Association between cardiorespiratory fitness and social cognition in healthy adults.

PURPOSE: Whereas there is compelling evidence for an association between cardiorespiratory fitness (CRF) and executive function and attention, its relation with social cognition has not been investigated yet. However, social cognition is linked with mental health and career success in jobs with high demands on social interaction. The present study aims to examine the association between CRF and the facial emotion recognition aspect of social cognition in police officers. METHODS: The study utilized a cross-sectional design. 198 male and female participants (aged 38.3 ± 1.3 years) completed the Åstrand submaximal bicycle ergometer test and their CRF was estimated using the Åstrand-Rhyming nomogram. Additionally, a 2-choice reaction time task and two facial emotion recognition tasks (labeling and matching) with low (emotion recognition from faces) and high (emotion recognition from eyes) difficulty trials were administered for the assessment of attention and social cognition. RESULTS: Adjusting for age, gender, education, and attention, hierarchical regression supported higher CRF to be related to higher performance on overall performance on the facial emotion labeling and matching tasks, Beta = 0.141, P = .046. With regard to difficulty levels, a similar association between CRF and task performance was found for the faces condition, Beta = 0.147, P = .043, but not for the eyes condition, Beta = 0.105, P = .132. CONCLUSIONS: Social cognition appears to differ as a function of adults' CRF level. The present findings have a high relevance for police officers, because they need to rely on this cognitive domain for many decisions in their work-life.

Correction to: Consent requirements for research with human tissue: Swiss ethics committee members disagree.

It has come to our attention that in the original article [1] information regarding dates was omitted. The data in this study were obtained in Switzerland four years before the entering into force of the new Swiss Human Research Act in 2014, when the guidelines of the Swiss Academy of Medical Sciences (SAMS) ceased to apply. It is important for readers to know that at the time of the study there was no binding law in Switzerland, only the more open SAMS guidelines that have a different legal status. We would expect to find less variation of opinions among research ethics committee members if the study were repeated after the federal law came into force.

Implicit and explicit attitudes towards sport among young elite athletes with high versus low burnout symptoms.

The development of cynical attitudes towards elite sport is a core symptom of athlete burnout and has been associated with dropout from elite sport. To date, this phenomenon has mainly been studied by investigating explicit attitudes towards sport, whereas athletes' automatic evaluations (i.e. implicit attitudes) that have been shown to influence behavior as well were not considered. This study aimed to compare explicit and implicit attitudes towards sport of young elite athletes with high (N = 24) versus low (N = 26) burnout symptoms. Using self-reported measures, general and athlete burnout symptoms were assessed. Additionally, a single-target implicit association test was administered to examine participants' automatic evaluation of sport. Statistical analysis revealed greater emotional/physical exhaustion and sport devaluation in athletes reporting high compared to low burnout symptoms. Implicit attitudes towards sport did not significantly differ between the groups. Furthermore, no significant correlations were observed between different athlete burnout symptoms and implicit attitudes. Athletes with high burnout symptoms show a tendency to explicitly detach themselves from sport, thus fostering sport devaluation as a core symptom of athlete burnout. However, this process does not seem to be reflected in their implicit attitudes towards sport.

Obstacles to Widening Biosample Research.

Switzerland has an excellent culture of medical research and is a melting pot for medical experts with international expertise. Nevertheless, as in other countries, the resources available to medical researchers are not being fully used. Biological samples, which enable a host of medical research studies to be carried out without invasive methods involving patients, are frequently left unused or forgotten. The aim of this study is to examine the experiences of biobank stakeholders regarding the use or underuse of biosamples, in order to develop paths to optimize biosample research. Interviews were carried out with 36 biobank stakeholders in Switzerland concerning their experiences with biosample use, and the possible obstacles at each stage of the process. Interviews revealed that standard operating procedures were the most frequently cited obstacle, although these were not judged to be severe hindrances. Despite a stated desire to develop biosample research, skepticism of sharing networks and wariness of new partnerships were strong themes. Biobanking still functions as an emerging field, in which exchange practices have yet to be established at the national and international levels. Sample exchange continues to function largely based on personal contacts; while this is an inherent feature of competitive medical research, opportunities for large-scale studies may be lost due to excessive caution.

Acute Exercise and Emotion Recognition in Young Adolescents.

While there is evidence that acute bouts of aerobic and coordinative exercise positively affect attention and executive functions, no study has focused on the impact of acute exercise on facial-emotion processing. A total of 106 adolescents (mean age 13.0 years) were randomly assigned to a group performing either an aerobic exercise session (AER), an aerobic exercise session with coordinative demands (AER+C), or stretching. Before and after the 35-min experimental session, participants completed computerized facial-emotion labeling and emotion-matching tasks. Facial-emotion labeling, but not emotion matching, increased over time, but more so in AER and AER+C conditions. When aerobic exercise is combined with coordinative demands, greater benefits seem to be elicited for some aspects of facial-emotion recognition. Results suggest a new direction for the influence of exercising on dimensions of psychological functioning, namely on emotion processing and social cognition.

Psychometric properties of the Shirom-Melamed Burnout Measure (SMBM) among adolescents: results from three cross-sectional studies.

BACKGROUND: Burnout has long been understood as work-related physical, emotional, and cognitive exhaustion. However, burnout symptoms can also be found among younger people, including school-aged adolescents. While the Shirom-Melamed Burnout Measure (SMBM) is a widely applied instrument, its psychometric properties have not yet been investigated in adolescent populations. We therefore examined the psychometric properties of the SMBM in three independent samples of adolescents. METHODS: In total, 249 high school students, 144 vocational students, and 257 adolescent elite athletes completed the SMBM, along with questionnaires related to perceived stress, depressive symptoms, and life satisfaction. Descriptive statistics, gender differences, and internal consistency, convergent/discriminant validity, and factorial validity (including measurement invariance across genders) were examined in each sample. RESULTS: The SMBM had adequate internal consistency. Confirmatory factor analyses showed that both a first- and second-order model achieve good model fit. Moreover, evidence for sufficient convergent and discriminant validity was found. Finally, in two of the three samples, female adolescents reported higher SMBM scores. CONCLUSIONS: The SMBM has been widely used in international burnout research. However, this is the first study providing empirical evidence that the SMBM has acceptable psychometric properties and satisfactory convergent/discriminant and factorial validity among young people. The SMBM is a concise and economic tool to assess self-rated symptoms of burnout, and presents a valuable alternative to existing school burnout inventories. In particular, the SMBM can facilitate the investigation of the transition of young people from school to working life.

Consent requirements for research with human tissue: Swiss ethics committee members disagree.

BACKGROUND: In Switzerland, research with identifiable human tissue samples, and/or its accompanying data, must be approved by a research ethics committee (REC) before it can be allowed to take place. However, as the demand for such tissue has rapidly increased in recent years, and biobanks have been created to meet these needs, committees have had to deal with a growing number of such demands. Detailed instructions for evaluating every kind of tissue request are scarce. Committees charged with evaluating research protocols therefore sometimes face uncertainty in their decision-making. METHODS: We examine how a pool of Swiss REC members deal with a number of cases involving human tissue, in order to determine the standards they adhere to, and their understanding and implementation of existing laws and guidelines. RESULTS: There is considerable divergence in the approaches and decisions of Swiss REC members regarding human tissue sample requests, particularly concerning the issue of informed consent. Despite recent trends towards less strict consent requirements for biosample research, many of our respondents continue to employ demanding standards for researchers. The question of informed consent, and the circumstances in which it is required, continues to result in differences of opinion. CONCLUSIONS: While room for local and cultural interpretation is essential to the workings of an REC, misunderstanding of existing guidelines, or an absence of regulation in sensitive areas, will only lead to suboptimal functioning of the REC itself. Our data suggests that there is uncertainty and disagreement on the question of consent for human tissue sample, which existing laws and guidelines may not fully clarify. Methods to address these uncertainties should be implemented in order to ensure efficient and harmonious review of research protocols.

Cross-Sectional and Longitudinal Associations Between Athlete Burnout, Insomnia, and Polysomnographic Indices in Young Elite Athletes.

Few studies have examined the association between sleep and burnout symptoms in elite athletes. We recruited 257 young elite athletes (Mage = 16.8 years) from Swiss Olympic partner schools. Of these, 197 were reassessed 6 months later. Based on the first assessment, 24 participants with clinically relevant burnout symptoms volunteered to participate in a polysomnographic examination and were compared with 26 (matched) healthy controls. Between 12% and 14% of young elite athletes reported burnout symptoms of potential clinical relevance, whereas 4-11% reported clinically relevant insomnia symptoms. Athletes with clinically relevant burnout symptoms reported significantly more insomnia symptoms, more dysfunctional sleep-related cognitions, and spent less time in bed during weeknights (p < .05). However, no significant differences were found for objective sleep parameters. A cross-lagged panel analysis showed that burnout positively predicted self-reported insomnia symptoms. Cognitive-behavioral interventions to treat dysfunctional sleep-related cognitions might be a promising measure to reduce subjective sleep complaints among young elite athletes.

In Individuals Following Aneurysmal Subarachnoid Haemorrhage, Hair Cortisol Concentrations Are Higher and More Strongly Associated with Psychological Functioning and Sleep Complaints than in Healthy Controls.

BACKGROUND: Following an aneurysmal subarachnoid haemorrhage (aSAH), many patients report persistent deficits in psychological functioning, characterised by high levels of stress and symptoms of depression, low life satisfaction, along with poor sleep. Such deficits have been associated with altered saliva and serum cortisol levels due to a dysregulation of hypothalamic-pituitary-adrenal axis activity (HPA-AA). However, hair cortisol concentrations (HCCs) have not been assessed in this population, although this method allows a long-term insight into cortisol values. Therefore, the objective of this study was to compare HCCs in aSAH patients and healthy controls and to examine how HCCs are associated with perceived stress, psychological functioning, and sleep complaints. METHODS: In this cross-sectional study, data on depressive symptoms, hypochondriacal beliefs, life satisfaction, and sleep complaints were gathered in 15 aSAH patients and 17 healthy controls. HCCs of the previous 3 months were assessed. RESULTS: aSAH patients had significantly higher HCCs than healthy controls. In aSAH patients, higher HCCs were significantly associated with increased depressive symptoms, hypochondriacal beliefs, lower life satisfaction, and increased sleep complaints. Such significant associations were not found in healthy controls. CONCLUSIONS: Our findings indicate that a dysregulation of HPA-AA is associated with some of the long-term impairments in psychological functioning and sleep in aSAH survivors. While the direction of association remained unclear, a dysregulated HPA-AA may be causally linked with the maintenance of poor psychological functioning and poor sleep. The overall findings should be considered in the planning of long-term treatment aimed at improving psychological functioning and sleep in aSAH patients.

A Twelve-Week Moderate Exercise Programme Improved Symptoms of Depression, Insomnia, and Verbal Learning in Post-Aneurysmal Subarachnoid Haemorrhage Patients: A Comparison with Meningioma Patients and Healthy Controls.

OBJECTIVES: Deficits in psychological functioning, cognitive functioning, and sleep are frequently experienced by individuals who have survived aneurysmal subarachnoid haemorrhage (aSAH). Exercise has been shown to improve these domains; to date, it has never been explored in patients following aSAH. The aim of this exploratory study is to compare the effects of an exercise programme in this population with another patient group, and a group of healthy controls. METHODS: The present study explored the effects of 12 weeks of moderate aerobic exercise training on 15 aSAH patients, 16 meningioma patients, and 17 healthy controls. Data on symptoms of depression, hypochondria, perceived stress, satisfaction with life, verbal learning and memory, and subjective and objective sleep, were gathered at baseline, following intervention, and at 6-month follow-up. RESULTS: aSAH patients and meningioma patients had decreased symptoms of depression and insomnia at follow-up. While perceived stress decreased in the meningioma group, in aSAH patients it increased. Total learning performance increased in all three groups. CONCLUSIONS: An exercise programme had a positive effect on symptoms of depression, insomnia, and verbal learning in patients following aSAH. No positive changes in other domains were observed. This may be due to the cautious approach taken with regard to exercise intensity.

In 6- to 8-year-old children, cardiorespiratory fitness moderates the relationship between severity of life events and health-related quality of life.

PURPOSE: In children, the pathways by which physical activity and fitness are associated with physical and psychological wellbeing are still not fully understood. The present study examines for the first time in young children whether high levels of cardiorespiratory fitness and physical activity moderate the relationship between severity of life events and health-related quality of life. METHODS: Three hundred and seventy-eight children (188 girls, 190 boys, M age = 7.27 years) participated in this cross-sectional study. Parental education, gender, age, severity of life events, health-related quality of life and physical activity were assessed via parental questionnaires. Cardiorespiratory fitness was assessed with the 20 m shuttle run test. Hierarchical regression analyses were used to test whether physical activity and fitness interacted with critical life events to explain health-related quality of life. RESULTS: When exposed to critical life events, children with higher fitness levels experienced higher levels of psychological wellbeing, relative to their less fit peers. On the other hand, children with higher fitness levels experienced higher physical wellbeing and more positive friendship relationships when severity of life events was low. A similar moderation effect was found for physical activity with overall quality of life as outcome. CONCLUSIONS: Recent stressful experiences alone were not sufficient to explain negative health outcomes in young children. Children with low cardiorespiratory fitness levels experienced lower psychological wellbeing when they were exposed to critical life events. More research is needed to find out whether similar findings emerge with objective physical activity measurements and when critical life events are assessed over longer periods of time.

Validation of the German version of the short form of the dysfunctional beliefs and attitudes about sleep scale (DBAS-16).

Research shows that dysfunctional sleep-related cognitions play an important role in the development, maintenance and exacerbation of insomnia. This study examines the factorial validity, psychometric properties and both concurrent and predictive validity of the German version of the 16-item DBAS (dysfunctional beliefs and attitudes about sleep) scale. Data was collected in 864 vocational students from the German-speaking part of Switzerland (43% females, M age = 17.9 years). Data collection took place twice within a 10-month interval. The students completed a German translation of the DBAS-16, the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and provided information about their psychological functioning. Descriptive statistics, factorial validity, internal consistency, gender differences, concurrent, and predictive validity were examined. Confirmatory factor analysis supported the 4-factor structure of the DBAS-16. All factors (consequences, worry/helplessness, expectations, medication) were positively correlated and had acceptable psychometric properties. Females reported higher scores across all DBAS measures. Weak-to-moderate correlations were found between dysfunctional sleep-related beliefs, insomnia and poor sleep quality. Dysfunctional sleep-related beliefs were also associated with decreased psychological functioning, and consistently predicted insomnia and poor psychological functioning at follow-up, even after controlling for socio-demographic background and baseline levels. The present study provides support for the validity and psychometric properties of the German version of the DBAS-16. Most importantly, it corroborates the relevance of cognitive-emotional factors in the onset and maintenance of insomnia and psychological symptoms among young people.

Sleep Quality, Sleep EEG Pattern, Mental Well-Being and Cortisol Secretion in Patients with Ruptured Aneurysm Post-Treatment: A Comparison with Post-Surgery Meningioma Patients and Controls.

BACKGROUND: Although the chance of surviving an aneurysmal subarachnoid haemorrhage (aSAH) has increased steadily, disturbed sleep and persistent psychological complaints are frequently experienced post-ictus. To date, however, few studies have sought to determine whether physiological parameters, such as objectively measured sleep and cortisol secretion, interrelate significantly with low sleep quality and psychological complaints such as depression. Furthermore, there is little evidence as to whether post-ictal complaints differ between aSAH patients and other groups who have experienced stressful medical intervention. METHODS: Data on objective and subjective sleep, sleep-related dysfunctional cognitions, psychological functioning and cortisol secretion were collected from 15 patients who had undergone medical intervention for aSAH. Data were also collected from a group of 16 individuals who had undergone surgery for a meningioma and a third group made up of 17 healthy participants. RESULTS: aSAH patients and meningioma patients had significantly poorer subjective sleep than healthy controls and reported more sleep-related dysfunctional cognitions and hypochondriacal beliefs. They also had a significantly higher morning cortisol response. Finally, a non-significant trend was found showing that aSAH patients and meningioma patients reported poorer psychological functioning than healthy controls. CONCLUSION: Following treatment, aSAH patients and meningioma patients experience poorer subjective sleep and some differences in objectively measured sleep, which might be attributable to increased sleep-related dysfunctional cognitions and poorer overall psychological functioning. Differences in cortisol production were also observed, suggesting that some physiological imbalances are still present post-ictus.

Validation of the German version of the insomnia severity index in adolescents, young adults and adult workers: results from three cross-sectional studies.

BACKGROUND: A variety of objective and subjective methods exist to assess insomnia. The Insomnia Severity Index (ISI) was developed to provide a brief self-report instrument useful to assess people's perception of sleep complaints. The ISI was developed in English, and has been translated into several languages including German. Surprisingly, the psychometric properties of the German version have not been evaluated, although the ISI is often used with German-speaking populations. METHODS: The psychometric properties of the ISI are tested in three independent samples: 1475 adolescents, 862 university students, and 533 police and emergency response service officers. In all three studies, participants provide information about insomnia (ISI), sleep quality (Pittsburgh Sleep Quality Index), and psychological functioning (diverse instruments). Descriptive statistics, gender differences, homogeneity and internal consistency, convergent validity, and factorial validity (including measurement invariance across genders) are examined in each sample. RESULTS: The findings show that the German version of the ISI has generally acceptable psychometric properties and sufficient concurrent validity. Confirmatory factor analyses show that a 1-factor solution achieves good model fit. Furthermore, measurement invariance across gender is supported in all three samples. CONCLUSIONS: While the ISI has been widely used in German-speaking countries, this study is the first to provide empirical evidence that the German version of this instrument has good psychometric properties and satisfactory convergent and factorial validity across various age groups and both men and women. Thus, the German version of the ISI can be recommended as a brief screening measure in German-speaking populations.

Getting a Fair Share: Attitudes and Perceptions of Biobank Stakeholders Concerning the Fairness of Sample Sharing.

Biobanks are essential tools for furthering a broad range of medical research areas. However, despite the plethora of national and international laws and guidelines which apply to them, the access and sharing policies of biobanks are only sparsely addressed by regulatory bodies. The 'give and take' process of biosample sharing is largely left up to biobank stakeholders themselves to oversee; it is therefore both in stakeholders' power, and in their interest, to ensure that sample accessibility is fair. This is an important step in motivating researchers to collaborate and pool samples, and is crucial to fostering trust in the absence of universally accepted standard practices. To date, little attention has been paid to how fairness considerations affect scientific material sharing, and no empirical research has been carried out to determine the role that fairness plays in collaborative studies. In order to begin to gain understanding in this area, we interviewed 36 biobank stakeholders currently working in Switzerland, focusing on their perceptions of current and optimal fair sharing practices. Our findings reveal that fairness is an important feature of exchange situations for these stakeholders, and that they have well-formed notions about the practical elements of fair sample access, although ideas about the concept of fairness itself are vague. In order to support efforts to network biobanks, attention should be paid to this issue to reassure all involved that they are getting a fair share in their cooperative efforts.

Sample and data sharing barriers in biobanking: consent, committees, and compromises.

The ability to exchange samples and data is crucial for the rapidly growth of biobanking. However, sharing is based on the assumption that the donor has given consent to a given use of her or his sample. Biobanking stakeholders, therefore, must choose 1 of 3 options: obtain general consent enabling multiple future uses before taking a sample from the donor, try to obtain consent again before sharing a previously obtained sample, or look for a legally endorsed way to share a sample without the donor's consent. In this study, we present the results of 36 semistructured qualitative interviews with Swiss biobanking stakeholders regarding these options and the role of ethics committees in the process of authorizing sharing. Our results show that despite a lack of legal or guideline-based barriers to general consent, some stakeholders and ethics committees have reservations about this method of consent. In most cases, however, a general consent form is already in use. Many interviewees describe processes involving the ethics committees as time-consuming and cumbersome and their requirements as too demanding for donors/patients. Greater awareness of donors' opinions and preferences and the content of guidelines and recommendations could therefore be helpful for a better justified perspective of biobanking stakeholders and ethical committee members, equally. Finally, it may be necessary to differentiate between procedures governing future samples, where general consent is clearly desirable, and the use of old yet still relevant samples, where the option of using them without consent can be highly beneficial for research.

How depression and ADHD relate to exercise addiction: a cross-sectional study among frequent exercisers.

Background: To date, there are no official diagnostic criteria for the frequently reported phenomenon of exercise addiction. Therefore, the aim of the present study was to investigate how mental disorders, specifically depression and attention-deficit hyperactivity disorder (ADHD), are related to exercise addiction (EA). Methods: A total of 173 participants aged between 18 and 70 years, who reported exercising more than 10 h a week and continued to exercise despite injury or illness, answered questionnaires including the Exercise Dependence Scale, the Beck Depression Inventory, and the Homburger ADHD scale for adults. Multiple linear regression analyses were performed adjusting for relevant confounders (age, gender) and stepwise regression was used to identify which of the two mental disorders is the more influential predictor of EA. Results: Pearson correlation analysis showed that depressive symptoms [r (171) = 0.422, p < 0.00] and ADHD symptoms [r (171) = 0.308, p < 0.001] were positively correlated with EA symptoms. The relation between depressive symptoms and EA remained after adjusting for confounders in the regression model (B = 20.531; t(170) = 5.950; 95% CI [13.719, 27.343]; p < 0.001). Similarly, the positive link between ADHD symptoms and EA persisted after controlling for confounders (B = 15.507; t(170) = 3.771; 95% CI [7.389, 23.625]; p < 0.001). Additionally, a stepwise regression model identified that depressive symptoms are a stronger predictor for EA than ADHD symptoms. Conclusion: Depressive symptoms seem to be a stronger predictor for EA compared to ADHD symptoms in frequent exercisers. Although individuals with ADHD May exercise extensively, they might be less at risk for EA than individuals with depression. These results contribute to the complex characterization of the psychiatric profile of individuals with exercise addiction, and underline the need for further research elucidating the interplay between mental disorders and EA.

Brain alterations in individuals with exercise dependence: A multimodal neuroimaging investigation.

Background: Exercise dependence (ED) is characterised by behavioural and psychological symptoms that resemble those of substance use disorders. However, it remains inconclusive whether ED is accompanied by similar brain alterations as seen in substance use disorders. Therefore, we investigated brain alterations in individuals with ED and inactive control participants. Methods: In this cross-sectional neuroimaging investigation, 29 individuals with ED as assessed with the Exercise Dependence Scale (EDS) and 28 inactive control participants (max one hour exercising per week) underwent structural and functional resting-state magnetic resonance imaging (MRI). Group differences were explored using voxel-based morphometry and functional connectivity analyses. Analyses were restricted to the striatum, amygdala, and inferior frontal gyrus (IFG). Exploratory analyses tested whether relationships between brain structure and function were differently related to EDS subscales among groups. Results: No structural differences were found between the two groups. However, right IFG and bilateral putamen volumes were differently related to the EDS subscales "time" and "tolerance", respectively, between the two groups. Resting-state functional connectivity was increased from right IFG to right superior parietal lobule in individuals with ED compared to inactive control participants. Furthermore, functional connectivity of the angular gyrus to the left IFG and bilateral caudate showed divergent relationships to the EDS subscale "tolerance" among groups. Discussion: The findings suggest that ED may be accompanied by alterations in cognition-related brain structures, but also functional changes that may drive compulsive habitual behaviour. Further prospective studies are needed to disentangle beneficial and detrimental brain effects of ED.

Effects of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals living in a refugee camp in Greece: A randomized controlled trial.

Background: The metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components. Methods: We conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling. Results: In total, 62.7 % of participants presented with low cardiorespiratory fitness levels (<40th percentile), and 24.6 % met the criteria for metabolic syndrome. In the intervention group, 73.5 % attended the exercise and sport sessions at least once a week. There was evidence for a direct intervention effect on cardiorespiratory fitness, ßdirect = 0.12, p = 0.022, but not for any of the metabolic syndrome components (p ≥ 0.192). Cardiorespiratory fitness significantly facilitated the intervention's indirect effect on abdominal obesity, ßindirect = -0.03, p = 0.012, high diastolic blood pressure, ßindirect = -0.04, p = 0.011, and elevated triglycerides, ßindirect = -0.03, p = 0.025. Conclusion: Implementing exercise and sport activities in a refugee camp in Greece effectively reaches a wider target population and improves cardiorespiratory fitness among forcibly displaced individuals. The intervention contributes to a decrease in abdominal obesity, high diastolic blood pressure and elevated triglycerides indirectly via improved cardiorespiratory fitness.

Exercise Addiction and Major Depressive Disorder - Clinical Diagnoses and Longitudinal Course.

Background: People at risk of exercise addiction report increased symptoms of psychopathology. The aim of this study was to clinically assess the lifetime prevalence of depressive disorders in individuals at risk of exercise addiction and to determine whether depressive symptoms tend to precede or follow excessive exercising. Methods: Based on the Exercise Dependence Scale-21, a total of 31 individuals categorized at risk of exercise addiction underwent the Structured Clinical Interview for DSM-5 to assess major depressive disorder (MDD). Findings: The results showed 16 of the 31 participants suffered from MDD. The onset of MMD occurred in 10 participants after excessive exercising and in 5 before excessive exercising. In one participant, the symptom onset was unclear. Conclusion: MDD is far more prevalent in patients with exercise addiction compared to the general population and develops more often after the beginning of exercise addiction. Caution in the use of exercise to treat depression may be warranted.