Association between Meeting 24-Hour Movement Guidelines and Psychological Features of Chinese Emerging Adults

Background:Emerging adulthood is a pivotal life stage,presenting significant psychological and social changes,such as decreased sociability,depression,and other mental health problems.Previous studies have associated these changes with an unhealthy lifestyle.The 24-h movement guidelines for healthy lifestyles have been developed to promote appropriate health behaviors and improve individual wellness.However,the relationship between adherence to the 24-h movement guidelines and different characteristics of Chinese emerging adults is yet to be explored.This cross-sectional study aimed to investigate the association between adherence to the 24-h movement guidelines and four characteristics(self-exploration,instability,possibilities,and responsibility)of Chinese emerging adults.Methods:Overall,1,510 Chinese emerging adults aged 18–29 years were included in this study.Each participant completed a self-administered questionnaire that included questions on adherence to the 24-h movement guidelines(physical activity,sedentary behavior,and sleep)and the inventory of dimensions of emerging adulthood.Multivariable logistic regression analysis was employed to investigate the associations between adherence to the 24-h movement guidelines and each of the four characteristics.Results:The proportion of participants who adhered to the 24-h movement guidelines was 31.72%.Multiple regression analysis revealed a significantly negative relationship between adhering to more guidelines and instability(β=−0.51,p<0.001).A statistically significant association was observed between instability and meeting only sedentary behavior(β=−1.27,95%confidence interval[CI]:[−2.32,−0.24],p=0.02),sedentary behavior+sleep(β=−1.30,95%CI:[−2.24,−0.35],p<0.01),and physical activity+sedentary behavior(β=−1.08,95%CI:[1.94,−0.21],p=0.02)guidelines.Further,positive and significant associations were observed between possibilities and meeting the guidelines for only physical activity(β=0.70,95%CI:[0.14,1.27),p=0.01),only sleep(β=0.61,95%CI:[0.01,1.21],p=0.04),physical activity+sedentary behavior(β=0.56,95%CI:[0.04,1.07),p=0.01),and physical activity+sleep(β=0.76,95%CI:[0.23,1.27],p=0.01).Conclusions:These findings suggest that adherence to the 24-h movement guidelines was associated with instability in Chinese emerging adults.Future studies are warranted to verify our findings to highlight the importance of maintaining a heath lifestyle to promote health in emerging adulthood.

Alexa,let's train now!——A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging

Background:There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging.Consequently,the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions.In this context,digital and home-based physical training interventions might be a promising alternative to center-based intervention programs.Thus,this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance.Methods:In this pre-registered systematic review(PROSPERO;ID:CRD42022320031),5 electronic databases(PubMed,Web of Science,Psyclnfo,SPORTDiscus,and Cochrane Library)were searched by 2 independent researchers(FH and PT)to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults.The systematic literature search yielded 8258 records(extra17 records from other sources),of which 27 controlled trials were considered relevant.Two reviewers(FH and PT)independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise(TESTEX scale).Results:Of the 27 reviewed studies,15 reported positive effects on cognitive and motor-cognitive outcomes(i.e.,performance improvements in measures of executive functions,working memory,and choice stepping reaction test),and a considerable heterogeneity concerning study-related,population-related,and intervention-related characteristics was noticed.A more detailed analysis suggests that,in particular,interventions using online classes and technology-based exercise devices(i.e.,step-based exergames)can improve cognitive performance in healthy older adults.Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence(≤85%)and monitoring of the level of regular physical activity in the control group.Conclusion:The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall,though there is limited evidence that specific types of digital and home-based physical training interventions(e.g.,online classes and step-based exergames)can be an effective strategy for improving cognitive performance in older adults.However,due to the limited number of available studies,future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

Commentary on “Why people should run after positive affective experiences instead of health benefits”

Maltagliati et al.1 recently highlighted the vital role of affective experiences in promoting physical activity(PA).The authors suggested that positive affective experiences,rather than health benefits,can tip the balance in favor of PA over sedentary alternatives.The authors proposed a new formal decision model between PA and sedentary alternatives and reported that when health benefits are the unique reason to action,the costs of PA(e.g.,effort)and the subjective value(SV)of sedentary alternatives(V_(sed))are the main drivers of decision-making processes.

Linking 24-h Movement Behavior Guidelines to Cognitive Difficulties,Internalizing and Externalizing Problems in Preterm Youth

Background:Given the heightened risk of developmental challenges associated with preterm birth,it is crucial to explore interventions that may ameliorate potential adverse outcomes.This study aimed to examine whether meeting the 24-h movement behavior(24-HMB)guidelines,which include recommendations on physical activity(PA),screen time(ST),and sleep(SL),is related to indicators of cognitive difficulties,internalizing problems(e.g.,depression and anxiety),and externalizing problems(e.g.,difficulties in making friends and arguing)in a sample of preterm youth(children and adolescents born preterm).Methods:In this cross-sectional study,data from 3410 preterm youth(aged 6 to 17 years)were included for data analyses.Multivariable logistic regression was used to investigate associations between meeting the 24-HMB guidelines and the above-mentioned health outcomes,while controlling for sociodemographic and health-related factors.Results:The prevalence of meeting 24-HMB guidelines varied across independent and integrated components of the 24-HMB guidelines.Meeting the ST guideline alone(p<0.05)and integrated guidelines(i.e.,ST+SL and ST+SL+PA)were associated with fewer cognitive difficulties and reduced internalizing and externalizing problems(p<0.05).Specifically,meeting the SL guideline alone and integrated guidelines(i.e.,SL+ST)were associated with lower odds of depression and anxiety(p<0.01).Additionally,meeting independent,and integrated(PA and/or ST)guidelines were associated with less pronounced difficulties in making friends and arguing(p<0.05).Meeting 24-HMB guidelines in an isolated and integrated manner are linked to better cognitive performance and fewer internalizing and externalizing problems in preterm youth.Conclusion:Results suggest that advocating for the implementation of the 24-HMB guidelines may reduce cognitive challenges and behavioral issues,which is of high relevance for improving public health.Future longitudinal studies in preterm youth should investigate how modifying specific 24-HMB behaviors,especially ST,influence cognitive difficulties,internalizing and externalizing problems in this vulnerable population.

Relationships between Features of EmergingAdulthood, Situated Decisions toward PhysicalActivity, and Physical Activity among CollegeStudents: The Moderating Role of ExerciseIntensity Tolerance

A significant portion of emerging adults do not achieve recommended levels of physical activity (PA). Previous studies observedassociations between features of emerging adulthood and PA levels, while the potential psychological mechanisms that mightexplain this phenomenon are not fully understood. In this context, there is some evidence that situated decisions towardphysical activity (SDPA) and exercise-intensity tolerance might influence PA level. To provide empirical support for thisassumption, the current study investigated whether (i) features of emerging adulthood are linked to SDPA, which, in turn,might affect PA engagement;(ii) exercise-intensity tolerance moderate the relationship between SDPA and PA level;and (iii)SDPA is a mediator of the relationship between features of emerging adulthood and PA levels under the prerequisite thatexercise-intensity tolerance moderates the link between SDPA and PA engagement. In this study a group of 1,706 Chinesecollege students was recruited and asked to complete a set of questionnaires assessing their SDPA, PA levels, exercise-intensitytolerance, and features associated with emerging adulthood, namely Self-exploration, Instability, and Possibility. Our resultsindicated that SDPA positively predicted PA levels and this relationship became stronger when exercise-intensity tolerance wasused as a moderator. Furthermore, it was observed that individuals with a higher level of Instability and a lower level ofPossibility during emerging adulthood exhibited a lower level of SDPA. Taken together, the results of our study providefurther insights on a potential psychological mechanism linking features of emerging adulthood and physical activity.

Associations between meeting 24-hour movement guidelines and quality of life among children and adolescents with autism spectrum disorder

Background:The Canadian 24-hour movement behavior(24-HMB)guidelines suggest that a limited amount of screen time use,an adequate level of physical activity(PA),and sufficient sleep duration are beneficial for ensuring and optimizing the health and quality of life(QoL)of children and adolescents.However,this topic has yet to be examined for children and adolescents with autism spectrum disorder(ASD)specifically.The aim of this cross-sectional observational study was to examine the associations between meeting 24-HMB guidelines and several QoLrelated indicators among a national sample of American children and adolescents with ASD.Methods:Data were taken from the 2020 U.S.National Survey of Children’s Health dataset.Participants(n=956)aged 617 years and currently diagnosed with ASD were included.The exposure of interest was adherence to the 24-HMB guidelines.Outcomes were QoL indicators,including learning interest/curiosity,repeating grades,adaptive ability,victimization by bullying,and behavioral problems.Categorical variables were described with unweighted sample counts and weighted percentages.Age,sex,race,preterm birth status,medication,behavioral treatment,household poverty level,and the educational level of the primary caregivers were included as covariates.Odds ratio(OR)and 95%confidence interval(95%CI)were used to present the strength of association between adherence to 24-HMB guidelines and QoL-related indicators.Results:Overall,452 participants(45.34%)met 1 of the 3 recommendations,216(22.65%)met 2 recommendations,whereas only 39 participants(5.04%)met all 3 recommendations.Compared with meeting none of the recommendations,meeting both sleep duration and PA recommendations(OR=3.92,95%CI:1.639.48,p<0.001)or all 3 recommendations(OR=2.11,95%CI:1.034.35,p=0.04)was associated with higher odds of showing learning interest/curiosity.Meeting both screen time and PA recommendations(OR=0.15,95%CI:0.040.61,p<0.05)or both sleep duration and PA recommendations(OR=0.24,95%CI:0.070.87,p<0.05)was associated with lower odds of repeating any grades.With respect to adaptive ability,participants who met only the PA recommendation of the 24-HMB were less likely to have difficulties dressing or bathing(OR=0.11,95%CI:0.020.66,p<0.05)than those who did not.For participants who met all 3 recommendations(OR=0.38,95%CI:0.150.99,p=0.05),the odds of being victimized by bullying was lower.Participants who adhered to both sleep duration and PA recommendations were less likely to present with severe behavioral problems(OR=0.17,95%CI:0.040.71,p<0.05)than those who did not meet those guidelines.Conclusion:Significant associations were found between adhering to 24-HMB guidelines and selected QoL indicators.These findings highlight the importance of maintaining a healthy lifestyle as a key factor in promoting and preserving the QoL of children with ASD.

The Relationship between Dimensions of Emerging Adulthood and Behavioral Problems among Chinese Emerging Adults: The Mediating Role of Physical Activity and Self- Control

Emerging adulthood(EA)is a critical stage of life to develop and sustain a healthy lifestyle,which is also a time of vulnerability to poor physical and mental health outcomes.In this study,we conducted a path analysis(N=1326)to examine associations among four dimensions of EA,levels of regular physical activity(PA),self-control,MPA tendency and irrational procrastination.Results found:1)higher levels of PA predicted both MPA tendency(β=−0.08,95%CI:−0.11 to−0.06,p<0.001)and irrational procrastination(β=−0.01,95%CI:−0.17 to−0.008,p<0.01)indirectly via self-control;2)Instability(β=0.13,95%CI:0.08 to 0.18,p<0.01)and Responsibility(β=−0.06,95%CI:−0.10 to−0.08,p=0.03)exerted direct effects on irrational procrastination and Instability also indirectly predicted irrational procrastination via MPA tendency(β=0.03,95%CI:0.02 to 0.05,p<0.01).These findings proved that perceived features of EA are linked to behavioral problems and supported that regular PA plays a crucial role to protect mental health.

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.

Validity and Reliability of the Preference for and Tolerance of the Intensity of Exercise Questionnaire among Chinese College Students

The rising prevalence of physical inactivity is in all age groups(e.g.,in college students)a major public health issue as not meeting the recommended minimum amount of regular physical activity is linked to adverse health events.Vice versa,there is mounting evidence that achieving the recommended amount of regular physical activity is a vital element to prevent chronic diseases,but there is often an insufficient adherence to planned and structured forms of physical activity(i.e.,physical exercises).In this context,there is a large body of evidence indicating that exercise adherence is,among other factors,influenced by exercise-related affective responses.The Preference for and Tolerance of the Intensity of Exer-cise Questionnaire(PRETIE-Q)has been developed to measure these affective responses(e.g.,to specific exercise inten-sities).So far,no validated Chinese version of the PRETIE-Q has been available in the literature.To address this gap in literature,the present study developed and validated a Chinese version of the PRETIE-Q in a large sample of Chinese college students.Data from a total of 1117 college students were collected for analyses concerning factorial validity and construct validity.The re-test reliability was established using a sample of 150 randomly selected participants.In addition,the level of regular physical activity(PA),cardiorespiratoryfitness(CRF),and resilience were used to examine possible links with two domains(preference and tolerance)of the PRETIE-Q.Our results showed that a Chinese version of the PRETIE-Q has a goodfit and reliability(Cronbach’sαof 0.72 to 0.85 for preference and tolerance,respectively;ICC:r=0.72 of preference and r=0.67 of tolerance;fit indices:χ^(2)=21.612,df=19,p>0.05,TLI=0.997,CFI=0.998,RMSEA=0.016,SRMR=0.024).Secondly,positive associations of intensity-tolerance with PA,CRF,and resilience were observed.In summary,this study indicates that the Chinese version of the PRETIE-Q has sound psychometric properties and can be used in Chinese college students.The adapted version of the PRETIE-Q paves the way for further research on exer-cise-related affective responses in Chinese-speaking samples,although the generalizability of ourfindings needs to be established for other cohorts such as adolescents and older people with and without chronic diseases.

A Bifactor Analysis Approach to Construct Validity and Reliability of the Affective Exercise Experience Questionnaire among Chinese College Students

Affective exercise experience as an emerging theoretical concept has great potential to provide a more nuanced understanding of individual factors that influence exercise behavior.However,concerning the Affective Exercise Experiences(AFFEXX)questionnaire,it has not been examined yet whether the structural score of the AFFEXX is a useful index to predict physical activity(refers to any bodily movement produced by skeletal muscles that requires energy expenditure).Furthermore,there is currently a gap in knowledge regarding the psychological mechanisms that can explain the relationship between affective exercise experiences and the level of physical activity(PA).In order to adress these gaps in the literature,we conducted two studies among Chinese collge students that aimed(i)to investigated whether the total score of the three AFFEXX-C constructs(antecedent appraisals,core affective exercise experiences,and attraction-antipathy towards exercise)is a relaible indicator that can be utilized in research and pratical settings and(ii)to evalute the specific psychological mechanisms that can explain the relationship between affective exercise experience and PA.In Study 1,we recruited 801 voluntary Chinese college students for bifactor and correlational analyses.In Study 2,875 Chinese college students were enrolled to verify our findings from Study 1 and to explore the aforementioned mechanism.Results from the bifactor analyses supported our hypothesis that the total scores of the three AFFEXX-C constructs can be used among Chinese college students to establish a link with PA.Additionally,our results suggested that core affective exercise experiences and attraction-antipathy mediated the relationship between antecedent appraisals and the level of moderate-to-vigorous intensity PA.Therefore,measuring affective exercise experiences using the AFFEXX-C,specifically the total scores of each individual construct may be a useful approach to predict future PA levels.

Validation of the Chinese Version of the Affective Exercise Experiences Questionnaire (AFFEXX-C)

Despite the well-established benefits of regular physical activity(PA)on health,a large proportion of the world population does not achieve the recommended level of regular PA.Although affective experiences toward PA may play a key role to foster a sustained engagement in PA,they have been largely overlooked and crudely measured in the existing studies.To address this shortcoming,the Affective Exercise Experiences(AFFEXX)questionnaire has been developed to measure such experiences.Specifically,this questionnaire was developped to assess the following three domains:antecedent appraisals(e.g.,liking vs.disliking exercise in groups),core affective exercise experiences(i.e.,pleasure vs.displeasure,energy vs.tiredness,and calmness vs.tension),and exercise motivation(i.e.,attraction vs.antipathy toward exercise).The current study aimed to validate a Chinese version of the AFFEXX questionnaire(AFFEXX-C).In study 1,722 Chinese college students provided data for analyses of factorial,convergent,discriminant,criterion validity,and test-retest reliability of the AFFEXX-C.In addition,1,300 college students were recruited in study 2 to further validate its structural model.Results showed that the AFFEXX-C demonstrates a goodfit and reliability.Additionally,results further supported the hypothesized model based on previous research:antecedent appraisals predicted core affective exercise experiences,which in turn predicted attraction-antipathy toward physical exercise.The AFFEXX-C was found to be a reliable and valid measure of affective exercise experiences in a population of Chinese college students.

Look into my eyes:What can eye-based measures tell us about the relationship between physical activity and cognitive performance?

Background:There is a growing interest to understand the neurobiological mechanisms that drive the positive associations of physical activity and fitness with measures of cognitive performance.To better understand those mechanisms,several studies have employed eye-based measures(e.g., eye movement measures such as saccades,pupillary measures such as pupil dilation,and vascular measures such as retinal vessel diameter)deemed to be proxies for specific neurobiological mechanisms.However,there is currently no systematic review providing a comprehensive overview of these studies in the field of exercise-cognition science.Thus,this review aimed to address that gap in the literature.Methods:To identify eligible studies,we searched 5 electronic databases on October 23,2022.Two researchers independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise(TESTEX scale,for interventional studies) and the critical appraisal tool from the Joanna Briggs Institute(for cross-sectional studies).Results:Our systematic review(n=35 studies) offers the following main findings:(a) there is insufficient evidence available to draw solid conclusions concerning gaze-fixation-based measures;(b) the evidence that pupillometric measures,which are a proxy for the noradrenergic system,can explain the positive effect of acute exercise and cardiorespiratory fitness on cognitive performance is mixed;(c) physical training-or fitness-related changes of the cerebrovascular system(operationalized via changes in retinal vasculature) are,in general,positively associated with cognitive performance improvements;(d) acute and chronic physical exercises show a positive effect based on an oculomotor-based measure function(operationalized via antisaccade tasks);and(e) the positive association between cardiorespiratory fitness and cognitive performance is partly mediated by the dopaminergic system(operationalized via spontaneous eye-blink rate).Conclusion:This systematic review offers confirmation that eye-based measures can provide valuable insigt into the neurobiological mechanisms that may drive positive associations between physical activity and fitness and measures of cognitive performance.However,due to the limited number of studies utilizing specific methods for obtaining eye-based measures(e.g.,pupillometry,retinal vessel analysis,spontaneous eye blink rate) or investigating a possible dose-response relationship,further research is necessary before more nuanced conclusions can be drawn.Given that eye-based measures are economical and non-invasive,we hope this review will foster the future application of eye-based measures in the field of exercise-cognition science.

The Effects of Therapeutic Horseback Riding Program on Motor Skills inChildren with Autism Spectrum Disorder

Therapeutic horseback riding(THR)as an animal-assisted intervention is one of the innovative approaches emer-ging in the treatment for children with autism spectrum disorder(ASD).The current study was designed to inves-tigate the effects of a 12-week,twice a week THR program on motor skills in sixty-eight children with ASD aged 5–10 years old.All participants selected met the DSM-V criteria for ASD,and a total offifty-three participants completed the study.A randomized controlled trial design was utilized for the study.Data was collected via a pre-THR test,interim-THR test,and post-THR test to investigate the possible changes in motor skills throughout the 12-week THR program.Results showed that the THR program significantly improved overall motor skills across time points(p<0.05)and sub-skills of run,gallop and two-hand catch(as compared to the control group,p<0.05).In conclusion,the THR program may be an effective option for improving motor skills in children with ASD and further investigation with a longer period of intervention is warranted.

Effects of Health Qigong Exercise on Depression and Anxiety in Patients with Parkinson’s Disease

Objective: This study explored the effects of Health Qigong exercise on depression and anxiety in patients withParkinson’s disease (PD). Methods: A total of 42 volunteers who met the inclusion criteria were recruited andrandomly allocated into the experimental group and the control group. The experimental group carried out60-minute sessions of Health Qigong exercise five times a week for 12 weeks while the control group did not performany regular physical exercise. Data on cognitive impairment, psychomotor retardation, somatic anxiety,weight loss and sleep disorders, the sum score of the 17-item Hamilton Depression Rating Scale (HDRS-17), stateanxiety, trait anxiety as well as the sum score of the State-Trait Anxiety Inventory (STAI) were collected for threerepeated measurements (baseline, 6, and 12 weeks). Results: Significant differences were observed in depression,state anxiety, trait anxiety, cognitive impairment and psychomotor retardation in the experimental group but nodifference in somatic anxiety, weight loss and sleep disorders. Conclusion: Health Qigong exercise can pose positivepsychological effects and alleviate the depression and anxiety in patients with Parkinson’s disease. It can beapplied as an accessible supplement to the existent drug treatment for PD.

The Contribution of BMI,Body Image Inflexibility,and Generalized Anxiety to Symptoms of Eating Disorders and Exercise Dependence in Exercisers

1)Background:The common factors which potentially contribute to the development of eating disorders and exercise dependence during early adulthood are still relatively unclear.The present study aimed to examine the role of BMI,body image inflexibility,and generalized anxiety in these two behavioral problems in a sample of college students.2)Methods:In total,878 habitual exercisers(58.1%male with BMI=22.12±2.39;41.9%female with BMI=20.55±2.21)with age of 20.09±1.76 years participated in this study.The main outcomes of interest are exercise dependence symptoms,eating disorders symptoms,body image inflexibility,and symptoms of generalized anxiety(as measured by Exercise Dependence Scale-Revised,Eating Disorder Examination-Questionnaire-Short Form,Body Image Acceptance and Action Questionnaire,and Generalized Anxiety Disorder-7,respectively).Pearson correlation,path analysis,and model fit information were tested.3)Results:After controlling for age,gender,and field of study,lower BMI was linked to more exercise dependence symptoms but this association was not statistically significant,while a greater BMI was significantly associated with a higher risk of developing eating disorders(β=−0.08,p<0.001).Moreover,higher body image inflexibility significantly and positively contributed to severe exercise dependence(β=0.26,p<0.001)as well as abnormal eating attitudes and behaviors(β=0.74,p<0.001).Furthermore,generalized anxiety is a significant contributor to exercise dependence symptoms(β=0.14,p<0.001)but not eating disorders symptoms.4)Conclusion:Based on our finding that body image inflexibility is a common risk factor for the development of exercise dependence and eating disorders,the prevention and treatment of these two disorders should involve the improvement of psychological flexibility.In addition,the individual with a higher BMI is more vulnerable to developing eating disorders,while those who have severer generalized anxiety symptoms should be given more attention when screening for exercise dependence.