Sedentary time negatively influences health and is a risk factor for chronic low back pain (CLBP). Emerging evidence suggests breaking up prolonged sedentary behaviors may improve CLBP. This pilot trial examined the influence of decreasing sedentary behaviors on pain, mood, and quality of life in CLBP. Forty adults with CLBP and elevated depressive symptoms were randomized to wear an activity tracker with an idle alert along with receiving health coaching based on Motivational Interviewing and Habit Theory (INT) or a wait-list control condition (WLC) for eight weeks with a 12-week follow-up. Actigraphy-assessed time in total and prolonged sedentary behaviors, pain, depressed mood, quality of life, Patient Global Impression of Change (PGIC), and habits surrounding sedentary behavior were assessed at pre-intervention, post-intervention, and at follow-up. Repeated measures ANOVAs were used to examine changes in outcomes. Results demonstrated that INT reduced time spent in prolonged sedentary bouts by an average of 53 min/day (95

This secondary analysis explored pre- to post-intervention changes in accelerometer-derived activity and sleep data from adults with major depressive disorder (MDD). The CBT+ trial comprised two 8-week Cognitive Behavioral Therapy (CBT) arms: ActiveCBT (n = 13; 30 min of moderate-intensity exercise before each CBT session) and CalmCBT (n = 12; 30 min of quiet rest before each session). Pre- and post-intervention acceleromtetry data were included in mean-centered linear models for sleep (time in bed; TIB), activity and sedentary time. There were no significant between-group effects, but there was a significant average within-person decrease of 47.2 mins/day of sedentary time across all participants (95% CI: -82.0 to -14.4 min/day; p = .007), a significant increase of 36.5 mins/day of sleep duration-TIB (4.2 to 68.8 min/day; p = .028), and a non-significant increase of 12.3 mins/day of total physical activity (-34.5 to 59.1 min/day; p = .589). Overall, CBT was associated with beneficial changes in daily activity patterns. The findings of reduced sedentary time and increased TIB indicate possible additional health benefits of CBT for adults with depression, although replication in larger sample sizes is needed. Future work should explore whether these behavioral improvements can be sustained beyond the intervention period.

Introduction Students enrolling in higher education often adopt lifestyles linked to worse mental health, potentially contributing to the peak age onset of mental health problems in early adulthood. However, extensive research is limited by focusing on single lifestyle behaviours, including single time points, within limited cultural contexts, and focusing on a limited set of mental health symptoms.Methods and analysis The UNIversity students’ LIFEstyle behaviours and Mental health cohort (UNILIFE-M) is a prospective worldwide cohort study aiming to investigate the associations between students’ lifestyle behaviours and mental health symptoms during their college years. The UNILIFE-M will gather self-reported data through an online survey on mental health symptoms (ie, depression, anxiety, mania, sleep problems, substance abuse, inattention/hyperactivity and obsessive/compulsive thoughts/behaviours) and lifestyle behaviours (ie, diet, physical activity, substance use, stress management, social support, restorative sleep, environment and sedentary behaviour) over 3.5 years. Participants of 69 universities from 28 countries (300 per site) will be assessed at university admission in the 2023 and/or the 2024 academic year and followed up for 1, 2 and 3.5 years.Ethics and dissemination The study was first approved at a national level in Brazil (CAE:63025822.8.1001.5346). Study sites outside Brazil obtained additional ethics approval from their institutions using the main approval. Results from the UNILIFE-M cohort will be disseminated through scientific publications, presentations at scientific meetings, press releases, the general media and social media.

Vaccination under deliberately varied metabolic conditions provides a framework to identify metabolic determinants of immune response to vaccine and to identify metabolic pathways that may serve as immunomodulators or future adjuvant targets. Suboptimal vaccine immunogenicity and waning antibody durability remain significant public health challenges requiring effective interventions. To examine the association between vaccine immunogenicity and altered metabolic microenvironments, we applied a short-term metabolic intervention coinciding with SARS-CoV-2 immunization. In this randomized trial, half of the participants completed a metabolically targeted 90-min exercise bout immediately post-immunization, a stimulus known to induce sustained shifts in systemic metabolic changes for up to 24 h. Participants in the control group did not exercise after vaccination. Serum anti-RBD IgG antibody and a putative biomarker of germinal center activity (CXCL13) were assessed as measures of immunogenicity in longitudinally collected samples, and metabolic profile was analyzed by Raman spectroscopy. Associations between age, BMI, psychosocial stress and immune response and metabolic profiles were determined. The exercise-metabolic treatment enhanced antibody durability and shifted the kinetics of CXCL13 and serum antibody response in participants without pre-existing immunity. Specific immuno-metabolic signatures distinguished exercise-metabolic treatment from control, identified participants with pre-existing immunity, and revealed effects of age. This study demonstrates the feasibility of a readily accessible short-term metabolic intervention applied at vaccination in shaping in vivo adaptive immunity and provides critical insights into metabolic predictors of immunogenicity. These findings can be used to interrogate further host factor-related metabolic predictors of vaccine response (i.e., age, BMI, stress) and develop innovative vaccine platforms that influence the metabolic microenvironment.

Major depressive disorder (MDD) is a debilitating condition with frequent relapses. Augmentation strategies may improve psychotherapy outcomes, particularly if they enhance mechanisms of change. Using an experimental therapeutics approach, this pilot trial evaluated whether 30 min of individual moderate exercise immediately before individual cognitive behavioral therapy (ActiveCBT) engages two mechanistic targets (behavioral activation and therapeutic alliance) compared to a time- and attention-matched control (CalmCBT). Forty adults with DSM-5 MDD were severity-stratified and randomized to 8 weeks of ActiveCBT (n = 19) or CalmCBT (n = 21). Primary outcomes were the Working Alliance Inventory-Short Revised (WAI; Bond, Task, Goals subscales) and Behavioral Activation for Depression Scale (BADS). Depression outcomes included Hamilton Rating Scale for Depression (HAMD) response (≥50% reduction) and remission (HAMD<8) from a masked assessor. Generalized estimating equations estimated group effects across time, standardized as Cohen's d, with a priori success defined as d ≥ 0.35 for both or d ≥ 0.55 for either WAI or BADS. The average standardized effect for WAI-Bond favoring ActiveCBT was d = 0.36 (95% CI: -0.19, 0.90, p = 0.20) and BADS was d = 0.43 (-0.07, 0.94; p = 0.09). Secondary exploratory analyses found a significant remission benefit for ActiveCBT over CalmCBT (69% vs 33%, p < 0.05), with similar response rates. Exercise priming demonstrated directional mechanistic signals in both specific (behavioral activation) and nonspecific (therapeutic bond) targets, with potential remission benefits from exploratory analyses. These findings preliminarily suggest that exercising before therapy could augment CBT and offer a safe, accessible way to potentially boost its antidepressant effects. CLINICAL TRIAL REGISTRATION: This study was prospectively registered at ClinicalTrials.gov (NCT06001346).

PURPOSE:This secondary analysis of a randomized controlled trial (RCT) of resistance exercise training (RET) compared with a waitlist quantified the acute effects of a single resistance exercise session on depressed mood state. METHODS:Sixty-two young adults (26.6 ± 5.6 yr; 39 female) were randomized to 8 wk of World Health Organization and American College of Sports Medicine guidelines-based RET or a waitlist, with an acute RCT nested in at week 1. In the first session, RET participants completed moderate-intensity resistance exercise, comprising two sets of 8-12 repetitions of eight exercises targeting the major muscle groups. Waitlist participants completed 30 min of quiet rest. The Depression subscale of the Profile of Mood States Brief Form (POMS-B) measured depressed mood state pre- and 10 min post-session. Two group × two time (pre/post) RMANOVAs examined differences between resistance exercise and quiet rest. Subanalyses were conducted among young adults with analogue generalized anxiety disorder (AGAD), major depressive disorder (AMDD), comorbid AGAD and AMDD, and pre-exercise POMS-B ≥1 and ≥4. RESULTS:No significant group-time interaction ( F(1,59) = 1.70, P = 0.198) was found for depressed mood state. Significant main effects for time were found among the total ( F(1,59) = 14.74, P < 0.001), AGAD ( F(1,28) = 13.22, P ≤ 0.001), AMDD ( F(1,12) = 5.12, P ≤ 0.043), POMS-B ≥1 ( F(1,31) = 30.29, P < 0.001) and ≥4 ( F(1,11) = 10.71, P = 0.007) samples, such that depressed mood state reduced following a single bout of resistance exercise ( d = 0.29 to 1.26) and quiet rest ( d = 0.27 to 0.39). CONCLUSIONS:Resistance exercise and quiet rest elicited significant small-to-large and small-to-moderate magnitude reductions in depressed mood state, respectively, that were not significantly different from each other.

Epilepsy is negatively associated with psychosocial health. Regular physical activity is known to improve psychosocial health, yet population-based studies on the relationship between activity behavior, psychosocial health, and epilepsy are limited. This study aimed to determine the prevalence of psychosocial health concerns among adults with epilepsy compared to the adults without epilepsy and evaluate relationships between physical activity and epilepsy status on psychosocial health using cross-sectional data from the 2022 National Health Interview Survey (n = 26,311). Epilepsy status was coded as adults with: active epilepsy (n = 301), inactive epilepsy (n = 162), and no history of epilepsy (n = 25,848). Aerobic and muscle-strengthening physical activity were coded based on the 2018 Physical Activity Guidelines for Americans from self-reported questions. Psychosocial health concerns (depression, anxiety, concentration/memory difficulties, poor life satisfaction, and social functioning difficulties), were coded into binary variables (yes/no). The weighted mean age was 48.29 years (SE = 0.17), 51 % were female, and 77 % were White. Survey-weighted and IPTW-adjusted logistic regression models showed odds of depression, anxiety, concentration/memory difficulties, and social functioning difficulties were 2-4 times higher in adults with active epilepsy and 1-2 times higher in adults with inactive epilepsy compared to adults without epilepsy. Stratified analyses revealed a similar positive influence of guideline adherence on psychosocial health for adults with and without epilepsy. This study supports the need to improve psychosocial health among adults with epilepsy and suggests both aerobic and muscle-strengthening activities as potential intervention targets. Future exercise intervention trials are warranted to determine causality.

Metabolic syndrome (MetS) is a major global health concern that continues to rise in prevalence and further augments disease burden by predisposing individuals to cognitive impairment (CI). Managing MetS through lifestyle habits or interventions may prevent or improve CI. The ketogenic diet (KD) has garnered interest, but its long-term efficacy in preventing CI remains unknown, as does the optimal regimen in individuals that have already developed MetS. Herein, in a preventative paradigm in mice, we evaluated the ability of relatively longterm KD to prevent CI versus a Western-style high-fat diet (HFD) that induces MetS and CI. In an intervention paradigm to mice that had already developed MetS and CI, we compared the efficacy of low-fat standard diet intervention (SDI), KD intervention (KDI), exercise intervention (EXI), and combined KD-exercise intervention (KDI-EXI). We found that KD more effectively managed metabolism and prevented CI versus HFD. Among interventions, SDI, KDI, and KDI-EXI outperformed EXI, suggesting that dietary regimens universally surpass exercise alone in ameliorating HFD-induced MetS and CI. In tandem, to gain molecular insight, we profiled gene expression, and HFD hippocampus differed from other groups particularly in metabolic and neuroactive ligandreceptor signaling pathways. Overall, our findings have important health implications and especially advocate dietary strategies for preventing or improving MetS and associated CI.

Many adults with major depressive disorder (MDD) do not engage in treatment and may also not respond when current frontline treatments are completed. Resistance exercise training (RET) is an understudied behavioral treatment option, which may help with MDD management through improving cerebral blood flow that is commonly impaired in adults with MDD. The purpose of this study is to use gold-standard research methods to determine the validity (clinical efficacy) of RET for treating MDD and to determine potential cerebrovascular pathways through which RET might improve MDD symptoms. This study will be a randomized controlled trial of 200 adults with DSM-5-diagnosed MDD of at least mild severity. Participants will be randomized to 16 weeks of twice-weekly RET at either guidelines-based high dose (60 https://clinicaltrials.gov/study/NCT06110897 ).

Middle-aged and older adults living in rural settings have been consistently less likely to report regular physical activity (PA) than those living in urban settings. While past literature has identified sociodemographic and environmental correlates of PA that may contribute to these differences, consideration of psychological correlates has been limited. A total of 95 rural and urban adults ≥50 years old provided self-reported sociodemographic information, PA level, and psychological correlates of PA including measures assessing motivation, self-efficacy, social support, and attitudes related to PA. The average participant age was 68.6 years, and most were female (62.1%) and married (70.5%). While PA level did not differ significantly between the rural and urban groups, different psychological correlates contributed significantly to separate rural and urban linear regression models considering PA status. Among rural adults, more positive attitudes toward PA, and greater PA self-efficacy and social support were associated with greater amounts of PA while for urban adults, no psychological correlates were significantly associated with PA. Psychosocial factors may be key considerations in developing more effective PA interventions in middle-aged and older adults living in rural areas.

Abstract Background Depression is a leading cause of disability worldwide, and treatments could be more effective. Identifying methods to improve treatment success has the potential to reduce disease burden dramatically. Preparing or “priming” someone to respond more effectively to psychotherapy (e.g., cognitive behavioral therapy [CBT]) by preceding sessions with aerobic exercise, a powerful neurobiological activator, could enhance the success of the subsequently performed therapy. However, the success of this priming approach for increasing engagement of working mechanisms of psychotherapy (e.g., increased working alliance and behavioral activation) has yet to be formally tested. Methods The CBT + trial will be a parallel-arm randomized controlled trial that will recruit 40 adult participants with DSM-5 diagnosed depression (verified with clinical interview) via referrals, mass emails, local flyers, and social media posts. Participants will be randomized to an ActiveCBT or CalmCBT condition. The ActiveCBT group will receive an 8-week CBT intervention primed with 30 min of moderate-intensity aerobic exercise (cycling on a stationary bike at a 13 rating of perceived exertion). The CalmCBT group will receive the same 8-week CBT intervention while resting for 30 min before CBT (i.e., cycling vs no cycling is the only difference). The primary outcome measures will be mean working alliance (assessed with the client version of the Working Alliance Inventory—Short Revised) and mean behavioral activation (self-reported Behavioral Activation for Depression Scale) recorded at each of the 8 therapy sessions. Secondary outcomes include evaluation of state anhedonia and serum brain-derived neurotrophic factor before the active/calm conditions, between the condition and therapy, and after the therapy. Additional exploratory analyses will evaluate group differences in algorithm-generated ratings of therapist-participant interactions via the Lyssn platform. Discussion The novel approach of priming CBT with moderate-intensity aerobic exercise evaluated in a randomized controlled trial (CBT + trial) has the potential to demonstrate the usefulness of exercise as an augmentation strategy that improves working mechanisms of therapy and overall treatment outcomes for adults with depression. Trial registration ClinicalTrials.gov NCT06001346. Registered on August 21, 2023.

IntroductionLittle is known about physical activity behaviors among people with SUD. This study aimed to (a) describe self-reported moderate-to-vigorous physical activity (MVPA) and sedentary (SED) behaviors of adults with SUD initiating treatment (b), determine the potential contributions of drug of choice (DOC) on these behaviors, and (c) determine the potential contributions of level of care and demographic variables on these behaviors.MethodsSecondary data that was collected via surveys including demographic information, psychological health, drug of choice, MVPA (categorized as inactive, insufficiently active, meets guidelines, exceeds guidelines) and SED (<4 h/day, 4-<6 h/day, 6-8 h/day, >8 h/day) were analyzed from 1,293 patients in inpatient/outpatient treatment facilities across the United States. ResultsOn average, over half (51%) of patients entering treatment reported not meeting guidelines, but sitting time was generally low (median= 360 min/day). MVPA levels differed based on level of care (p<0.001) with 48% of patients in detox facilities reporting inactivity compared to 37% in residential and 29% in outpatient programs. MVPA and SED levels differed by sex with women less likely to report sitting <4 h/day (27.9% vs. 38.2%, p<0.001) and more likely to report sitting for >8 h/day (31.5% vs. 21.8%, p<0.001) compared to men. SED differed by race (p=0.01), with 54% of Black patients reporting <4 h/day compared to 33% of White patients. DiscussionUnderstanding activity behavior patterns among individuals entering SUD treatment provides opportunities for identifying the extent of lifestyle behavior needs and opportunities to develop personalized treatment strategies.

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.PurposeTo 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.MethodsTen 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.ResultsNine 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).ConclusionsPreliminary 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.

Interventions often fail to achieve long-term behavioral maintenance. Utilizing motivational and volitional strategies to promote behavioral maintenance factors may improve this. Using a full-factorial experiment, we tested the effects of three intervention components (focused on intrinsic motivation and identity, exercise preparation habit, and exercise instigation habit) on exercise participation over a year, among new users (N = 751; 91% identifying as female, 54% identifying as White race) of a global, online exercise class platform, run by Les Mills International Ltd, called LM+. We also tested the intervention components' theoretical mechanisms of action-habit formation, intrinsic motivation, identity, and self-efficacy. Multi-level models found some support for a main effect of the exercise preparation habit intervention component in promoting self-reported and objective exercise participation (behavioral outcomes measured via monthly surveys and the LM+ platform; mechanisms measured via monthly surveys)-in particular online exercise class frequency (fixed effect estimate = 0.84, p < 0.05, and = 0.12, p < 0.05, respectively). The preparation habit component also significantly increased preparation habit strength (0.30, p < 0.05) and instigation habit strength (0.33, p < 0.05). Other expected effects were nonsignificant. Helping individuals form an exercise preparation habit may facilitate initiating and maintaining exercise over time, in particular for attending online exercise classes, potentially through promoting greater preparation and exercise instigation habit strength.