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ObjectivesRefugees may have an increased risk of developing overweight/obesity as they often experience a nutritional transition. Because maintaining good cardiorespiratory fitness can help reduce the negative impact of excess weight on overall health, the objective of this study was to examine whether fitness moderates the relationship between weight status and cardiovascular and mental health outcomes in forcibly displaced individuals living in a Greek refugee camp.MethodsA sample of 142 forcibly displaced individuals were recruited. Cardiorespiratory fitness was assessed with the submaximal Åstrand-Rhyming bicycle ergometer test. Blood pressure, blood lipids, blood glucose, and hs-CRP were assessed as physical health outcomes, whereas post-traumatic stress disorder, depression and anxiety symptoms, pain, and quality of life were assessed as mental health outcomes. Main and interaction effects were tested via analyses of covariance (ANCOVAs).ResultsAlmost 50% of the participants were overweight/obese, more than 60% presented with very poor fitness levels, and the percentage of participants with very poor fitness levels was particularly high among overweight/obese participants. Whereas overweight/obesity was associated with a less favorable body composition and cardiovascular risk profile, poor fitness was associated with a higher percentage of body fat and a lower percentage of muscle mass. Cardiorespiratory fitness did not moderate the relationship between overweight/obesity and most of the assessed health outcomes.ConclusionsOnly limited support was found for the applicability of the fit-but-fat concept to our population of forcibly displaced individuals. Public health services should prioritize measures to prevent overweight/obesity and associated diseases in refugee camps. Moreover, efforts are needed to improve the fitness of camp residents via exercise/sport interventions.

BackgroundTo date, there are no official diagnostic criteria for the frequently reported phenomenon of exercise addiction. Therefore, the aim of the present study was to investigate how mental disorders, specifically depression and attention-deficit hyperactivity disorder (ADHD), are related to exercise addiction (EA).MethodsA total of 173 participants aged between 18 and 70 years, who reported exercising more than 10 h a week and continued to exercise despite injury or illness, answered questionnaires including the Exercise Dependence Scale, the Beck Depression Inventory, and the Homburger ADHD scale for adults. Multiple linear regression analyses were performed adjusting for relevant confounders (age, gender) and stepwise regression was used to identify which of the two mental disorders is the more influential predictor of EA.ResultsPearson correlation analysis showed that depressive symptoms [r (171) = 0.422, p

Abstract Muscular strength represents a specific component of health-related fitness. Hand grip strength is used as a simple and dynamic marker of maximum voluntary force of the hand and to estimate overall strength. Today, little is known about the relationship between grip strength and health in forcibly displaced populations. In the present study, we examined whether grip strength is associated with various health outcomes in a sample of forcibly displaced people living in a Greek refugee camp. The present analyses are part of a larger pragmatic randomized controlled trial. In this paper, cross-sectional baseline data of 143 participants (71 men, 72 women) will be presented. In addition to grip strength, the following physical and mental health outcomes were assessed: body weight and body composition, blood pressure, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, blood glucose levels (HbA1c), post-traumatic stress disorder (PTSD) symptoms, depressive and anxiety symptoms, pain, and quality of life. Linear regression analyses were carried out to examine how grip strength is associated with the health outcomes, separately for absolute and normalized grip strength scores. Grip strength was positively and strongly associated with percentage muscle mass (normalized grip strength: Stand. B = 0.58, p

Background: The metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components. Methods: We conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling. Results: In total, 62.7 % of participants presented with low cardiorespiratory fitness levels (

Background: People at risk of exercise addiction report increased symptoms of psychopathology. The aim of this study was to clinically assess the lifetime prevalence of depressive disorders in individuals at risk of exercise addiction and to determine whether depressive symptoms tend to precede or follow excessive exercising. Methods: Based on the Exercise Dependence Scale-21, a total of 31 individuals categorized at risk of exercise addiction underwent the Structured Clinical Interview for DSM-5 to assess major depressive disorder (MDD). Findings: The results showed 16 of the 31 participants suffered from MDD. The onset of MMD occurred in 10 participants after excessive exercising and in 5 before excessive exercising. In one participant, the symptom onset was unclear. Conclusion: MDD is far more prevalent in patients with exercise addiction compared to the general population and develops more often after the beginning of exercise addiction. Caution in the use of exercise to treat depression may be warranted

BackgroundForcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO’s call for evidence-based public health policies and programs for forcibly displaced people.MethodsWe conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake.ResultsThe prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002).ConclusionThere is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.

Abstract Background Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. Therefore, the risk of psychiatric disorders is markedly increased among international refugees. International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With patients with post-traumatic stress disorders (PTSD), very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent. Methods We intend to implement a pragmatic randomized controlled trial (RCT) with an exercise and sport intervention group (n = 68, 50% women) and a wait-list control group (n = 68, 50% women) in the Koutsochero refugee camp, located close to the city of Larissa (Greece). During the RCT, exercise and sport will be offered five times per week (60 min/session) for 10 weeks. Participants will be asked to participate in at least two sessions per week. The programme is developed according to the participants’ needs and preferences and they will be able to choose between a range of activities. PTSD symptoms will serve as primary outcome, and several secondary outcomes will be assessed. Qualitative data collection methods will be used to gain a more in-depth appraisal of the participants’ perception of the intervention programme. In the second year of study, the programme will be opened to all camp residents. A strategy will be developed how the programme can be continued after the end of the funding period, and how the programme can be scaled up beyond the borders of the Koutsochero camp. Discussion By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of refugee camp residents in Greece. Our findings may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle. Trial registration The study was registered prospectively on the 8 February 2021 with ISRCTN https://www.isrctn.com/ISRCTN16291983

Abstract Background While exercise and physical activity are important parts of a healthy life, there is evidence that some individuals exercise to a degree which may jeopardize their health. These individuals may in some cases be exercising to lose weight or compensate binge eating episodes as part of an eating disorder. Others may experience an addiction-like relationship with exercise. Fitness center employees are ideally placed to observe these forms of unhealthy behavior, and are responsible for ensuring that clients do not put themselves at undue risk; however, to date, no study has addressed both eating disorders and excessive exercise. Therefore, the aim of our study is to determine whether these employees report incidences of these issues, and if they believe they can differentiate between them. Methods One-hundred-and-forty fitness centers in the German-speaking regions of Switzerland were contacted. Of these, 99 employees (60 men, 39 women, Mage = 33.33 years, SD = 12.02) responded to an online questionnaire. The questionnaire briefly described the two issues of interest (eating disorders and excessive exercise), and then invited respondents to complete a number of questions detailing whether they had experience with these issues, and how they dealt with them. Results Approximately 75% of the employees had suspected a client of having an eating disorder or exercising excessively, and 65% of these respondents confronted the client at least once. Interestingly, respondents reported clearly that they felt able to differentiate between the two types of disorder. Older respondents were significantly more likely to have suspicions and act on them. However, less than half of the respondents were aware of guidelines addressing this issue, and the majority desired more information about how to identify and address both disorders. Conclusions Swiss fitness center employees frequently encounter individuals who they suspect of exercising excessively, or suffering from an eating disorder. While they often confront these individuals, they would like more detailed information about how to manage this process. Given that both disorders can potentially lead to severe health consequences, a detailed description of symptoms, management techniques and resources should be a feature in all Swiss fitness center guidelines.

BackgroundExercise addiction is increasingly being recognized as a psychologically and physically burdensome set of symptoms. However, little is known about the psychiatric profiles of individuals who are at risk. It is well-established that individuals affected by substance use disorders frequently suffer from depression, attention deficit hyperactivity disorder (ADHD), and experiences of childhood trauma. The aim of this study is to determine whether this pattern of psychiatric disturbance is also present in individuals at risk for exercise addiction.MethodsIndividuals exercising for 10+ h/week were divided into those at risk and not at risk for exercise addiction based on their scores on the Exercise Dependence Scale (EDS). Demographic data and scores on the Beck Depression Inventory (BDI), a measure for ADHD in adults and the Childhood Trauma Questionnaire (CTQ) were also gathered.ResultsOne hundred and twenty-three individuals agreed to participate in the study, and completed the questionnaires. Twenty-nine (23.6%) of these individuals were classed as at risk for exercise addiction. There was a statistically significant difference between the at-risk and not at-risk groups on the combined dependent variable after controlling for hours of exercise per week, F(3, 95)= 10.198, p = 0.00, Wilk's Λ = 0.756, partial η2 = 0.244. Compared to those not at risk, individuals at risk for exercise addiction had significantly higher scores for symptoms of depression [t(121) = 4.944, p = 0.000], ADHD [t(121) = 2.915, p = 0.004], and childhood trauma [t(121) = 2.297, p = 0.024].ConclusionOur results suggest that exercise addiction may be accompanied by a disturbed psychiatric profile consistent with other addictive disorders. Clinical interviewing in individuals at risk for exercise addiction is a valuable and worthwhile next step in characterizing this phenomenon.

Background and Aims: Exercise addiction has not yet been designated as an addictive disorder in the DSM-5 due to a lack of detailed research. In particular, associations with other psychiatric diagnoses have received little attention. In this study, individuals with a possible exercise addiction are clinically assessed, in order to establish a profile of co-occurring psychiatric disorders in individuals with exercise addiction.Methods: One hundred and fifty-six individuals who reported exercising more than 10 h a week, and continued to do so despite illness or injury, were recruited for the study. Those who met the cut-off of the Exercise Dependence Scale (n = 32) were invited to participate in a screening with the Structured Clinical Interview for DSM-5 (SCID-5-CV) and personality disorders (SCID-5-PD). Additionally, an interview based on the DSM-5 criteria of non-substance-related addictive disorders was conducted to explore the severity of exercise addiction symptoms.Results: 75% of participants fulfilled the criteria for at least one psychiatric disorder. Depressive disorders (56.3%), personality disorders (46.9%) and obsessive-compulsive disorders (31.3%) were the most common disorders. Moreover, there was a significant positive correlation between the number of psychiatric disorders and the severity of exercise addiction (r = 0.549, p = 0.002).Discussion: The results showed a variety of mental disorders in individuals with exercise addiction and a correlation between the co-occurrence of mental disorders and the severity of exercise addiction. Exercise addiction differs from other addictive und substance use disorders, as obsessive-compulsive (Cluster C), rather than impulsive (Cluster B) personality traits were most commonly identified.Conclusions: Our results underscore the importance of clinical diagnostics, and indicate that treatment options for individuals with exercise addiction are required. However, the natural history and specific challenges of exercise addiction must be studied in more detail.

Coronary artery disease (CAD) remains the leading cause of death worldwide. Expanding patients' metabolic phenotyping beyond clinical chemistry investigations could lead to earlier recognition of disease onset and better prevention strategies. Additionally, metabolic phenotyping, at the molecular species level, contributes to unravel the roles of metabolites in disease development. In this cross-sectional study, we investigated clinically healthy individuals (n = 116, 65% male, 70.8 ± 8.7 years) and patients with CAD (n = 54, 91% male, 67.0 ± 11.5 years) of the COmPLETE study. We applied a high-coverage quantitative liquid chromatography-mass spectrometry approach to acquire a comprehensive profile of serum acylcarnitines, free carnitine and branched-chain amino acids (BCAAs), as markers of mitochondrial health and energy homeostasis. Multivariable linear regression analyses, adjusted for confounders, were conducted to assess associations between metabolites and CAD phenotype. In total, 20 short-, medium- and long-chain acylcarnitine species, along with L-carnitine, valine and isoleucine were found to be significantly (adjusted p ≤ 0.05) and positively associated with CAD. For 17 acylcarnitine species, associations became stronger as the number of affected coronary arteries increased. This implies that circulating acylcarnitine levels reflect CAD severity and might play a role in future patients' stratification strategies. Altogether, CAD is characterized by elevated serum acylcarnitine and BCAA levels, which indicates mitochondrial imbalance between fatty acid and glucose oxidation.

Background: Preliminary evidence among adults suggests that the ways in which individuals think about their physical activity (PA) behavior is more closely associated with their well-being than self-reported PA. This study therefore aimed to examine whether and how self-reported PA and personal beliefs about sufficient PA are associated with sleep and psychological functioning in a sample of Swiss adolescents, using both cross-sectional and prospective data. Methods: An overall sample of 864 vocational students (368 girls, 17.98 ± 1.36 years, mean ± SD) was followed prospectively over a 10-month period. At each measurement occasion, participants filled in a series of self-report questionnaires to assess their PA levels, their personal beliefs about whether or not they engage in sufficient PA, sleep (insomnia symptoms, sleep quality, sleep-onset latency, and number of awakenings), and psychological functioning (depressive symptoms, quality of life, perceived stress, and mental toughness). Results: Adolescents who believe that they are sufficiently physically active to maintain good health reported more restoring sleep. No differences in sleep were found between adolescents who meet PA recommendations vs. those who do not. Additionally, adolescents who believe that they were sufficiently physically active also reported better psychological functioning. This close relationship between adolescents’ beliefs about their PA involvement and their sleep and psychological functioning was corroborated in the prospective analyses. Conclusion: Cognitive factors should be studied more intensively when elucidating the relationship among PA, sleep, and psychological functioning in young people, particularly when aiming to develop new exercise interventions targeting psychological outcomes. Keywords: Adolescents, Beliefs, Mental health, Physical activity, Psychological well-being, Public health recommendations, Sleep

Abstract Background Numerous studies suggest that exercise may be an effective adjunct treatment for substance use disorders. It has been suggested that exercise-induced improvements in inhibitory control may reduce craving for the substance of abuse. However, this potential mechanism has seldom been researched. Objectives The aim of the ExAlCo Study is to examine how acute bouts of exercise, at varying intensities, impact on craving for cocaine or alcohol. Cerebral haemodynamic responses during cognitive tests of inhibitory control, and exposure to substance-related cue imagery, will also be assessed using functional near-infrared spectroscopy. Design The study is a crossover randomised controlled trial. Participants will be recruited from inpatient and outpatient psychiatric treatment centres, on the approval of their treating physician. A healthy control group will be recruited using online advertising. All participants will undergo each of three conditions in randomised order: 20 min of cycle ergometry at 50–60% of maximum heart rate; 20 min of exercise at 70–80% of maximum heart rate; and 20 min of quiet reading. Immediately before and after each condition, participants will be asked to complete a computerised Stroop test, watch a film containing substance-related images and self-report craving levels. During the Stroop test and film viewing, participants’ neural activity will be measured via functional near-infrared spectroscopy. Outcomes The primary outcome measures are self-reported craving, inhibitory control and cerebral haemodynamic response to the Stroop test and a substance-related film. It is hoped that the findings from this study will shed more light on the role of exercise in the treatment of substance use disorders, particularly its scope in preventing relapse through reduced craving severity. Trial registration ClinicalTrials.gov, NCT03502486. Registered retrospectively on 5 April 2018.

Introduction: Exercise addiction is one of several behavioral addictions which has not yet been designated as an addictive disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). This is in part due to a lack of clarity concerning co-occurring mental disorders of individuals at risk for exercise addiction. The aim of this review is to summarise the spectrum of psychopathology in populations at risk of exercise addiction. Methods: The MEDLINE, Web of Science and PsycINFO databases were searched. All studies from the date of database creation until February 2020 were considered eligible. Terms used were “exercise addiction” and other mental disorders mentioned in conjunction with substance-related and addictive disorders. Studies were included if they assessed risk for exercise addiction and at least one other mental disorder. Results: Twenty studies were included. The disorders assessed were eating disorders (n = 14), depression (n = 6), anxiety (n = 4), other substance-related and addictive disorders (n = 5), and borderline personality disorder (n = 1). In thirteen of the studies, evidence was found for higher rates of at least one mental disorder (most commonly eating disorders, anxiety and other addictive disorders) in individuals at risk for exercise addiction, compared to those not at risk. Conclusions: Individuals at risk for exercise addiction show a broad range of mental disorders as assessed by self-report, which is in line with sufferers of other addictive disorders. Systematic psychological and clinical assessments in those at risk of exercise addiction are worthwhile, and will serve to characterize the mental health problems of individuals suffering from exercise addiction.

BackgroundHigh psychosocial stress can impair executive function in adolescents, whereas acute exercise has been reported to benefit this cognitive domain. The aim of this study was to investigate whether an acute bout of aerobic exercise improves the inhibitory aspect of executive function and the associated dorsolateral prefrontal cortex (DLPFC) oxygenation when under stress.MethodsSixty male high school students aged 16–20 years performed a Stroop task (baseline condition) and were randomly assigned to an exercise group (30 min on ergometer at 70% of maximum heart rate) and a control group (30 min of reading). Subsequently, all participants underwent a modified Trier Social Stress Test, which included a Stroop task under enhanced stress. The Stroop tasks in both conditions were combined with functional near-infrared spectroscopy to record changes in DLPFC oxygenation in response to the tasks. Stress reactivity was measured with saliva samples (cortisol, alpha-amylase), heart rate monitoring, and anxiety scores.ResultsAll stress parameters indicated increases in response to the stressor (p < 0.001), with higher alpha-amylase [t(58) = −3.45, p = 0.001, d = 1.93] and anxiety [t(58) = −2.04, p = 0.046, d = 0.53] reactions in the control compared to the exercise group. Controlling for these two parameters, repeated measures analyses of covariance targeting changes in Stroop interference scores showed no main effect of stress [F(1,58) = 3.80, p = 0.056, ηp2 = 0.063] and no stress × group interaction [F(1,58) = 0.43, p = 0.517, ηp2 = 0.008]. Similarly, there was no main effect of stress [F(1,58) = 2.38, p = 0.128, ηp2 = 0.040] and no stress × group interaction [F(1,58) = 2.80, p = 0.100, ηp2 = 0.047] for DLPFC oxygenation.ConclusionOur study confirms potentially health-enhancing effects of acute exercise on some of the physiological and psychological stress reactivity indicators. However, our data do not support the notion of an effect on interference control and DLPFC activation under stress.

Background and Aims: While a number of studies have reported on individuals who exercise excessively, and feel unable to stop despite negative consequences, there is still insufficient evidence to categorize exercise as an addictive disorder. The aim of this meta-review is to summarize the published articles and to compile a list of symptoms reported in the qualitative literature in conjunction with excessive exercise. This list is compared with the DSM-5 criteria for gambling disorder, and initial diagnostic criteria for exercise addiction are suggested.Methods: The databases MEDLINE, Web of Science and PsycInfo were searched for qualitative studies or case reports, in which excessive exercise was the main focus. All symptoms reported in conjunction with excessive exercise were extracted from each study and documented. Symptoms were also compared to the diagnostic criteria for gambling disorder.Results: Seventeen studies were included in the review, yielding 56 distinct symptoms. The Critical Appraisal Skills Program tool showed that the majority of the studies were of acceptable quality. Exercise-related symptoms corresponded with seven of the nine DSM-5 criteria for gambling disorder. The ten suggested criteria for exercise addiction are: increasing volume, negative affect, inability to reduce, preoccupation, exercise as coping, continuation despite illness/injury, minimization, jeopardized relationships, continuation despite recognizing consequences, guilt when exercise is missed.Discussion: Our results suggest that excessive exercise may constitute a behavioral addiction, based on the criteria of the DSM-5.Conclusions: Subsequent studies should aim to systematically classify symptoms of excessive exercise; in addition, it should be noted that basic questionnaires may be need to be supplemented with detailed clinical examinations.

High levels of cardiorespiratory fitness have the potential to buffer against physical and mental health impairments, which can result from exposure to occupational stress. Police officers are especially at risk of high psychosocial stress; therefore, effective intervention strategies are warranted. Given this background, the purpose of the present study was to examine whether police officers with different levels of cardiorespiratory fitness differ with regard to their (a) physiological stress reactivity during acute real-life stress situations, and (b) physiological recovery related to acute and chronic work stress. In total, 201 police officers took part in this study (M = 38.6 years, SD = 10.1, 35.8% females). Officers were contacted eight times on a smartphone during their workday, and asked to report their current level of positive and negative affect, as well as feelings of stress and anger. Physiological stress responses and recovery (heart rate variability) were assessed using Movisens EcgMove3 devices. The Åstrand bicycle ergometer test was used to assess participants' cardiorespiratory fitness. Chronic work stress was assessed using the effort-reward imbalance model and the job strain model. Multilevel modeling was used to test buffering effects of cardiorespiratory fitness on physiological stress reactivity. Linear regression was applied to test stress-buffering effects of cardiorespiratory fitness on physiological recovery. Results showed lowered physiological stress reactivity to acute work stress in officers with higher levels of cardiorespiratory fitness. However, these results were not consistent, with no effects occurring for feelings of anger, positive affect, and negative affect. Chronic work stress (effort-reward imbalance) was related to lower physiological recovery. Cardiorespiratory fitness was positively related to physiological recovery. Data did not support interactions between work stress and cardiorespiratory fitness on physiological recovery. To some extent, cardiorespiratory fitness seems to have the potential to buffer stress reactivity in police officers in acute stress situations. Therefore, we encourage promoting fitness programs which aim to enhance cardiorespiratory fitness in stressful occupations such as law enforcement. Improvements in cardiorespiratory fitness might further enhance physiological recovery from chronic work stress, which is thought to improve cardiovascular health.

Metabolic syndrome (MetS) is a worldwide health concern related to cardiovascular disease. Stress at work increases the risk for MetS, whereas physical activity and cardiorespiratory fitness (CF) have been shown to be potential buffers against stress. The aim of this study was to test the stress-buffering effects of physical activity and CF on the relationship between work stress and MetS. In a prospective study, we followed 97 police officers (mean age = 39.7 years; mean body mass index = 25.74 kg/m2) over one year and assessed MetS, as defined by the National Cholesterol Education Program Adult Treatment Panel III. Stress at work was measured with the Job Content Questionnaire, as well as the Effort-Reward Imbalance Questionnaire. Physical activity was assessed objectively via 7-day accelerometry. CF was assessed with the Åstrand bicycle ergometer test. Hierarchical linear regression models were carried out to predict MetS at follow-up (mean overall MetS score = 1.22), after controlling for baseline levels and sociodemographic background (mean overall MetS score = 1.19). Higher CF levels were significantly associated with lower MetS risk at follow-up (β = -.38). By contrast, no main effects were found for physical activity and work stress. However, high effort and demand were significantly correlated with increased blood pressure (effort: r = .23 for systolic blood pressure; r = .21 for diastolic blood pressure) and waist circumference (effort: r = .26; demand: r = .23). Moreover, no significant interaction effects occurred between work stress and CF/physical activity. The results emphasize the importance of high levels of CF in the prevention of MetS in police officers. Accordingly, provision of regular training opportunities and repeated CF testing should be considered as a strategy in overall corporate health promotion.

Abstract Background In Switzerland, research with identifiable human tissue samples, and/or its accompanying data, must be approved by a research ethics committee (REC) before it can be allowed to take place. However, as the demand for such tissue has rapidly increased in recent years, and biobanks have been created to meet these needs, committees have had to deal with a growing number of such demands. Detailed instructions for evaluating every kind of tissue request are scarce. Committees charged with evaluating research protocols therefore sometimes face uncertainty in their decision-making. Methods We examine how a pool of Swiss REC members deal with a number of cases involving human tissue, in order to determine the standards they adhere to, and their understanding and implementation of existing laws and guidelines. Results There is considerable divergence in the approaches and decisions of Swiss REC members regarding human tissue sample requests, particularly concerning the issue of informed consent. Despite recent trends towards less strict consent requirements for biosample research, many of our respondents continue to employ demanding standards for researchers. The question of informed consent, and the circumstances in which it is required, continues to result in differences of opinion. Conclusions While room for local and cultural interpretation is essential to the workings of an REC, misunderstanding of existing guidelines, or an absence of regulation in sensitive areas, will only lead to suboptimal functioning of the REC itself. Our data suggests that there is uncertainty and disagreement on the question of consent for human tissue sample, which existing laws and guidelines may not fully clarify. Methods to address these uncertainties should be implemented in order to ensure efficient and harmonious review of research protocols.

Abstract Background Burnout has long been understood as work-related physical, emotional, and cognitive exhaustion. However, burnout symptoms can also be found among younger people, including school-aged adolescents. While the Shirom-Melamed Burnout Measure (SMBM) is a widely applied instrument, its psychometric properties have not yet been investigated in adolescent populations. We therefore examined the psychometric properties of the SMBM in three independent samples of adolescents. Methods In total, 249 high school students, 144 vocational students, and 257 adolescent elite athletes completed the SMBM, along with questionnaires related to perceived stress, depressive symptoms, and life satisfaction. Descriptive statistics, gender differences, and internal consistency, convergent/discriminant validity, and factorial validity (including measurement invariance across genders) were examined in each sample. Results The SMBM had adequate internal consistency. Confirmatory factor analyses showed that both a first- and second-order model achieve good model fit. Moreover, evidence for sufficient convergent and discriminant validity was found. Finally, in two of the three samples, female adolescents reported higher SMBM scores. Conclusions The SMBM has been widely used in international burnout research. However, this is the first study providing empirical evidence that the SMBM has acceptable psychometric properties and satisfactory convergent/discriminant and factorial validity among young people. The SMBM is a concise and economic tool to assess self-rated symptoms of burnout, and presents a valuable alternative to existing school burnout inventories. In particular, the SMBM can facilitate the investigation of the transition of young people from school to working life.

Cardiometabolic diseases (CMD) represent a growing socioeconomic burden and concern for healthcare systems worldwide. Improving patients’ metabolic phenotyping in clinical practice will enable clinicians to better tailor prevention and treatment strategy to individual needs. Recently, elevated levels of specific lipid species, known as ceramides, were shown to predict cardiometabolic outcomes beyond traditional biomarkers such as cholesterol. Preliminary data showed that physical activity, a potent, low-cost, and patient-empowering means to reduce CMD-related burden, influences ceramide levels. While a single bout of physical exercise increases circulating and muscular ceramide levels, regular exercise reduces ceramide content. Additionally, several ceramide species have been reported to be negatively associated with cardiorespiratory fitness, which is a potent health marker reflecting training level. Thus, regular exercise could optimize cardiometabolic health, partly by reversing altered ceramide profiles. This short review provides an overview of ceramide metabolism and its role in cardiometabolic health and diseases, before presenting the effects of exercise on ceramides in humans.

Burnout is considered an occupation-related psychological syndrome consisting of emotional, physical, and cognitive exhaustion. To assess dimensions of burnout, the Shirom–Melamed Burnout Measure (SMBM) is widely used, but its validity and reliability have rarely been examined in adult samples. The aim of this study is to examine the psychometric properties of the German version of the SMBM in two independent samples of adults. In total, 311 adult workers and 201 police officers completed the SMBM, and questionnaires related to perceived stress and mental well-being. Descriptive statistics, internal consistency, convergent validity, and factorial validity were assessed for both samples, separately for male and female participants. The German SMBM had adequate psychometric properties and sufficient convergent validity. In confirmatory factor analyses, we found a good fit for both the first- and second-order model. Furthermore, measurement invariance across gender was observed in both samples. Although the SMBM is a popular instrument among burnout researchers, this study demonstrates for the first time that the SMBM can be considered a valid and reliable tool to assess burnout symptoms in both male and female adults and across different professional groups. Furthermore, with its 14 items, the SMBM is a succinct and economic self-assessment tool for symptoms of burnout.

Background: Restoring sleep is associated with favorable cognitive, emotional, and behavioral adaptations. As regards the association between sleep duration and facial emotion recognition (FER), results are conflicting, and as regards the association between symptoms of insomnia and FER, no study has been performed so far. Accordingly, the aim of the present study was to investigate whether subjective sleep was associated with FER, along with perceived stress and mental toughness.Method: A total of 201 police officers (mean age = 38.5 years, 64.2% males) took part in the present cross-sectional study. They completed questionnaires covering socio-demographic data, subjective symptoms of insomnia, perceived stress, and mental toughness. Further, they underwent a computerized FER test, consisting of facial emotion labeling and facial emotion matching.Results: Performance of FER (accuracy, speed) was unrelated to subjective symptoms of insomnia. Lower FER was associated with higher age, but not to perceived stress or mental toughness. No gender differences were observed. Higher symptoms of insomnia were associated with higher stress scores and lower scores of mental toughness.Conclusions: The pattern of results suggests that FER was not associated with symptoms of insomnia, understood as a proxy of sleep quality, among adults. This observation replicates those studies showing a zero-association between sleep and FER.

Background: In the past 3 decades, there has been an increase in the number of studies assessing exercise as a form of treatment for substance use disorders (SUDs). While a variety of substance types and outcomes have been assessed, exercise intensities have never been systematically examined. Consequently, it remains unclear whether particular forms of exercise are better suited to the treatment of these populations. Anaerobic exercise has been shown to have positive effects in populations with psychiatric disorders, but its effectiveness in the treatment of SUDs has to date not been reviewed.Methods: The aim of this systematic review is to identify and evaluate studies which have employed either an acute or chronic anaerobic exercise component as a therapy modality for SUDs. The primary outcomes are abstinence, craving, withdrawal, consumption, quality of life, and the following psychological symptoms and disorders: depression, anxiety, stress, and mood. A secondary objective is to assess whether the type of training described in the study protocol can be reliably categorized as anaerobic training.Results: Twenty-six studies are included in this review. Twelve studies addressed nicotine dependence, one addressed alcohol dependence, and 13 addressed dependence on various illicit drugs. Thirteen studies reported the intensity at which participants actually exercised, but only one employed a test to determine whether training was carried out above the anaerobic threshold (AT). The risk of bias in the included studies was generally high. Results of the studies were mixed, with the most positive effects being found for abstinence in nicotine dependence.Conclusion: The evidence for the effects of anaerobic exercise in SUDs is weak, although a tendency toward positive effects on abstinence in nicotine dependent individuals was observable. The majority of studies do not report data on exercise intensity, making a categorization of anaerobic exercise impossible in all but one case. This means that the effects of this form of exercise cannot be determined, and therefore not evaluated or compared with other forms. In order to improve the quality of evidence for exercise in SUD treatment, clearly defined and objectively assessed evaluations of anaerobic and anaerobic exercise are necessary.

As ageing is a major risk factor for the development of non-communicable diseases, extending healthspan has become a medical and societal necessity. Precise lipid phenotyping that captures metabolic individuality could support healthspan extension strategies. This study applied ‘omic-scale lipid profiling to characterise sex-specific age-related differences in the serum lipidome composition of healthy humans. A subset of the COmPLETE-Health study, composed of 73 young (25.2 ± 2.6 years, 43% female) and 77 aged (73.5 ± 2.3 years, 48% female) clinically healthy individuals, was investigated, using an untargeted liquid chromatography high-resolution mass spectrometry approach. Compared to their younger counterparts, aged females and males exhibited significant higher levels in 138 and 107 lipid species representing 15 and 13 distinct subclasses, respectively. Percentage of difference ranged from 5.8% to 61.7% (females) and from 5.3% to 46.0% (males), with sphingolipid and glycerophophospholipid species displaying the greatest amplitudes. Remarkably, specific sphingolipid and glycerophospholipid species, previously described as cardiometabolically favourable, were found elevated in aged individuals. Furthermore, specific ether-glycerophospholipid and lyso-glycerophosphocholine species displayed higher levels in aged females only, revealing a more favourable lipidome evolution in females. Altogether, age determined the circulating lipidome composition, while lipid species analysis revealed additional findings that were not observed at the subclass level.

Psychosocial stress has negative effects on cognition in adolescents. The aim of this study was to investigate whether physical exercise can buffer such effects on inhibitory control and associated cortical brain areas. Forty-two male high school students aged 16–20 years and with either low or high exercise levels performed a Stroop task under stress-free conditions and after the Trier Social Stress Test (TSST). Oxygenation of the dorsolateral prefrontal cortex (DLPFC) was measured with functional near-infrared spectroscopy. For inhibitory control, there was no significant primary effect of condition (F(1,40) = 1.09, p = 303., ηp² = 0.027) and no significant condition × group interaction (F(1,40) = 2.40, p = 0.129, ηp² = 0.057). For DLPFC oxygenation, a significant primary effect of condition was observed (F (1,38) = 6.10, p = 0.018, ηp² = 0.138). However, the condition × group interaction (F (1,38) = 0.05, p = 0.823, ηp² = 0.001) remained not significant. Adolescents’ exercise level was not associated with inhibitory control before and after stress. An impact of stress on a neurocognitive level was observed.

Background: Few studies have tested whether the stress-buffering effects of leisure-time physical activity (LTPA) depend on other resources, such as the satisfaction of basic psychological needs. Therefore, the present study examines the interaction between perceived stress, LTPA and psychological need satisfaction (PNS) on occupational burnout symptoms in a sample of Swiss workers.Methods: The sample consisted of 306 employees (48% women; Mage = 42.9 years, SD = 14.1). Perceived stress was assessed with the Perceived Stress Scale, LTPA with the International Physical Activity Questionnaire, PNS (autonomy, relatedness, and competence) with the Need Satisfaction Scale, and occupational burnout symptoms with the Shirom-Melamed Burnout Measure. A hierarchical regression analysis and single slopes tests were performed to examine two- and three-way interactions.Results: Stress was positively correlated with burnout, and negatively correlated with LTPA and PNS levels. LTPA was positively associated with PNS, and negatively correlated with burnout. A negative association existed between PNS and burnout. In the hierarchical regression analysis, all main effects, two- and three-way interactions were significant. People who engaged in more LTPA reported fewer burnout symptoms, if they reported high stress. However, the potential of LTPA to buffer stress was particularly evident in participants who reported low PNS.Conclusion: If adult workers are exposed to elevated stress, they are particularly likely to show increased burnout levels if they report low LTPA in combination with low PNS, specifically a lack of autonomy, competence and relatedness.

Background: People with mental disorders engage in sedentary behaviors more often than their healthy counterparts. In Switzerland, nearly all psychiatric hospitals offer structured exercise and sport therapy as part of their standard therapeutic treatment. However, little is known about the degree to which psychiatric patients make use of these treatment offers. The aim of this study is to examine, in a sample of psychiatric in-patients (a) how many participate in the structured exercise and sport therapy programs offered by the clinic, (b) how many engage in exercise and sport activities on an individual basis, and (c) how many meet recommended levels of health-enhancing physical activity during their stay at the clinic. Furthermore, we examine whether those who engage in exercise and sport activities are more likely to meet internationally accepted physical activity recommendations.Methods: 107 psychiatric in-patients (49% women, Mage = 39.9 years) were recruited at three psychiatric clinics in the German-speaking part of Switzerland. All participants were engaged in treatment and received usual care. Based on accelerometer data, participants were classified as either meeting or not meeting physical activity recommendations (≥150 min of moderate-to-vigorous physical activity per week). Participation in structured and individually performed exercise and sport activities was assessed with the Simple Physical Activity Questionnaire.Results: In total, 57% of all patients met physical activity recommendations. 55% participated in structured exercise and sport therapy activities, whereas only 22% of all patients engaged in exercise and sport activities independently. Psychiatric patients were significantly more likely to meet recommended levels of health-enhancing physical activity if they engaged in at least 60 min per week of structured exercise and sport therapy or in at least 30 min of individually performed exercise and sport activity.Conclusions: Given that prolonged immobilization and sedentary behavior have harmful effects on patients' physical and mental well-being, promoting exercise and sport activities is an important endeavor in psychiatric care. Clinics currently succeed in involving between 50 and 60% of all patients in sufficient physical activity. While this is encouraging, more systematic efforts are needed to ensure that all patients get enough physical activity.

Background: Studies at the macro level (such as longer-term interventions) showed that physical activity impacts positively on cognitive-emotional processes of patients with mental disorders. However, research focusing on the immediate impact of acute bouts of exercise (micro level) are missing. The aim of the present study was therefore to investigate whether and to what extent single bouts of moderately intense exercise can influence dimensions of psychological functioning in inpatients with mental disorders.Method: 129 inpatients (mean age: 38.16 years; 50.4% females) took part and completed a questionnaire both immediately before and immediately after exercising. Thirty inpatients completed the questionnaires a second time in the same week. The questionnaire covered socio-demographic and illness-related information. Further, the questionnaire asked about current psychological states such as mood, rumination, social interactions, and attention, tiredness, and physical strengths as a proxy of physiological states.Results: Psychological states improved from pre- to post-session. Improvements were observed for mood, social interactions, attention, and physical strengths. Likewise, rumination and tiredness decreased. Mood, rumination, and tiredness further improved, when patients completed the questionnaires the second time in the same week.Conclusion: At micro level, single bouts of exercise impacted positively on cognitive-emotional processes such as mood, rumination, attention and social interactions, and physiological states of tiredness and physical strengths among inpatients with mental disorders. In addition, further improvements were observed, if patients participated in physical activities a second time.

It has come to our attention that in the original article [1] information regarding dates was omitted. The data in this study were obtained in Switzerland four years before the entering into force of the new Swiss Human Research Act in 2014, when the guidelines of the Swiss Academy of Medical Sciences (SAMS) ceased to apply. It is important for readers to know that at the time of the study there was no binding law in Switzerland, only the more open SAMS guidelines that have a different legal status. We would expect to find less variation of opinions among research ethics committee members if the study were repeated after the federal law came into force.