Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial.

BACKGROUND: Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health. OBJECTIVE: We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre-COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented. METHODS: In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre-COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre-COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre-COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants' health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18. RESULTS: Dropout rates were low in both cohorts in the IG (pre-COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre-COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre-COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre-COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms. CONCLUSIONS: With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios. TRIAL REGISTRATION: German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078.

Regulating emotions with experience - the effectiveness of reappraisal inventiveness depends on situational familiarity.

BACKGROUND AND OBJECTIVES: Previous research identified cognitive reappraisal as an adaptive emotion regulation strategy. However, theories on emotion regulation flexibility suggest that reappraisal effectiveness (RE) may depend on an individual's familiarity with stressors. In this study, we expect high reappraisal inventiveness (RI), i.e., the generation of many and categorically different reappraisals, to increase RE for individuals with low situational familiarity. Individuals with high situational familiarity, however, would be more effective with low RI. DESIGN: A total of 148 participants completed the Script-based Reappraisal Task, in which they were presented with fear- and anger-eliciting scripts. Depending on trial type, participants were instructed to reappraise (reappraisal-trial) or react naturally (control-trial) to the scripts. After each trial, participants indicated affective states and reappraisals. We assessed RI and calculated RE-scores as difference between affect ratings in reappraisal- and control-trials for valence and arousal. Finally, participants rated the familiarity with each situation. RESULTS: The results indicated a significant moderating effect of situational familiarity on the relationship between RI and RE-valence (not RE-arousal). The moderation was mainly driven by a detrimental effect of RI for individuals with high situational familiarity. CONCLUSIONS: Our results hint at the importance of individual experience with emotional content in the research of cognitive reappraisal.

It's worth the trouble: Stressor exposure is related to increased cognitive reappraisal ability.

Recent theories propose moderate (compared to high or no) stressor exposure to promote emotion regulation capacities. More precisely, stressful situations are expected to serve as practice opportunities for cognitive reappraisal (CR), that is, the reinterpretation of a situation to alter its emotional impact. Accordingly, in this study, we expect an inverted U-shaped relationship between exposure to daily hassles and performance in a CR task, that is, best reappraisal ability in individuals with a history of moderate stressor exposure. Participants (N = 165) reported the number of daily hassles during the last week as indicator of stressor exposure and completed the Script-based Reappraisal Test (SRT). In the SRT, participants are presented with fear-eliciting scripts and instructed to either downregulate negative affect via reappraisal (reappraisal-trials) or react naturally (control-trials). Two measures indicate CR ability: (1) reappraisal effectiveness, that is, the difference between affective ratings in reappraisal- and control-trials and (2) reappraisal inventiveness, that is, the number of valid and categorically different reappraisal thoughts. Multiple regression analyses revealed positive linear, but not quadratic, relationships of exposure to daily hassles and both indicators of CR ability. Potential benefits of stressor exposure for emotion regulation processes are discussed.

Association of Innate and Acquired Aerobic Capacity With Resilience in Healthy Adults: Protocol for a Randomized Controlled Trial of an 8-Week Web-Based Physical Exercise Intervention.

BACKGROUND: Physical activity alleviates chronic stress. The latest research suggests a relationship between resilience and physical fitness. Beneficial adaptations of the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, endocannabinoid system, and tryptophan pathway, which are induced by an active lifestyle, are considered to be conducive to resilience. However, detailed knowledge on the molecular link between the effects of acute and chronic physical exercise and improved resilience to stress in humans is missing. Moreover, the relationship between innate and acquired aerobic capacity and resilience is poorly understood. OBJECTIVE: The aim of this study is to implement a human exercise intervention trial addressing the following main hypotheses: a high innate aerobic capacity is associated with high resilience to stress, and web-based physical exercise training improves aerobic capacity of physically inactive adults, which is accompanied by improved resilience. In this setting, we will analyze the relationship between resilience parameters and innate and acquired aerobic capacity as well as circulating signaling molecules. METHODS: A total of 70 healthy, physically inactive (<150 minutes/week of physical activity) adults (aged 18-45 years) will be randomly assigned to an intervention or control group. Participants in the intervention group will receive weekly training using progressive endurance and interval running adapted individually to their remotely supervised home training performance via web-based coach support. A standardized incremental treadmill exercise test will be performed before and after the intervention period of 8 weeks to determine the innate and acquired aerobic capacity (peak oxygen uptake). Before and after the intervention, psychological tests and questionnaires that characterize parameters implicated in resilience will be applied. Blood and saliva will be sampled for the analysis of cortisol, lactate, endocannabinoids, catecholamines, kynurenic acid, and further circulating signal transducers. Statistical analysis will provide comprehensive knowledge on the relationship between aerobic capacity and resilience, as well as the capacity of peripheral factors to mediate the promoting effects of exercise on resilience. RESULTS: The study was registered in October 2019, and enrollment began in September 2019. Of the 161 participants who were initially screened via a telephone survey, 43 (26.7%) fulfilled the inclusion criteria and were included in the study. Among the 55% (17/31) of participants in the intervention group and 45% (14/31) of participants in the control group who completed the study, no serious adverse incidents were reported. Of 43 participants, 4 (9%) withdrew during the program (for individual reasons) and 8 (19%) have not yet participated in the program; moreover, further study recruitment was paused for an indeterminate amount of time because of the COVID-19 pandemic. CONCLUSIONS: Our study aims to further define the physiological characteristics of human resilience, and it may offer novel approaches for the prevention and therapy of mental disorders via an exercise prescription. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29712.

Cognitive emotion regulation withstands the stress test: An fMRI study on the effect of acute stress on distraction and reappraisal.

Cognitive emotion regulation is a key mechanism for the maintenance of mental health, but may fail, when individuals are exposed to acute stress. To date, it is not well understood whether and to what extent acute stress effects contribute to impairments in emotion regulation capacities as the sparse existing studies have yielded heterogeneous results, indicating that stress timing might be a crucial factor. In the present study, 81 healthy participants underwent either an acute stress task (ScanSTRESS-C; n = 40) or a control condition (n = 41) while lying in the MRI scanner. In the subsequent Cognitive Emotion Regulation Task (CERT), participants were confronted with neutral or negative pictures and instructed to either view them, or regulate their upcoming emotions using either distraction or reappraisal. Subjective ratings of affective state as well as functional brain imaging data served to indicate emotion regulation. The results showed a successful stress manipulation as indicated by group differences in subjective wellbeing, saliva cortisol concentrations, heart rate, and functional brain activity in regions implicated in stress processing. With respect to emotion regulation, CERT data revealed a significant regulation effect at the neural and behavioral level (less negative emotional ratings after reappraisal and distraction trials compared to view trials) in both groups. However, no significant group differences were observed, neither in BOLD responses to the CERT, nor in behavioral ratings. Contrary to previous studies, our study did not reveal further evidence of stress-related effects on emotion regulation, potentially being related to differences between studies in experimental setting, timing, and procedures. This study therefore underlines the need of future studies that disentangle the complex interplay of stress and emotion regulation and identify different factors influencing their bidirectional relationship.

Investigating individual stress reactivity: High hair cortisol predicts lower acute stress responses.

Identifying individual differences in stress reactivity is of particular interest in the context of stress-related disorders and resilience. Previous studies already identified several factors mediating the individual stress response of the hypothalamus-pituitary-adrenal axis (HPA). However, the impact of long-term HPA axis activity on acute stress reactivity remains inconclusive. To investigate associations between long-term HPA axis variation and individual acute stress reactivity, we tested 40 healthy volunteers for affective, endocrine, physiological, and neural reactions to a modified, compact version of the established in-MR stress paradigm ScanSTRESS (ScanSTRESS-C). Hair cortisol concentrations (HCC) served as an integrative marker of long-term HPA axis activity. First, the ScanSTRESS-C version proved to be valid in evoking a subjective, endocrine, physiological, and neural stress response with enhanced self-reported negative affect and cortisol levels, increased heart rate as well as increased activation in the anterior insula and the dorso-anterior cingulate cortex (dACC). Second and interestingly, results indicated a lower neuroendocrine stress response in individuals with higher HCC: HCC was negatively correlated with the area under the curve (respect to increase; AUCi) of saliva cortisol and with a stress-related increase in dACC activity. The present study explicitly targeted the relationship between HCC and acute stress reactivity on multiple response levels, i.e. subjective, endocrine and neural stress responses. The lower stress reactivity in individuals with higher HCC levels indicates the need for further research evaluating the role of long-term HPA axis alterations in the context of vulnerability or immunization against acute stress and following stress-related impairments.

Script-based Reappraisal Test introducing a new paradigm to investigate the effect of reappraisal inventiveness on reappraisal effectiveness.

The ability to regulate emotions is essential for psychological well-being. Therefore, it is particularly important to investigate the specific dynamics of emotion regulation. In a new approach, we developed a novel paradigm - the Script-based Reappraisal Test (SRT) - to measure the processes involved in reappraisal, especially reappraisal inventiveness, i.e. the ability to create multiple and differing reappraisals. The aim of this study was twofold: (1) experimentally validate the SRT and (2) investigate whether reappraisal inventiveness increases reappraisal effectiveness. Healthy students (N = 143) completed the SRT. In this task, we presented everyday emotional situations in textual form and instructed participants to either decrease negative emotions by generating different reappraisals (reappraisal-trials) or react naturally (control-trials) to the situations. After each trial, participants indicated their affective state (SAM) and typed in their reappraisal thoughts. Within-subjects analyses showed significantly less negative affect and arousal in reappraisal-trials compared to control-trials, indicating a successful emotion regulation through reappraisal. Contrary to our hypothesis, reappraisal inventiveness and reappraisal effectiveness were not related. The theoretical and practical implications are discussed in the light of a person-by-situation approach.

Elderly migrants in outpatient and inpatient care services in Baden-Württemberg/Germany.

OBJECTIVE: Given the expected underrepresentation of elderly migrant populations in healthcare utilization we examined their proportion in nursing homes and care services for the elderly. We expected that cultural aspects were rarely addressed in the services´ concepts. METHODS: A questionnaire was administered to all care providers; 66.3% of 2724 in- and outpatient services in Baden-Württemberg, Germany participated. RESULTS: 78% of the services provided healthcare to migrants, who accounted for 14.1% of the clientele. This proportion was higher in urban (e.g. Heilbronn: 16.1%) than in rural areas (e.g. Lake Constance: 7.7%) and was significantly (r = 0.545, p < .05) correlated with the proportion of migrants in the general population. 39.1% of the migrants came from Russia, Poland and Turkey. Migrants from Turkey preferred outpatients´ rather than inpatients´ services. While 87.4% of services employed migrants, only 20% of services provided measures to increase intercultural competency to their employees. CONCLUSIONS: Migrants utilize inpatient and outpatient services regularly as their proportion was closely associated to that of the general population. Although their number will likely increase in the near future, the vast majority of nursing facilities did not provide specialized measures to better meet the demands of residents with a migration background.