Exergame-based exercise training for depressive symptoms in adults: A systematic review and meta-analysis

ObjectiveThe aim of this study was to pool existing data to investigate the overall effectiveness of exergame-based exercise training in improving depressive symptoms in adults.DesignA systematic review and meta-analysis.MethodsTen databases were systematically searched from inception to August 18, 2021, and the search was last updated on November 6, 2021. Standardized mean differences (SMDs) were calculated using random effects models. The Risk of Bias 2 (RoB 2) tool was used to assess the methodological quality of the studies, and GRADEpro software was used to assess confidence in the cumulative evidence. Funnel plots, Egger's test, and Begg's test were used to analyse publication bias. Sensitivity, subgroup and meta-regression analyses were performed to explore potential sources of heterogeneity.ResultsTwenty-one studies were included, and the results showed exergame-based exercise training had a significant effect on depressive symptoms in adults (SMD = −0.69; 95% CI, −1.01 to −0.36; P < 0.001; 19 RCTs, 924 participants; low-quality evidence). The predictive interval was not significant (95% PI, −3.45, 2.07). Subgroup analysis showed that in the intervention with the general adult population, game devices with Kinect and long-term interventions appeared to be more effective. Sensitivity analysis found the results to be robust.ConclusionExergame-based exercise training has the potential to reduce depressive symptoms. Additionally, different populations, devices and durations of intervention could influence the effect. In the future, high-quality studies with large samples, multiple centres and long follow-up durations should be performed to further explore the efficacy of exergame-based exercise training.     

Diverse multi-week physical activity programs reduce ADHD symptoms: A systematic review and meta-analysis

ObjectivePhysical activity (PA) has been proposed as an adjunct treatment and secondary prevention intervention for attention-deficit hyperactivity/impulsivity disorder (ADHD) and oppositional defiant disorder (ODD). However, meta-analyses testing effects on symptoms and functional impairment have yielded conflicting results.MethodsA systematic search of eight databases yielded 15 randomized controlled trial and 2 quasi-experimental design studies—including N = 881 youth (M = 9.75 years, 71% male)—that tested the effects of multi-week PA programs on symptoms and impairment of children with [or at-risk for] ADHD and/or ODD.ResultsRandom effects meta-analyses favored PA groups on omnibus ADHD measures (g = −0.42, 95%CI[-0.62;-0.21]), combined ADHD symptoms (g = −0.50, 95%CI[-0.82;-0.17]), inattention (g = −0.41,95%CI[-0.82; 0.00]), and hyperactivity/impulsivity (g = −0.30, 95%CI[-0.56;-0.04]). Heterogeneity was moderate across studies (I² = 49%, 95%CI[12%-to-70%]). Significant differences favored PA programs whether inclusion required diagnosis, programs augmented frontline treatments, and active or passive comparison groups were utilized.ConclusionDiverse PA programs can reduce ADHD symptoms, especially where they intentionally pursue this end.     

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors

Objectives“Fast” (i.e., implicit) processing is relatively automatic; “slow” (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes.DesignWe assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms.MethodUndergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms.ResultsImplicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised.ConclusionImplicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence.     

Personality and physical activity: A systematic review and meta-analysis

Whether personality determines physical activity or its outcomes is relevant for theory and public health but has been understudied. We estimated the population correlations between Big-Five personality factors and physical activity and examined whether they varied according to sample characteristics and study features. Database searches were conducted according to PRISMA guidelines, for articles published in the English language prior to November 1st, 2013. Sixty-four studies including a total of 88,400 participants yielded effects (k) for Extraversion (88), Neuroticism (82), Conscientiousness (69), Openness (51) and Agreeableness (52). Significant mean r was found for Extraversion (r = .1076), Neuroticism (r = −.0710), Conscientiousness (r = .1037) and Openness (r = .0344), but not Agreeableness (r = .0020). Effects were moderately heterogeneous (I² range = 44–65%) and varied by sample characteristics (e.g., age, gender, or clinical status) and/or study features (e.g., measure quality or item format). This analysis expands results of previous reviews and provides new support for a relationship between physical activity and Openness. Future studies should use better measures of physical activity and prospective designs, adjust for statistical artifacts, and consider advances in the conceptualization of personality.     

Gait variability in people with neurological disorders: A systematic review and meta-analysis

There has been growing evidence showing gait variability provides unique information about gait characteristics in neurological disorders. This study systemically reviewed and quantitatively synthesized (via meta-analysis) existing evidence on gait variability in various neurological diseases, including Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), cerebellar ataxia (CA), Huntington’s disease (HD), multiple sclerosis (MS), and Parkinson’s disease (PD). Keyword search were conducted in PubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Meta-analysis was performed to estimate the pooled effect size for gait variability for each neurological group. Meta-regression was performed to compare gait variability across multiple groups with neurological diseases. Gait variability of 777 patients with AD, ALS, CA, HD, MS, or PD participating in 25 studies was included in meta-analysis. All pathological groups had increased amount of gait variability and loss of fractal structure of gait dynamics compared to healthy controls, and gait variability differentiated distinctive neurological conditions. The HD groups had the highest alterations in gait variability among all pathological groups, whereas the PD, AD and MS groups had the lowest. Interventions that aim to improve gait function in patients with neurological disorders should consider the heterogeneous relationship between gait variability and neurological conditions.     

Mindfulness induction and cognition: A systematic review and meta-analysis

Mindfulness meditation might improve a variety of cognitive processes, but the available evidence remains fragmented. This preregistered meta-analysis (PROSPERO-CRD42018100320) aimed to provide insight into this hypothesis by assessing the effects of brief mindful attention induction on cognition. Articles were retrieved from Pubmed, PsycInfo and Web of Science up until August 1, 2018. A total of 34 studies were included. The outcomes were categorized into four cognitive domains: attentional functioning, memory, executive functioning and higher-order function. A small effect was found across all cognitive domains (Hedges’ g = 0.18, 95% IC = 0.07–0.29). Separated analyses for each cognitive domain revealed an effect only in higher-order cognitive functions (k = 10, Hedges’ g = 0.35, 95% IC = 0.20–0.50). Results suggest that mindfulness induction improves cognitive performance in tasks involving complex higher-order functions. There was no evidence of publication bias, but studies generally presented many methodological flaws.     

Profiles of exercise dependence symptoms in Ironman participants

ObjectiveTo identify distinct profiles of Ironman participants based on levels of exercise dependence, and examine whether these profiles differed in relation to eating patterns and psychological distress.DesignCross-sectional survey study of 345 Ironman participants in Australia.Main outcome measuresExercise dependence symptoms were assessed via the Exercise Dependence Scale. Eating patterns were assessed via the three-factor eating questionnaire, and psychological distress measured using the Kessler 6 scale.ResultsLatent profile analysis identified five distinct profiles based on responses to the Exercise Dependence Scale, which were labelled: Asymptomatic; Time Committed; Low psychological dependence; Symptomatic; and At-risk. The At-risk and Symptomatic profiles had less healthy eating patterns and higher psychological distress compared with the other profiles.ConclusionsThese findings suggest important individual differences in the nature and severity of exercise dependence symptoms in Ironman participants. The majority of Ironman participants appeared to have a healthy involvement with Ironman. However, approximately 30% of Ironman participants belonged to the At-risk and Symptomatic profiles, which could reflect maladaptive patterns of exercise.     

Individual differences in the social facilitation effect: A review and meta-analysis

The present study reviews the social facilitation literature and identifies two overarching responses to social presence: negative-apprehensive and positive-self-assured. These responses correspond to two general orientations toward the social environment described in current personality literature: a negative orientation, comprised of neuroticism and low self-esteem; and a positive orientation, comprised of extraversion and high self-esteem. A meta-analysis reveals that social presence is associated with performance impairment for negatively oriented individuals, and with performance improvement for positively oriented individuals. Additional analysis reveals that personality is a more substantial moderator of the effect of social presence than is task complexity. The results of this study open a new avenue in the research on social facilitation, encouraging a closer inspection of the meaning that various individuals attribute to social presence.     

The effects of exercise at different temperatures on cognitive function: A systematic review

To date, no review has focused specifically on the potential modulating role of environmental temperature on the effects of exercise on cognitive function. Despite this, a range of occupations and performance contexts exist (e.g., military personnel, emergency services, sport) where the maintenance of cognitive function in environmentally challenging environments is crucial. Therefore, this systematic review aimed to evaluate the experimental research investigating how manipulating environmental temperature influenced the effects of acute bouts exercise on cognitive functioning from pre-to-post exercise, or during exercise. Studies to be included were assessed by two authors reviewing title, abstract, and then full-text. From the searches conducted, twenty articles were identified which met the inclusion criteria. For the purpose of this review, exercise involved in each study was categorised into low, moderate, and vigorous dosages (dependent on intensity and duration). The results indicate that moderate dosages of exercise help stimulate improved cognitive performance from pre-to-post exercise in temperate conditions, where cold exposure appears to blunt these effects. In addition, hot environments led to cognitive decrements during and post exercise which were often identified in studies that implemented prolonged moderate or vigorous exercise protocols. Therefore, suggesting a combination of heightened physiological strain from increased dose of exercise, alongside heat exposure, can be detrimental to optimal cognitive functioning, whereby executive functioning tasks appeared to be most affected. The findings from this systematic review highlight the potential modulating role of environmental temperature on the effects of exercise on cognitive function. Thus, highlighting the importance of considering the role of environmental temperature for individuals either exercising to elicit desired cognitive benefits or for those involved in physically demanding occupations or performance domains.     

Working memory outcomes following traumatic brain injury in children: A systematic review with meta-analysis

The aim of this review is to systematically examine the literature concerning multicomponent working memory (WM)—comprising a central executive (CE), two storage components (phonological loop, PL and visuo-spatial sketchpad, VSSP), and episodic buffer (EB)—in pediatric traumatic brain injury (TBI). Electronic searches were conducted of MEDLINE, PsychINFO and EMBASE up to October 2014 with the inclusion criteria of children and adolescents with TBI, and quantitative methods to assess at least one component of WM. Meta-analytic procedures calculated pooled effect sizes for WM outcomes. Of the studies examined, 27 met the inclusion criteria. Children with TBI exhibited deficits in the CE and PL, but not in the VSSP, and no study could be found which examined the EB. Qualitative analysis found that greater TBI severity was associated with poorer CE functioning in five out of nine studies. Differences in patterns of brain activation were evident in four out of five fMRI studies that examined WM in TBI children and controls. Deficits in CE were associated with poorer mathematical skills in the only study that examined relations between WM and academic deficits. Notwithstanding the heterogeneity of the studies reviewed, TBI places children at risk of WM deficits. Moreover, this meta-analysis suggests that various components of WM have differential vulnerability to pediatric TBI, with significant deficits found in the CE and PL, but not in the VSSP (although the VSSP has rarely been examined to date). Future studies should be theoretically driven, employ tasks assessing all components of the WM model and examine the functional ramifications (including academic outcomes) of WM deficits in this population.     

Effects of psychological interventions for patients with osteoarthritis: a systematic review and meta-analysis

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) ?0.28, 95% CI ?0.48, ?0.08, P-value 0.005)] and fatigue (SMD ?0.18, 95% CI ?0.34, ?0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients’ self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

Sex differences in humor production ability: A meta-analysis

We offer the first systematic quantitative meta-analysis on sex differences in humor production ability. We included studies where participants created humor output that was assessed for funniness by independent raters. Our meta-analysis includes 36 effect sizes from 28 studies published between 1976 and 2018 (N = 5057, 67% women). Twenty of the 36 effect sizes, accounting for 61% of the participants, were not previously published. Results based on random-effects model revealed that men's humor output was rated as funnier than women's, with a combined effect size d = 0.321. Results were robust across various moderators and study characteristics, and multiple tests indicated that publication bias is unlikely. Both evolutionary and cultural explanations were considered and discussed.     

Differentiated associations between childhood maltreatment experiences and social understanding: A meta-analysis and systematic review

The extreme parenting experiences encountered by children who are physically abused or neglected place them at increased risk for impaired socio-emotional development. There is growing evidence that maltreated children may apprehend interpersonal encounters in different ways from children without such traumatic histories. This systematic review examines the links between childhood physical abuse and neglect and various constituent skills of social understanding (including emotion recognition and understanding, perspective taking, false belief understanding, and attributional biases) in 51 empirical studies. The review incorporates a meta-analysis of 19 studies on emotion recognition and understanding in this population. This showed an overall negative effect of maltreatment, but moderation analyses revealed that significantly stronger effects were found for measures of emotion understanding rather than recognition, and for younger rather than older age groups. The broader review also reveals a complex and differentiated profile of social understanding among maltreated children. Directions for future research that addresses individual differences in children’s experiences, both within and outside the maltreatment context, are discussed.     

A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials

ABSTRACT

Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.     

Fitness correlates of obligatory versus health motives for exercise: An examination of men in the military

Objectives

To examine quantity of exercise and motives for exercise as predictors of men in the military’s health and fitness level.

Design

Participants completed a survey to address research questions of interest.

Methods

One-hundred and fourteen men who were active duty Air Force members, with a mean age of 31.43 years (SD = 7.43) and an average military time in service of 10.66 years (SD = 7.75), completed a modified version of the Reasons for Exercise Inventory, a survey assessing their quantity of exercise, and reported their most recent score on their Air Force Fitness Test.

Results

Correlational analyses indicated a relation between quantity of exercise and men’s score on the Air Force Fitness Test and a relation between intrinsic motives for exercise and quantity of exercise. Intrinsic motivation was found to moderate the relation between quantity of exercise and men’s health and fitness score.

Conclusions

Men in the military who exercise because of their military obligation are less likely to score high on the Air Force Fitness Test than are men who are motivated to exercise for health benefits.     

Sex differences in the ability to recognise non-verbal displays of emotion: A meta-analysis

The present study aimed to quantify the magnitude of sex differences in humans' ability to accurately recognise non-verbal emotional displays. Studies of relevance were those that required explicit labelling of discrete emotions presented in the visual and/or auditory modality. A final set of 551 effect sizes from 215 samples was included in a multilevel meta-analysis. The results showed a small overall advantage in favour of females on emotion recognition tasks (d = 0.19). However, the magnitude of that sex difference was moderated by several factors, namely specific emotion, emotion type (negative, positive), sex of the actor, sensory modality (visual, audio, audio-visual) and age of the participants. Method of presentation (computer, slides, print, etc.), type of measurement (response time, accuracy) and year of publication did not significantly contribute to variance in effect sizes. These findings are discussed in the context of social and biological explanations of sex differences in emotion recognition.     

Mind-over-body beliefs in sport and exercise: A driving force for training volume and performance,but with risks for exercise addiction

We assume that athletic success is associated with certain beliefs that on the one hand promote performance-enhancing behavior (training volume), but on the other hand can also be detrimental to health (sports addiction). These beliefs are succinctly characterized by the title of the 9-item “Mind-over-Body” scale presented here. They are the three beliefs that 1) athletic performance requires a high level of effort, 2) that willpower plays an important role in athletic success, and 3) that athletic success requires pain tolerance. A total of six web-survey-based studies with a total of 1121 participants (approximately gender parity), including individuals with different levels of athletic performance (no competition; amateur sport; regional, national, or international competition), examined the psychometric network and construct and criterion validity of the MoB scale. Exploratory graph analyses, which included the studies with the largest sample sizes, showed that the three belief components (effort, willpower, pain) form separable communities within the MoB network and that the MoB items form communities distinct from self-control and self-efficacy. Meta-analyzed correlations across all six studies showed low positive correlations with self-control and self-efficacy. In terms of criterion validity, MoB beliefs were positively correlated with training volume and exercise addiction. We discuss MoBs as “on the edge of unhealthy” and place MOBs within a framework of related but distinct concepts.     

Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments.     

Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis

ObjectivesThis review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious.MethodsThe protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool.ResultsThe search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31–0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96–38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46–1.16), which were individualised (d = 0.62, 95% CI = 0.34–0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34–0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques.ConclusionsInterventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques.