Feasibility and preliminary efficacy of a theory-informed resistance exercise training single-arm intervention for major depression.

Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes. PURPOSE: To assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow. METHODS: Ten adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility. RESULTS: Nine participants completed the intervention. Strong feasibility and acceptability (98 % adherence, 93 % compliance, and 90 % retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges' g = 0.84-2.13). There were small-to-moderate increases in MCA velocity (g = 0.32-0.57) and conductance (g = 0.20-0.76) across time, with minimal changes in pulsatility (all g < 0.21). CONCLUSIONS: Preliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET's efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.

Physical activity dose for generalized anxiety disorder & worry: Results from the Irish longitudinal study on ageing.

The lowest moderate-to-vigorous physical activity (MVPA) dose that conveys protection for Generalized Anxiety Disorder (GAD) and worry is unknown. This study quantified associations of weekly accumulated MVPA doses with GAD and worry across 10 years using data from The Irish Longitudinal Study on Ageing (TILDA). Continuous MVPA (metabolic equivalent of task [MET] minutes per week [MET.min.week-1]; e.g., moderate-intensity brisk walking = 4METs), three-dose and, more precise, five-dose MVPA categories were examined. Worry symptoms and GAD status were measured using the Penn State Worry Questionnaire-Abbreviated and the Composite International Diagnostic Interview. Multivariable negative random effect binomial regression and logistic models adjusted for relevant covariates quantified associations across time. Among the 7,650 participants, compared to no MVPA (0 MET.min.week-1), 18 % (OR: 0.82; 95 %CI: [0.69-0.98]), 22 % (OR: 0.78; [ 0.64-0.95]) and 31 % (OR: 0.69; [0.59-0.79]) lower odds of GAD were found for the doses of 1-<600, 600-<1,200 and ≥2,400 MET.min.week-1 respectively. Post-hoc analysis demonstrated 47 % lower odds (OR: 0.53; (0.36-0.78) of GAD for 1-<200 MET.min.week1 compared to inactivity. Compared to no activity, engaging in even minimal physical activity equivalent of 10 min/day for five days/week of moderate-intensity activity (e.g., brisk walking), may lower the risk of GAD over time among older adults.

Do changes in mood and anxiety mediate exercise-induced reductions in alcohol cravings? An exploratory study.

OBJECTIVE: Exercise is increasingly used as adjunct treatment for alcohol use disorder (AUD). Evidence suggests that moderate-to-high-intensity exercise can ameliorate cravings. We explored the potential mediating effects of changes in mood states in the relationship between exercise intensity and alcohol cravings. METHOD: Secondary analyses of a nested single-arm trial within a randomized controlled trial (FitForChange). In total, 117 sedentary adults (68.4% female, M = 52 ± 12 years) with clinician diagnosed (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) AUD and indications of craving (Desire for Alcohol Questionnaire) completed a 12-min submaximal cardiorespiratory fitness test on a cycle ergometer. Assessments of craving, mood states (POMS), and state anxiety (STAI-Y1) were taken immediately before, after, and 30 min after exercise. Ratings of perceived exertion (RPE) were included as indirect measures of exercise intensity. The med4way command in Stata was used to explore mediating and interaction effects of improvements in total mood disturbance (TMD) and state anxiety. RESULTS: Improvements in mood and anxiety did not mediate the effect of higher exercise intensity on reductions in alcohol craving. A significant reference interaction was found between "hard" (or greater) exertion and anxiety improvements (ß = -1.06, 95% CI [-1.50, -0.61]). Participants whose anxiety reduced during exercise had two times higher odds of reduced cravings when exercising at a higher intensity than participants whose anxiety worsened (OR = 2.04, 95% CI [1.12, 3.72]). CONCLUSIONS: Reductions in anxiety may partly explain the positive effect of higher exercise intensity on alcohol cravings. The findings are preliminary and require replication in future studies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Resistance exercise for anxiety and depression: efficacy and plausible mechanisms.

Anxiety and depressive symptoms and disorders are prevalent and poorly treated. The salutary benefits of resistance exercise training (RET), a potential alternative therapy, are well established, but mental health effects are understudied. This forum article summarizes the most rigorous evidence regarding efficacy of resistance exercise and provides a primer for putative psychobiological mechanisms.

Physical Activity Dose and Depression in a Cohort of Older Adults in The Irish Longitudinal Study on Ageing.

Importance: Among older adults (aged ≥50 years), depression is associated with an increased risk of physical, social, and cognitive dysfunction. Regular moderate to vigorous physical activity (MVPA) has been associated with lower odds of depression. However, the lowest dose for protection against depression and the extent to which exceeding this level conveys additional protection are unknown. Objective: To evaluate different MVPA doses, depressive symptoms, and major depression status in a large cohort of older adults with and without chronic disease. Design, Setting, and Participants: A longitudinal cohort study of the same 4016 individuals at each of 5 time points (ie, waves) from The Irish Longitudinal Study on Ageing was conducted. Data were collected from October 2009 to December 2018, and data were analyzed from June 15 to August 8, 2022. Exposures: Continuous MVPA (metabolic equivalent of task [MET]-minutes per week [MET-min/wk]), 3 dose categories, and 5 dose categories measured with the International Physical Activity Questionnaire. Main Outcomes and Measures: Depressive symptoms and major depression status were measured using the short form of the Centre for Epidemiological Studies Depression scale along with the Composite International Diagnostic Interview for diagnosis of a major depressive episode during the past 12 months. Multivariable negative random-effects binomial regression models, adjusted for relevant covariates, quantified associations across time. Results: Among the 4016 participants at each wave of the study (2205 women [54.9%]; mean [SD] age, 61.0 [8.1] years) during 10.0 years of follow-up, depression rates increased from a mean of 8.2% (95% CI, 7.4%-9.1%) to 12.2% (95% CI, 11.2%-13.2%). Bonferroni-corrected post hoc analysis indicated that participants performing 400 to less than 600 MET-min/wk had a 16% lower rate of depressive symptoms (adjusted incidence rate ratio [AIRR], 0.84; 95% CI, 0.81-0.86) and 43% lower odds of depression (adjusted odds ratio [AOR], 0.57; 95% CI, 0.49-0.66) compared with 0 MET-min/wk. Those with chronic disease performing 600 to less than 1200 MET-min/wk had an 8% (AIRR, 0.92; 95% CI, 0.86-0.98) lower rate of depressive symptoms and 44% (AOR, 0.56; 95% CI, 0.42-0.74) lower odds of depression compared with 0 MET-min/wk. Those without disease required more than 2400 MET-min/wk for similar protection for depressive symptoms (AIRR, 0.81; 95% CI, 0.73-0.90). Conclusions and relevance: In this cohort study of older adults, significant antidepressant benefits were noted for MVPA doses below current recommendations for overall health, although greater doses were associated with larger AIRR reductions. It may be useful for public health interventions to investigate the achievability of lower physical activity thresholds among older adults with and without chronic illness to reduce the risk of depression.

Effects of resistance exercise training on depressive symptoms among young adults: A randomized controlled trial.

Evidence supports the antidepressant effects of resistance exercise training (RET); however, findings among young adults at-risk for elevated depressive symptoms are limited. This randomized controlled trial examined the effects of eight weeks of ecologically-valid, guidelines-based RET, compared to a wait-list control, on depressive symptoms among 55 young adults (26±5y; 36 female) with and without subclinical, or analogue, Generalized Anxiety Disorder (AGAD; Psychiatric Diagnostic Screening Questionnaire GAD subscale ≥6 and Penn State Worry Questionnaire ≥45) and Major Depressive Disorder (AMDD). Following a three-week familiarization period, participants completed one-on-one, twice-weekly RET sessions. The 16-item, self-reported Quick Inventory of Depressive Symptomatology (QIDS) assessed depressive symptoms. RM-ANCOVAs examined between-group differences, and significant interactions were decomposed with simple effects analysis. Hedges' d effect sizes (95%CI) quantified the magnitude of differences in change between groups across time. Stratified analyses were conducted among subsamples with AMDD and AGAD. There were no baseline depressive symptom differences between groups. Attendance was 83%, and compliance was 80%. RET induced statistically significant, clinically-meaningful, large-magnitude reductions in depressive symptoms from baseline to week eight in the total (d = 1.01; [95%CI: 0.44-1.57]), AMDD (d = 1.71; [95%CI: 0.96-2.46]), and AGAD (d = 1.39; [95%CI: 0.55-2.24]) samples. These findings support guidelines-based RET as a promising treatment for mild depression.

Perspectives of youth in Ireland on school-based mental health and suicide prevention: the MYSTORY study.

Anxiety, depression, and suicide are leading causes of disability and death among young people, globally. Schools are an ideal setting to target young people's mental health, yet young people's beliefs about and experiences with school mental health and suicide prevention are not well understood. This gap in knowledge contradicts both national and international youth mental health recommendations and the United Nations Convention on the Rights of the Child, which collectively advocate for understanding young people's perspectives on matters concerning them, including school mental health. Therefore, the Mental Health of Youth Story (MYSTORY) study explored young people's perspectives on school mental health and suicide prevention using a participatory-based approach incorporating photovoice. MYSTORY consisted of a community/university partnership involving young people as participants (n = 14) and advisors (n = 6). Experiential, reflexive thematic analysis (TA) within a critical approach generated three themes relating to young people's experiences with and beliefs about school mental health promotion and suicide prevention. Findings highlight the critical role of schools in impacting young people's mental health, with the need to amplify youth voice and involvement in school mental health evident. Our study addresses an important gap by employing participatory-based approaches to explore young people's perspectives on school mental health and suicide prevention. This is the first known study to explore young people's perspectives on their voice and involvement in school mental health. Findings have important implications for youth and school mental health and suicide prevention research, policy, and practice.

Physical activity for depression among the chronically Ill: Results from older diabetics in the Irish longitudinal study on ageing.

Among chronically-ill older adults, the benefits of moderate-to-vigorous physical activity (MVPA) are established. Comorbid depressive symptoms and Major Depression are prevalent among the chronically-ill, but how different doses of MVPA may protect against depression remains understudied. Thus, using 10 years of data from The Irish Longitudinal Study on Ageing, we quantified longitudinal associations between MVPA doses and depressive symptoms and Major Depression among chronically-ill older adults living with type 2 diabetes (T2DM). Continuous MVPA (MET.min.week-1), three dose and five dose MVPA categories were examined. Depressive symptoms and Major Depression were measured using the center for Epidemiological Studies Depression and the Composite International Diagnostic Interview for Major Depressive Episode. Negative binomial regression and logistic models, adjusted for covariates, quantified associations across time. Among the 2,262 participants, those adhering to the WHO guidelines of 600-<1,200 MET.min.week-1 had 28% lower odds of Major Depression compared to those not achieving the guidelines (OR: 0.72; 95%CI: 0.53-0.98). For depressive symptoms, a higher MVPA dose was required with a 13% (IRR: 0.87; 95%CI: 0.82-0.93) lower rate of symptoms among those exceeding recommendations (1200-<2,400 MET.min.week-1). Interventions should focus on enhancing achievability of and compliance with these MVPA doses among the chronically-ill, including T2DM, to protect against depression.

Dose-response effects of acute exercise intensity on state anxiety among women with depression.

Anxiety is common in people with major depressive disorder (MDD), yet the anxiolytic effects of acute exercise in MDD are unknown. The purpose of this analysis was to determine a potentially optimal acute exercise intensity for reducing state anxiety in women with MDD, the duration of the response, and the potential influences of depression severity and preferred-intensity exercise. Using a within-subject, randomized, counter-balanced design, 24 participants completed five separate visits including 20 min of steady-state bicycling at prescribed (via RPE) light, moderate, or hard intensities, a preferred/self-selected session, or a quiet rest (QR) session. State anxiety was measured via the State-Trait Anxiety Inventory (STAI-Y1) and anxiety visual analog scale (VAS) at pre-, immediately (VAS only), 10 min, and 30 min post-exercise. Depression was measured via the Beck Depression Inventory (BDI-II) pre-exercise. Moderate exercise resulted in a moderate state anxiety reduction compared to QR 10 min (STAI-Y1: g = 0.59, padj = 0.040) and 30 min post-exercise (STAI-Y1: g = 0.61, padj = 0.032). Pairwise differences indicated each exercise session decreased state anxiety pre to 10 min and 30 min post-exercise (all padj < 0.05) for the STAI-Y1, and for moderate and hard exercise from pre to each time point post-exercise (all padj < 0.05) for the VAS. Depression severity was associated with state anxiety (p < 0.01) but did not influence the overall results. Prescribed moderate intensity exercise led to greater reductions in state anxiety compared to preferred at 30 m (STAI-Y1: g = 0.43, p = 0.04). These findings suggest steady-state prescribed moderate exercise reduces state anxiety in women with MDD for at least 30 min following exercise regardless of their depression severity.

Sticking with it? Factors associated with exercise adherence in people with alcohol use disorder.

BACKGROUND: Emerging evidence suggests that exercise may be an efficacious treatment for alcohol use disorder (AUD), but adherence is suboptimal. We examined factors associated with adherence to an exercise intervention for non-treatment seeking adults with AUD. METHODS: This secondary analysis of a randomized controlled trial included 95 physically inactive adults aged 18-75 years with clinician-diagnosed AUD. Study participants were randomly assigned to 12-weeks fitness centre-based, supervised aerobic exercise or yoga classes and asked to attend at least three times/week. Adherence was assessed both objectively (based on use of a keycard at entry) and subjectively using an activity calendar. The association between AUD and other predictor variables with adherence was assessed using logistic and Poisson regression models. RESULTS: Just under half of participants (47/95, 49%) completed ≥ 12 supervised exercise sessions. When both supervised classes and self-reported sessions were included, 32/95 (34%) participants completed ≤ 11 sessions, 28/95 (29%) did 12-23 sessions and 35/95 (37%) completed ≥ 24 sessions. In univariate logistic regression analyses, lower education was associated with non-adherence (<12 sessions) (OR = 3.02, 95%CI = 1.19-7.61). In models adjusted for demographic and clinical variables, moderate AUD (OR = 0.11, 95%CI = 0.02-0.49) and severe AUD (OR = 0.12, 95%CI = 0.02-0.69) were associated with non-adherence, when compared to low severity AUD. Higher body mass index (OR = 0.80, 95%CI = 0.68-0.93) was also associated with non-adherence. Results were materially the same when objective and subjective adherence data were combined. CONCLUSION: Adults with AUD can be supported to engage in yoga and aerobic exercise. Additional support may be required for those with moderate or severe AUD, higher BMI, and lower education.

Exploring adolescents' perspectives on and experiences with post-primary school-based suicide prevention: a meta-ethnography protocol.

BACKGROUND: Globally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviors (STBs), PSSP effectiveness does not easily translate to school settings. Adolescents' perspectives on PSSP are particularly important for (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, yet there is a gap in understanding adolescents' experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesize adolescents' perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. METHODS: The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The protocol was guided by the seven-stage process for meta-ethnography proposed by Noblit and Hare. Searches of PsycINFO, MEDLINE, Web of Science, CINAHL, ERIC, Scopus, and study reference lists will identify peer-reviewed studies. Gray literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesized in line with Noblit and Hare's stages and evaluated using the Critical Appraisal Skills Program (CASP) checklist. DISCUSSION: To our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents' perspectives on engaging with PSSP interventions. Understanding adolescents' experiences of engaging with PSSP will impact the field of PSSP in several ways by (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022319424.

A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention.

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.

The Interplay Between Expected Psychological Responses to Exercise and Physical Activity in Analogue Generalized Anxiety Disorder: a Cross-sectional Study.

BACKGROUND: Expectations for psychological responses to exercise are not well characterized, particularly in people at risk for anxiety-related illnesses. Given the substantial evidence for salutary effects of exercise on anxiety symptoms and emerging recognition for expectations as a critical mechanism of placebo/nocebo effects, this study explored the interplay between expectations and physical activity in young adults with and without analogue generalized anxiety disorder. METHODS: Participants (N=470, 23.2±4.8 years, 63% female) completed a physical activity and mood survey, including a 7-day physical activity recall questionnaire, and a 20-item questionnaire designed to measure positive and negative expectations for psychological and perceptual responses to exercise, particularly expectations for symptoms in the generalized anxiety disorder symptom profile. Analogue generalized anxiety disorder status was determined using the Generalized Anxiety Disorder subscale of the Psychiatric Diagnostic Screening Questionnaire. RESULTS: For select outcomes, expected exercise-induced changes significantly differed according to analogue generalized anxiety disorder (whole-body pain, sleep quality, psychological well-being, stress, relaxation) and active versus inactive (anxious mood, depressed mood, concentration, physical function, psychological well-being, relaxation) status. However, these findings did not survive corrections for multiple comparisons and the magnitude of these differences was small, approximating 0.25 standard deviations. Expectations for anxious (Spearman's ρ=-0.14, p≤0.002) and depressed mood (ρ=-0.15, p≤0.002), and psychological well-being (ρ=0.15, p≤0.001) were significantly associated with higher physical activity levels. Exercise expectations for anxious mood explained a significant, but small (+1.5%, p≤0.03), amount of variance in physical activity. CONCLUSIONS: Expectations for exercise-induced improvements did not significantly differ between young adults based on analogue generalized anxiety disorder or physical activity status.

Associations between screen-time, physical activity and depressive symptoms differ based on gender and screen-time mode.

Higher levels of physical activity (PA) and screen time (ST) are associated with positive and negative mental health outcomes among adolescents, respectively. Research is needed to determine the interrelationship between ST and PA with depressive symptoms and the influence of ST modes. This study examines the associations between ST and PA level with depressive symptoms among 1756 adolescents (15.2 ± 1.6y; 995 female) in Ireland. Participants completed the Quick Inventory of Depressive Symptomatology and self-reported weekly ST (TV, computer, and phone use) and PA level (low, moderate, and high). Linear regressions examined associations between ST mode, PA level and relevant covariates with depressive symptoms in the full sample by gender, and in a sample stratified by PA level. Chi-square tests and one-way ANOVA examined gender differences in hours of ST, PA levels, and depressive symptoms. Differential associations were observed depending on the gender and ST mode. Higher levels of computer (ß = 0.106, p ≤ 0.000) and phone use (ß = 0.138, p ≤ 0.000) showed the strongest associations with depressive symptoms. PA level was inversely associated with depressive symptoms (ß = - 0.175, p ≤ 0.000). When the sample was stratified by PA level, only associations between phone use and depressive symptoms were moderated by PA level for males and females. These findings highlight the complex interrelationships between ST, PA, and depressive symptoms, and that associations may vary based on gender and ST mode. This may have implications for future interventions. Increasing PA and reducing ST should be targeted concurrently with consideration given to different media and genders. Future research should explore longitudinal and prospective associations.

Differential Associations of Total and Context-Specific Sedentary Time with Depressive Symptoms Among Adolescents: Results from Ireland's CSPPA Study.

BACKGROUND: Higher levels of sedentary behaviour (SB) and screen-time are associated with greater symptoms of depression in adolescents, but the effect of the type and context of SB and screen-time remains underexplored. As part of a nationally-representative observational study, the current cross-sectional study examined associations between SB, screen-time and depressive symptoms among 422 adolescents (13.5 ± 0.92 years; 125 female) in the Republic of Ireland. METHOD: Participants completed the Quick Inventory of Depressive Symptomatology and self-reported weekly SB, categorised into mentally-active screen-time (e.g., computer use for fun), mentally-passive screen-time (e.g., television viewing) and mentally-active non-screen-based SB (e.g., reading). Mann-Whitney U tests and Kruskal-Wallis H tests examined differences in screen-time and depressive symptoms by relevant covariates. Linear regression quantified crude and adjusted associations between total SB and mentally-active and mentally-passive screen-time and SB, and depressive symptoms. RESULTS: Crude and adjusted linear regressions showed total SB was significantly, positively associated with depressive symptoms (unadjusted: ß = 0.27, p = 0.002, adjusted: ß = 0.27, p = 0.002). When type and context were examined in the same model, only mentally-active screen-time was positively associated with depressive symptoms (unadjusted: ß = 0.37, p = 0.009, adjusted: ß = 0.39, p = 0.007). CONCLUSION: Differential associations between total SB and mentally-active screen-time and SB, versus mentally-passive screen-time, and depressive symptoms among Irish adolescents were observed. Findings highlight the importance of investigating the context and type of SB and screen-time in adolescents.

Research Review: The effect of school-based suicide prevention on suicidal ideation and suicide attempts and the role of intervention and contextual factors among adolescents: a meta-analysis and meta-regression.

BACKGROUND: Globally, suicide is the fourth highest cause of adolescent mortality (Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide). The effects of post-primary school-based suicide prevention (PSSP) on adolescent suicidal thoughts and behaviours (STBs) have not been comprehensively synthesised. We aim to estimate the population effect for PSSP interventions on adolescent STBs and explore how intervention effects vary based on intervention and contextual moderators. METHODS: Searches of PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials identified cluster randomised trials examining the effectiveness of PSSP on adolescent STBs. The Cochrane Risk of Bias tool assessed bias. Crude and adjusted back-transformed odds ratios (ORs) were calculated. Multilevel random-effects models accounted for dependencies of effects. Univariate meta-regression explored variability of intervention and contextual moderators on pooled effects. RESULTS: There were 19 and 12 effects for suicidal ideation (SI) and suicide attempts (SA). Compared with controls, interventions were associated with 13% (OR = 0.87, 95%CI [0.78, 0.96]) and 34% (OR = 0.66, 95%CI [0.47, 0.91]) lower crude odds reductions for SI and SA, respectively. Effects were similar for adjusted SI (OR = 0.85, 95%CI [0.75, 0.95]) and SA (OR = 0.72, 95%CI [0.59, 0.87]) models. Within-study (0.20-9.10%) and between-study (0-51.20%) heterogeneity ranged for crude and adjusted SA models and SI heterogeneity was 0%. Moderator analyses did not vary SA effects (ps > .05). CONCLUSIONS: This meta-analysis contributes to the PSSP evidence-base by demonstrating that PSSP targeting STBs as both primary intervention outcomes and with other health and well-being outcomes reduced SI and SA among 33,155 adolescents attending 329 schools, compared to controls. The number needed to treat estimates suggests the potential of reducing the incidence of SA and SI in one adolescent by implementing PSSP in 1-2 classrooms, supporting PSSP as a clinically relevant suicide prevention strategy. Although moderator analyses were nonsignificant and contained a small number of trials, larger SA effect sizes support particular effectiveness for interventions of a duration of ≤1 week, involving multiple stakeholders and with a 12-month follow-up.

The Acute Effects of Interrupting Prolonged Sitting Time in Adults with Standing and Light-Intensity Walking on Biomarkers of Cardiometabolic Health in Adults: A Systematic Review and Meta-analysis.

BACKGROUND: Increasing evidence highlights that accumulating sitting time in prolonged bouts is detrimental to cardiometabolic health. OBJECTIVES: This systematic review aimed to compare the effects of fractionating prolonged sitting with frequent short bouts of standing and light-intensity walking on cardiometabolic health markers and conduct a meta-analysis for differences in systolic blood pressure (SBP), postprandial glucose and insulin. METHODS: Experimental randomised crossover trials with at least three intervention arms that assessed interrupting sitting with frequent short bouts of standing and light-intensity walking over a single day compared to a prolonged sitting condition were retrieved. These studies measured at minimum one marker of cardiometabolic health in adults > 18 years. An electronic search was completed on the 2nd of August 2021, searching PubMed and Web of Science Core Collection, Scopus, Embase, Cochrane Library and APA PsycINFO. Risk of bias was assessed using a modified Downs and Black checklist. A meta-analysis was conducted using calculated Cohen's d quantifying the magnitude of difference between experimental conditions. RESULTS: Seven studies met the inclusion criteria for the systematic review. All seven studies were included within the meta-analysis for postprandial glucose, four studies were pooled for postprandial insulin and three for SBP. Biomarkers of cardiometabolic health were discussed qualitatively if fewer than three studies measured and reported the variable. A meta-analysis of seven acute, 1-day randomised crossover trials that sampled mixed-sex adults (aged > 18 years) who were predominately overweight or participants with obesity found that standing as an interruption to prolonged sitting significantly reduced postprandial glucose (∆ = - 0.31, 95% CI - 0.60, - 0.03; z = - 2.15, p < 0.04) but had no significant effect on insulin or SBP. Light-intensity walking was shown to significantly attenuate postprandial glucose (∆ = - 0.72, 95% CI - 1.03, - 0.41; z = - 4.57, p < 0.001) and insulin (∆ = - 0.83, 95% CI - 1.18, - 0.48; z = - 4.66, p < 0.001) compared to continued sitting. When comparing light-intensity walking breaks compared to standing breaks a significant reduction in glucose (∆ = - 0.30, 95% CI - 0.52, - 0.08; z = -2.64, p < 0.009) and insulin (∆ = - 0.54, 95% CI - 0.75, - 0.33; z = -4.98, p < 0.001) was observed. Both standing and light-intensity walking showed no effect on SBP. CONCLUSIONS: Frequent short interruptions of standing significantly attenuated postprandial glucose compared to prolonged sitting; however, light-intensity walking was found to represent a superior physical activity break. The feasibility and longitudinal implications of breaking sedentary behaviour with light-intensity walking should be investigated in a free-living setting. REGISTRATION: Not available.

Participant experiences of eight weeks of supervised or home-based Pilates among people with multiple sclerosis: a qualitative analysis.

PURPOSE: An exploratory qualitative study investigating participants' experiences of a feasibility study of supervised and home-based Pilates. METHODS: All 10 females who participated in an eight-week supervised (n = 4) or home-based Pilates (n = 6) program were invited and agreed to be interviewed. Data were collected via semi-structured interviews and researcher observations of participant experiences. Data were analysed using codebook thematic analysis framework. RESULTS: Two domain summaries emerged: (1) the suitability of home-based Pilates in particular for this population. Participants indicated that supervised and home-based Pilates was a safe, intensity-appropriate, and implementable exercise method to improve mental health outcomes among persons with multiple sclerosis (PwMS), and (2) the benefits experienced by PwMS while participating in Pilates. Home-based Pilates reduced both exercise participation and accessibility barriers commonly experienced by PwMS. Furthermore, PwMS reported improvements in mental health outcomes following Pilates, in both exercise environments. CONCLUSIONS: PwMS reported experiencing improved mood following regular Pilates training and indicated that home-based in particular reduced barriers regularly experienced by this population. Results support Pilates as a feasible exercise modality providing potential mood improvements among PwMS. Future appropriately powered home-based randomised controlled trials to further explore the effects of Pilates training on mental health among PwMS with minimal-to-mild mobility disability are warranted.Implications for RehabilitationParticipants in this study described the mental health benefits experienced from engaging in Pilates, a non-traditional exercise modality.Home-based Pilates overcame participatory and accessibility barriers to exercise among people with multiple sclerosis (MS).Participants valued that Pilates was low intensity and did not exacerbate fatigue.Home-based Pilates is a feasible exercise method for people with MS with minimal-to-mild mobility disability.

The effects of acute resistance exercise among young adults: A randomized controlled trial.

Background The effects of a single bout of resistance exercise (RE) on state anxiety and worry symptoms are understudied. Further, how resistance exercise training (RET) changes response to acute RE is unknown. Methods Sixty-two untrained young adults (mean age (y):26.6; RET n = 27, Wait-list (WL): n = 35, 62.9% female) were randomized to an eight-week, ecologically-valid, guidelines-based RET condition, or eight-week WL control condition. Two acute RE trials were nested within the design at week one and eight, to determine RE response, and change in RE response following RET. The RET condition completed a twice-weekly RET intervention. The WL condition completed 30-minute bouts of quiet-rest at week one and eight. Two-condition (RE/quiet-rest) x two-time (pre/post) x two-session (weeks one/eight) RM-ANCOVAs examined differences between acute RE and quiet-rest pre-post and between acute sessions. Sub-analyses were conducted among young adults with analogue-Generalized Anxiety Disorder (AGAD). Primary outcomes were anxiety and worry symptoms. Results Compliance was 99% (Rate of perceived exertion (6-20) = 14±1, Muscle soreness (1-10)=4 ± 2), with no adverse events. There were no significant three-way interactions for anxiety symptoms or worry symptoms (all p ≥ 0.51) among the total sample or AGAD sample. The magnitude of change in outcomes at each session for both samples were small and non-significant (Hedges' d = -0.26 to 0.23). Limitations Post-condition assessment of primary outcomes was only conducted at a single time point. Conclusion RE did not elicit significant reductions in state anxiety or worry symptoms ten minutes post-RE. RET did not change response to acute RE. Clinicians should encourage RET for maximum anxiolytic benefits.

Bidirectional Associations Between Depressive and Anxiety Symptoms and Loneliness During the COVID-19 Pandemic: Dynamic Panel Models With Fixed Effects.

Background: Understanding the direction and magnitude of mental health-loneliness associations across time is important to understand how best to prevent and treat mental health and loneliness. This study used weekly data collected over 8 weeks throughout the COVID-19 pandemic to expand previous findings and using dynamic panel models with fixed effects which account for all time-invariant confounding and reverse causation. Methods: Prospective data on a convenience and snowball sample from all 50 US states and the District of Colombia (n = 2,361 with ≥2 responses, 63.8% female; 76% retention rate) were collected weekly via online survey at nine consecutive timepoints (April 3-June 3, 2020). Anxiety and depressive symptoms and loneliness were assessed at each timepoint and participants reported the COVID-19 containment strategies they were following. Dynamic panel models with fixed effects examined bidirectional associations between anxiety and depressive symptoms and loneliness, and associations of COVID-19 containment strategies with these outcomes. Results: Depressive symptoms were associated with small increases in both anxiety symptoms (ß = 0.065, 95% CI = 0.022-0.109; p = 0.004) and loneliness (ß = 0.019, 0.008-0.030; p = 0.001) at the subsequent timepoint. Anxiety symptoms were associated with a small subsequent increase in loneliness (ß = 0.014, 0.003-0.025; p = 0.015) but not depressive symptoms (ß = 0.025, -0.020-0.070; p = 0.281). Loneliness was strongly associated with subsequent increases in both depressive (ß = 0.309, 0.159-0.459; p < 0.001) and anxiety (ß = 0.301, 0.165-0.436; p < 0.001) symptoms. Compared to social distancing, adhering to stay-at-home orders or quarantining were not associated with anxiety and depressive symptoms or loneliness (both p ≥ 0.095). Conclusions: High loneliness may be a key risk factor for the development of future anxiety or depressive symptoms, underscoring the need to combat or prevent loneliness both throughout and beyond the COVID-19 pandemic. COVID-19 containment strategies were not associated with mental health, indicating that other factors may explain previous reports of mental health deterioration throughout the pandemic.