Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression.

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Exercise as the sum of our choices between behavioral alternatives: The Decisional Preferences in Exercising (DPEX) test.

Exercising can be theorized as the result of choosing one behavior over alternative behaviors. The Decisional Preferences in Exercising (DPEX) test is a computerized, easy-to-use, publicly available (open source Python code: https://osf.io/ahbjr/) and highly adaptive research tool based on this rationale. In the DPEX, participants are asked to choose between two images by pressing a key on the computer keyboard, one showing a physical exercise and the other showing a non-exercise behavioral alternative in a series of trials. Combinations are randomly assembled from two definable pools of stimuli trial-per-trial. The test can be scored either based on a crossed random effects model (facilitating the use of different stimulus material in different studies without compromising the comparability of test scores) or with a simple proportion score. Data from diverse study samples (N = 451) showed strong correlations of DPEX scores with past and future exercise behavior (r = 0.42 and 0.47 respectively) as well as with affective experiences with exercise (e.g., 'pleasure-displeasure': r = 0.47). DPEX test scores discriminated between exercisers and non-exercisers according to receiver operating curve (ROC) analysis. The DPEX may be used to examine research questions derived from dual process theories, the effects of psychological states on behavioral choices can be tested, or the effects of behavior change interventions can be evaluated. The DPEX helps to avoid common method bias in the assessment of exercise behavior, for example, when psychological variables are measured with questionnaires.

Affective Responses to Increasing- and Decreasing-Intensity Resistance Training Protocols.

This study compared the effects of an increasing-intensity (UP) and a decreasing-intensity (DOWN) resistance training protocol on affective responses across six training sessions. Novice participants (Mage 43.5 ± 13.7 years) were randomly assigned to UP (n = 18) or DOWN (n = 17) resistance training groups. Linear mixed-effects models showed that the evolution of affective valence within each training session was significantly moderated by the group (b = -0.45, p ≤ .001), with participants in the UP group reporting a decline in pleasure during each session (b = -0.82) and the DOWN group reporting an improvement (b = 0.97; ps < .001). Remembered pleasure was significantly higher in the DOWN group compared to the UP group (b = 0.57, p = .004). These findings indicate that a pattern of decreasing intensity throughout a resistance exercise session can elicit more positive affective responses and retrospective affective evaluations of resistance training.

Exercise or not? An empirical illustration of the role of behavioral alternatives in exercise motivation and resulting theoretical considerations.

Objective: Individuals' decisions to engage in exercise are often the result of in-the-moment choices between exercise and a competing behavioral alternative. The purpose of this study was to investigate processes that occur in-the-moment (i.e., situated processes) when individuals are faced with the choice between exercise and a behavioral alternative during a computerized task. These were analyzed against the background of interindividual differences in individuals' automatic valuation and controlled evaluation of exercise. Method: In a behavioral alternatives task 101 participants were asked whether they would rather choose an exercise option or a behavioral alternative in 25 trials. Participants' gaze behavior (first gaze and fixations) was recorded using eye-tracking. An exercise-specific affect misattribution procedure (AMP) was used to assess participants' automatic valuation of exercise before the task. After the task, self-reported feelings towards exercise (controlled evaluation) and usual weekly exercise volume were assessed. Mixed effects models with random effects for subjects and trials were used for data analysis. Results: Choosing exercise was positively correlated with individuals' automatic valuation (r = 0.20, p = 0.05), controlled evaluation (r = 0.58, p < 0.001), and their weekly exercise volume (r = 0.43, p < 0.001). Participants showed no bias in their initial gaze or number of fixations towards the exercise or the non-exercise alternative. However, participants were 1.30 times more likely to fixate on the chosen alternative first and more frequently, but this gaze behavior was not related to individuals' automatic valuation, controlled evaluation, or weekly exercise volume. Conclusion: The results suggest that situated processes arising from defined behavioral alternatives may be independent of individuals' general preferences. Despite one's best general intention to exercise more, the choice of a non-exercise alternative behavior may seem more appealing in-the-moment and eventually be chosen. New psychological theories of health behavior change should therefore better consider the role of potentially conflicting alternatives when it comes to initiating physical activity or exercise.

The Influence of Affective Priming on the Affective Response During Exercise: A Replication Study.

The affective response during exercise is an important factor for long-term exercise adherence. Pottratz et al. suggested affective priming as a behavioral intervention for the enhancement of exercise-related affect. The present paper aims to replicate and extend upon these findings. We conducted a close replication with 53 participants completing a brisk walking task in two conditions (prime vs. no prime). Affective valence was assessed during exercise, and exercise enjoyment and remembered/forecasted pleasure were assessed postexercise. We could not replicate the findings of Pottratz et al., finding no evidence for positive changes in psychological responses in the priming condition. However, linear mixed models demonstrated significant interindividual differences in how participants responded to priming. These results demonstrate that affective priming during exercise does not work for everyone under every circumstance and, thus, provide an important contribution to the understanding of boundary conditions and moderating factors for priming in exercise psychology.

Tracking Self-Control - Task Performance and Pupil Size in a Go/No-Go Inhibition Task.

There is an ongoing debate about how to test and operationalize self-control. This limited understanding is in large part due to a variety of different tests and measures used to assess self-control, as well as the lack of empirical studies examining the temporal dynamics during the exertion of self-control. In order to track changes that occur over the course of exposure to a self-control task, we investigate and compare behavioral, subjective, and physiological indicators during the exertion of self-control. Participants completed both a task requiring inhibitory control (Go/No-Go task) and a control task (two-choice task). Behavioral performance and pupil size were measured during the tasks. Subjective vitality was measured before and after the tasks. While pupil size and subjective vitality showed similar trajectories in the two tasks, behavioral performance decreased in the inhibitory control-demanding task, but not in the control task. However, behavioral, subjective, and physiological measures were not significantly correlated. These results suggest that there is a disconnect between different measures of self-control with high intra- and interindividual variability. Theoretical and methodological implications for self-control theory and future empirical work are discussed.

Using COVID-19 Pandemic as a Prism: A Systematic Review of Methodological Approaches and the Quality of Empirical Studies on Physical Activity Behavior Change.

Background: The COVID-19 pandemic has highlighted the importance of scientific endeavors. The goal of this systematic review is to evaluate the quality of the research on physical activity (PA) behavior change and its potential to contribute to policy-making processes in the early days of COVID-19 related restrictions. Methods: We conducted a systematic review of methodological quality of current research according to PRISMA guidelines using Pubmed and Web of Science, of articles on PA behavior change that were published within 365 days after COVID-19 was declared a pandemic by the World Health Organization (WHO). Items from the JBI checklist and the AXIS tool were used for additional risk of bias assessment. Evidence mapping is used for better visualization of the main results. Conclusions about the significance of published articles are based on hypotheses on PA behavior change in the light of the COVID-19 pandemic. Results: Among the 1,903 identified articles, there were 36% opinion pieces, 53% empirical studies, and 9% reviews. Of the 332 studies included in the systematic review, 213 used self-report measures to recollect prepandemic behavior in often small convenience samples. Most focused changes in PA volume, whereas changes in PA types were rarely measured. The majority had methodological reporting flaws. Few had very large samples with objective measures using repeated measure design (pre and during the pandemic). In addition to the expected decline in PA duration, these studies show that many of those who were active prepandemic, continued to be active during the pandemic. Conclusions: Research responded quickly at the onset of the pandemic. However, most of the studies lacked robust methodology, and PA behavior change data lacked the accuracy needed to guide policy makers. To improve the field, we propose the implementation of longitudinal cohort studies by larger organizations such as WHO to ease access to data on PA behavior, and suggest those institutions set clear standards for this research. Researchers need to ensure a better fit between the measurement method and the construct being measured, and use both objective and subjective measures where appropriate to complement each other and provide a comprehensive picture of PA behavior.

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.

Continuity and Discontinuity of Sport and Exercise Type During the COVID-19 Pandemic. An Exploratory Study of Effects on Mood.

Involvement in sport and exercise not only provides participants with health benefits but can be an important aspect of living a meaningful life. The COVID-19 pandemic and the temporary cessation of public life in March/April/May 2020 came with restrictions, which probably also made it difficult, if not impossible, to participate in certain types of sport or exercise. Following the philosophical position that different types of sport and exercise offer different ways of "relating to the world," this study explored (dis)continuity in the type of sport and exercise people practiced during the pandemic-related lockdown, and possible effects on mood. Data from a survey of 601 adult exercisers, collected shortly after the COVID-19 outbreak in Finland, were analyzed. Approximately one third (35%) of the participants changed their "worldmaking" and shifted to "I-Nature"-type activities. We observed worse mood during the pandemic in those who shifted from "I-Me," compared to those who had preferred the "I-Nature" relation already before the pandemic and thus experienced continuity. The clouded mood of those experiencing discontinuity may be the result of a temporary loss of "feeling at home" in their new exercise life-world. However, further empirical investigation must follow, because the observed effect sizes were small.

Step Away from Depression-Study protocol for a multicenter randomized clinical trial for a pedometer intervention during and after in-patient treatment of depression.

OBJECTIVES: Increasing the number of daily steps by using a pedometer and a diary leads to an activity increase and improved health outcomes in a variety of somatic disorders. Hence, for the inpatient treatment of depression, supervised exercise interventions are more widespread. We aim to examine if a self-managed pedometer intervention (PI) with the option of being proceeded after discharge leads to reduction of depression and to a physical activity (PA) increase. METHODS: The Step Away from Depression (SAD) study is a multicenter randomized controlled trial targeting 400 patients with major depressive disorder. Treatment as usual (TAU) is compared to TAU plus PI after 4 weeks, at discharge, and 6 months after hospital admission. Primary outcomes are clinically rated depression severity and accelerometer-measured step counts. Secondary outcomes include self-reported depression symptoms and PA level, psychiatric symptoms, health-related quality of life, self-efficacy, and components of the Motivation Volition Process Model. RESULTS: We report the design of the SAD study considering several methodological aspects for exercise studies, in general. CONCLUSIONS: Results of our study will provide information about efficacy of PI for inpatient treatment and about interrelating processes of change concerning depression, PA, and aspects of motivation and volition.

When Pandemic Hits: Exercise Frequency and Subjective Well-Being During COVID-19 Pandemic.

The governmental lockdowns related to the COVID-19 pandemic have forced people to change their behavior in many ways including changes in exercise. We used the brief window of global lockdown in the months of March/April/May 2020 as an opportunity to investigate the effects of externally imposed restrictions on exercise-related routines and related changes in subjective well-being. Statistical analyses are based on data from 13,696 respondents in 18 countries using a cross-sectional online survey. A mixed effects modeling approach was used to analyze data. We tested whether exercise frequency before and during the pandemic would influence mood during the pandemic. Additionally, we used the COVID-19 pandemic data to build a prediction model, while controlling for national differences, to estimate changes in exercise frequency during similar future lockdown conditions depending on prelockdown exercise frequency. According to the prediction model, those who rarely exercise before a lockdown tend to increase their exercise frequency during it, and those who are frequent exercisers before a lockdown tend to maintain it. With regards to subjective well-being, the data show that those who exercised almost every day during this pandemic had the best mood, regardless of whether or not they exercised prepandemic. Those who were inactive prepandemic and slightly increased their exercise frequency during the pandemic, reported no change in mood compared to those who remained inactive during the pandemic. Those who reduced their exercise frequency during the pandemic reported worse mood compared to those who maintained or increased their prepandemic exercise frequency. This study suggests that under similar lockdown conditions, about two thirds of those who never or rarely exercise before a lockdown might adopt an exercise behavior or increase their exercise frequency. However, such changes do not always immediately result in improvement in subjective well-being. These results may inform national policies, as well as health behavior and exercise psychology research on the importance of exercise promotion, and prediction of changes in exercise behavior during future pandemics.

Affect and exertion during incremental physical exercise: Examining changes using automated facial action analysis and experiential self-report.

Recent research indicates that affective responses during exercise are an important determinant of future exercise and physical activity. Thus far these responses have been measured with standardized self-report scales, but this study used biometric software for automated facial action analysis to analyze the changes that occur during physical exercise. A sample of 132 young, healthy individuals performed an incremental test on a cycle ergometer. During that test the participants' faces were video-recorded and the changes were algorithmically analyzed at frame rate (30 fps). Perceived exertion and affective valence were measured every two minutes with established psychometric scales. Taking into account anticipated inter-individual variability, multilevel regression analysis was used to model how affective valence and ratings of perceived exertion (RPE) covaried with movement in 20 facial action areas. We found the expected quadratic decline in self-reported affective valence (more negative) as exercise intensity increased. Repeated measures correlation showed that the facial action mouth open was linked to changes in (highly intercorrelated) affective valence and RPE. Multilevel trend analyses were calculated to investigate whether facial actions were typically linked to either affective valence or RPE. These analyses showed that mouth open and jaw drop predicted RPE, whereas (additional) nose wrinkle was indicative for the decline in affective valence. Our results contribute to the view that negative affect, escalating with increasing exercise intensity, may be the body's essential warning signal that physiological overload is imminent. We conclude that automated facial action analysis provides new options for researchers investigating feelings during exercise. In addition, our findings offer physical educators and coaches a new way of monitoring the affective state of exercisers, without interrupting and asking them.

Implicit and explicit attitudes towards sport among young elite athletes with high versus low burnout symptoms.

The development of cynical attitudes towards elite sport is a core symptom of athlete burnout and has been associated with dropout from elite sport. To date, this phenomenon has mainly been studied by investigating explicit attitudes towards sport, whereas athletes' automatic evaluations (i.e. implicit attitudes) that have been shown to influence behavior as well were not considered. This study aimed to compare explicit and implicit attitudes towards sport of young elite athletes with high (N = 24) versus low (N = 26) burnout symptoms. Using self-reported measures, general and athlete burnout symptoms were assessed. Additionally, a single-target implicit association test was administered to examine participants' automatic evaluation of sport. Statistical analysis revealed greater emotional/physical exhaustion and sport devaluation in athletes reporting high compared to low burnout symptoms. Implicit attitudes towards sport did not significantly differ between the groups. Furthermore, no significant correlations were observed between different athlete burnout symptoms and implicit attitudes. Athletes with high burnout symptoms show a tendency to explicitly detach themselves from sport, thus fostering sport devaluation as a core symptom of athlete burnout. However, this process does not seem to be reflected in their implicit attitudes towards sport.

I Can See It in Your Face. Affective Valuation of Exercise in More or Less Physically Active Individuals.

The purpose of this study was to illustrate that people's affective valuation of exercise can be identified in their faces. The study was conducted with a software for automatic facial expression analysis and it involved testing the hypothesis that positive or negative affective valuation occurs spontaneously when people are reminded of exercise. We created a task similar to an emotional Stroop task, in which participants responded to exercise-related and control stimuli with a positive or negative facial expression (smile or frown) depending on whether the photo was presented upright or tilted. We further asked participants how much time they would normally spend for physical exercise, because we assumed that the affective valuation of those who exercise more would be more positive. Based on the data of 86 participants, regression analysis revealed that those who reported less exercise and a more negative reflective evaluation of exercise initiated negative facial expressions on exercise-related stimuli significantly faster than those who reported exercising more often. No significant effect was observed for smile responses. We suspect that responding with a smile to exercise-related stimuli was the congruent response for the majority of our participants, so that for them no Stroop interference occurred in the exercise-related condition. This study suggests that immediate negative affective reactions to exercise-related stimuli result from a postconscious automatic process and can be detected in the study participants' faces. It furthermore illustrates how methodological paradigms from social-cognition research (here: the emotional Stroop paradigm) can be adapted to collect and analyze biometric data for the investigation of exercisers' and non-exercisers' automatic valuations of exercise.

Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions.

INTRODUCTION: While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior. METHODS: N = 83 outpatients with MD (F1-F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention. RESULTS: Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change. CONCLUSIONS: MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.

Corrigendum: "I Want It All, and I Want It Now": Lifetime Prevalence and Reasons for Using and Abstaining from Controlled Performance and Appearance Enhancing Substances (PAES) among Young Exercisers and Amateur Athletes in Five European Countries.

[This corrects the article DOI: 10.3389/fpsyg.2017.00717.].

"I Want It All, and I Want It Now": Lifetime Prevalence and Reasons for Using and Abstaining from Controlled Performance and Appearance Enhancing Substances (PAES) among Young Exercisers and Amateur Athletes in Five European Countries.

Doping use in recreational sports is an emerging issue that has received limited attention so far in the psychological literature. The present study assessed the lifetime prevalence of controlled performance and appearance enhancing substances (PAES), and used behavioral reasoning theory to identify the reasons for using and for avoiding using controlled PAES in young exercisers across five European countries, in the context of the "SAFE YOU" Project. Participants were 915 young amateur athletes and exercisers (M = 21.62; SD = 2.62) from Cyprus, Germany, Greece, Italy, and UK who completed an anonymous questionnaire that included measures of self-reported use of controlled PAES, as well as reasons for using and not using controlled PAES. The results of the descriptive analyses demonstrated that almost one out five exercisers in the sample had a previous experience with controlled PAES. Higher prevalence rates were found in Greece and Cyprus and lower in Italy. The most frequently reported reasons for using controlled PAES included achieving the desired results faster; pushing the self to the (physical) limits; and recovering faster after exercise/training. Furthermore, the most frequently reported reasons for not using controlled PAES involved worry about any possible adverse health effects; not feeling the need for using them; and wanting to see what can be achieved naturally without using any controlled PAES. The findings of the present study indicate that the use of controlled PAES is fast becoming a crisis in amateur sports and exercise settings and highlight the need for preventive action and concerted anti-doping education efforts.

Physical activity in outpatients with mental disorders: status, measurement and social cognitive determinants of health behavior change.

INTRODUCTION: Physical activity (PA) can play an important role in improving the mental and physical health in patients with mental disorders but is not well studied in this population. The aim of this study was to assess the status of PA in outpatients with mental disorders, compare the convergence of self-rating and accelerometer measurement and examine the influence of social cognitive variables from the Motivation-Volition (MoVo) model and clinical measures on PA. METHODS: Eighty-four patients were recruited from three psychiatric outpatient clinics and local psychiatrists (Distribution of ICD-10-Diagnoses: F3.x = 59.5%, F4.x = 20.2%, F2.x = 17.9%, F1.x = 2.4%). PA, Self-efficacy, Outcome-expectancies, Intention, Self-concordance, Action- and Coping-planning, Health-related Quality of Life (SF-12) and Psychiatric Symptoms (SCL-27) were assessed through questionnaires. PA was assessed objectively by accelerometers. RESULTS: Most of the participants did not reach PA recommendations. Subjective and objective measurement of PA showed good accordance for total PA on group level but lower accordance on individual level. Motivational and volitional determinants of health behavior change showed a similar pattern of correlations with PA as in populations without mental disorders. CONCLUSION: Outpatients with mental disorders have the ability and are willing to perform PA but a large proportion of our sample did not meet PA recommendations. To assess group levels of PA, subjective and objective measurement seem equally apt, for individual diagnostics, a combination of both should be considered. Social cognitive determinants of health behavior change seem to be as helpful for the design of PA interventions for patients with mental disorders as they are in other populations.