Körperliche Aktivität bei ambulanten Patient*innen mit psychischen Erkrankungen: Prävalenz, motivationale und volitionale Determinanten als Ansatzpunkte zur Förderung körperlicher Aktivität

Körperliche Aktivität hat einen positiven Einfluss auf die psychische Gesundheit und kann zur Prävention und Therapie psychischer Erkrankungen eingesetzt werden. Da nur eine Minderheit der Menschen mit psychischen Erkrankungen ein gesundheitsförderliches Ausmaß körperlicher Aktivität betreibt, scheint die Entwicklung von Interventionen, die Patient*innen dabei unterstützen, ihr Aktivitätsniveau zu steigern, dringend geboten. In den vorliegenden Arbeiten wird zunächst die Prävalenz körperlicher Aktivität bei ambulanten Patient*innen mit psychischen Erkrankungen und die Übereinstimmung von subjektiven und objektiven Messverfahren zur Erfassung körperlicher Aktivität bei dieser Population untersucht. Zudem wird untersucht, inwieweit sich das Motivations-Volitions-Modell (MoVo-Modell), das sozial-kognitive Determinanten körperlicher Aktivität zusammenfasst, auch auf Menschen mit psychischen Erkrankungen übertragen lässt. Daraufhin wird evaluiert, ob eine auf diesem Modell basierende psychologische Gruppenintervention zur Steigerung körperlicher Aktivität, die für Populationen ohne psychische Erkrankungen entwickelt wurde, auch bei ambulanten Patienten mit psychischen Erkrankungen effektiv ist. Zudem wird evaluiert, ob körperliche Aktivität unmittelbar vor der Exposition bei der Verhaltenstherapie der Panikstörung und Agoraphobie eine wirksame Kombinationstherapie darstellt. Die Ergebnisse zeigen, konsistent mit dem aktuellen Forschungsstand, dass auch in unserer Stichprobe nur eine Minderheit der Menschen mit psychischen Erkrankungen ein ausreichendes Maß körperlicher Aktivität betreibt. Bezüglich der Messbarkeit körperlicher Aktivität zeigt sich eine gute Übereinstimmung von subjektiven und objektiven Messverfahren für globale Gruppenmittelwerte. Bei der Messung auf Individualebene oder der Differenzierung in verschiedene Intensitätslevel zeigen sich jedoch deutlich Differenzen zwischen subjektiver und objektiver Messung, sodass sich die Kombination beider Messverfahren für zukünftige Studien, in denen die solche Parameter von Interesse sind, dringend empfiehlt. Zudem ergeben sich Hinweise darauf, dass das MoVo-Modell grundsätzlich auch bei Menschen mit psychischen Erkrankungen Anwendung finden kann. Bezüglich der darauf aufbauenden Intervention zur Steigerung körperlicher Aktivität zeigt sich, dass dieses auch bei ambulanten Patienten mit psychischen Erkrankungen wirksam ist. Bezüglich der Rolle körperlicher Aktivität zur Kombination mit expositionsbasierter Verhaltenstherapie bei Panikstörung und Agoraphobie zeigen sich erste Hinweise auf eine mögliche Reduktion der Wirklatenz der Verhaltenstherapie durch körperliche Aktivität unmittelbar vor der Exposition. Zusammengefasst zeigt sich, dass viele Menschen mit psychischen Erkrankungen die Empfehlungen bezüglich gesundheitsförderlicher Aktivität nicht erfüllen, dass die untersuchte Intervention effektiv ist, den Anteil dieser zu steigern und dass körperliche Aktivität effektiv sein könnte, um die Wirklatenz expositionsbasierter Verhaltenstherapie zu reduzieren.Physical activity has a positive effect on mental health and can be used in prevention and treatment of mental disorders. As only a minority of patients with mental disorders shows a health beneficial level of physical activity, there is a strong need for the development of interventions that support patients to increase their level of physical activity. The present work examines the prevalence of physical activity and the congruence of subjective and objective measurements of physical activity in outpatients with mental disorders. It further examines if the Motivation-Volition-Model (MoVo-Model), that summarizes social-cognitive determinants of physical activity, is suitable for patients with mental disorders as well. A psychological group intervention to increase physical activity, that is based on this model and was developed for populations without mental disorders, is tested on its effectiveness in patients with mental disorders. Additionally, it is investigated, if physical activity is an effective combination therapy with cognitive behavioural therapy, when applied directly prior to in-vivo exposure in patients with agoraphobia and panic disorder. Consistently with other research, our findings show that only a minority of patients with mental disorders shows a sufficient level of physical activity. Concerning the measurement of physical activity, there is a good accordance of subjective and objective measurement for global group averages. When it comes to measurement on individual-level or the differentiation into different intensity levels, there are noticeable differences between subjective and objective measurement. Therefore, the combination of both forms of measurement is strongly advised for studies where these parameters are of interest. Furthermore, from the present work arises evidence that the MoVo-Model is suitable for patients with mental disorders as well. The examined group intervention was effective in increasing physical activity in outpatients with mental disorders. Concerning the role of physical activity as a combination therapy with exposure based cognitive behavioural therapy in agoraphobia and panic disorder, from the present work arises some evidence that physical activity prior to exposure might accelerate the effect of cognitive behavioural therapy. Summarized the present work shows that a large proportion of patients with mental diseases does not reach the recommendations for health beneficial physical activity, that the used intervention is effective in increasing this proportion and that physical activity might be effective to accelerate the effect of exposure based cognitive behavioural therapy

Topology optimization subject to additive manufacturing constraints

In Topology Optimization the goal is to find the ideal material distribution in a domain subject to external forces. The structure is optimal if it has the highest possible stiffness. A volume constraint ensures filigree structures, which are regulated via a Ginzburg-Landau term. During 3D Printing overhangs lead to instabilities, which have only been tackled unsatisfactorily. The novel idea is to incorporate an Additive Manufacturing Constraint into the phase field method. A rigorous analysis proves the existence of a solution and leads to first order necessary optimality conditions. With an Allen-Cahn interface propagation the optimization problem is solved iteratively. At a low computational cost the Additive Manufacturing Constraint brings about support structures, which can be fine tuned according to engineering demands. Stability during 3D Printing is assured, which solves a common Additive Manufacturing problem

Topology optimization subject to additive manufacturing constraints

In topology optimization the goal is to find the ideal material distribution in a domain subject to external forces. The structure is optimal if it has the highest possible stiffness. A volume constraint ensures filigree structures, which are regulated via a Ginzburg–Landau term. During 3D printing overhangs lead to instabilities. As a remedy an additive manufacturing constraint is added to the cost functional. First order optimality conditions are derived using a formal Lagrangian approach. With an Allen-Cahn interface propagation the optimization problem is solved iteratively. At a low computational cost the additive manufacturing constraint brings about support structures, which can be fine tuned according to demands and increase stability during the printing process

Topology optimization subject to additive manufacturing constraints

In Topology Optimization the goal is to find the ideal material distribution in a domain subject to external forces. The structure is optimal if it has the highest possible stiffness. A volume constraint ensures filigree structures, which are regulated via a Ginzburg-Landau term. During 3D Printing overhangs lead to instabilities, which have only been tackled unsatisfactorily. The novel idea is to incorporate an Additive Manufacturing Constraint into the phase field method. A rigorous analysis proves the existence of a solution and leads to first order necessary optimality conditions. With an Allen-Cahn interface propagation the optimization problem is solved iteratively. At a low computational cost the Additive Manufacturing Constraint brings about support structures, which can be fine tuned according to engineering demands. Stability during 3D Printing is assured, which solves a common Additive Manufacturing problem

Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID‐19 pandemic in Germany

Background: The COVID-19 pandemic is related to multiple stressors and therefore may be associated with psychological distress. The aim of this study was to longitudinally assess symptoms of (un-)specific anxiety and depression along different stages of the pandemic to generate knowledge about the progress of psychological consequences of the pandemic and to test the role of potential risk and resilience factors that were derived from cross-sectional studies and official recommendations. Methods: The present study uses a longitudinal observational design with four waves of online data collection (from March 27 to June 15, 2020) in a convenience sample of the general population in Germany. A total of N = 2376 participants that completed at least two waves of the survey were included in the analyses. Findings: Specific COVID-19-related anxiety and the average daily amount of preoccupation with the pandemic decreased continuously over the four waves. Unspecific worrying and depressive symptoms decreased on average but not on median level. Self-efficacy, normalization, maintaining social contacts, and knowledge, where to get medical support, were associated with fewer symptoms relative to baseline. Suppression, unhealthy habits, and a longer average daily time of thinking about the pandemic were correlated with a relative increase of symptoms. Interpretation: Our findings provide insight into the longitudinal changes of symptoms of psychological distress along the first three months of the COVID-19 pandemic in Germany. Furthermore, we were able to reaffirm the anticipated protective and risk factors that were extracted from previous studies and recommendations

“The first man on the street” - tracing a famous Hilbert quote (1900) back to Gergonne (1825)

A short, catchy, and in its content somewhat exaggerated, quote allows us to draw a connection through three-quarters of a century between two leaders of mathematics who apparently held somewhat similar philosophical, pedagogical, and political views. In addition to providing some new facets to the biographies of Gergonne and Hilbert, our article relates to increasing demands for the dissemination of mathematical knowledge and to corresponding structural changes within mathematics during the 19th century

Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample

Introduction: The COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures. Methods: The mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age. Results: Seventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p < 0.0001; 0.39 < r < 0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and Mental Health in Para-Athletes During COVID-19 a stress level, respectively. Reduced physical activity was significantly (p < 0.0001) associated with higher PHQ-4 values in the general population sample. Discussion: Lower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population