cochrane Library, and Embase databases up to July 28, 2023. The language was limited to English. Two independent reviewers conducted literature screening and data extraction. Review Manager 5.4 was used to perform Pairwise meta-analysis and risk assessment, while STATA version 15 software was used for network meta-analysis.

Result

A total of 42 studies, involving 2974 participants, were included. The results of the traditional meta-analysis showed that mind-body exercises were superior to the control group in alleviating anxiety (SMD: -0.87, 95% CI: -1.43, -0.31, p<0.05, I2 = 95%) and depressive (SMD: -0.52, 95% CI: -0.71, -0.34, p<0.05, I2 = 80%). In the network meta-analysis, the ranking of treatment effects for anxiety showed that Tai Chi > Qigong > Yoga > Dance > control group, while for depression, the ranking showed Tai Chi > Pilates > Yoga > Qigong > Dance > control group.

Conclusion

This study found that mind-body exercises have positive effects on improving anxiety and depression in older adults. Among the five different types of mind-body exercise interventions, Tai Chi was considered an effective approach for improving anxiety and depression. However, we encourage older adults to choose exercise modalities that suit their interests to enhance adherence.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023464296.

Tai Chi Effects on Heart Rate Variability: A Systematic Review and Meta-Analysis

Background: Tai Chi, originating in China, is a mind-body exercise that integrates mind training, Qi training, and body training. While Tai Chi practice has demonstrated beneficial physical and psychological health benefits, how it achieves effects has been less studied. In recent years, some researchers have begun to explore the potential of heart rate variability (HRV) changes as balancing the autonomic nervous system (ANS) to achieve results, but only a few studies have directly tested how Tai Chi impacts HRV, and results have been mixed. Objective: This study systematically evaluates the effects of Tai Chi on HRV. Methods: Electronic databases including Web of Science, PubMed, Scopus, Cochrane Library, and EBSCOhost direct from inception until December 2020 were searched to obtain eligible studies. The primary outcomes examined were HRV parameters (time domain and frequency domain), and secondary analysis was whether breathing was emphasized during Tai Chi interventions. Results: Based on the 11 randomized controlled trials included comparing Tai Chi with non-active control condition, meta-analyses showed significantly beneficial effects on HRV parameters (low-frequency power [LF], mean difference [MD] = -200.40, 95% confidence interval [CI]: 365.31 to -35.49, p = 0.02; normalized low-frequency power [nLF], MD = -7.39, 95% CI: -12.48 to -2.29, p = 0.004; total power [TP], MD = -649.82, 95% CI: -1180.54 to -119.11, p = 0.02; very low-frequency power [VLF], MD = -200.55, 95% CI: -349.63 to -51.46, p = 0.008; root mean square of the square sum of the difference between adjacent normal heartbeat intervals [RMSSD], MD = 2.59, 95% CI: -7.23 to 12.41, p < 0.0001; standard deviation of the heartbeat interval [SDNN], MD = 8.33, 95% CI: 0.69 to 15.98, p = 0.03). The effect of Tai Chi on certain HRV parameters compared with active control conditions was less favorable (nLF, MD = 6.42, 95% CI: 3.74 to 9.09, p < 0.00001; normalized high-frequency power [nHF], MD: -6.13, 95% CI: -8.76 to -3.50, p < 0.00001; low-frequency/high-frequency power ratio [LF/HF], MD = 1.00, 95% CI: 0.68 to 1.33, p < 0.00001). In addition, studies describing an emphasis on breathing in the Tai Chi intervention showed positive impact on HRV (nLF, MD = -3.22, 95% CI: -5.32 to -1.12, p = 0.003; nHF, MD = 3.80, 95% CI: 0.80 to 6.81, p = 0.01; SDNN, MD = 5.55, 95% CI: 4.85 to 6.25, p < 0.00001). Conclusions: Meta-analysis results showed that Tai Chi compared with non-active control conditions has a positive impact on key HRV parameters associated with the ANS balance. However, active control condition comparisons showed greater HRV improvements than for Tai Chi. Considering the limited number of studies and their heterogeneity, further robust studies are necessary to verify findings and investigate differential effects of Tai Chi on HRV.

CGRP Antagonism and Ketogenic Diet in the Treatment of Migraine

The study of migraine is based on the complexity of the pathology, both at the pathophysiological and epidemiological levels. Although it affects more than a billion people worldwide, it is often underestimated and underreported by patients. Migraine must not be confused with a simple headache; it is a serious and disabling disease that causes considerable limitations in the daily life of afflicted people, including social, work, and emotional effects. Therefore, it causes a daily state of suffering and discomfort. It is important to point out that this pathology not only has a decisive impact on the quality of life of those who suffer from it but also on their families and, more generally, on society as a whole. The clinical picture of migraine is complex, with debilitating unilateral or bilateral head pain, and is often associated with characteristic symptoms such as nausea, vomiting, photophobia, and phonophobia. Hormonal, environmental, psychological, dietary, or other factors can trigger it. The present review focuses on the analysis of the physiopathological and pharmacological aspects of migraine, up to the correct dietary approach, with specific nutritional interventions aimed at modulating the symptoms. Based on the symptoms that the patient experiences, targeted and specific therapy is chosen to reduce the frequency and severity of migraine attacks. Specifically, the role of calcitonin gene-related peptide (CGRP) in the pathogenesis of migraine is analyzed, along with the drugs that effectively target the corresponding receptor. Particularly, CGRP receptor antagonists (gepants) are very effective drugs in the treatment of migraine, given their high diffusion in the brain. Moreover, following a ketogenic diet for only one or two months has been demonstrated to reduce migraine attacks. In this review, we highlight the diverse facets of migraine, from its physiopathological and pharmacological aspects to prevention and therapy.

Effects of Tai Chi in diabetes patients: Insights from recent research

Tai Chi, a practice that combines elements of both exercise and mindfulness, offers a wide range of health benefits. The body of evidence concerning the impact of Tai Chi on diabetes has recently been growing. This editorial aims to provide a concise summary of the current state of evidence for Tai Chi's effects on individuals with type 2 diabetes (T2D). The review includes 3 randomized controlled trials (RCTs) and 5 systematic reviews and meta-analyses, all of which investigate the effectiveness of Tai Chi on various health outcomes in individuals with T2D. Tai Chi demonstrates a significant effect to enhance glycemic control, lower blood pressure, improve serum lipid profiles, reduce insulin resistance, positively influence obesity-related indices, and improve overall quality of life in individuals with T2D. However, it is noteworthy that recent RCTs have reported inconsistent findings regarding the effects of Tai Chi on glycemic control and insulin resistance. The author also delves into potential mechanisms by which Tai Chi may exert its influence on the human body. Finally, the editorial highlights the critical issues that warrant further exploration in the future.

Does Osteopathic Heart-Focused Palpation Modify Heart Rate Variability in Stressed Participants with Musculoskeletal Pain? A Randomised Controlled Pilot Study

Heart rate variability (HRV) describes fluctuations in time intervals between heartbeats and reflects autonomic activity. HRV is reduced in stressed patients with musculoskeletal pain and improved after osteopathic manipulative treatment and mind-body interventions. Heart-focused palpation (HFP) combines manual and mind-body approaches to facilitate relaxation. This randomised controlled pilot study investigated the feasibility and sample size for a future randomised controlled trial and the effect of a single treatment with HFP or sham HFP (SHAM) on short-term HRV. A total of Thirty-three adults (47.7 ± 13.5 years old) with stress and musculoskeletal pain completed the trial with acceptable rates of recruitment (8.25 subjects per site/month), retention (100%), adherence (100%), and adverse events (0%). HFP (n = 18), but not SHAM (n = 15), significantly increased the root mean square of successive RR interval differences (p = 0.036), standard deviation of the NN intervals (p = 0.009), and ratio of the low-frequency to high-frequency power band (p = 0.026). HFP and SHAM significantly decreased the heart rate (p < 0.001, p = 0.009) but not the stress index and ratio of the Poincaré plot standard deviation along and perpendicular to the line of identity (p > 0.05). A power analysis calculated 72 participants. Taken together, the study was feasible and HFP improved HRV in stressed subjects with musculoskeletal pain, suggesting a parasympathetic effect.

Evaluation and Comparison of Relaxation-Related Workplace Interventions Among Office Workers at an Insurance Institution: An Intervention Study

Relaxation-related workplace interventions can be counterstrategies for stress due to office work and should be evaluated for success after implementation. This study reports on the evaluation and comparison of 3 relaxation techniques introduced as an intervention for health promotion. A Germany-wide multicenter evaluation of a 3-month relaxation intervention (30 min, once a week) including autogenic training, progressive muscle relaxation (PMR) or Tai Chi was conducted at 14 locations as an intervention study. Anonymous questionnaires (n = 244) were used to collect self-reports of perceived stress after the courses. Status before the courses (pre) and after completion (post) were reported at the end of the intervention. All 3 relaxation techniques were able to improve the subjective perception of stress (SPS) score. Autogenic training was reported to improve all singular items with large effects, whereas only 2 items showed change for Tai Chi and none for PMR. Singular items were also influenced by the location of the courses. All 3 methods were able to improve stress-related outcomes in terms of stress perception and individual aspects of stress management. For this specific intervention autogenic training yielded the largest and wide-ranging effects. Tai Chi was also effective, but additional effect due to an associated increase in physical activity were not found. For a workplace intervention PMR could not be recommended based on this study. The literature on workplace interventions is surprisingly scarce, and future studies should focus on the selection of appropriate participants while avoiding potential bias.

Adaptive yoga versus low-impact exercise for adults with chronic acquired brain injury: a pilot randomized control trial protocol

Background

Each year, millions of Americans sustain acquired brain injuries (ABI) which result in functional impairments, such as poor balance and autonomic nervous system (ANS) dysfunction. Although significant time and energy are dedicated to reducing functional impairment in acute phase of ABI, many individuals with chronic ABI have residual impairments that increase fall risk, decrease quality of life, and increase mortality. In previous work, we have found that yoga can improve balance in adults with chronic (i.e., ≥6 months post-injury) ABI. Moreover, yoga has been shown to improve ANS and brain function in healthy adults. Thus, adults with chronic ABI may show similar outcomes. This protocol details the methods used to examine the effects of a group yoga program, as compared to a group low-impact exercise, on primary and secondary outcomes in adults with chronic ABI.

Methods

This study is a single-blind randomized controlled trial comparing group yoga to group low-impact exercise. Participants must be ≥18 years old with chronic ABI and moderate balance impairments. Group yoga and group exercise sessions occur twice a week for 1 h for 8 weeks. Sessions are led by trained adaptive exercise specialists. Primary outcomes are balance and ANS function. Secondary outcomes are brain function and structure, cognition, quality of life, and qualitative experiences. Data analysis for primary and most secondary outcomes will be completed with mixed effect statistical methods to evaluate the within-subject factor of time (i.e., pre vs. post intervention), the between-subject factor of group (yoga vs. low-impact exercise), and interaction effects. Deductive and inductive techniques will be used to analyze qualitative data.

Discussion

Due to its accessibility and holistic nature, yoga has significant potential for improving balance and ANS function, along with other capacities, in adults with chronic ABI. Because there are also known benefits of exercise and group interaction, this study compares yoga to a similar, group exercise intervention to explore if yoga has a unique benefit for adults with chronic ABI.Clinical trial registration:ClinicalTrials.gov, NCT05793827. Registered on March 31, 2023.

The effect of mind-body exercise in lung cancer patients: a meta-analysis of RCTs

PURPOSE

This study aimed to evaluate the impact of mind-body exercise (yoga, tai chi, qigong, etc.) on lung cancer.

METHODS

We performed a literature search of the electronic databases PubMed, Web of Science, Cochrane Library, Embase, CNKI, CBM, WanFang Data, and VIP from their inception to 16 May 2023. The primary outcome was the 6-min walk test (6MWT), while the secondary outcomes were anxiety levels and quality of life (QoL). Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Cochrane risk of bias (ROB) tool for randomized controlled trials, with differences agreed by consensus. Meta-analysis was performed using RevMan 5.4 and Stata 15 software to analyze the extracted data.

RESULTS

This meta-analysis included a total of 11 studies involving 897 patients. The results indicated that compared to the usual care group, lung cancer patients in the mind-body exercise group could increase the 6-min walk distance (5 studies, 346 participants, WMD: 18.83, 95% CI (7.55, 30.10) P = 0.001), reduce anxiety levels (4 studies, 362 participants, SMD: - 1.51, 95% CI (- 1.74, - 1.27), P < 0.05), and enhance the overall quality of life (6 studies, 594 participants, SMD: 0.71, 95% CI (0.10, 1.31), P = 0.02). The overall certainty of the evidence for all outcomes was low; seven studies were judged to be at low risk of bias, and four studies were judged to be at moderate risk of bias.

CONCLUSION

Mind-body exercise could improve exercise capacity in lung cancer survivors, reduce anxiety, and positively affect overall quality of life.

PROSPERO REGISTRATION NUMBER

CRD42023426800.

The effectiveness of a single session of mindfulness-based cognitive training on cardiac vagal control and core symptoms in children and adolescents with attention-deficit/hyperactivity disorder (ADHD): a preliminary randomized controlled trial

This study examined the effectiveness of a mindfulness-based intervention (MBI) on Conners' continuous performance test scores (CPTs), cardiac vagal control (CVC) assessed by vagally mediated heart rate variability (HRV), and mood in children and adolescents with ADHD. We conducted a randomized controlled trial (RCT) recruiting 70 children and adolescents (M age 11.03, SD 2.78) with a clinical diagnosis of ADHD, which were allocated to either 1 session of mindfulness cognitive training, or an active control condition and were examined at baseline, post-treatment and 4-week follow-up. See clinicaltrials.gov: NCT04316832. There was a significant main effect of time on the primary outcomes measured by CPT scores of attention-related problems (omission errors, reaction time) and hyperactivity-impulsivity (commission errors). However, time-by-group interaction did not achieve statistical significance for commission errors and hit RT, indicating that the changes over time in these outcomes were not significantly different between the MBI and Control conditions. In addition, there was a significant time-by-group interaction for omission errors. Relative to control, MBI resulted in a small (d = 0.011) non-statistically significant reduction in omission errors post-treatment. Furthermore, there were no significant differences in detectability. Secondary outcomes were CVC and mood. A small treatment effect on CVC (d = 0.37) was observed; there was a slight increase in vagally mediated HRV measure post-treatment. There were no significant differences in mood improvement over time between conditions. One brief session of MBI effectively enhances CVC but does not significantly improve CPT scores of attention-related problems and hyperactivity-impulsivity or mood in children with ADHD.Clinicaltrials.gov: NCT04316832.

The Potential of Heart Rate Variability Monitoring for Mental Health Assessment in Top Wheel Gymnastics Athletes: A Single Case Design

The assessment of heart rate variability (HRV) upon waking has been proposed as a method to evaluate mental health; however, owing to large individual differences among athletes, it is unclear whether HRV is adequate to predict mental health decline. In this study, we sought to establish this by evaluating HRV upon awakening in one athlete over 20 months. We assessed mental health once a month by calculating the depression index. In addition, self-reported training load and psychological fatigue index were assessed as psychological indices for athletes. Heart rate and HRV were each measured three days per week in both resting (supine) and standing (upright) positions. The results showed that orthostatic HRV upon waking had moderate linear relationships with the scores on the depression index and psychological fatigue index. By contrast, self-reported training load, a measure of physical stressor, was not associated with HRV. The findings suggest that the repeated assessment of HRV upon waking and mental health indicators may be useful in preventing mental health decline in athletes.

Can XunTian Tai Chi intervention improve the level of emotional regulation of crew members in the Controlled Ecological Life Support System?

To explore the appropriate exercise methods and means for astronauts in confined and small isolation conditions, a set of XunTian Tai Chi suitable for the spaceflight workforce was created, with the aim of discovering the practical effects of XunTian Tai Chi and providing a scientific basis for the subsequent development of new astronaut health maintenance techniques with Chinese characteristics. Using the Controlled Ecological Life Support System (CELSS) as a research platform, we observed the changes in a crew member's emotion regulation-related indexes during 180 days of working and living in a confined isolation chamber through periodic interventions of the XunTian Tai Chi and conducted statistical analyses. During the 180-day cabin mission, expression suppression, cognitive reappraisal, attention index, and relaxation index were all lower than those before entering the cabin, suggesting that the crew member's emotion regulation ability decreased during the in-cabin mission. A single Tai Chi exercise could cause favorable changes in the indicators, positively affecting the crew member's emotional regulation. The attention and relaxation indices of the occupants were improved significantly by both single and periodic Tai Chi exercises. After the Tai Chi exercise cycle, the results of each index showed a certain degree of effect. The 180-day ground-based simulation of Tai Chi in the confinement of a space capsule positively affects the occupant's emotional regulation.

Exercise-based interventions on sleep quality in patients with fibromyalgia syndrome: An umbrella and mapping review with meta-analysis

The main aim of this umbrella review was to assess the impact of exercise-based interventions (EBIs) on sleep quality in patients with fibromyalgia syndrome (FMS). We searched systematically in PubMed, PEDro, EMBASE, CINAHL, SPORTDiscus and Google Scholar. Methodological quality was analyzed using AMSTAR and ROBIS scale, and the strength of evidence was established according to GRADE. Nine systematic reviews were included. Meta-analysis (MA) of primary studies (n = 42) were performed with a random-effects model. The MA revealed a moderate statistically significant effect of EBIs (SMD=-0.46 [-0.69 to -0.23]). Subgroup analyses by type of exercise showed significant effect of body-mind exercises (SMD=-0.55 [-0.86 to -0.23]) and combined exercises (SMD=-1.11 [-2.12 to -0.11]) but not for aerobic (SMD=-0.04 [-0.15 to 0.07]) or strength (SMD=-0.52 [-1.14 to 0.1]) exercises in isolation. The results obtained showed that EBIs were effective in improving sleep quality compared to minimal intervention, no intervention or usual care, with a low certainty of evidence. Subgroup analyses showed that mind-body and combined exercises elicited the strongest effect, while aerobic and strength exercise in isolation did not show significant effects.

An RCT-reticulated meta-analysis of six MBE therapies affecting college students' negative psychology

The positive impact of mind-body movement therapy on mental health has been confirmed, but the current effect of various mind-body movement-specific therapies on improving the negative psychology of college students is controversial. This study compared the effects of six mind-body exercise (MBE) therapies on improving negative psychological symptoms in college students. The study found that Tai Chi (standardized mean difference [SMD] = -0.87, 95% confidence interval [CI] (-1.59, -0.15), p < 0.05), yoga (SMD = -0.95, 95% CI (-1.74, -0.15), p < 0.05), Yi Jin Jing (SMD = -1.15, 95% CI (-2.36, -0.05), p=<0.05), Five Animal Play (SMD = -1.1, 95% CI (-2.09, -0.02), p < 0.05), and Qigong Meditation (SMD = -1.31, 95% CI (-2.2, -0.4), p < 0.05) improved depressive symptoms in college students (p < 0.05). Tai Chi (SMD = -7.18, 95% CI (-13.18, -1.17), p = 0.019), yoga (SMD = -6.8, 95% CI (-11.79, -1.81), p = 0.008), and Yi Jin Jing (SMD = -9.21, 95% CI (-17.55, -0.87), p = 0.03) improved college students' anxiety symptoms. It shows that the six MBE therapies are effective in improving anxiety and depression in college students.

Depression, anxiety, and burnout among psychiatrists during the COVID-19 pandemic: a cross-sectional study in Beijing, China

BACKGROUND

With the rise of reported mental disorders and behavioral issues after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, psychiatrists and mental health care are urgently needed more than ever before. The psychiatric career carries a high emotional burden and stressful demands, which bring issues on psychiatrists' mental health and well-being into question. To investigate the prevalence and risk factors of depression, anxiety, and work burnout among psychiatrists in Beijing during the COVID-19 pandemic.

METHODS

This cross-sectional survey was conducted from January 6 to January 30, 2022, two years after COVID-19 was declared a global pandemic. Recruitment was performed using a convenience sample approach by sending online questionnaires to psychiatrists in Beijing. The symptoms of depression, anxiety, and burnout were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). The perceived stress and social support were measured by the Chinese Perceived Stress Scale (CPSS) and Social Support Rating Scale (SSRS), respectively.

RESULTS

The data of 564 psychiatrists (median [interquartile range] age, 37 [30-43] years old) of all 1532 in Beijing were included in the statistical analysis. The prevalence of symptoms of depression, anxiety and burnout were 33.2% (95% CI, 29.3-37.1%, PHQ-9 ≥ 5), 25.4% (95% CI, 21.8-29.0%, GAD-7 ≥ 5) and 40.6% (95% CI, 36.5-44.7%, MBI-GS ≥ 3 in each of the three subdimensions), respectively. The psychiatrist with a higher score on perceived stress was more likely to suffer from depressive symptoms (adjusted odds ratios [ORs]: 4.431 [95%CI, 2.907-6.752]); the anxiety symptoms (adjusted ORs: 8.280 [95%CI, 5.255-13.049]), and the burnout conditions (adjusted ORs: 9.102 [95%CI, 5.795-14.298]). Receiving high social support was an independent protective factor against symptoms of depression (adjusted ORs: 0.176 [95%CI, [0.080-0.386]), anxiety (adjusted ORs: 0.265 [95%CI, 0.111-0.630]) and burnout (adjusted ORs: 0.319 [95%CI, 0.148-0.686]).

CONCLUSIONS

Our data suggest a considerable proportion of psychiatrists also suffer from depression, anxiety, and burnout. Perceived stress and social support influence depression, anxiety, and burnout. For public health, we must work together to reduce the pressure and increase social support to mitigate mental health risks in psychiatrists.

Yi Jin Bang exercise versus usual exercise therapy to treat subacromial pain syndrome: a pilot randomised controlled trial

To evaluate the effect of Yi Jin Bang (YJB) exercise on pain, disability, flexibility, and muscular endurance in individuals with subacromial pain syndrome (SAPS). Fifty-four adults with SAPS were randomly allocated into either a YJB (n = 18), a usual exercise therapy (UET; n = 18), or a control group (n = 18). YJB and UET interventions involved 10 weeks of home-based exercise training, with four sessions per week. The control group received no treatment. Outcome measures included Shoulder Pain and Disability Index (SPADI), pain at rest and during activity, flexion and abduction range of motion (ROM), back scratch test, and shoulder abduction endurance test. These measures were assessed at baseline, immediately after a single face-to-face session (acute effects), and after 10 weeks of intervention (chronic effects). For acute effects, significant group-by-time interactions were observed for flexion ROM, abduction ROM, and the back scratch test (all p < 0.05). For chronic effects, significant group-by-time interactions were found for pain during activity, the SPADI score, and the back scratch test (all p < 0.05). Home-based YJB exercise is comparable to home-based UET in reducing pain and disability and improving flexibility.

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

BACKGROUND

Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9-11 h for 5 to 13-year-olds; 8-10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD.

METHODS

Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children's Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders.

RESULTS

In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12-0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21-0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39-0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26-0.76, p = .003) in relation to none of the guidelines.

CONCLUSION

Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.

From Ancient Patterns of Hand-to-Hand Combat to a Unique Therapy of the Future

The purpose of this publication is to provide generalized knowledge of the area of changes that took place over past centuries in relation to health, social and cultural conditions. In Greek mythology, it was necessary to nurture both body and spirit to be a perfect human being. This link between the concepts of physical beauty and goodness can be also found in later works dedicated to ancient Greek history. Particularly in Greek myths, and in Greek education in general, it was believed that both physical and spiritual excellence were necessary to raise men to achieve their true form. Some of the main forms of implementing this idea were hand-to-hand combat exercises (wrestling, boxing and pankration). Ideas characteristic of the world of ancient Greece, in a general sense, can be observed in the culture of the Far East. The main difference is the fact that these principles did not survive in Western culture as a result of transformation into a consumer society focused on the rejection of moral principles. The brutalisation of the forms of the Roman Games meant that the ideals of the ancient world were forgotten for more than 1500 years. The modern Olympic Games were resurrected in the 19th century. Inspired by the ancient Greek cult of health of body and spirit, they gave rise to a movement known as Olympism. In the Olympic Charter written by Coubertin, Olympism was called "a philosophy of life exalting and combining in a balanced whole the qualities of body, will and mind". The combat sports disciplines have had their place there since the beginning of the modern Olympic Games. The evolution of hand-to-hand combat disciplines, including numerous scientific studies indicating a very broad impact in the area of health, led to this type of physical activity being reached for as an essential element in supporting the health-promoting behaviour of society. Nowadays, physical activity in the area of exercise with elements of hand-to-hand combat, combat sports, or martial arts is an indissoluble link in the prevention and treatment of 21st century diseases. For Parkinson's disease patients, drug treatment is an essential resource for continuing to function in society, but it will not be completely effective without supporting the treatment with appropriate and attractive physical activity (e.g., "Rock Steady Boxing"). Of similar importance is the prevention of dangerous falls, which are common in this population as well as among the elderly or those affected by other diseases of civilisation. Implementing the principles and techniques of safe falling in the teaching of the young population significantly increases the likelihood of applying appropriate responses to these individuals in adulthood and old age. Actions that should be taken now for prevention can be implemented through social programmes, such as "Active today for a healthy future".

Dismantling the Component-Specific Effects of Yogic Breathing: Feasibility of a Fully Remote Three-Arm RCT with Virtual Laboratory Visits and Wearable Physiology

Despite the growing research base examining the benefits and physiological mechanisms of slow-paced breathing (SPB), mindfulness (M), and their combination (as yogic breathing, SPB + M), no studies have directly compared these in a "dismantling" framework. To address this gap, we conducted a fully remote three-armed feasibility study with wearable devices and video-based laboratory visits. Eighteen healthy participants (age 18-30 years, 12 female) were randomized to one of three 8-week interventions: slow-paced breathing (SPB, N = 5), mindfulness (M, N = 6), or yogic breathing (SPB + M, N = 7). The participants began a 24-h heart rate recording with a chest-worn device prior to the first virtual laboratory visit, consisting of a 60-min intervention-specific training with guided practice and experimental stress induction using a Stroop test. The participants were then instructed to repeat their assigned intervention practice daily with a guided audio, while concurrently recording their heart rate data and completing a detailed practice log. The feasibility was determined using the rates of overall study completion (100%), daily practice adherence (73%), and the rate of fully analyzable data from virtual laboratory visits (92%). These results demonstrate feasibility for conducting larger trial studies with a similar fully remote framework, enhancing the ecological validity and sample size that could be possible with such research designs.

Global trends of traditional Chinese exercises for musculoskeletal disorders treatment research from 2000 to 2022: A bibliometric analysis

Background

Traditional Chinese exercise has been shown to be effective in relieving long-term chronic pain, physical dysfunction, decreased ability to participate in society and decreased quality of life in musculoskeletal diseases. In recent years, there has been a steady increase in publications on the treatment of musculoskeletal disorders by traditional Chinese exercises. The purpose of this study is to review the characteristics and trends of Chinese traditional exercise studies on musculoskeletal diseases published since 2000 through bibliometric analysis, and identify current research hotspots, so as to guide the direction of future research.

Methods

Publications regarding traditional Chinese exercises for musculoskeletal disorders from 2000 to 2022 were downloaded from the Web of Science Core Collection. VOSviewer 1.6.18 and CiteSpace V software were used for bibliometric analyses. Bibliometric visualization and comparative analysis were conducted for authors, cited authors, journals, co-cited journals, institutions, countries, references, and keywords.

Results

A total of 432 articles were obtained, with an upward trend over time. The most productive countries and institutions in this field are the USA (183) and Harvard University (70). Evidence-based Complementary and Alternative Medicine (20) was the most prolific journal, Cochrane Database System Review (758) was the most commonly cited journal. Wang Chenchen published the largest number of articles (18). According to high frequency keywords, the hot spot musculoskeletal disorder and the type of traditional Chinese exercise are knee osteoarthritis and Tai Chi.

Conclusion

This study provides a scientific perspective for the research of traditional Chinese exercises for musculoskeletal disorders and provides valuable information for researchers to discover the current research status, hot spots and new trends of future research.

The effect of different combinations of physical activity and natural environment videos on children's attention levels between class breaks

BACKGROUND

Physical activity intervention and watching natural environment videos have been proven to improve young children's attention levels. However, evidence comparing the improvement effects of different combinations of the two activities has rarely been reported. By comparing the differences in the improvement effects of four combinations of physical activities and watching natural environment videos on young children's attention levels, this study can enrich the evidence in this research field and also provide a reference for arranging effective intervention methods for children's attention recovery between classes.

METHOD

A total of 152 children aged 4 to 6 years were recruited and randomly divided into four intervention groups: (1) physical activity intervention first and thereafter watching a natural environment video group (activity + video group), (2) watching a natural environment video first and thereafter the physical activity intervention group (video + activity group), (3) physical activity-based group, and (4) natural environment video-based group. Physical activity involved 4 min of moderate-intensity basic physical fitness combination training. The subjects wore the Pico Neo pioneer version of the VR glasses all-in-one machine to watch a natural environment video. Thereafter, population sociological variables and daily physical activity levels were investigated. Auditory and visual sustained attention tests were performed before and after intervention in each group.

RESULT

The auditory attention post-test scores of the four groups showed an improvement trend compared with the pretest scores. In particular, the activity + video group (F = 10.828; ɳp2 = 0.226; p = 0.002) and natural environment video-based group (F = 9.452; ɳp2 = 0.203; p = 0.004) have the best improvement effect. For visual attention, only the activity + video group showed a significant improvement trend (F = 4.287; ɳp2 = 0.104; p = 0.045), while the other three groups showed a downward trend in scores.

CONCLUSIONS

Among the different intervention combinations, the physical activity intervention first and watching natural environment videos thereafter group has the best effect on improving children's attention during recess. Physical activity interventions at the end of recess adversely affect young children's visual attention levels at the beginning of the class. Therefore, this study recommends that children should not engage in physical activity interventions in the second half of the class break. Lastly, the current research recommends presenting the content of physical activity interventions first and further improving their attention thereafter by watching natural environment videos.