Gymnastik- och idrottshögskolan, GIH

Background

Is exercise beneficial or detrimental for patients with stress-induced exhaustion disorder (ED)? While previousstudies have shown the benefits of exercise for various mental health conditions, its effects on ED —characterized by persistent fatigue following chronic psychosocial stress — remain underexplored.This study compares the effects of acute exercise on heart rate variability (HRV) and cortisol between patientswith ED and healthy controls across two exercise intensities. The results could provide insights into how EDinfluences the body’s ability to handle and recover from exercise.

Methods

We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Onseparate occasions, they performed 22-minute cycling sessions at either low or moderate intensity. Wemeasured HRV and salivary cortisol before, after, and 30 minutes after exercise. HRV measures RMSSD,LF/HF, and SD2/SD1 were analyzed. Exercise effects were assessed using linear mixed models.

Findings

RMSSD was significantly lower in the ED group than controls (p <0.05), but there was no difference in exerciseresponse between groups or intensities. SD2/SD1 and LF/HF values in response to exercise were higher in theED group (p <0.05), indicating increased sympathetic activation. This effect was particularly pronounced atmoderate intensity. There were no differences across groups, time, or intensity for cortisol.

Discussion

The findings indicate chronic dysregulation of the autonomic nervous system in individuals with ED, withaltered autonomic responses to exercise, slower recovery, and increased sympathetic activity post-exercise.These results can inform treatment strategies for ED patients.

Objectives: We investigated changes in weight, exercise frequency, and perceived health from the first to last health profile assessment (HPA) and between the number of tests within five years. We examined whether sociodemographic factors, or baseline values influenced these changes.

Methods: Data from 106 005 employees with ≥2 HPA (1990-2021) were included. Change between the first and last HPA within a five-year period was analyzed. Baseline age, sex, education, occupation, and baseline values of each outcome were included as predictors. XGBoost models assessed changes in the outcomes, and performance was evaluated via root mean squared error, mean absolute error, and R-squared. We employed Shapley Additive Explanations and forward marginal effects to interpret dose-response relationships and subgroup differences.

Results: Predictive performance was low, suggesting that the included variables only partially explained observed changes. Nonetheless, longer intervals between the first and last HPA correlated with greater weight gain, while a higher number of tests predicted slightly lower weight gain and modest improvements in perceived health and exercise frequency, compared to the average change. Younger participants had larger weight increases, whereas those with higher education showed smaller declines in exercise frequency.

Conclusions: Infrequent HPA alone did not appear to substantially influence the lifestyle-related factors studied. However, more frequent HPA, coupled with enhanced feedback and support, may yield small improvements in weight, perceived health, and exercise frequency compared to the average change.

BACKGROUND: Understanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.

AIMS: This study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.

METHODS: We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.

RESULTS: ED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.

CONCLUSIONS: A 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.

TRIAL REGISTRATION: The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022-04943-01.

Background: We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period.

Methods: Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models.

Results: Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress.

Conclusions: The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components.

Background: Internet-based Cognitive Behavior Therapy (ICBT) and mindfulness interventions are commonly used to treat elevated levels of stress. There are however few high-quality studies that examine ICBT with integrated mindfulness components for symptoms of stress and exhaustion, and the role of mindfulness exercises in digital treatment.

Method: The aim of the present study was to evaluate if a mindfulness-focused ICBT-program could reduce symptoms of stress and exhaustion, and increase quality of life, in a randomized controlled trial including 97 self-referred participants between 18 and 65 years who experienced elevated levels of stress.

Results: The intervention group had significantly reduced symptoms of stress and exhaustion, and increased quality of life, compared to the control group. Compared with the controls, participants in the intervention group showed a significant improvement with moderate to large effects on the primary outcome measure perceived stress (d = 0.79), and the secondary outcomes, exhaustion (d = 0.65), and quality of life (d = 0.40). Participants in the ICBT group also increased their level of mindfulness (d = 0.66) during the program. The amount of mindfulness training was significantly associated with an increased level of mindfulness, which in turn was significantly associated with reduced stress symptoms.

Conclusions: Mindfulness-focused ICBT can be an effective method to reduce stress-related mental health problems and the amount of mindfulness training seems to be of importance to increase the level of experienced mindfulness after treatment.

Aim: To study how change in cardiorespiratory fitness over time is associated with the development of poor self-rated health in healthy Swedish adults, and whether this association varies with sex, age, body mass index and cardiorespiratory fitness at baseline. A secondary aim was to study the influence of other predictors of self-rated health. Methods: A total of 98,718 participants (45% women, mean age 42.2 years) with two assessments from occupational health service screenings between 1988 and 2019 (mean duration 4.3 years), with good self-rated health at baseline were included. Cardiorespiratory fitness was assessed as estimated maximal oxygen consumption using submaximal cycle testing. Change in cardiorespiratory fitness was expressed as percentage annual change. Poor self-rated health at follow-up was defined as percieving self-rated health as 'poor' or 'very poor'. Results: A large decrease in cardiorespiratory fitness (⩾-3%) was associated with a 34% higher risk of poor self-rated health compared to maintainers (-1 to +1%) after multi-adjustment including change in body mass index, back/neck pain, stress, exercise habits and sleep quality or sleep problems. The associations for decreasers were stronger with longer follow-up time (>10 years). Preserving, or changing to, risk level for body mass index, back/neck pain, stress, exercise and sleep quality/problems were associated with a higher risk of poor self-rated health. Conclusions: Preserving or increasing cardiorespiratory fitness is associated with a lower risk of poor self-rated health, independently of change in other health-related variables, which may act as a protection against future poor self-rated health. This is of high clinical value, and strategies for maintaining or improving cardiorespiratory fitness have the potential to influence both disease and mortality.

Purpose: This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level.

Methods: Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis.

Results: The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult.

Conclusions: The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study.

Brain-derived neurotrophic factor (BDNF) and cortisol are both capable of modulating synaptic plasticity, but it is unknown how physical activity-induced changes in their plasma levels relate to corticospinal plasticity in humans. Sixteen inactive middle-aged men and women participated in three separate interventions consisting of 3hours prolonged sitting (SIT); 3hours sitting interrupted every 30minutes with frequent short physical activity breaks (FPA); and 2.5hours prolonged sitting followed by 25minutes of moderate intensity exercise (EXE). These 3hour sessions were each followed by a 30min period of paired associative stimulation over the primary motor cortex (PAS). Blood samples were taken and corticospinal excitability measured at baseline, pre PAS, 5min and 30min post PAS. Here we report levels of plasma BDNF and cortisol over three activity conditions and relate these levels to previously published changes in corticospinal excitability of a non-activated thumb muscle. There was no interaction between time and condition in BDNF, but cortisol levels were significantly higher after EXE compared to after SIT and FPA. Higher cortisol levels at pre PAS predicted larger increases in corticospinal excitability from baseline to all subsequent time points in the FPA condition only, while levels of BDNF at pre PAS did not predict such changes in any of the conditions. Neither BDNF nor cortisol modified changes from pre PAS to the subsequent time points, suggesting that the increased corticospinal excitability was not mediated though an augmented effect of the PAS protocol. The relationship between cortisol and plasticity has been suggested to be U-shaped. This is possibly why the moderately high levels of cortisol seen in the FPA condition were positively associated with changes AURC, while the higher cortisol levels seen after EXE were not. A better understanding of the mechanisms for how feasible physical activity breaks affect neuroplasticity can inform the theoretical framework for how work environments and schedules should be designed. DATA AVAILABILITY: Data are available from the corresponding author upon reasonable request.

Background: Behavior change research suggests that interventions addressing not only the individual, but also the environmental and organizational level might be more effective than those addressing only one. However, few RCTs have tried to change movement behavior among office workers with the aim of improving mental health outcomes, using multi-component interventions that address several levels. Above that, researchers seldomly assess acceptability, feasibility and fidelity of such complex interventions, even though they are considered important moderators of study outcomes. 

Purpose: This study aims at determining aspects of intervention acceptability, feasibility and fidelity of two multi-component cluster RCT interventions among office workers (N=263). Specifically, we want to answer: 

1. How did participants experience specific intervention components as facilitating or hindering a movement behavior change? 

2. Which factors in the work and non-work context did participants experience as facilitating or hindering a movement behavior change? 

3. Were intervention components implemented and perceived as intended? 

Methods The interventions addressed the individual level (counseling sessions based on cognitive behavior therapy and motivational interviewing), the environmental level (e.g. walking meetings or lunch walks organized by team leaders) and the organizational level (participation during work time, employers encouraging participation). One intervention focused on reducing sedentary behavior, the other on increasing physical activity, compared to a wait-list control group. After completion of the 6-month intervention period, audio-recorded interviews and focus group discussions were performed with participants, health coaches delivering the counseling sessions, team leaders and Human Resource staff). Verbatim transcribed data will be analyzed using thematic analysis (Braun&Clarke 2006). An initial codebook based on a-priori themes of interest will be created. Two researchers will apply it to a subset of transcripts, in an inductive fashion whilst allowing for new themes to emerge. Once agreement on a final version of the codebook will be achieved, remaining transcripts will be analyzed accordingly. 

Implications: We expect that the results of this study may help to understand and interpret the results of the quantitative effectiveness evaluations. This study may generate valuable knowledge that can inform future similar studies or workplace health promotion efforts and make their conduct more efficient. 

Background: To date it is unknown whether movement behavior change interventions among office workers are effective for improving mental health. Therefore, we designed a multi-component cluster RCT among office workers (N=263). One intervention group focused on reducing sedentary behavior (SED), the other on increasing moderate to vigorous physical activity (MVPA) compared to a wait-list control group. Based on ecological models of health behavior, intervention components addressed the individual (counseling using cognitive behavioral therapy (CBT) and motivational interviewing (MI)), the environmental (group activities such as lunch walks), and the organizational level (companies promoting the interventions internally). Primary outcomes were changes in accelerometer-measured and self-reported SED and MVPA, secondary outcomes were depression and anxiety symptoms, burnout, stress and mental well-being, assessed via validated, web- based questionnaires. Previous analyses using a compositional data analysis (CoDA) approach did not find intervention effects on 24-h movement behavior, i.e., SED, light intensity, moderate or vigorous physical activity. 

Purpose: This study aims at investigating intervention effects on mental health, i.e., depression and anxiety symptoms, burnout, stress and mental well-being. Secondary aims are to describe those participants that achieved a significant change in accelerometer- and device-measured SED and MVPA in comparison to those that did not, and to investigate whether changes in movement behavior were associated with changes in mental well-being. 

Methods: Linear mixed model analysis will be performed to analyze effects on mental health, according to the published study protocol. 

Performing exploratory analyses, quartiles of participants, based on changes in MVPA and SED, will be described on demographic characteristics and compared across quartiles. Change change analyses will investigate whether changes in SED or MVPA are associated with changes in mental well-being. CoDA will be applied, taking the co-dependence of 24-h movement behaviors into account. 

Implications: High sedentariness and sick-leave due to mental illness are challenges associated with office work. This RCT is the first among office workers that applies a multi-component approach to address several levels of health behavior, and that includes CBT and MI techniques. Results may inform occupational health and researcher efforts aiming at addressing the burden of sedentariness and its related consequences on mental health.