Psychophysiological Variables Research Articles

Alter Game: A Study Protocol on a Virtual "Serious Game" for Relapse Prevention in Patients With Gambling Disorder.

Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.

Effects of a dance program on psychophysiological variables in hospitalized patients with depression: A mixed model approach

This study intended to examine the effects of two programs, pharmacological treatment vs. pharmacological treatment+Dance Program (DP), on the perception of self-efficacy, depression, and heart rate variability (HRV) in hospitalized patients with major depressive disorder (MDD); The primary caregiver's perception was also considered and recorded. The sample consisted of 27 patients (pharmacological=14 and pharmacological+DP=13) who were admitted to the IMSS Psychiatric Hospital, with a diagnosis of MDD. There was a significant increase in the perception of self-efficacy in the pharmacological+ DP group after treatment (Z = 3.19, p < .01), but not in the pharmacological group (Z = 0.126, p > .01). Regarding depression, a greater decrease was found in the pharmacological+ DP group. In HRV there were differences only in heart rate, showing a reduction due to the impact of the time factor and the time and group factor. As for the results of the interview with primary caregivers, their perceptions indicate that dance is an activity that can fortify the recovery process of their family members. In conclusion, a dance program of moderate to vigorous intensity in conjunction with pharmacological treatment reduces depressive symptoms and increases the perception of self-efficacy, resulting in a greater benefit for the recovery of depressive patients. Similarly, the primary caregivers involved in this study highlighted the importance of the dance program as an option to support the standard treatment of depression.

On the applicability of eye movement desensitization and reprocessing (EMDR) as an intervention in dogs with fear and anxiety disorders after a traumatic event

Abstract Fear and anxiety disorders are prevalent in dogs. These disorders are not adequately resolved by current interventions, which urges exploration of additional interventions. In humans, fear and anxiety disorders such as post-traumatic stress disorder (PTSD), are effectively treated by Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a non-invasive and non-pharmacological intervention involving bilateral sensory stimulation while memorizing the traumatic event, resulting in decreased emotionality of the memory. We argue EMDR might be applied as an intervention for fear and anxiety disorders in dogs, adding to the currently available interventions for the field of Clinical Ethology. Particularly nonverbal EMDR protocols used in preverbal children can be applied and the setup can be adapted for dogs. Future research should focus on the development of nonverbal EMDR protocols including proper controls, and on clinical effectiveness of such EMDR protocols for dogs. Apart from behavioural measures, psychophysiological variables should be incorporated as well.

Therapeutic alliance in psychological therapy for posttraumatic stress disorder: A systematic review and meta-analysis.

Therapeutic alliance is a key element of successful therapy. Despite being particularly relevant in people with posttraumatic stress disorder (PTSD), due to fear, mistrust and avoidance, there has not yet been a comprehensive systematic review of therapeutic alliance in this population. This review explored (a) variables which may predict alliance and (b) whether alliance predicts PTSD outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, the review identified 34 eligible studies. Studies were subjected to a quality assessment. Predictors of alliance were considered in a narrative synthesis. Twelve studies were entered into a meta-analysis of the association between therapeutic alliance and PTSD outcomes. There was some evidence for individual variables including attachment, coping styles and psychophysiological variables predicting the alliance. Therapy variables did not predict alliance. The therapeutic alliance was found to significantly predict PTSD outcomes, with an aggregated effect size of r = -.34, across both in-person and remote therapies. Included studies were restricted to peer-reviewed, English language studies. Quality of included studies was mostly rated weak to moderate, primarily reflecting issues with selection bias in this area of research. This is the first review to demonstrate that therapeutic alliance is a consistent predictor of PTSD outcomes, in both in-person and remote therapies, and the effect appears at least as strong as in other populations. This is of relevance to clinicians working with traumatized populations. The review identified a need for further research to determine variables predicting alliance in therapy for PTSD.

Emotional Intelligence Training: Influence of a Brief Slow-Paced Breathing Exercise on Psychophysiological Variables Linked to Emotion Regulation.

Designing emotional intelligence training programs requires first testing the effectiveness of techniques targeting its main dimensions. The aim of this study was to investigate the effects of a brief slow-paced breathing (SPB) exercise on psychophysiological variables linked to emotion regulation, namely cardiac vagal activity (CVA), as well as perceived stress intensity, emotional arousal, and emotional valence. A total of 61 participants completed a 5-min SPB exercise and a control condition of a 5-min rest measurement. CVA was indexed with the root mean square of successive differences (RMSSD). Participants were also asked to rate their perceived stress intensity, emotional arousal, and emotional valence. Results showed that CVA was higher during SPB in comparison to the control condition. Contrary to our hypothesis, perceived stress intensity and emotional arousal increased after SPB, and perceived emotional valence was less positive after SPB. This could be explained by experiencing dyspnea (i.e., breathing discomfort), and the need to get acclimatized to SPB. Consequently, we may conclude that although physiological benefits of SPB on CVA are immediate, training may be required in order to perceive psychological benefits.

Psychophysiological responses of firefighters to day and night rescue interventions

This study aimed 1) to assess the psychophysiological responses throughout a rescue intervention performed during the day and at night and 2) to determine if a vibrating alarm influences these psychophysiological responses at night.Sixteen male firefighters completed a simulated intervention under three different conditions: 1) during the day with a sound alarm signal (DaySA), 2) during the night with a sound alarm signal (NightSA), 3) during the night with a vibrating alarm signal (NightVA). Cardiovascular and psychological stress were recorded throughout the interventions.During the alarm signal, HR reactivity was greater in NightSA than in DaySA (p < 0.01). Parasympathetic reactivation and self-confidence were significantly lower in NightSA than in DaySA (p < 0.05). HR reactivity was decreased in NightVA in comparison to NightSA (p < 0.05).Overall, the rescue intervention had a greater impact on the psychophysiological variables during the night than during the day, and the type of alarm had a minor effect.

Pre-exercise skin temperature evolution is not related with 100m front crawl performance.

During the transition between warm-up and competition there is a change in core, muscle and (eventually) skin temperature that may affect swimming performance. We have aimed to assess skin temperature evolution during transition phases of different durations before a typical front crawl effort and to investigate its relationship with performance. Following a standardized warm-up, nine adolescent male swimmers performed three maximal randomized 100m maximum front crawl trials after 10, 20 and 45min transition phases. Skin temperature, performance (time, stroke frequency, length and index, and propelling efficiency), heart rate, lactate and perceived effort were assessed. Data showed a skin temperature log increase over time (R2>0.96, p<0.01) without differences from the 15min with the following instants. Performance and psychophysiological variables were similar between transition phases. However, skin temperature at the end of the transition periods, i.e., just before the 100m trials, was lower in the 10min than the 20 and 45min transitions (32.0±0.6 vs 33.0±0.4 and 33.5±0.5°C, respectively). The main finding was that no relevant relationships were observed between pre-test skin temperature and performance times (|r| < 0.6, p > 0.05) for the studied transition phases. We have concluded that transitions longer than 10min will not present thermal changes and that, within the physiologic limits studied, pre-exercise skin temperature does not influence swimming performance.

Phenomenological experience personality profile: A test to identify the affective dimensions of psychopathology in the context of precision psychotherapy

IntroductionArtificial intelligence algorithms are increasingly used to highlight refined qualifiers of pathologies and to build treatment protocols based on them. These possibilities open up new perspectives for personalized interventions in psychotherapy. The affective neurosciences that link psychopathological phenomena to the hypersensitization of emotional systems are an excellent field of application of deep learning algorithmsObjectivesIn this contribution we present the standardization of a psychodiagnostic test that can be analyzed with a deep learning algorithm for the development of personalized treatments for depressive disorders in a perspective of precision psychotherapyMethodsPreviously we have constructed a psychodiagnostic test that correlates the psychopathological characteristics to the emotional systems described in affective neuroscience. The construction of this test was carried out with the use of a neural network that discriminated 161 items from a pull of 300 psychopathological and character descriptions. In the present work, the 161 selected items were compared, in a sample of 600 subjects, with the measurement of sadness described in the Panksepp model. Comparation was performed with linear and non-linear statistical analysis methods.ResultsThe items emerging from the statistical analyzes as strongly indicative of a hypersensitivity of the sadness system outline a psychopathological profile for which it is possible to adapt specific psychotherapeutic treatment protocols.ConclusionsIn future prospect, neurobiological and psychophysiological variables such as heart rate variability, skin conductance and activity of the areas of the cortex, measured with a scanner of the near infrared photons, will be correlated to these descriptors of psychopathology.

Gender differences in ultradian serum levels of NGF and BDNF correlate with psychophysical traits in healthy humans.

We aimed at investigating the gender and/or ultradian pattern of serum levels of the Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF). Blood samples were collected at the 8.00, 13.00 and 20.00 hours of the day in healthy men and women, and the neurotrophins concentration was measured in the serum by ELISA. A further aim of the study was to evaluate whether or not the NGF/BDNF variations might be related to specific physiological or psychological traits as mood, feeling good and feeling rested, sexual desire and energy. Heart rate and blood pressure were also monitored at the same hours in each enrolled subject. The anxiety (STAI-T and STAI-S score) and sleeping quality were once evaluated in the morning too. We found that serum BDNF increases in men and decreases in women from morning to evening, while NGF shows a similar ultradian profile between men and women, but with higher concentrations in women. Both neurotrophins also show gender-related associations with psychophysiological variables. High NGF levels correlated with a high score for all the psychological variables in men, but with a low score in women. An inverse correlation was found between BDNF and energy and sexual desire in women, while no correlations were found in men. These data disclose that the condition of well-being (or activity/arousal status) is featured by an increasing NGF profile in men and a negative BDNF/NGF trend in women. The clinical relevance of the present data is discussed.

A comparative analysis of neuromarketing methods for brand purchasing predictions among young adults

Until now, neuromarketing studies have usually been aimed at assessing the predictive value of psychophysiological measures gathered while watching a marketing message related to a particular product. This study is the first attempt to verify the possibility of predicting familiar and unfamiliar brand purchases based on psychophysiological reactions to a retailer television advertisement measured by EEG, EDA and eye-tracking. The number of private label products chosen later served to assess the binary dependent variable. A logistic regression model (with a prediction rate of 61.2%) was applied to determine which psychophysiological variables explained the largest part of the variance of a final purchase decision. The results show that among various measures, only the electrodermal peaks per second were significant in predicting further purchase decisions. The decision to buy was also influenced by brand familiarity. The article concludes that EDA is an unobtrusive measure of emotion-related anticipation of significant outcomes, particularly for dynamic stimuli, as related to decision-making.

Psychophysiological Characteristics of Aggression Associated with Depression before and after Successful Treatment with Sertraline: A Clinical Trial Study

Background: Depression associated with aggression can lead to violent behaviors. The present study was aimed to determine how sertraline, a standard medication for depression treatment, can efficiently decrease aggression and affect psychophysiological parameters in patients with depression. Methods: Patients with depression and aggression were included in a six-week trial with sertraline (50 100 mg/day). Depression diagnosis was confirmed by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR). Depression severity before and after treatment was assessed using Beck Depression Inventory (BDI). Aggression was evaluated by Spielberger’s State-Trait Anger Expression Inventory-2 (STAXIII). The BDI and STAXI-II were finally applied to evaluate the effectiveness of treatment. For each patient, peripheral and central psychophysiological parameters were recorded using peripheral biofeedback apparatus and electroencephalogram in the initial and final stages of treatment. These recordings were attempted to assess variations of the autonomic nervous system and electrocortical activity in response to treatment. Results: Depressive and aggressive symptoms decreased significantly over the six-week treatment period, as measured by BDI and STAXI-II. Significant changes in some of the peripheral and central psychophysiological variables were observed. Sensorimotor rhythm (SMR)/theta ratio (p=0.01) have decreased during a task, delta (p=0.02) and theta (p=0.008) wave activity and theta/alpha ratio (p=0.01) have increased during task, and theta/beta ratio has increased during both rest and task (p=0.02 for both). Among peripheral psychophysiological variables, skin conductance during task decreased significantly (p=0.03). Conclusion: Several numbers of psychophysiological parameters were influenced significantly after successful pharmacotherapy of aggressiveness in patients with depression.

Changes in physiological reactivity in response to the trauma memory during prolonged exposure and virtual reality exposure therapy for posttraumatic stress disorder.

A key symptom of posttraumatic stress disorder (PTSD) is hyperreactivity to trauma-relevant stimuli. Though physiological arousal is reliably elevated in PTSD, the question remains whether this arousal responds to treatment. Virtual reality (VR) has been posited to increase emotional engagement during prolonged exposure therapy (PE) for PTSD by augmenting imaginal exposures with trauma-relevant sensory information. However, the comparative effects of VR exposure therapy (VRE) have received limited empirical inquiry. Ninety active-duty soldiers with combat-related PTSD participating in a randomized-controlled trial to receive PE, VRE, or a waitlist-control (WL) condition had their physiological reactivity, indexed by galvanic skin response (GSR), to their trauma memories assessed at pre-, mid-, and posttreatment. Although both VRE and PE conditions showed reduced GSR reactivity to trauma memories from pre- to posttreatment, only the VRE group differed significantly from WL. Across the sample, reductions in GSR were significantly correlated with reductions in self-reported PTSD and anxiety symptoms. This was the first study comparing effects of VRE and PE on psychophysiological variables. Given previous research finding limited differences between VRE and PE in PTSD symptom reduction, these findings lend support to the rationale for including VR in exposure therapy protocols while raising important questions about the potential benefits of VRE. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Serious Game Design of Virtual Reality Balance Rehabilitation with a Record of Psychophysiological Variables and Emotional Assessment

Virtual Reality (VR) offers an alternative to complement physical or neurological rehabilitation based on the efficacy of Gamification as a technique to get compromised, enjoy, and turn treatment periods less annoying through an immersive task. This work presents the design of a VR environment and takes into a count three levels of presence: self-presence, physical, and social. Thirteen healthy participants performed a traditional balance session with a wobble board through a parachute game. The direction of the fall is controlled with the inclination of a wobble board platform instrumented with a Gyroscope, electrocardiography (ECG), electrodermal activity (EDA), and respiratory rate (RESP) signals are simultaneously recorded. These psychophysiological responses of the Autonomous Nervous System (SNA) are contrasted with a standardized emotional self-report questionnaire to gather information about the experience and was filled out by the participant with the eye selection of the Oculus Rift device. The integrated Unity-Matlab system stored and processed some of the extraction data of 15 characteristics associated with the biosignals and three emotional levels, In addition to proposing a severe game as a solution to problems of conventional methodology such as low attention, monotonous and predictable sessions, combining computerized simulation and innovative technologies for more pleasant recovery therapy.

Effect of Tethered Swimming as Postactivation Potentiation on Swimming Performance and Technical, Hemophysiological, and Psychophysiological Variables in Adolescent Swimmers

To investigate whether tethered swimming (TS) performed 8 minutes before a 50-m freestyle swimming sprint could be an effective postactivation potentiation method to improve performance in young swimmers. Fourteen regional-level male adolescent swimmers (age 13.0 [2.0]y; height 161.1 [12.4]cm; body mass 52.5 [9.5]kg) underwent 2 trial conditions in a randomized and counterbalanced order (1 experimental [TS], 1 control) on different days. During the experimental session, the participants performed a standard warm-up of 1200m followed by a TS exercise, which consisted of 3 × 10-second maximal efforts of TS with 1-minute rests between bouts. In the control condition, the warm-up phase was immediately followed by 200m at a moderate pace (same duration as the TS in the experimental session). Performance (time trial); biomechanical (stroke length), physiological (blood lactate concentrations), and psychophysiological (ratings of perceived exertion) variables; and countermovement-jump (CMJ) flight time were collected. TS warm-up had no significant effect on 50-m swimming performance (P = .27), postexercise ratings of perceived exertion, stroke length, or CMJ flight time (P ≥ .05). Blood lactate concentrations significantly increased at the end of the warm-up in the TS condition only (interaction effect: F1.91,29.91 = 4.91, P = .01, η2 = .27) and after the 50-m trial in both conditions (F1.57,20.41 = 62.39, P = .001, η2 = .82). The present study demonstrated that 3 × 10-second TS exercises performed 8 minutes prior to the event did not affect ratings of perceived exertion, stroke length, or CMJ flight time. In addition, tethered swimming did not affect 50-m freestyle sprint performance in young swimmers.

Alexithymia as a Predictor of Arousal and Affect Dysregulations when Batterers with Attention Deficit Hyperactivity Disorder Cope with Acute Stress.

Empirical research has stated that Attention Deficit Hyperactivity Disorder (ADHD) might underlie intimate partner violence against women (IPVAW) perpetration. Even though there is a clear relationship between these two variables, it is still unknown how ADHD facilitates violence proneness. In this regard, psychophysiological variables such as skin conductance levels (SCL) might offer information about emotional regulation when individuals cope with stress. Furthermore, alexithymia traits might be a strong candidate in explaining the above-mentioned emotional dysregulations. Hence, we compared the SCL response to acute cognitive stress in IPVAW perpetrators with and without ADHD symptoms to that of controls (non-violent and unaffected), and we also assessed the presence of alexithymia traits and their role in emotional regulation. Our data point out that ADHD IPVAW perpetrators presented higher SCL and negative affect than controls, particularly during the recovery period. Moreover, ADHD IPVAW perpetrators showed higher self-reported alexithymia, and this variable was a good predictor of autonomic and psychological state dysregulations, even after controlling for the effects of alcohol and drug misuse. Therefore, our study reinforces the need to consider psychophysiological measurements when screening the therapeutic needs of IPVAW perpetrators, due to their relatively low cost and the significant contents of their results. Finally, we also highlight the key role of alexithymia in this violent population, which should be considered when designing cognitive intervention training coadjutant to current psychotherapies for IPVAW perpetrators.

Further Exploration of Treatment Response in Latinos with Comorbid Asthma and Panic Disorder: A Brief Report of HRV and ETCO2 as Potential Mediators of Treatment Response.

Heart rate variability (HRV) and end tidal CO2 (ETCO2) in relation to treatment response have not been studied in Latino populations or in comorbid asthma and panic disorder (PD). An extension of previously published research, the current study explored psychophysiological variables as possible mediators of treatment response. Latino treatment completers (N = 32) in the Bronx with asthma-PD received either Cognitive-Behavioral Psychophysiological Therapy (CBPT) or Music Relaxation Therapy (MRT). CBPT included HRV-biofeedback (HRVB); in-the-moment heart rate data to help an individual learn to influence his/her own heart rate. The sample was primarily female (93.8%) and Puerto Rican (81.25%). Treatment groups did not differ on demographics, except for less education in CBPT. The Panic Disorder Severity Scale (PDSS) and Asthma Control Questionnaire (ACQ) assessed changes in symptoms. HRV and ETCO2 were measured at four of eight therapy sessions. Baseline ETCO2 and changes in HRV from first to last of psychophysiology sessions were investigated as mediators of change on ACQ and PDSS. Mixed model analyses indicated in the CPBT group, changes in both asthma control and PD severity were not mediated by changes in HRV. In the CBPT and MRT groups combined, changes in PD severity were not mediated by baseline ETCO2. These findings may be due to the brevity of HRVB in CBPT, multiple treatment components, ETCO2 not directly targeted, and/or unique physiological pathways in Latinos with asthma-PD.

Affective responses to different prescriptions of high-intensity interval exercise in hypertensive patients.

Studies have indicated that high-intensity interval training (HIIT) promotes similar acute reductions on blood pressure (BP) when compared to continuous moderate aerobic exercise. However, it has been associated with lower affective responses to exercise. Therefore, strategies to improve affective responses to exercise are needed. The purpose of this study was to verify the effect of different prescriptions of HIIT on the affective responses of hypertensive elderly women. This is a cross-sectional study. Twenty hypertensive women (65.3±4.2 years) performed four HIIT sessions: 10×1:1 at ±20% of self-selected intensity [SSI] Self20), 10×1:1 at ±30% of SSI (Self30), 10×1:1 at ±40% of SSI (Self40) and an imposed intensity session 5×2-min intervals at 80-85% interspersed with 2-min intervals at 40-50% VO2peak (ImpVO2) and one control session with participants remaining in the sitting position for 28 minutes. Affect response, rating of perceived exertion (RPE) and heart rate (HR) were recorded every five minutes during exercise, and systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR were assessed before and after sessions. The effect of session and moment on the psychophysiological variables was examined by analysis of variance. Affect was lower in the ImpVO2 when compared to SSI sessions. There was no difference in RPE between sessions. The percentage of HRpeak was higher in ImpVO2 compared to SSI sessions. There were no differences in SBP and DBP responses between the sessions. HIIT prescribed based on SSI promoted higher affective responses than HIIT prescribed from 80-85%/40-50% VO2peak with similar BP responses.

Relationship between biomechanical and psychophysiological indicators and performance in a vertical mountain race

In order to know the relationship between biomechanical and psychophysiological indicators, as well as the possible pre-post psychophysiological differences and the use of poles in the uphill performance on mountain runners, we performed a prospective and descriptive study of one vertical mountain race. Thus, it was analysed biomechanical (speed and strength/power manifestations) and psychophysiological variables (lactate, heart rate and subjective perception of fatigue) with a total of nine (n = 9) experienced runners divided into groups to use (n = 4) or not (n = 5) poles during the race. Nonparametric analyses were performed to observe the correlations between variables, the differences between groups and the differences between the psychophysiological values before and after the test. The results do not present significant (p &lt; 0.05) differences or correlations of performance between those that used poles or not. There are significant differences between the psychophysiological variables pre and post, in addition they show correlations of performance (final time and relation of time with the first classified) with higher mean and maximum heart rate, as well as a lower lactate accumulation. It is concluded that a better performance in a mountain vertical race is associated to higher physiological efficiency but not to greater strength and power jump manifestations in trained runners.

Multidisciplinary Analysis of Differences Between Finisher and Non-finisher Ultra-Endurance Mountain Athletes.

Ultra-endurance races are one of the most physically and psychologically demanding sports, depending performance on several elements. The aims of the present study were (i) to analyze differences in selected psychophysiological parameters between finisher and non-finisher ultra-endurance mountain athletes, and (ii) to analyze modifications in psychophysiological parameters before and after an ultra-endurance mountain event. Selected psychophysiological variables were assessed in 46 finishers and 24 non-finishers in two over 100 km ultra-endurance races were examined. We found how an ultra-endurance mountain race produced dehydration, a decrease in systolic blood pressure, weight and leg strength muscle values, as well as an increase in heart rate and rate of perceived exertion values. Finishers presented lower systolic blood pressure, weight, body mass index, half marathon time and fluid intake before competition day compared to non-finishers. In addition, body mass index, pre-race hydration, and performance in lower distance races were predictors of performance in these ultra-endurance mountain races.

Yoga Protocol for Cancer Patients: A Systematic Exploration of Psychophysiological Benefits.

Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the "Yoga in Oncology" project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer. Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index. Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep. It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients' behavior.