The daily reciprocal associations between electroencephalography measured sleep and affect.

Self-report studies show that sleep and positive and negative affect are closely and bidirectionally linked. However, studies assessing sleep objectively yield more inconsistent results. This study assessed the reciprocal, daily relationship between sleep as measured with electroencephalography (EEG) and affect (measured in the evening) in a natural setting. We assessed sleep both on the macrolevel (i.e., rapid eye movement [REM] sleep and slow-wave sleep [SWS] duration) and on the microlevel (i.e., REM sleep fragmentation). In this study, 33 participants (i.e., healthy college students, mean [standard deviation] age 21.55 [3.73] years, 67% female) were followed for 2 weeks. Each participant wore an EEG headband for 15 nights and had polysomnography during 3 of the 15 nights providing 72 analysable nights of polysomnography and 271 analysable nights with the EEG headband. Every evening participants reported their momentary negative and positive affect. We examined the relationship between pre-sleep affect and the sleep variables, as well as the reverse relationship, with sleep variables predicting evening affect the next day. We detected that higher negative affect in the evening was related to more fragmented REM sleep. However, this result was only found with polysomnography and not with the EEG headband. No significant associations were found between affect and time spent in REM sleep and SWS. Overall, no support was found for the reciprocal association between negative and positive affect and EEG measured sleep. Only limited support was found for an association in one direction (i.e., evening negative affect was associated with more REM sleep fragmentation at night).

Maternal Postpartum Work Resumption Stress: Questionnaire Development and Validation.

Transitioning back to work after maternity leave is increasingly common. While differences exist, for many mothers this transition represents a stressor. This study aimed to define the construct of maternal postpartum work resumption stress and develop and validate a self-report measure in a low-risk sample of Dutch mothers. First, the item pool (N = 71) and face and content validity of the questionnaire were established. Next, two independent samples of mothers returning to work (N = 298, N = 291) were recruited to identify factor structure, reduce the number of items, and assess the dimensionality, reliability, convergent and discriminant validity of the questionnaire. Based on exploratory and confirmatory factor analyses, the reliable and valid REturn to Work INventory (REWINd) with 30 items across three factors was established. While further validation is needed, REWINd can be used to further study the nature and consequences of maternal postpartum work resumption stress.

Sustainable employability of long-term care staff in self-managing teams: A qualitative study.

AIM: To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable. DESIGN: Qualitative study with semi-structured interviews. METHODS: In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti. RESULTS: LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence. CONCLUSION: In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs. IMPLICATIONS: It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs. IMPACT: A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector. REPORTING METHOD: The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used. PATIENT OR PUBLIC CONTRIBUTION: Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

Psychological reactance and vaccine uptake: a longitudinal study.

OBJECTIVE: In most countries, vaccine uptake is a voluntary decision. If people experience threats to this freedom, for example, by pro-vaccination media campaigns or government pressure, psychological reactance may be induced. To regain freedom, the opposite behaviour (vaccine refusal) may become more attractive, forming a vaccination barrier. It remains unclear how state reactance fluctuates and how it relates to vaccination intention versus behaviour. Therefore, this pre-registered longitudinal study aimed to gain insight in the changes in state reactance during a COVID-19 vaccination programme and its relationship with vaccine uptake. METHODS: A representative sample of Dutch adults under 60 completed questionnaires before being eligible for vaccination, shortly before they were invited for vaccination, and after the opportunity for vaccination. RESULTS: Data were analysed using regression analyses (N = 1411). Reactance did not change as hypothesised, but remained stable over time. As hypothesised, reactance predicted lower subsequent vaccination intention. Controlling for intentions, however, reactance did not predict vaccine uptake. Furthermore, reactance predicted lower decision confidence about vaccination, except for people who strongly opposed vaccination. CONCLUSION: Reactance has a sustained role in anticipation of a vaccination decision. Although reactance seems to affect the process towards the decision, this does not determine the final choice.

The sound of stress recovery: an exploratory study of self-selected music listening after stress.

BACKGROUND: Empirical support for the notion that music listening is beneficial for stress recovery is inconclusive, potentially due to the methodological diversity with which the effects of music on stress recovery have been investigated. Little is presently known about which recovery activities are chosen by individuals for the purpose of stress recovery, and whether audio feature commonalities exist between different songs that are selected by individuals for the purpose of stress recovery. The current pre-registered study investigated whether audio feature commonalities can be extracted from self-selected songs for the purpose of stress recovery. Furthermore, the present study exploratorily examined the relationship between audio features and participants' desired recovery-related emotions while listening and after listening to self-selected music. METHODS: Participants (N = 470) completed an online survey in which they described what music they would listen to unwind from a hypothetical stressful event. Data analysis was conducted using a split-sample procedure. A k-medoid cluster analysis was conducted to identify audio feature commonalities between self-selected songs. Multiple regression analyses were conducted to examine the relationship between audio features and desired recovery emotions. RESULTS: Participants valued music listening as a recovery activity to a similar extent as watching TV, sleeping, or talking to a significant other. Cluster analyses revealed that self-selected songs for the purpose of stress recovery can be grouped into two distinct categories. The two categories of songs shared similarities in key, loudness, speechiness, acousticness, instrumentalness, liveness, musical valence, tempo, duration, and time signature, and were distinguished by danceability, energy, and mode. No audio features were significantly associated with participants' desired recovery emotions. CONCLUSIONS: Although a comprehensive portrait of the relationship between audio features and stress recovery still warrants further research, the present study provides a starting point for future enquiries into the nuanced effects of musical audio features on stress recovery.

Effectiveness of Team and Organisational Level Workplace Interventions Aimed at Improving Sustainable Employability of Aged Care Staff: A Systematic Review.

Purpose The sustainable employability of healthcare professionals in aged care is under pressure, but research into the effectiveness of interventions aimed at improving employees' sustainable employability is scarce. This review therefore aimed to investigate the effectiveness of workplace interventions on sustainable employability of healthcare professionals in aged care. Methods A systematic literature search was performed. Studies were included when reporting about the effect of an intervention at work in an aged care setting on outcomes related to one of the three components of sustainable employability (i.e. workability, vitality, employability). The methodological quality of each study was assessed and a rating system was used to determine the level of evidence. Additionally, a sensitivity analysis was performed, accounting for the match between the intervention's focus and the targeted component of sustainable employability. Results Current review includes 32 interventions published between 1996 and 2019. Interventions covered learning and improving skills, changing the workplace, and exercising or resting. The initial analysis showed a strong level of evidence for employability and insufficient evidence for workability and vitality. The sensitivity analysis revealed strong evidence for the effectiveness of interventions addressing either employability or workability, and insufficient evidence for vitality. Conclusions Evidence for workplace interventions on sustainable employability of healthcare professionals in aged care differed. We found strong evidence for effects of workplace interventions on employability and for those directly targeting workability. Evidence for effects of interventions on vitality was insufficient. The alignment of the interventions to the targeted component of sustainable employability is important for effectiveness.

Music listening and stress recovery in healthy individuals: A systematic review with meta-analysis of experimental studies.

Effective stress recovery is crucial to prevent the long-term consequences of stress exposure. Studies have suggested that listening to music may be beneficial for stress reduction. Thus, music listening stands to be a promising method to promote effective recovery from exposure to daily stressors. Despite this, empirical support for this opinion has been largely equivocal. As such, to clarify the current literature, we conducted a systematic review with meta-analysis of randomized, controlled experimental studies investigating the effects of music listening on stress recovery in healthy individuals. In fourteen experimental studies, participants (N = 706) were first exposed to an acute laboratory stressor, following which they were either exposed to music or a control condition. A random-effects meta-regression with robust variance estimation demonstrated a non-significant cumulative effect of music listening on stress recovery g = 0.15, 95% CI [-0.21, 0.52], t(13) = 0.92, p = 0.374. In healthy individuals, the effects of music listening on stress recovery seemed to vary depending on musical genre, who selects the music, musical tempo, and type of stress recovery outcome. However, considering the significant heterogeneity between the modest number of included studies, no definite conclusions may currently be drawn about the effects of music listening on the short-term stress recovery process of healthy individuals. Suggestions for future research are discussed.

A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial.

BACKGROUND: Staff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff's sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers' basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level. METHODS: We developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study. DISCUSSION: This study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022. TRIAL REGISTRATION: Netherlands Trial Register, NL9627 . Registered 29 July 2021 - Retrospectively registered.

The effect of opportunity costs on mental fatigue in labor/leisure trade-offs.

Most people experience the feeling of mental fatigue on a daily basis. Previous research shows that mental fatigue impacts information processing and decision making. However, the proximal causes of mental fatigue are not yet well understood. In this research, we test the opportunity cost model of mental fatigue, which proposes that people become more fatigued when the next-best alternative to the current task is higher in value. In 4 preregistered experiments (N = 430), participants repeatedly reported their current level of fatigue and chose to perform a paid labor task versus an unpaid leisure task. In Study 1, all participants were offered the same labor/leisure choice. In Studies 2 and 3, we manipulated the opportunity costs of a labor task by varying the value of an alternative leisure task. In Study 4, we manipulated the opportunity costs of a labor task by varying the value of that labor task. In all studies, we found that people were more likely to choose for leisure as they became more fatigued. In Studies 2 through 4, we did not find that the manipulated leisure value influenced the amount of fatigue participants experienced nor the likelihood to choose for leisure. However, in exploratory analyses, in all studies, we found that participants who reported to value the leisure task more got more fatigued during labor and less fatigued during leisure. Collectively, these results provide cautious support for the opportunity cost model, but they also show that cost-benefit analyses relating to labor and leisure tasks are fleeting. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

No pain, no gain? Recovery and strenuousness of physical activity.

The present study aimed to advance insight in the role of leisure time physical activity (LTPA) in the recovery process, by focusing on the strenuousness of LTPA. It was proposed that-compared with less strenuous LTPA-more strenuous LTPA would show stronger positive relationships with recovery through higher levels of mental disengagement from stressors resulting from more strenuous LTPA. This hypothesis was examined in two studies, in which participants' positive and negative affective states were included as indicators of recovery. Study 1 was a 10-day daily diary study (3 measurements daily) among 74 employees. Each day, participants reported the time they had spent on mild, moderate, and strenuous LTPA. Multilevel path analysis showed that only strenuous LTPA was related to beneficial changes in the two indicators of recovery before bedtime and in the next morning through its positive relationship with psychological detachment from work. Study 2 was an experiment with two between-participants conditions, in which-after a stress-inducing task-44 participants engaged in either (a) a 20-min moderate intensity cycling task, or (b) a 20-min high intensity cycling task. Results showed that high intensity exercise was indirectly related to higher recovery as indicated by a lower level of participants' negative affective state, through lower levels of rumination about the stress-inducing task in this condition. The results of these two studies indicate that to fully savor LTPA's beneficial effects through mental disengagement from stressors, it is best conducted with a high level of strenuousness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The state of boredom: Frustrating or depressing?

Boredom is a prevalent emotion with potential negative consequences. Previous research has associated boredom with outcomes indicating both high and low levels of arousal and activation. In the present study we propose that the situational context is an important factor that may determine whether boredom relates to high versus low arousal/activation reactions. In a correlational (N = 443) and an experimental study (N = 120) we focused on the situational factor (perceived) task autonomy, and examined whether it explains when boredom is associated with high versus low arousal affective reactions (i.e., frustration versus depressed affect). Results of both studies indicate that when task autonomy is low, state boredom relates to more frustration than when task autonomy is high. In contrast, some support (i.e., Study 1 only) was found suggesting that when task autonomy is high, state boredom relates to more depressed affect than when task autonomy is low. These findings imply that careful attention is needed for tasks that are relatively boring. In order to reduce frustration caused by such tasks, substantial autonomy should be provided, while monitoring that this does not result in increased depressed affect.

Does Mindfulness Training Enhance the Professional Development of Residents? A Qualitative Study.

PURPOSE: In addition to developing diagnostic and clinical skills, postgraduate medical education should stimulate residents' professional development. Teaching medical professionalism is challenging and is often left largely to the informal and hidden curricula. An intervention that might be beneficial for medical residents is mindfulness-based stress reduction (MBSR). The authors implemented MBSR as an optional course for residents and qualitatively explored how it influenced residents professionally. METHOD: Between 2014 and 2016, the authors conducted 19 in-depth, face-to-face interviews with residents who had participated in an MBSR course at Radboud university medical center, The Netherlands. Medical and surgical residents, across a range of disciplines, participated. The authors used the constant comparison method to analyze the data. RESULTS: The analysis of the data resulted in five themes: awareness of thoughts, emotions, bodily sensations, and behavior; increased self-reflection; acceptance and nonjudgment; increased resilience; and relating to others. Residents indicated that the MBSR training increased their awareness and self-reflection at work, and they were more accepting toward themselves and toward their limitations. Furthermore, they mentioned being more resilient and better at setting priorities and limits. They improved their self-care and work-life balance. In addition, residents indicated that the training made them more aware of how they communicated. They asked for help more often and seemed to be more open toward feedback. Lastly, they indicated an increased sense of compassion for others. CONCLUSIONS: This study indicated that mindfulness training can serve as a tool to cultivate important professional competencies for residents.

Trajectories of well-being during an exercise randomized controlled trial: The role of exposure and exercise experiences.

We examined how process factors were related to the development of various indicators of well-being during the course of an exercise randomized controlled trial aimed at reducing fatigue among university students. We investigated (a) whether actual exposure to the exercise sessions was related to differences in students' trajectories of well-being, (b) the minimally required exposure to exercise needed before well-being started to differ between the intervention and control condition, and (c) whether exercise experiences (enjoyment and detachment) were related to differences in well-being trajectories. University students with high levels of fatigue were randomly allocated to a 6-week exercise intervention (n = 50) or wait list (n = 49). All participants were measured before, 5 times during, and at the end of the intervention period. Multilevel analyses showed that exercisers with high exposure showed an increase in self-efficacy whereas those with low exposure did not. Effects of exercise on well-being became visible after 2 to 4 weeks during the intervention period and (partly) depended on the extent of psychological detachment. We recommend that both outcomes and process factors throughout the intervention period should be measured in order to better understand "when" and "under what conditions" an exercise intervention works.

Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial.

BACKGROUND: Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents. OBJECTIVE: To determine the effectiveness of MBSR in reducing burnout in residents. DESIGN: A randomized controlled trial comparing MBSR with a waitlist control group. PARTICIPANTS: Residents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred. INTERVENTION: The MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day. MAIN MEASURES: The primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory-Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work-home interference, mindfulness skills, self-compassion, positive mental health, empathy and medical errors. Assessment took place at baseline and post-intervention approximately 3 months later. KEY RESULTS: Of the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit. CONCLUSIONS: The results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results.

The relationship between work and home characteristics and work engagement in medical residents.

INTRODUCTION: Work engagement is important for medical residents and the healthcare organizations they work for. However, relatively little is known about the specific predictors of work engagement in medical residents. Therefore, we examined the associations of work and home characteristics, and work-home interference with work engagement in male and female residents. METHODS: This study was conducted on a nationwide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire. Path analysis was used to examine the associations between the potential predictors and work engagement. RESULTS: In total, 2115 (41.1%) residents completed the questionnaire. Job characteristics, home characteristics and work-home interference were associated with work engagement. Important positive contributing factors of work engagement were opportunities for job development, mental demands at work, positive work-home interference and positive home-work interference. Important negative contributing factors were emotional demands at work and negative home-work interference. The influence of these factors on work engagement was similar in male and female residents. DISCUSSION: Opportunities for job development and having challenging work are of high relevance in enhancing work engagement. Furthermore, interventions that teach how to deal skilfully with emotional demands at work and home-work interference are expected to be the most effective interventions to enhance work engagement in medical residents.

The effect on sleep of being on-call: an experimental field study.

The aim of this study was to: (i) gain more insight into the relationship between being on-call and sleep and (ii) investigate the role of stress in this relationship. Data were collected by means of an experimental field study with a within-subject design (two conditions, random order). Ninety-six students participated during two consecutive nights: a reference night and a simulated on-call night without an actual call. Participants were told they could be called at any time during the on-call night. In the case of a call, participants had to perform online tasks for approximately 30 min. Self-reported sleep quality and the extent to which participants experienced stress during the on-call period were assessed by means of short questionnaires. Actigraphy was used to obtain objective sleep measures. Results for actigraphy data revealed no significant within-person differences between conditions. However, participants reported longer sleep onset latencies, more awakenings and more wake after sleep onset during the on-call night than during the reference night. They also reported more sleep problems and a lower overall sleep quality, and felt less recuperated after the on-call night. Perceived stress moderated the relationship between being on-call, on one hand, and the number of awakenings, wake after sleep onset, sleep problems and overall sleep quality, on the other hand. Results show that, even in the absence of an actual call, sleep during on-call nights is of lower quality and has less restorative value - especially when being on-call is experienced as stressful.

Exercise to reduce work-related fatigue among employees: a randomized controlled trial.

Objectives The present study evaluated the efficacy of an exercise intervention to reduce work-related fatigue (emotional exhaustion, overall fatigue, and need for recovery). The effects of exercise on self-efficacy, sleep, work ability, cognitive functioning and aerobic fitness (secondary outcomes) were also investigated. Methods Employees with high levels of work-related fatigue were randomly assigned to either a 6-week exercise intervention (EI; N=49) or a wait-list control group (WLC; N=47). All participants were measured pre- (T0) and post-intervention (T1). EI participants were also measured 6 (T2) and 12 weeks (T3) after the end of the intervention. Analyses were based on intention-to-treat (ITT) and per-protocol (PP). PP analyses only included EI participants (N=31) who completed the intervention and WLC participants (N= 35) who did not increase their exercise level during the wait period. Results Analyses of covariance (ANCOVA) revealed that, at T1, the EI group reported lower emotional exhaustion and overall fatigue than the WLC group, however, only according to PP analyses. Both according to ITT and PP analyses, EI participants showed higher sleep quality, work ability, and self-reported cognitive functioning at T1 compared to WLC participants. Intervention effects were maintained at T2 and T3. Conclusions The exercise intervention had enduring effects on work-related fatigue and broader indicators of employee well-being. This study demonstrates that, in case of work-related fatigue, exercise does constitute a powerful medicine for those who comply with the treatment.

The contribution of work characteristics, home characteristics and gender to burnout in medical residents.

Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work-home interference. Path analysis was used to examine the associations between job and home characteristics and work-home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents.

Day-to-day relations between stress and sleep and the mediating role of perseverative cognition.

OBJECTIVE: The goals of this longitudinal diary-based study were to shed light on the day-level relationship between stress and subsequent sleep, and to examine whether perseverative cognition is a mediating factor in this relation. METHODS: A total of 44 Dutch PhD students were followed during a two-month period, from one month before their public thesis defense (ie, a stressful life event), until one month thereafter. Participants completed short evening and morning questionnaires on eight occasions (in anticipation of and following the defense), including questions about day-level stress, sleep quality, and perseverative cognition. Objective sleep parameters were collected with the SenseWear Pro Armband. RESULTS: Multilevel analysis was used to analyze daily observations nested within individuals. Analyses revealed that day-level stress was not directly related to subsequent subjective sleep indicators or to subsequent objective sleep indicators. Day-level stress was significantly associated with day-level perseverative cognition, and daily variations in perseverative cognition were significantly related to several day-level objective sleep parameters (sleep efficiency, marginally to number of awakenings, and wake after sleep onset), and to several day-level subjective sleep parameters (sleep quality, number of awakenings, wake after sleep onset). Finally, mediation analyses using path analysis suggested that, on the day level, perseverative cognition functions as a mediator between stress and several sleep parameters, namely, subjective sleep quality, objective sleep efficiency, and subjective wake after sleep onset. CONCLUSION: Perseverative cognition is a promising explanatory mechanism linking day-level stress to subjective and objective measures of sleep.

Exercise as an Intervention to Reduce Study-Related Fatigue among University Students: A Two-Arm Parallel Randomized Controlled Trial.

BACKGROUND: Many university students experience high levels of study-related fatigue. This high prevalence, and the negative impact of fatigue on health and academic performance, call for prevention and reduction of these symptoms. The primary aim of the current study was to investigate to what extent an exercise intervention is effective in reducing three indicators of study-related fatigue (emotional exhaustion, overall fatigue, and need for recovery). Effects of exercise on secondary outcomes (sleep quality, self-efficacy, physical fitness, and cognitive functioning) were also investigated. METHODS: Participants were students with high levels of study-related fatigue, currently not exercising or receiving other psychological or pharmacological treatments, and with no medical cause of fatigue. They were randomly assigned to either a six-week exercise intervention (low-intensity running three times a week, n = 49) or wait list (no intervention, n = 48). All participants were measured before the intervention (T0), and immediately after the intervention (T1). Exercisers were also investigated 4 weeks (T2) and 12 weeks (T3) after the intervention. RESULTS: Participants in the exercise condition showed a larger decrease in two of the three indicators of study-related fatigue (i.e., overall fatigue and need for recovery) as compared to controls. Additionally, sleep quality and some indicators of cognitive functioning improved more among exercisers than among controls. No effects were found for self-efficacy, and physical fitness. The initial effects of the exercise intervention lasted at follow-up (T2 and T3). At 12-week follow up (T3), 80% of participants in the exercise condition still engaged in regular exercise, and further enhancements were seen for emotional exhaustion, overall fatigue, and sleep quality. CONCLUSIONS: These results underline the value of low-intensity exercise for university students with high levels of study-related fatigue. The follow-up effects that were found in this study imply that the intervention has the potential to promote regular exercise and accompanying beneficial effects in the longer run. TRIAL REGISTRATION: Netherlands Trial Register NTR4412.