Exercise remains greatly underutilized in clinical practice for reasons that are only partly understood. This critical review situates the problem within the broader political and economic context. It focuses on depression, the leading cause of disability worldwide, and the processes that followed the inclusion of exercise as a treatment option in clinical practice guidelines in the British National Health Service. The review highlights previously unaddressed phenomena, including antiexercise lobbying by primary care physicians and efforts to present the evidence for the antidepressant effects of exercise as weak, nonexistent, or methodologically flawed. Notably, the field of kinesiology remained silent while these processes unfolded. This information suggests that the path from research evidence to implementation in clinical settings remains dependent on factors beyond the amount and quality of research evidence. The review underscores the need to vigilantly monitor, critically appraise, and actively participate in the clinical research literature and the development of guidelines.
Why Is Exercise Underutilized in Clinical Practice Despite Evidence It Is Effective? Lessons in Pragmatism From the Inclusion of Exercise in Guidelines for the Treatment of Depression in the British National Health Service
Illuminating the Black Box: Investigating Prefrontal Cortical Hemodynamics during Exercise with Near-Infrared Spectroscopy
Near-infrared spectroscopy (NIRS) presents an appealing option for investigating hemodynamic changes in the cerebral cortex during exercise. This review examines the physical basis of NIRS and the types of available instruments. Emphasis is placed on the physiological interpretation of NIRS signals. Theories from affective neuroscience and exercise psychobiology, including Davidson's prefrontal asymmetry hypothesis, Dietrich's transient hypofrontality hypothesis, and Ekkekakis's dual-mode model, are reviewed, highlighting the potential for designing NIRS-based tests in the context of exercise. Findings from 28 studies involving acute bouts of exercise are summarized. These studies suggest that the oxygenation of the prefrontal cortex increases during mild-to-moderate exercise and decreases during strenuous exercise, possibly proximally to the respiratory compensation threshold. Future studies designed to test hypotheses informed by psychological theories should help elucidate the significance of these changes for such important concepts as cognition, affect, exertion, and central fatigue.
Critical Review of Measurement Practices in the Study of Automatic Associations of Sedentary Behavior, Physical Activity, and Exercise
Zachary Zenko and Panteleimon Ekkekakis
Studies of automatic associations of sedentary behavior, physical activity, and exercise are proliferating, but the lack of information on the psychometric properties of relevant measures is a potential impediment to progress. The purpose of this review was to critically summarize measurement practices in studies examining automatic associations related to sedentary behavior, physical activity, and exercise. Of 37 studies, 27 (73%) did not include a justification for the measure chosen to assess automatic associations. Additional problems have been noted, including the nonreporting of psychometric information (validity, internal consistency, test–retest reliability) and the lack of standardization of procedures (e.g., number, type of stimuli). The authors emphasize the need to select measures based on conceptual arguments and psychometric evidence and to standardize measurement procedures. To facilitate progress, the review concludes with a proposal for conceptually appropriate validation criteria to be used in future studies.
Extraordinary Claims in the Literature on High-Intensity Interval Training: II. Are the Extraordinary Claims Supported by Extraordinary Evidence?
Panteleimon Ekkekakis and Nicholas B. Tiller
Dishman challenged kinesiologists to seek a compromise between “the ideal physiological prescription and a manageable behavioral prescription.” High-intensity interval training (HIIT) is the first exercise modality that has been claimed to meet this challenge, combining substantial benefits for fitness and health with pleasure and enjoyment. If true, these claims may revolutionize the science and practice of exercise. In this paper, four claims are critically appraised: (a) HIIT lowers the risk of mortality more than moderate-intensity continuous exercise, (b) HIIT doubles endurance performance after only 15 min of training over 2 weeks, (c) 1 min of HIIT is equivalent to 45 min of moderate-intensity continuous exercise, and (d) HIIT is more pleasant and enjoyable than moderate-intensity continuous exercise. The evidence for these claims appears questionable. Kinesiology should heed the principle endorsed by Hume, Laplace, and Sagan, namely that extraordinary claims should be supported by commensurate evidence.
Can You Have Your Vigorous Exercise and Enjoy It Too? Ramping Intensity Down Increases Postexercise, Remembered, and Forecasted Pleasure
Zachary Zenko, Panteleimon Ekkekakis, and Dan Ariely
There is a paucity of methods for improving the affective experience of exercise. We tested a novel method based on discoveries about the relation between exercise intensity and pleasure, and lessons from behavioral economics. We examined the effect of reversing the slope of pleasure during exercise from negative to positive on pleasure and enjoyment, remembered pleasure, and forecasted pleasure. Forty-six adults were randomly assigned to a 15-min bout of recumbent cycling of either increasing intensity (0–120% of watts corresponding to the ventilatory threshold) or decreasing intensity (120–0%). Ramping intensity down, thereby eliciting apositive slope of pleasure during exercise, improved postexercise pleasure and enjoyment, remembered pleasure, and forecasted pleasure. The slope of pleasure accounted for 35–46% of the variance in remembered and forecasted pleasure from 15 min to 7 days postexercise. Ramping intensity down makes it possible to combine exposure to vigorous and moderate intensities with a pleasant affective experience.
Overcoming the “Ostrich Effect”: A Narrative Review on the Incentives and Consequences of Questionable Research Practices in Kinesiology
Nicholas B. Tiller and Panteleimon Ekkekakis
Increasing transparency and openness in science is an ongoing endeavor, one that has stimulated self-reflection and reform in many fields. However, kinesiology and its related disciplines are among those exhibiting an “ostrich effect” and a reluctance to acknowledge their methodological shortcomings. Notwithstanding several high-profile cases of scientific misconduct, scholars in the field are frequently engaged in questionable research practices (QRPs) such as biased experimental designs, inappropriate statistics, and dishonest/inexplicit reporting. To advance their careers, researchers are also “gaming the system” by manipulating citation metrics and publishing in predatory and/or pay-to-publish journals that lack robust peer review. The consequences of QRPs in the discipline may be profound: from increasing the false positivity rate to eroding public trust in the very institutions tasked with informing public health policy. But what are the incentives underpinning misconduct and QRPs? And what are the solutions? This narrative review is a consciousness raiser that explores (a) the manifestations of QRPs in kinesiology; (b) the excessive publication pressures, funding pressures, and performance incentives that are likely responsible; and (c) possible solutions for reform.
Can High-Intensity Exercise Be More Pleasant? Attentional Dissociation Using Music and Video
Leighton Jones, Costas I. Karageorghis, and Panteleimon Ekkekakis
Theories suggest that external stimuli (e.g., auditory and visual) may be rendered ineffective in modulating attention when exercise intensity is high. We examined the effects of music and parkland video footage on psychological measures during and after stationary cycling at two intensities: 10% of maximal capacity below ventilatory threshold and 5% above. Participants (N = 34) were exposed to four conditions at each intensity: music only, video only, music and video, and control. Analyses revealed main effects of condition and exercise intensity for affective valence and perceived activation (p < .001), state attention (p < .05), and exercise enjoyment (p < .001). The music-only and music-and-video conditions led to the highest valence and enjoyment scores during and after exercise regardless of intensity. Findings indicate that attentional manipulations can exert a salient influence on affect and enjoyment even at intensities slightly above ventilatory threshold.
Physical Activity, Stress, and Metabolic Risk Score in 8- to 18-Year-Old Boys
Megan E. Holmes, Joey C. Eisenmann, Panteleimon Ekkekakis, and Douglas Gentile
We examined whether physical activity modifies the relationship between stress and the metabolic risk score in 8- to 18-year-old males (n = 37).
Physical activity (PA) and television (TV)/videogame (VG) use were assessed via accelerometer and questionnaire, respectively. Stress was determined from self-report measures. A metabolic risk score (MRS) was created by summing age-standardized residuals for waist circumference, mean arterial pressure, glycosylated hemoglobin, and high-density lipoprotein cholesterol.
Correlations between PA and MRS were low (r < –.13), and TV and VG were moderately associated with MRS (r = .39 and .43, respectively). Correlations between stress-related variables and MRS ranged from r = .19 to .64. After partitioning by PA, significant correlations were observed in the low PA group between school- and sports-related self-esteem and anxiety with the MRS.
The results provide suggestive evidence that PA might modify the relationship between stress and MRS in male adolescents.
A Methodological Checklist for Studies of Pleasure and Enjoyment Responses to High-Intensity Interval Training: Part I. Participants and Measures
Panteleimon Ekkekakis, Mark E. Hartman, and Matthew A. Ladwig
For decades, the exercise psychology research literature echoed the conclusion that exercise makes most people feel better, with no clear evidence that this “feel-better effect” is moderated by intensity. An overhaul of the methodological approach subsequently showed that high-intensity exercise is experienced as unpleasant, and the “feel-better effect,” although possible, is conditional and therefore not as robust or prevalent as initially thought. Recently, several studies investigating high-intensity interval training (HIIT) have concluded that HIIT is pleasant and enjoyable, despite the high intensity. Considering that HIIT is emerging as an option in physical activity recommendations and exercise prescription guidelines, in part due to these claims, a methodological checklist is presented to aid researchers, peer reviewers, editors, and other readers in critically appraising studies examining the effects of HIIT on affect and enjoyment. This first part addresses the characteristics and number of participants, as well as the selection of measures of affect and enjoyment.
A Methodological Checklist for Studies of Pleasure and Enjoyment Responses to High-Intensity Interval Training: Part II. Intensity, Timing of Assessments, Data Modeling, and Interpretation
Panteleimon Ekkekakis, Mark E. Hartman, and Matthew A. Ladwig
Recent studies have concluded that high-intensity interval training should be seen as a “viable alternative” to, and may be more enjoyable than, moderate-intensity continuous exercise. If true, these claims have the potential to revolutionize the science and practice of exercise, establishing high-intensity interval training as not only a physiologically effective exercise modality but also a potentially sustainable one. However, these claims stand in contrast to voluminous evidence according to which high levels of exercise intensity are typically experienced as less pleasant than moderate levels. To help researchers, peer reviewers, editors, and critical readers appreciate possible reasons for the apparently conflicting results, we present a checklist that identifies crucial methodological elements in studies investigating the effects of high-intensity interval training on affect and enjoyment. This second installment covers how “high-intensity” and “moderate-intensity” experimental conditions are defined, the timing of assessments of affect, the modeling of affective responses, and data interpretation.