Brain-Periphery Interactions in Huntington's Disease: Mediators and Lifestyle Interventions.

Prominent pathological features of Huntington's disease (HD) are aggregations of mutated Huntingtin protein (mHtt) in the brain and neurodegeneration, which causes characteristic motor (such as chorea and dystonia) and non-motor symptoms. However, the numerous systemic and peripheral deficits in HD have gained increasing attention recently, since those factors likely modulate disease progression, including brain pathology. While whole-body metabolic abnormalities and organ-specific pathologies in HD have been relatively well described, the potential mediators of compromised inter-organ communication in HD have been insufficiently characterized. Therefore, we applied an exploratory literature search to identify such mediators. Unsurprisingly, dysregulation of inflammatory factors, circulating mHtt, and many other messenger molecules (hormones, lipids, RNAs) were found that suggest impaired inter-organ communication, including of the gut-brain and muscle-brain axis. Based on these findings, we aimed to assess the risks and potentials of lifestyle interventions that are thought to improve communication across these axes: dietary strategies and exercise. We conclude that appropriate lifestyle interventions have great potential to reduce symptoms and potentially modify disease progression (possibly via improving inter-organ signaling) in HD. However, impaired systemic metabolism and peripheral symptoms warrant particular care in the design of dietary and exercise programs for people with HD.

Validity, reliability, and invariance across sex of a German version of the Behavioral Regulation in Exercise Questionnaire.

Objective: Since there is no scientifically validated German version of the Behavioral Regulation in Exercise Questionnaire (BREQ-3), the aim of this study was to assess its psychometric parameters and invariance across sex in a sample of German-speaking young adults. The BREQ-3 is an instrument measuring the social and internal influences of motivation toward exercising. This tool is widespread within the scientific community and has been validated in several languages. Methods: A total of 271 participants (45% women; mean age = 20.67 ± 2.17 years; effect size ≥ 0.5) filled in the BREQ-3 at one time point, with a small sub-sample (n = 37) responding it a second time after 15 days. Confirmatory Factorial Analysis, Structural Modeling, and Intraclass Correlation Coefficient were used to examine the German version of the questionnaire. Results: Results highlighted a good fit of the six-dimensional model after the removal of two items (CFI = 0.912; SRMR = 0.0594; RMSEA = 0.064), as well as full invariance across sex (pχ2 = 0.218; ΔCFI < 0.01). Internal consistency and reliability were moderate to good. Conclusions: The 22-item German BREQ-3 is a scientifically valid instrument that can be used in cross-national studies dealing with social aspects of exercise behaviors.

Hypoxia Sensing and Responses in Parkinson's Disease.

Parkinson's disease (PD) is associated with various deficits in sensing and responding to reductions in oxygen availability (hypoxia). Here we summarize the evidence pointing to a central role of hypoxia in PD, discuss the relation of hypoxia and oxygen dependence with pathological hallmarks of PD, including mitochondrial dysfunction, dopaminergic vulnerability, and alpha-synuclein-related pathology, and highlight the link with cellular and systemic oxygen sensing. We describe cases suggesting that hypoxia may trigger Parkinsonian symptoms but also emphasize that the endogenous systems that protect from hypoxia can be harnessed to protect from PD. Finally, we provide examples of preclinical and clinical research substantiating this potential.

Acute effects of outdoor and indoor walking on cigarette cravings, withdrawal symptoms and affective response during temporary smoking abstinence.

RATIONALE: Cigarette smoking is one of the leading preventable causes of premature death worldwide. There is evidence in the literature that brief exercise units indoors can improve well-being in temporarily abstinent smokers and reduce cigarette cravings and withdrawal symptoms. OBJECTIVE: Because exercise in natural environments showed enhanced psychological effects, the aim of our study was to examine the acute effects of outdoor exercise compared with indoor exercise on craving, withdrawal symptoms and affective response in temporarily abstinent smokers. METHODS: In a randomized controlled within-subject-design, temporarily abstinent smokers (N = 16) participated in three interventions lasting 10 min: outdoor walking (OUT-EX), indoor walking (IN-EX) and a sedentary control condition (CC). Self-reported cigarette craving, withdrawal symptoms and affective response were assessed pre-, mid-, post-interventions and at follow-up. RESULTS: In contrast to CC, OUT-EX and IN-EX significantly reduced cigarette cravings during and at the end of the intervention compared to pre-intervention, but not at 20 min follow-up. Cigarette withdrawal symptoms decreased significantly over time in all three groups, but no significant group differences were found. OUT-EX and IN-EX, but not CC, showed significantly improved affective valence at the end of the intervention and at follow-ups. Outdoor walking resulted in significantly lower cigarette cravings than indoor walking at the end of the intervention. CONCLUSION: The study adds to existing evidence that short bouts of indoor or outdoor exercise can help reduce cigarette cravings and increase well-being in abstinent smokers. Further studies are needed to address the potential additional effect of outdoor exercise on craving, affective states and smoking cessation.

Examining acute environmental effects on affective state, expectancy, and intention in sport climbing.

Introduction: Psychological research has shown that, among other variables, affective state, expectancy, and behavioral intention influence whether or not a (physically active) behavior is performed. Environmental effects during physical activity on affective state have been well studied; however, research regarding environmental effects on expectancy or intention is limited. Sport climbing is a form of physical activity that is performed both indoors and outdoors and is therefore considered as suitable to study environmental effects. Therefore, the aim of the present study was to investigate environmental effects during sport climbing on affective state, expectancy, and intention. The nature of the relationship between some of these parameters should also be explored. Methods: Using a within-subjects design, 48 participants were to climb both once indoors in a climbing gym and once outdoors at a crag. The design included questionnaire-based surveys at multiple time points. Affective state, expectancy, and behavioral intention were measured at different test time points. Results: Two-factor repeated-measures ANOVAs revealed significant main effects of the factors environment (indoor - outdoor) and time (T1 - T2 - T3) for affective state, indicating more positive affective state during outdoor climbing. No environment*time interactions were found. Furthermore, significantly higher intention (d = 0.32; p = 0.032) was measured after the outdoor condition (M = 32.5, SD = 4.1) compared to the indoor condition (M = 31.2, SD = 4.7). Multiple linear regressions revealed that expectancies (measured before and after the session) significantly predicted post-climbing intention only indoors. Conclusion: The results at least partly suggest environmental effects on behaviorally relevant variables during climbing. Outdoor climbing might provide more favorable characteristics for physically active behavior compared to indoor climbing. Health psychologists or public health professionals who focus on increasing physical activity for their clients could recommend outdoor climbing over indoor climbing.

Risk Factors for Accidents and Close Calls in Junior Freeriders, Adolescent Alpine Skiers and Adult Freeriders-A Comparison.

Understanding factors associated with risk-taking behavior, accidents and close calls could enhance prevention strategies and thus contribute to preventing serious injury or death in the long term. The following study aims to assess these factors in junior freeride athletes in comparison with competitive alpine skiers of similar age and adult freeriders. A cross-sectional questionnaire design was used to assess risk-related variables and potential associated factors. Accident and close call involvement did not significantly differ between the groups (p > 0.080). No significant relationships between gender and risk-related variables were found (|r| < 0.26). Precautionary behavior was higher in freeride adults and freeride juniors compared to alpine skiers (p < 0.001) and deliberate risk-taking was lower in freeride adults compared to junior freeriders and alpine skiers (p < 0.001). Regression analyses revealed that the association between self-objectification and accidents was stronger in freeride juniors compared to alpine skiers of similar age and freeride adults (p < 0.049). Although accidents and close calls were similar between groups, age seems to be an associated variable to deliberate risk-taking and precautionary behavior. The relationship between accidents and self-objectification in freeride juniors implicates a need for risk education in freeriders in the sensitive phase of adolescence beyond the mere presentation of environmental dangers.

Climbing as an Add-On Treatment Option for Patients with Severe Anxiety Disorders and PTSD: Feasibility Analysis and First Results of a Randomized Controlled Longitudinal Clinical Pilot Trial.

BACKGROUND: Exercise has considerable effects on physical and psychological health. Anxiolytic effects of climbing exercise have been found in people suffering from depression. However, there are no studies on patients with severe anxiety disorders or post-traumatic stress disorder (PTSD) practicing climbing as add-on treatment. Additionally, many studies on physical therapy fail to use adequate active control groups. Therefore, this study aimed to investigate the feasibility of a four-week climbing exercise program for patients with anxiety disorders or PTSD in comparison to a standard exercise treatment and a social control group. METHODS: Outpatients diagnosed with anxiety disorders or PTSD (F 40, F 41, F 43.1 according to ICD-10) were randomly assigned to (a) climbing exercise (n = 27), (b) Nordic walking exercise (n = 23), or (c) control condition (n = 23) providing the same amount of social contact for eight sessions of 90 minutes each. Psychological parameters (symptom severity, worry symptoms, self-efficacy, quality of life) and biological parameters were assessed at the beginning and at the end of the four-week program. Additionally, follow-up assessments were conducted three and six months after the program ended. RESULTS: Sixty outpatients (75% female) aged 18-65 years with a longstanding history of a mental disorder (>10 years) and classified as treatment-resistant (95%) and with averaging 3.8 psychiatric comorbidities completed the pilot trial. After participation, symptoms of anxiety disorders were significantly reduced (p = 0.003), and health-related characteristics significantly improved (depression symptoms: p < 0.001, worry symptoms: p < 0.001, self-efficacy: p < 0.001, quality of life-physical health: p = 0.002, quality of life-psychological health: p = 0.006) in all groups. The feasibility of conducting climbing exercises for the patient groups could be demonstrated, and a general acceptance in the groups was recorded. No significant time-by-group interactions were found. At the completion of the program, psychological parameters improved, while biological parameters remained the same in all three groups. CONCLUSIONS: Participation in the climbing group as well as in Nordic walking and social contact groups demonstrated beneficial results in patients with anxiety disorders and PTSD with severe mental burden. Nevertheless, climbing did not show any additional clinically relevant benefits compared to Nordic walking or social contact. Studies with larger sample sizes and qualitative insights are needed to further evaluate the possible benefits of climbing in this population.

Better Together? Analyzing Experiences from Male and Female Students and Teachers from Single-Sex and Coeducational Physical Education Classes.

PURPOSE: Since personal, environmental and behavioral factors influence students' and teachers' actions and experiences, the present study aimed to assess gender-related experiences of students and teachers from single-sex and coeducational physical education (PE) settings. METHOD: In total, 64 students (mean age: 13.8 ± 0.5 years) and 12 PE teachers from single-sex and coeducational PE settings from higher education schools (6th to 13th grade) in Germany and Austria were interviewed. Interviews were analyzed using a thematic content approach. RESULTS: Students from coeducational PE settings described more gender-unrelated behavior and a higher variety of activities including various non-gender conforming activities. Male students from single-sex PE settings reported performing only gender conform and some gender-neutral activities. Teachers from coeducational settings stated that they purposefully formed mixed-gender groups to foster social processes. A lack of time and lack of knowledge were named by PE teachers as reasons for not addressing gender issues in PE by teachers. CONCLUSION: Performed activities and teachers' behavior differed between PE settings, eventually influencing reported differences in terms of behavior and gender perception by students. Further studies should evaluate the influence of specific physical activity interventions on gender perceptions and students' behavior in order to give practical recommendations for PE classes.

Effects of a Two-Step Cognitive and Relaxation Training Program in Care Home Residents with Mild Cognitive Impairment.

The aim of the present study was to assess the impact of a relaxation training program (RT), a cognitive training program (CT), and the combination of both on changes in cognitive status, emotional status, and experience of pain in older adults with mild cognitive impairment (MCI). Fifty care home residents underwent either RT (26 participants) or CT (24 participants) in the first training period, followed by the combined relaxation and cognitive training program in the second. Psychological tests on cognitive performance, mood disturbance/well-being, depression, and experience of pain were implemented at three time points of measurement, before (t1), after (t2) the first training period, and after the second training period (t3). Both RT and CT with the subsequent combined training program in the second training period, respectively, increased cognitive performance and well-being, and reduced mood disturbance, depression, and the experience of pain. The study showed the non-inferiority of RT in respect of cognitive and emotional status in care home residents with MCI compared to the more frequently implemented CT. Both training programs are high in acceptability and positive outcomes on cognitive, emotional, and pain status support the use of a combination of RT and CT.

Intention to Engage in Mountain Sport During the Summer Season in Climate Change Affected Environments.

Natural environments can make it easier to engage in regular physical activity, including mountain sport activities. However, global warming is expected to change natural environments, especially in mountainous regions with potential impacts on physical activity behavior. While there is some evidence of a reduced intention to engage in winter sport in climate change affected environments, little is known on the impact of climate change in mountain sports conducted in the summer season. Therefore, the present study aimed at comparing the effect of being exposed to a climate change affected scenario (CCA) to being exposed to a climate change unaffected scenario (CCU) on the intention to engage in summer mountain sport activities. Furthermore, we aimed to analyze the role of anticipated affective responses in the context of the Theory of Planned Behavior (TPB). Using a web-based experimental cross-sectional study design, participants were randomly allocated to scenarios of either CCA or CCU pictures. Participants were asked to complete questions about TPB variables and about affective responses referring to the displayed scenarios. Statistical analyses included tests on group differences and hierarchical linear regression analyses. TPB variables (intention to engage in summer mountain sport, attitude, and perceived behavioral control) did not show significant group differences between CCA (n = 155) and CCU (n = 156), p > 0.131; r < -0.10. Significantly lower anticipated affective valence was found in CCA compared to CCU, p < 0.001, r = -0.43. Affective valence did not significantly improve the TPB model, change in R2 = 0.7%, p = 0.096. However, a higher affective valence was significantly associated with a higher attitude toward summer mountain sport, beta = 0.19, p < 0.001. Intention to engage in summer mountain sport was similar in the groups. Therefore, an immediate reduced engagement in mountain sport activities due to climate change seems unlikely in the summer season, although differentiated findings across various activities of summer mountain sport cannot be excluded. A reduced affective valence during summer mountain sport activities might occur in the presence of signs of climate change in the environment, which may lead to longer-term behavior changes in climate change affected scenarios also in the summer by repeated experiences of reduced valence.

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

Background: Exercise programs have shown anxiolytic effects in psychiatric patients. Adherence to exercise programs and subsequent long-term lifestyle change is influenced by acute affective responses of the exercise programs. This research aimed to assess acute affective responses of two different exercise modalities compared to a non-exercise control program and its effects on persisting physical activity behavior change. Methods: Sixty-six outpatients diagnosed with an anxiety disorder or posttraumatic stress disorder were randomly allocated to one of three groups in a randomized longitudinal controlled clinical pilot trial: climbing (n = 26), nordic walking (n = 19), social contact control (n = 21). Affective responses were assessed pre, during, and post activity. General physical activity behavior was recorded prior to participation in the program, post program, and at follow-ups three and six months after the program. Results: Multilevel modeling analyzes of 1,066 individual data points revealed increases in affective valence in the exercise sessions compared to the social contact sessions. State anxiety decreased in the climbing group compared to the social contact group. Physical activity behavior was increased immediately following the program as well as at six months follow-up in both exercise groups. A larger increase in affective valence during and after the sessions was associated with higher physical activity post program. Conclusions: Climbing and conventional nordic walking exercise sessions revealed positive affective changes in outpatients indicating therapeutic potential of both modalities for acute emotion regulation. In accordance with theoretical models of human behavior change, it was judged that the experience of a more pleasant affective state following the exercise sessions induced more persisting effects on physical activity behavior after the exercise programs. Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT03758599, identifier: NCT03758599.

Add-on exercise interventions for smoking cessation in people with mental illness: a systematic review and meta-analysis.

BACKGROUND: Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness. METHODS: Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel-Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up). RESULTS: Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13-1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89-2.04). CONCLUSIONS: Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).

Physical Activity Behavior During and After COVID-19 Stay-at-Home Orders-A Longitudinal Study in the Austrian, German, and Italian Alps.

Background: In Alpine regions, which are very similar due to their topographical location and their wide-ranging sports offerings, the restrictions on sports activities during the COVID-19 pandemic differed in type and level: while in some regions (Tyrol, South Tyrol, Trentino), all sports activities were forbidden except for walking near the home, in other regions (Upper Bavaria, Vorarlberg), people were allowed to go hiking and running during the first lockdown. Objective: The aim of this study was to investigate the change in physical activity (PA) behavior in different Alpine regions (Upper Bavaria, Vorarlberg, Tyrol, South Tyrol, Trentino) over four periods in 2020, to examine the effects of COVID-19 measures of varying severity on PA behavior and to identify factors associated with a change in PA over time. Methods: A retrospective online survey was conducted (N = 2975) from December 2020, to January 2021. Using the questionnaire of the Eurobarometer 472 study, PA behavior was measured over four periods: before COVID-19 (March), during the first lockdown (March and April), during the relaxed period (May-October) and during the second lockdown (November and December) in 2020. Results: During the first (M = 5.0h, SD = 4.5) and the second lockdowns (M = 4.9h, SD = 4.3), the participants (age: 42 years, overly active in sports) engaged less in sports than before (M = 5.9h, SD = 4.8) and during the relaxed period in summer (M = 6.4h, SD = 5.0) (average number of hours per week being physically active). A larger percentage of participants from Alpine regions with severe restrictions (Tyrol, South Tyrol, Trentino) decreased their PA during the first lockdown as compared to participants from Upper Bavaria and Vorarlberg with a less strict first lockdown. Those with psychological distress, male participants, and individuals with decreased physical health and less free time during COVID-19 were more likely to reduce their PA. Conclusions: Despite a short-term negative effect of COVID-19 restrictions on exercise participation during lockdowns, the majority of respondents returned to their original levels of PA during the relaxed COVID-19 phases. As a comparison of Alpine regions shows, particularly severe COVID-19 measures seem to have reduced PA with potential negative health effects. For the future, policy makers and sports organizations should collaborate to support the population in their PA behavior during pandemics to outweigh restrictions.

A Comparison of Acute Effects of Climbing Therapy with Nordic Walking for Inpatient Adults with Mental Health Disorder: A Clinical Pilot Trial.

As climbing therapy is increasingly used for mental health disorders, the present study aimed to compare acute effects of a therapeutic climbing intervention (CT) on affective responses, anxiety, and self-efficacy with those of Nordic walking (NW) and a sedentary control condition (SC) in an inpatient setting with persons with depression, anxiety, or obsessive−compulsive disorders. A total of 21 inpatients (32 ± 12.2 years) participated in a clinical trial in all interventions using an experimental within-subject design. Anxiety and self-efficacy were assessed preintervention (t0) and postintervention (t2) using the State-Trait Anxiety Inventory and the General Self-Efficacy Scale, and affective responses were additionally evaluated during (t1) and 180 min after the intervention (t3) using the Feeling Scale, Felt Arousal Scale, and Positive and Negative Affect Schedule. Statistical evaluation was performed with a 3 × 2 or 3 × 4 repeated measures ANOVA. Significant interaction effects were found for affective responses regarding positive affect, affective valence, and perceived activation (p < 0.015) favoring CT over NW and SC. For anxiety, a significant interaction effect was found (F(2.40) = 6.603; p = 0.003; η2 = 0.248), and also perceived self-efficacy increased significantly (F(2.40) = 6.046; p = 0.005; η2 = 0.232). Single CT sessions may enhance affective responses and self-efficacy and reduce anxiety in inpatients with mental health disorders to a higher extent than NW. CT as part of an inpatient therapy program may help to improve key affective mechanisms and should be further studied in comparison with other exercise interventions with comparable intensity.

The interplay of hypoxic and mental stress: Implications for anxiety and depressive disorders.

Adequate oxygen supply is essential for the human brain to meet its high energy demands. Therefore, elaborate molecular and systemic mechanism are in place to enable adaptation to low oxygen availability. Anxiety and depressive disorders are characterized by alterations in brain oxygen metabolism and of its components, such as mitochondria or hypoxia inducible factor (HIF)-pathways. Conversely, sensitivity and tolerance to hypoxia may depend on parameters of mental stress and the severity of anxiety and depressive disorders. Here we discuss relevant mechanisms of adaptations to hypoxia, as well as their involvement in mental stress and the etiopathogenesis of anxiety and depressive disorders. We suggest that mechanisms of adaptations to hypoxia (including metabolic responses, inflammation, and the activation of chemosensitive brain regions) modulate and are modulated by stress-related pathways and associated psychiatric diseases. While severe chronic hypoxia or dysfunctional hypoxia adaptations can contribute to the pathogenesis of anxiety and depressive disorders, harnessing controlled responses to hypoxia to increase cellular and psychological resilience emerges as a novel treatment strategy for these diseases.

Staying Active under Restrictions: Changes in Type of Physical Exercise during the Initial COVID-19 Lockdown.

The COVID-19 pandemic and the associated governmental restrictions suddenly changed everyday life and potentially affected exercise behavior. The aim of this study was to explore whether individuals changed their preference for certain types of physical exercise during the pandemic and to identify risk factors for inactivity. An international online survey with 13,881 adult participants from 18 countries/regions was conducted during the initial COVID-19 related lockdown (between April and May 2020). Data on types of exercise performed during and before the initial COVID-19 lockdown were collected, translated, and categorized (free-text input). Sankey charts were used to investigate these changes, and a mixed-effects logistic regression model was used to analyze risks for inactivity. Many participants managed to continue exercising but switched from playing games (e.g., football, tennis) to running, for example. In our sample, the most popular exercise types during the initial COVID-19 lockdown included endurance, muscular strength, and multimodal exercise. Regarding risk factors, higher education, living in rural areas, and physical activity before the COVID-19 lockdown reduced the risk for inactivity during the lockdown. In this relatively active multinational sample of adults, most participants were able to continue their preferred type of exercise despite restrictions, or changed to endurance type activities. Very few became physically inactive. It seems people can adapt quickly and that the constraints imposed by social distancing may even turn into an opportunity to start exercising for some. These findings may be helpful to identify individuals at risk and optimize interventions following a major context change that can disrupt the exercise routine.

A case-control study on physical activity preferences, motives, and barriers in patients with psychiatric conditions.

BACKGROUND: Physical activity in individuals diagnosed with psychiatric conditions (patients) has antidepressant and anxiolytic effects, but levels of physical activity are still low in this population. This study aimed to identify physical activity preferences, motives, and perceived barriers in patients compared to individuals without a diagnosed psychiatric condition (controls). METHODS: A total of 230 patients (age = 39.5 ± 14.0 years, 80% female) with major depression (34%), anxiety disorders (38%), or post-traumatic stress disorder (28%) completed a cross-sectional online survey to assess preferences, motives, and perceived barriers to physical activity (measured by the EMI-2). This group consisted of 100 patients with a clinical diagnosis (clinical subset) and 130 with self-reported psychiatric conditions (confirmed by the PHQ-4) from online help forums (online subset). Comparisons between patients of the clinical and the online subsets were performed and are referenced whenever significant. The patients group was compared to a healthy control group matched by sex and age (n = 230, age = 39.4 ± 14.9 years, 80% female). RESULTS: More patients reported insufficient physical activity levels and more daily sitting hours (measured by the IPAQ) compared to controls. Patients reported lower preference in more ambitious types of physical activity, such as hiking, cycling, and running. The commonly most preferred type of physical activity in both groups was walking and yoga. Patients had fewer motives and more perceived barriers to physical activity in comparison to the control group. Some differences in motives and perceived barriers to physical activity were also found between patients of the clinical and the online subset. CONCLUSIONS: Findings of low physical activity levels in patients are consistent with the literature. Due to the patients' lack of motivation and perception of barriers, health care providers should consider offering different and individualized forms of physical activity. Easier types of physical activity, such as walking and yoga, appear to be the most feasible and provide a good starting point to overcome perceived barriers to physical activity.

Aiming at Optimal Physical Activity for Longevity (OPAL).

Although even small volumes (15-20 min) of daily physical activity (PA) are associated with health benefits, the optimal volume for healthy aging and longevity is substantially larger, amounting to about 100 min of daily moderate PA. The accomplishment of this objective likely requires the development of an appropriate PA lifestyle at an early age. Research initiatives are necessary addressing the motivational contribution of families, school surroundings and sport clubs, perhaps combined with role model effects and instructions for the specific implementation. Such approaches would need an enlarged agreement in readdressing this new aim followed by the launch of a new research strategy in order to develop specific offers for the respective age cohorts.