Understanding and optimising gratitude interventions: the right methods for the right people at the right time.

OBJECTIVE: Gratitude has consistently been associated with various beneficial health-related outcomes, including subjective wellbeing, positive mental health, and positive physical health. In light of such effects, positive psychology researchers and practitioners have often implemented gratitude interventions in an attempt to build individuals' orientations toward appreciation and thankfulness. Recent meta-analyses and reviews have revealed, however, that these interventions often have mixed effects on gratitude or other health outcomes. With this issue in mind, we aimed to identify (a) contextual considerations that may impact the effectiveness of these approaches, and (b) recommendations for the optimisation of gratitude interventions. METHODS AND MEASURES: Seventeen mental health professionals or experienced health psychology researchers engaged in semi-structured interviews to address the research questions. RESULTS: Thematic analysis of the data resulted in three contextual themes-cultural considerations, personal characteristics, and life experience-that were discussed as factors likely to influence intervention effectiveness. With respect to recommendations, participants highlighted the importance of encouraging deep engagement in gratitude tasks, consistent repetition of those tasks, and the value of interpersonal expressions of gratitude. CONCLUSION: Discussion is centred on suggestions for future research on gratitude and on implications for the implementation of gratitude interventions.

The Right Advice, from the Right Person, in the Right Way: Non-Engaged Consumer Families' Preferences for Lifestyle Intervention Design Relating to Severe Obesity in Childhood.

Family-based lifestyle interventions for children/adolescents with severe levels of obesity are numerous, but evidence indicates programs fail to elicit short- or longer-term weight loss outcomes. Families with lived experience can provide valuable insight as we strive to improve outcomes from programs. Our aim was to explore elements that families desired in a program designed to treat severe levels of obesity in young people. We recruited a cross-sectional sample of 13 families (parents and young people) who had been referred but had not engaged with the state-wide Perth Children's Hospital, Healthy Weight Service (Perth, Australia), between 2016 and 2018. Utilizing semi-structured interviews and reflexive qualitative thematic analysis, we identified two broad themes, (1) bridging the gap between what to do and how to do it, and (2) peers doing it with you. The first theme reflected parents' and young people's feelings that programs ought to teach specialist-designed practical strategies utilizing non-generic information tailored to address the needs of the family, in a collaboratively supportive way, and encourage young people to learn for themselves. The second theme reflected the importance of social connection facilitated by peer support, and intervention programs should be offered in a group format to foster inclusion. Families indicated a willingness to engage in tertiary intervention programs but desired support from specialized health professionals/programs to be tailored to their needs, sensitive to their experiences and challenges and provide useful practical strategies that support the knowledge-to-action process.

The Stride program: Feasibility and pre-to-post program change of an exercise service for university students experiencing mental distress.

Rates of mental illness are disproportionately high for young adult and higher education (e.g., university student) populations. As such, universities and tertiary institutions often devote significant efforts to services and programs that support and treat mental illness and/or mental distress. However, within that portfolio of treatment approaches, structured exercise has been relatively underutilised and greater research attention is needed to develop this evidence base. The Stride program is a structured 12-week exercise service for students experiencing mental distress. We aimed to explore the feasibility of the program and assess pre- and post-program change, through assessments of student health, lifestyle, and wellbeing outcomes. Drawing from feasibility and effectiveness-implementation hybrid design literatures, we conducted a non-randomised feasibility trial of the Stride program. Participants were recruited from the Stride program (N = 114, Mage = 24.21 years). Feasibility results indicated the program was perceived as acceptable and that participants reported positive perceptions of program components, personnel, and sessions. Participants' pre-to-post program change in depressive symptomatology, physical activity levels, mental health-related quality of life, and various behavioural outcomes were found to be desirable. Our results provide support for the feasibility of the Stride program, and more broadly for the delivery and potential effectiveness of structured exercise programs to support university students experiencing mental distress.

'It's been a lifelong thing for me': parents' experiences of facilitating a healthy lifestyle for their children with severe obesity.

OBJECTIVE: For parents and guardians, assisting children/adolescents with severe obesity to lose weight is often a key objective but a complex and difficult challenge. Our aim in this study was to explore parents' (and guardians') perspectives on the challenges they have faced in assisting their children/adolescents with severe obesity to lead a healthy lifestyle. METHODS: Thirteen parents/guardians were interviewed from a pool of families who had been referred but did not engage between 2016 and 2018 (N = 103), with the Perth Children's Hospital Healthy Weight Service, a clinical obesity program for children/adolescents (parent age M = 43.2 years, children age M = 10.3 years). Using semi-structured interviews and thematic analysis, we identified 3 broad themes. RESULTS: Parental weight-related factors reflected parents' own lifelong obesity narrative and its effect on their own and their families' ability to live a healthy lifestyle. Perceived inevitability of obesity in their child reflected parents' feelings that the obesity weight status of their children/adolescent was a persistent and overwhelming problem that felt 'out of control'. Lastly, parents reported challenges getting medical help stemming from co-morbid medical diagnosis in their child/adolescent, and difficulties with medical professionals. CONCLUSION: This study demonstrates that parents face challenges in supporting healthy lifestyle for children/adolescents with severe obesity due to parents own internal weight biases and their negative experiences within the healthcare system when seeking help.

Psychological Flow Training: Feasibility and Preliminary Efficacy of an Educational Intervention on Flow.

Despite there being an increasing number of applied flow studies across scientific disciplines, there exists no consistent or broadly applicable intervention to promote flow experiences. This study provides a detailed account of a new educational flow training program developed following recent advancements in the flow literature that have provided a more parsimonious understanding of flow experiences and antecedents. Guided by CONSORT guidelines for feasibility trials, we conducted a single-group, non-randomized feasibility trial of an educational flow training program (N = 26). We assessed participant retention, perceptions about and experiences of the program, perceptions about the flow education training, and preliminary assessments of flow as an outcome. Results broadly supported program feasibility, and participants reported positive experiences in, and perceptions of, program components. In terms of preliminary efficacy, we observed evidence of noteworthy change pre-to-post-program in flow (d = 0.84), performance (d = 0.81), competence (d = 0.96), well-being (d = 0.68), intrinsic motivation (d = 0.47), interest (d = 0.72), choice (d = 0.38), stress (d = -1.08), ability to handle stress (d = 0.74), and anxiety (d = - 0.86). These results provide preliminary evidence that it may be possible to 'train' flow in line with recent perspectives on a core three-dimensional flow experience (and antecedents). The study has developed a research foundation for flow intervention "curriculum" and quality standards, and for measuring results. It offers a foundation for the implementation of a larger-scale program. Supplementary Information: The online version contains supplementary material available at 10.1007/s41042-023-00098-2.

Structured exercise programs for higher education students experiencing mental health challenges: background, significance, and implementation.

The incidence of mental illness is greatest among young adults, and those enrolled in higher education may be particularly vulnerable compared to the general young adult population. Many higher education institutions employ student support staff tasked with implementing strategies to improve student wellbeing and mental illness. However, these strategies tend to be focused on clinical therapies and pharmacological interventions with limited lifestyle approaches. Exercise is an effective method for addressing mental illness and promoting wellbeing, yet widespread provision of structured exercise services to support treatment options for students with mental health challenges has not been fully realized. In an effort to guide exercise strategies for student mental health, we synthesize considerations for developing and delivering exercise programs in higher education settings. We draw directly from the evidence base on existing exercise programs in higher education; and the broader behavior change, exercise adherence, health psychology, implementation science, and exercise prescription literatures. Our broad considerations cover issues regarding program engagement and behavior change, exercise 'dose' and prescription, integration with other on-campus services, and robust research and evaluation. These considerations may provide impetus for widespread program development and implementation, as well as informing research focused on protecting and improving student mental health.

Support needs and experiences of young people living in families with mental illness.

INTRODUCTION: Children and adolescents living in families affected by mental illness are at elevated risk of developing mental health problems. A range of interventions have been designed to help these young people; however, the effectiveness of these programs is, in some cases, mixed. Our aim was to understand in detail the support needs and experiences of a group of Australian children and adolescents living in families with mental illness. METHODS: Our study is a qualitative in nature. In 2020-2021, we interviewed 25 Australian young people (Mage = 13.60, SD = 2.26, 20 females and 5 males) living with family members affected by mental illness to understand their (the young people's) experiences, and to identify the types of support that these young people considered important or effective. We conducted reflexive thematic analyses of interview data, underpinned by interpretivist assumptions. RESULTS: We identified seven themes within two higher-order categories reflecting our aims to understand (1) lived experiences within families affected by mental illness (i.e., increased responsibilities, missing out, and stigmatization), and (2) support experiences, needs, and preferences (i.e., respite, shared experiences with like-minded others, education, and flexibility). CONCLUSIONS: Our findings hold substantial practical value by informing services, interventions, and conversations that better support young people living in families affected by mental illness.

Strengthening Peer Mentoring Relationships for New Mothers: A Qualitative Analysis.

(1) Background: The transition to motherhood can be challenging, especially for first-time mothers, and can accompany maternal distress. Social support-such as that offered by peers-can be important in assisting mothers to manage such distress. Although primiparous mothers often seek out and value peer support programs, few researchers have investigated factors that may influence the strength of relationships in non-professional maternal peer support programs. Insight into these factors can be key to enhancing the success of future peer support interventions. (2) Methods: Reflexive thematic analysis was applied to data gathered from 36 semi-structured interviews conducted with 14 primiparous mothers and 17 peer mentors in a peer support program. (3) Results: Four themes related to successful mentorship were identified: expectations of peer relationship, independence of peer mentor, contact, and similarities. (4) Conclusions: For primiparous mothers who are developing their support network, these factors appear important for promoting close and effective peer support relationships. Interventions that harness the dynamics between these factors may contribute to more successful peer support relationships and mental health outcomes for participants.

MAN v FAT Soccer: Feasibility Study and Preliminary Efficacy of a Sport-Based Weight-Loss Intervention for Overweight and Obese Men in Australia.

MAN v FAT Soccer is a sport-based weight-loss program for overweight and obese men that originated in the United Kingdom (i.e., as MAN v FAT Football) and appears to successfully engage men with weight loss. We sought to explore whether the program would work in an Australian context by (a) establishing a foundation for the implementation of the program on a larger scale and (b) determining how large-scale implementation is most feasible. We conducted a nonrandomized, single intervention group feasibility trial of MAN v FAT Soccer in Australia with 418 male participants with a body mass index greater than 27.50 kg/m2. Results indicate that the program is acceptable, with participants reporting positive perceptions of the various components of the program and a high proportion reporting intentions to recommend the program to others (95.9%). Furthermore, preliminary effectiveness results indicate positive changes in weight (4.6% reduction) and physical activity (88.5% increase) and improvements in psychological outcomes such as depression (17.6% decrease), stress (19.0% decrease), and body appreciation (19.1% increase). Our findings provide general support for the feasibility of MAN v FAT Soccer and the notion that leveraging competition and masculinity may help drive men's health behavior change.

Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization.

BACKGROUND: Family-based lifestyle interventions (FBLIs) are an important method for treating childhood weight problems. Despite being recognized as an effective intervention method, the optimal structure of these interventions for children's overweight and obesity has yet to be determined. Our aim was to better understand participants' (a) implementation of behaviour strategies and long-term outcomes, (b) perceptions regarding the optimal structure of FBLIs, and (c) insights into psychological concepts that may explain the success of these programs. METHODS: Purposive sampling was used to recruit participants. We conducted focus groups as well as one-to-one interviews with parents (n = 53) and children (n = 50; aged 7-13, M = 9.4 yr, SD = 3.1) three months following their involvement in a 10-week, multi-component, FBLI involving education and activities relating to healthy nutrition, physical activity, and behavior modification. Using an interpretivist approach, a qualitative study design was employed to examine participant experiences. RESULTS: We identified three higher-order categories: (a) participants' program experiences and perceptions (b) lifestyle changes post-program, and (c) recommendations for optimizing family-based programs. Themes identified within these categories included (a) support and structure & content, (b) diet and physical activity, and (c) in-program recommendations and post-program recommendations. CONCLUSIONS: We identified several challenges that can impair lasting behavior change (e.g., physical activity participation) following involvement in a FBLI. On optimizing these programs, participants emphasized fun, interactive content, interpersonal support, appropriate educational content, and behavior change techniques. Concepts rooted in motivational theory could help address calls for greater theoretical and mechanistic insight in FBLIs. Findings may support research advancement and assist health professionals to more consistently realize the potential of these interventions.

Understanding parent perspectives on engagement with online youth-focused mental health programs.

OBJECTIVE: Online youth-focused health programs often include parent modules-that equip parents with skills to assist their child in improving their health-alongside youth-specific content. BRAVE Self-Help, an evidence-based program designed for children and teenagers with early signs of anxiety, is a popular Australian program that includes six parent modules. Despite its popularity and proven efficacy, BRAVE Self-Help shares the same challenge as many online self-help programs-that of low participant engagement. Using parents registered in BRAVE Self-Help as 'information rich' participants, we explored (a) factors that influenced parent engagement in online health programs, and (b) their recommendations for enhancing parent engagement. DESIGN AND OUTCOME MEASURE: We conducted semi-structured interviews with 14 parents registered in BRAVE Self-Help. Data were analysed through reflexive thematic analysis. RESULTS: Social-, family- and program-related factors drove parents' program engagement and recommendations. Social sub-themes related to the benefits of professional and community support in promoting more engagement. Family sub-themes included difficulties with program engagement due to competing priorities, perceptions that condition severity influenced engagement, and feelings that previously-acquired health knowledge reduced motivation to engage. Program sub-themes included perceived usefulness and ease-of-use. CONCLUSION: Program designers could target support systems, include flexible delivery options, and use iterative design processes to enhance parent engagement.

Attenuation of Post-Exercise Energy Intake Following 12 Weeks of Sprint Interval Training in Men and Women with Overweight.

An acute bout of sprint interval training (SIT) performed with psychological need-support incorporating autonomy, competence, and relatedness has been shown to attenuate energy intake at the post-exercise meal, but the long-term effects are not known. The aim of this trial was to investigate the effects of 12 weeks of SIT combined with need-support on post-exercise food consumption. Thirty-six physically inactive participants with overweight and obesity (BMI: 29.6 ± 3.8 kg·m−2; V˙O2peak 20.8 ± 4.1 mL·kg−1·min−1) completed three sessions per week of SIT (alternating cycling for 15 s at 170% V˙O2peak and 60 s at 32% V˙O2peak) with need-support or traditional moderate-intensity continuous training (MICT) without need-support (continuous cycling at 60% V˙O2peak). Assessments of appetite, appetite-related hormones, and ad libitum energy intake in response to acute exercise were conducted pre- and post-intervention. Fasting appetite and blood concentrations of active ghrelin, leptin, and insulin did not significantly differ between groups or following the training. Post-exercise energy intake from snacks decreased significantly from pre- (807 ± 550 kJ) to post- SIT (422 ± 468 kJ; p < 0.05) but remained unaltered following MICT. SIT with psychological need-support appears well-tolerated in a physically inactive population with overweight and offers an alternative to traditional exercise prescription where dietary intake is of concern.

Within- and between-person relationships between spontaneous self-affirmations, coping style, and wellbeing.

Self-affirmations-responding to self-threatening information by reflecting on positive values or strengths-help to realign working self-concept and may support adaptive coping and wellbeing. Little research has been undertaken on spontaneous self-affirmations in response to everyday threats, and less has been undertaken on the relationships between spontaneous self-affirmations, coping, and wellbeing. This study aimed to test both within- and between-person relationships between spontaneous self-affirmations, coping, and wellbeing, controlling for threat intensity and other outcomes. A repeated survey assessment design was adopted to achieve these aims. Outcome measures included approach coping, avoidance coping, positive affect, negative affect, and eudaimonic wellbeing. It was found that spontaneous self-affirmations positively predicted approach coping and positive affect at both within- and between-person levels, and eudaimonic wellbeing at the between-person level. Overall, spontaneous self-affirmations were positively associated with approach coping and aspects of wellbeing.

Advancing our understanding of psychological flow: A scoping review of conceptualizations, measurements, and applications.

Research on psychological flow is well established, although criticisms remain regarding conceptual and measurement issues associated with the construct. This scoping review maps flow-related research across scientific disciplines, examining the conceptualization, measurement instruments, and outcomes of flow between 2012 and 2019. Across 236 sources that met the review criteria, 108 different flow-related constructs were measured by 141 instruments, and 84 possible antecedents were identified. Despite the varied approaches, a common set of overarching antecedent constructs included "optimal challenge" and "high motivation," and recurring characteristics of the flow experience itself included "absorption," "effort-less control," and "intrinsic reward." Applied studies-albeit inconsistent in approach and largely correlational in nature-predominantly linked flow to "positive development" (i.e., well-being and health), "high functioning," and "further engagement." We contextualize the findings of the review relative to important work on flow that has recently emerged (following the review period)-in doing so, we hope this review offers a contemporary framework that can be used for the study of flow across scientific disciplines. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of diurnal exercise timing on appetite, energy intake and body composition: A parallel randomized trial.

OBJECTIVE: To determine the effect of diurnal exercise timing on appetite, energy intake and body composition in individuals with overweight or obesity. METHODS: Forty sedentary, individuals with overweight or obesity (17 males, 23 females; age: 51 ± 13 years; BMI: 30.9 ± 4.2 kg/m2) were randomly allocated to complete a 12-week supervised multi-modal exercise training program performed either in the morning (amEX) or evening (pmEX). Outcome measures included appetite in response to a standardised test meal, daily energy intake (EI), body weight and body composition. Measures of dietary behaviour were assessed at baseline and post-intervention, along with habitual physical activity, sleep quality and sleep quantity. Significance was set at p ≤ .05 and Hedge's g effect sizes were calculated. RESULTS: Regardless of timing, exercise training increased perceived fullness (AUC; g = 0.82-1.67; both p < .01), decreased daily EI (g = 0.73-0.93; both p < .01) and body-fat (g = 0.29-0.32; both p <. 01). The timing of exercise did not change the daily EI or body-fat response to training (all p ≥ .27), however, perceived fullness increased in the amEX group (p ≤ .01). DISINHIBITION: (g = 0.35-1.95; p ≤ .01) and Hunger (g = 0.05-0.4; p = .02) behaviours decreased following exercise training, with Disinhibition demonstrating greater improvements in the pmEX group (p = .01). Objective and subjective sleep quantity increased with training (all p ≤ .01), but sleep quality was not reported to change. CONCLUSIONS: Multi-modal exercise training improved body composition and some appetite outcomes, although changes were inconsistent and largely independent of exercise-timing. In the absence of dietary manipulation, the effect of diurnal exercise timing on appetite and body composition appear trivial compared to the overall benefits of exercise participation.

Understanding the determinants of stress-induced eating - A qualitative study.

The relationship between stress and food consumption is complex and often characterised by substantial between- and within-person variation. From a theoretical and practical perspective, more research is needed to improve our understanding of the factors that influence this relationship. The aim of this study was to identify those factors, and to derive insight into the nature of their effects on the relationship between stress and food consumption. Using semi-structured interviews, 41 adult participants (M ± SD age = 26.7 ± 6.3 yr, BMI = 22.9 ± 3.0 kg/m2) were invited to reflect on their food consumption following stressor exposure, and to elaborate on the factors that influence stress-induced eating behaviour. Reflexive thematic analyses revealed insight into the different ways in which individuals respond to stress in terms of food quantity and choices, and more significantly, highlighted a range of factors that may influence stress-induced eating behaviours. These factors included the intensity and/or nature of the stressor, aspects of prioritisation, rewarding, knowledge of and perceptions about food, normative (e.g., family, friend) influences, automated or habituated behaviours, the availability of food, and selected coping mechanisms. These findings present important directions for researchers seeking to study the variation in stress-induced eating, and may hold substantial practical value by way of informing interventions designed to alleviate unhealthy dietary responses to stress.

Perceived daily tension and food cravings and consumption: A within- and between-person investigation.

Previous research examining the relationship between negative states such as tension/anxiety and food intake has typically overlooked the naturally occurring variability of day-to-day experiences and the subsequent consequences for eating behavior. In this study, the relationship of within- and between-person perceived daily tension with food cravings and consumption was assessed. One hundred and forty-two men and women (Mage=21.3, SDage=5.3) completed a survey daily for 7 consecutive days. Levels of perceived daily tension, food cravings, and consumption were assessed. Linear and logistic mixed effect regression models were used to examine associations between tension and food cravings and consumption variables, respectively. Individuals reported greater cravings (for sweets, OR 95% CI 1.05-1.26; carbohydrates/starches, OR 95% CI 1.02-1.26; and fast foods, OR 95% CI 1.01-1.19) and consuming more carbohydrates/starches (b 95% CI 0.05-0.79) on days when they felt more tension. Individuals with higher tension had more cravings (total OR 95% CI 1.09-1.71; and specifically for sweets, OR 95% CI 1.04-1.42; and fast foods, OR 95% CI 1.15-1.54) and reported consuming more sweet (b 95% CI 0.21-1.10) and fast foods (b 95% CI 0.55-1.66). These findings suggest that greater perceived tension (both within and between individuals) is associated with increased food cravings and consumption.

Does motivation mediate the relationship between competence perceptions and patient outcomes among individuals with chronic low back pain? A multiple mediation analysis.

PURPOSE: The aim of this study was to examine: (1) motivations of patients with chronic low back pain to attend physical therapy; (2) relationships between competence perceptions, motivational regulations, and pain/disability; and (3) whether patient motivations to attend physical therapy mediate the relationship between competence perceptions and pain/disability. METHODS: A sample of 64 participants completed baseline assessment (1-week prior to initiation of physical therapy) and 6-week follow-up assessment. Differences between motivation variables at baseline were examined using one-way within-person ANOVA. Relationships between competence perceptions, motivation subscales, and pain/disability were calculated using bivariate correlations and multiple mediation analyses. RESULTS: Participants reported significantly higher levels of autonomous versus controlled motivation (mean difference = 3.5, p < 0.001, d = 2.3) and amotivation (mean difference = 3.6, p < 0.001, d = 2.4). Competence was positively associated with autonomous motivation (r = 0.45, p ≤ 0.05) and negatively associated with controlled motivation (r = -0.26, p ≤ 0.05), amotivation (r = -0.57, p ≤ 0.05), pain (r = -0.35, p ≤ 0.05), and disability (r = -0.34, p ≤ 0.05). Amotivation significantly mediated the competence-pain relationship (Amotivation IE = -0.19, 95% CI (-0.44, -0.06), p < 0.05) and the competence-disability relationship (Amotivation IE = -0.07, 95% CI (-0.17, -0.01), p < 0.05). CONCLUSION: Findings highlight the role of competence perceptions in mitigating amotivation for physical therapy and the deleterious implications of amotivation for patient-centered outcomes.Implications for rehabilitationWhile it is normal for patients to experience periods where they lack motivation for rehabilitation exercises, practitioners can encourage patients to assume responsibility for their recovery by informing them that amotivated states may increase the likelihood of increased pain perceptions and disability.Health-care practitioners should seek to foster competence perceptions in patients about to undergo physical therapy.Competence building strategies such as patient education, goal setting, and role modeling may be valuable in facilitating autonomous motivation and reducing amotivation for physical therapy.

'They deserve a treat': the nature and antecedents of parental licensing surrounding children's physical activity.

OBJECTIVE: Little is known about parents' compensatory health beliefs (CHB) surrounding their children's engagement in physical activity (PA). Our aim was to provide evidence regarding the nature of, and factors underpinning, parents' PA-related compensatory beliefs for their children. DESIGN: A qualitative descriptive approach and thematic content analysis were employed. SETTING: Parents were recruited from community sport and PA programmes. PARTICIPANTS: Eighteen parents aged 32-52 years (mean age = 40·8 (sd 5·4) years; six males; twelve females). RESULTS: Analyses indicated that parents compensate through 'passive' or 'active' means. Among parents who compensated, most described their provision of 'treat' foods/drinks and a minority described allowing extended sedentary time to their children. Parents' reasons underpinning these beliefs related to their child's general physical/health status and psychological characteristics, and their own motivation and mood state. CONCLUSIONS: These findings provide the first evidence of unhealthy dietary and sedentary behaviour CHB that parents may hold regarding their children's involvement in PA.

The effect of antecedent exercise on the acute stress response and subsequent food consumption: a preliminary investigation.

Physical activity has been shown to be protective against many of the deleterious consequences of stress; however, the effects of exercise on stress-induced food consumption are unclear. This study examined the effect of an acute bout of exercise prior to exposure to an acute stressor on subsequent eating behavior, together with the physiological (e.g., heart rate, blood pressure, salivary cortisol) and psychological (e.g., mood, perceived stress) responses to stress. Twenty-three men and women completed four experimental conditions (control, exercise only, stress only, and exercise prior to stress) conducted in a counterbalanced order using a within-subjects repeated measures design. Ad libitum energy intake from a laboratory test meal was assessed at each trial, together with monitoring of physiological and psychological responses. No difference in total energy intake (p = 0.146) or energy intake from 'unhealthy' foods was noted between conditions (p = 0.783), despite lower circulating ghrelin when antecedent exercise was performed compared with stress alone (p < 0.05). Exposure to an acute stressor is not necessarily associated with alterations in subsequent food intake, nor does antecedent exercise prior to stress exposure affect food choices, despite transient alterations in the hunger hormone ghrelin.