Objective To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. Design Systematic review and meta-analysis with meta-regression. Data sources The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). Eligibility criteria for selecting studies Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. Results Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=−0.946, 95% CI −1.18 to −0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=−0.998, 95% CI −1.39 to −0.61, k=20), supervised exercise interventions (SMD=−1.026, 95% CI −1.28 to −0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=−0.666, 95% CI −0.99 to −0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). Conclusion Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Meta-analyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors.

Background: Exposure to demands is normally considered to drain resources and threaten wellbeing. However, studies have indicated a resilience-strengthening role for stressors. Objectives: This paper introduces a unifying model, including five testable hypotheses regarding how resilience can be strengthened progressively via exposure to life-stressors. Methods: We review and synthesize relevant scholarship that underpins the Systematic Self-Reflection model of resilience-strengthening. Results: The model highlights the importance of a specific meta-cognitive skill (self-reflection on one’s initial stressor response) as a mechanism for strengthening resilience. The Systematic Self-Reflection model uniquely proposes five self-reflective practices critical in the on-going adaptation of three resilient capacities: (1) coping resources, (2) usage of coping and emotional regulatory repertoire, and (3) resilient beliefs. The self-reflective process is proposed to strengthen a person’s resilience by developing insight into their already-present capacities, the limitations of these capacities, and by stimulating the search for person-driven alternative approaches. Conclusion: This model extends the existing scholarship by proposing how the experience of stressors and adversity may have resilience-strengthening opportunities. The implication of this model is that engaging with stressors can have positive consequences for longer-term healthy emotional development if scaffolded in adaptive reflective practices.

Behaviour therapies have a well-established, useful tradition in psychological treatments and have undergone several major revisions. Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches are considered a third wave of behavioural therapies. Emerging evidence for ACT has demonstrated that this paradigm has promising effectiveness in improving functionality and well-being in a variety of populations that have psychological disturbances and/or medical problems. In this review we first evaluate traditional cognitive behavioural therapy (CBT) interventions used to manage psychological problems in distressed individuals who have sustained an acquired brain injury (ABI). We provide an overview of the ACT paradigm and the existent evidence base for this intervention. A rationale is outlined for why ACT-based interventions may have potential utility in assisting distressed individuals who have sustained a mild to moderate ABI to move forward with their lives. We also review emerging evidence that lends preliminary support to the implementation of acceptance and mindfulness-based interventions in the rehabilitation of ABI patient groups. On the basis of existent literature, we recommend that it is an opportune time for forthcoming research to rigorously test the efficacy of ACT-based interventions in facilitating ABI patient groups to re-engage in living a valued and meaningful life, in spite of their neurocognitive and physical limitations. The promising utility of testing the efficacy of the ACT paradigm in the context of multimodal rehabilitation programmes for ABI populations is also addressed.

Purpose National initiatives, such as the UK Improving Access to Psychological Therapies program (IAPT), demonstrate the feasibility of conducting empirical mental health assessments on a large scale, and similar initiatives exist in other countries. However, there is a lack of international consensus on which outcome domains are most salient to monitor treatment progress and how they should be measured. The aim of this project was to propose (1) an essential set of outcome domains relevant across countries and cultures, (2) a set of easily accessible patient-reported instruments, and (3) a psychometric approach to make scores from different instruments comparable. Methods Twenty-four experts, including ten health outcomes researchers, ten clinical experts from all continents, two patient advocates, and two ICHOM coordinators worked for seven months in a consensus building exercise to develop recommendations based on existing evidence using a structured consensus-driven modified Delphi technique. Results The group proposes to combine an assessment of potential outcome predictors at baseline (47 items: demographics, functional, clinical status, etc.), with repeated assessments of disease-specific symptoms during the treatment process (19 items: symptoms, side effects, etc.), and a comprehensive annual assessment of broader treatment outcomes (45 items: remission, absenteeism, etc.). Further, it is suggested reporting disease-specific symptoms for depression and anxiety on a standardized metric to increase comparability with other legacy instruments. All recommended instruments are provided online (www.ichom.org). Conclusion An international standard of health outcomes assessment has the potential to improve clinical decision making, enhance health care for the benefit of patients, and facilitate scientific knowledge.