Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials.

OBJECTIVE: To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: PubMed (Medline), the Cochrane library and Web of Science were systematically searched. ELIGIBILITY CRITERIA: Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included. RESULTS: 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively. CONCLUSION: Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.

Understanding the foot-in-the-door effect as a pseudo-effect from the perspective of the Campbell paradigm.

Compliance with a small request (a metaphorical foot-in-the-door) promotes compliance with a subsequent big request. Whereas some explanations expect a drop in the behavioural costs of the big request, others suspect that the effect comes from boosting the underlying attitude. However, evidence for both explanations is equivocal and circumstantial, at best. Drawing on what Kaiser et al. (2010) call the Campbell paradigm, we present an integrative account: Compliance with any request demands a corresponding attitude to counterbalance the costs of the request. In our research, 229 participants were randomly assigned to either a foot-in-the-door (i.e., initially asked to sign a pro-environmental petition) or a control condition. Small-request-compliant participants were more likely than control participants to also comply with the big request and to continue filling out environmental-issues-related questionnaires. However, this foot-in-the-door effect occurred without diminishing behavioural costs or increasing attitude levels. Accordingly, the greater likelihood of small-request-compliant participants to also comply with the big request can be parsimoniously explained by baseline variability in people's attitude levels that manifests in their compliance with the initial request. We conclude that several of the foot-in-the-door effects reported in the literature carry the risk of representing mere pseudo-effects.

The power of putting a label on it: green labels weigh heavier than contradicting product information for consumers' purchase decisions and post-purchase behavior.

Green products are appealing. Thus, labeling products as environmentally friendly is an effective strategy to increase sales. However, the labels often promise more than the products can actually deliver. In the present research, we examined the expectation that consumers with high ecological motivation have strong preferences for green-labeled products - even when presented product information contradicts the label's image. This unsettling hypothesis is grounded in the labels' potential to create a cognitive match between the labeled product and consumers' motives. For labels indicating environmental friendliness (green product labels), this link should be strongest when consumers' ecological motivation is high. Findings in a series of three experiments support our assumption, showing that consumers with high ecological motivation had strong preferences (i.e., product evaluations, purchase intentions, and simulated purchase decisions) for green-labeled products as compared to consumers with low ecological motivation (Studies 1-3). Crucially, these preferences were robust, despite contradicting environmental product information (Studies 1 and 2). We extended our findings by additionally examining the impact of product labels and motivation on moral self-regulation processes. This was established by assessing participants' pro-social behavior after the purchase task: participants with high ecological motivation acted, consistent with their motives, more pro-socially in post-decision occasions. In accordance with moral cleansing effects, pro-social behavior was intensified after purchasing conventional products (Studies 2 and 3). Green labels protected participants with high ecological motivation from moral threats due to the purchase, thus making pro-social behavior less likely. Findings suggest that highly ecologically motivated consumers are most susceptible to green labels, which may override detailed product information.

Attitudes and defaults save lives and protect the environment jointly and compensatorily: understanding the behavioral efficacy of nudges and other structural interventions.

A better understanding of when and why nudges (e.g., defaults, visibility or accessibility alterations) and other structural behavior-change measures work or fail can help avoid subsequent surprises such as unexpected political opposition. In this paper, we challenge the unilateral focus on structural interventions-which seemingly control people's behavioral decisions-as such a focus ignores the flipside-namely, attitudes or, as they are called in economics, preferences. We argue for a conceptual understanding of individual behavior that views personal attitudes and behavioral costs as its two separate compensatorily effective determinants. This classical understanding was reintroduced into attitude research as the Campbell paradigm. In the logic of the Campbell paradigm, a person's attitude becomes obvious in the face of the behavioral costs the person surmounts. Technically, individual attitudes reveal themselves in a set of cost-dependent transitively ordered performances. Behavioral costs in turn reflect the structural boundary conditions that are relevant as obstructive and/or supportive environmental forces that generically affect a specific behavior. So far, our research on people's attitudes toward environmental protection has demonstrated that the Campbell paradigm-and thus its conceptual account of individual behavior-holds true for approximately 95% of the people in a given society.

EEG-mapping differences between narcolepsy patients and controls and subsequent double-blind, placebo-controlled studies with modafinil.

The aim of the present study was to investigate the role of EEG mapping as an objective and quantitative measure of vigilance in untreated and modafinil-treated narcoleptics, and compare it with the conventional neurophysiological method of the Multiple Sleep Latency Test (MSLT) and the subjective Epworth Sleepiness Scale (ESS). In 16 drug-free narcoleptics and 16 normal controls a baseline 3-min vigilance-controlled EEG (V-EEG) and a 4-min resting EEG (R-EEG) were recorded during midmorning hours. Thereafter, in a double-blind, placebo-controlled crossover design, patients were treated with a 3-week fixed titration of modafinil (200, 300, 400 mg) and placebo. EEG-mapping, MSLT and ESS measures were obtained before and at the end of the third week of therapy. Statistical overall analysis by means of the omnibus significance test demonstrated significant EEG differences between untreated patients and controls in the resting condition only (R-EEG). Subsequent univariate analysis revealed an increase in absolute and relative theta power, a decrease in alpha-2 and beta power as well as a slowing of the dominant frequency and the centroids of the alpha, beta and total power spectrum and thus objectified a vigilance decrement in narcolepsy. Modafinil 400 mg/d significantly improved vigilance as compared with placebo (p < or = 0.01), inducing changes opposite to the aforementioned baseline differences (key-lock principle). The MSLT and the ESS also improved under modafinil as compared with placebo, but changes were less consistent. Spearman rank correlations revealed the highest correlations between EEG mapping and the ESS, followed by those between EEG mapping and the MSLT, while the lowest correlation was found between the MSLT and the ESS. In conclusion, EEG mapping is a valuable instrument for measuring vigilance decrements in narcolepsy and their improvement under psychostimulant treatment.

Differences in brain function between relapsing and abstaining alcohol-dependent patients, evaluated by EEG mapping.

AIMS: Early clinical electroencephalographers reported that low-voltage fast desynchronized patterns were frequently seen in chronic alcoholism, suggesting hyperarousal of the central nervous system (CNS). The aim of the present study was to investigate the brain function of drug-free, detoxified alcoholics, and compare this with that of normal controls, utilizing computerized quantitative EEG analysis and subsequent EEG mapping. Moreover, differences between patients relapsing or abstaining during 6 months of relapse prevention therapy, pharmacologically supported by either flupentixol decanoate 10 mg or placebo i.m. every 2 weeks, were determined. METHODS: 22 drug-free, detoxified patients (15 men, seven women) aged between 27 and 58 (mean 41.5 +/- 8.1) years, diagnosed as alcohol-dependent (ICD-10: F10.23) were included in the study. They were subdivided into abstainers (n = 11) and relapsers (n = 11), and matched with normal healthy controls according to age (mean 41.5 +/- 8.4 years) and sex. A 3-min vigilance-controlled EEG (V-EEG) was obtained and analysed off-line by multi-lead EEG power spectral analysis and subsequent mapping methods. RESULTS: The drug-free, detoxified, alcohol-dependent patients showed, as compared with controls, aberrant brain function characterized by a decrease in delta and slow alpha and an increase in beta activity as well as an acceleration of the total centroid. These findings were more pronounced in relapsing than in abstaining patients. After 6 months of treatment, abstaining patients showed an increase in slow activity, a decrease in fast alpha, an acceleration of the delta/theta centroid and a deceleration of the alpha centroid, reflecting a normalization of brain function. CONCLUSION: EEG maps of alcohol-dependent patients differ significantly from those of normal controls and patients suffering from other mental disorders and thus EEG mapping may be used for diagnostic purposes. Moreover, the quantitative EEG may also be of prognostic value as relapsing patients differ from abstaining ones, since they show a significantly more pronounced hyperarousal of the CNS.

Austrian medical students' attitudes towards male and female homosexuality: a comparative survey.

BACKGROUND: The attitudes of health-care professionals and medical students towards male and female homosexuality are of practical relevance and have increasingly become a topic of scientific research. Comparative investigations between medical students and other student groups have not yet been conducted. OBJECTIVES: To assess the attitudes of Austrian medical students towards homosexuality and to compare these with the attitudes of students of politics and veterinary medicine. METHODS: Students of medicine (122), politics (145), and veterinary medicine (153) completed a questionnaire consisting of validated instruments assessing anti-homosexual attitudes, items assessing knowledge on homosexual issues, and basic demographic information. RESULTS: Participants' attitudes were predominantly positive. For all instruments, two-way analyses of covariance revealed significant influences of participants' sex and study major: students of medicine and veterinary medicine held more negative attitudes than students of politics, and males were more prejudiced than females. Overall, attitudes towards male and female homosexuality were balanced, but male students of politics and veterinary medicine were more prejudiced towards male than female homosexuality. A significant influence of participants' sex (favoring females) was observed in knowledge of homosexual issues. CONCLUSIONS: Although neutrality and empathy are considered vital in the doctor-patient relationship, medical students revealed more negative attitudes than students of politics did, the latter's attitudes being similar to those of students of veterinary medicine. These findings suggest that educational and correcting interventions are required in medical training.

Confirmation of the neurophysiologically predicted therapeutic effects of trazodone on its target symptoms depression, anxiety and insomnia by postmarketing clinical studies with a controlled-release formulation in depressed outpatients.

Early human pharmaco-EEG and subsequent sleep laboratory studies identified trazodone, a 5-HT(2) antagonist and 5-HT reuptake inhibitor (SARI), as an antidepressant with therapeutic effects on its target symptoms depressed mood, anxiety and insomnia. On the occasion of the introduction of a controlled-release (CR) formulation (Trittico 150 mg retard, marketed in Austria by CSC Pharmaceuticals Handels GmbH, Vienna, Austria) in Austria in July 2000, a multi-center, open, clinical post-marketing study on the therapeutic effects, safety and target symptoms of trazodone CR in depression was carried out at 80 offices of Austrian neuropsychiatrists. 549 outpatients (63% females) of all age groups suffering from five different subtypes of depression were enrolled in the study. After a 2-week fixed dose-titration regimen up to 150 mg and a 4-week adjustment period to the optimum dose, 66% of the patients remained on 150 mg, 20% increased the dose and 11% decreased it. Only 3.7% discontinued treatment. Rating by the neuropsychiatrists based on the Clinical Global Impression showed very much to much improvement in 78.3% of the patients, and no change or a deterioration in only 3.6%. In the Hamilton Depression Scale (HAMD) a statistically significant improvement from a baseline score of 21 to a score of 14 after 2 weeks was found, and a normalization to a score of 8 after 6 weeks. Therapeutic effects were similar in the five groups suffering from different subtypes of depression and in patients with and without comedication. Self-rating by the patients based on the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) also showed a significant improvement in the 2nd and 6th week of therapy. Evaluation of the target symptoms of trazodone by ranking the most improved symptoms identified insomnia as the most improved psychopathological item in all three scales. While in the observer ratings also suicidal tendencies and weight loss were found much improved, in the self-rated Zung SDS sadness and loss of drive came second and third in the improvement ranking, in the self-rated Zung SAS anxiety and the feeling of falling apart. Tolerability was very good. In the 2nd week only 16.9% and in the 6th week only 7.6% of the patients reported side effects, mostly characterized by tiredness and rarely by nausea and vertigo. The present clinical study is in agreement with previous studies identifying trazodone as a safe and effective antidepressant, specifically regarding its target symptoms insomnia, depression and anxiety. It also confirms our own early predictions based on neurophysiological investigations concerning the mode of action of the drug.