Your palms get sweaty. You feel butterflies in your stomach. Or, does your mind flood with thoughts of previous errors or jump ahead to future outcomes like a missed goal or a slow finish time? Kristen Race, Ph. This mental chatter can make it difficult to maintain perspective and focus. Not only can our thoughts and internal dialogue create a stress response, it also impacts our behavior.

Recent studies by researchers at Coventry University and Staffordshire University found that increased stress and anxiety, including fear of failure, does affect athletic performance in competitive situations.

While some degree of stress is normal in athletics, we need a way to moderate that stress. We also need to be able to resist internal and external distractions — anxiety , fear, a loud crowd, or even a distracting teammate — so that we can make good decisions in the moment.

One major study found that those who reported a greater sense of mindfulness were more likely to experience a higher state of flow the feeling of being totally in the moment which has been linked to enhanced performance. These individuals also scored better in terms of control of attention and emotion, goal-setting and positive self-talk.

According to Dr. Through bringing out attention inward, we also activate the insular cortex of the brain. As a result, we experience a heightened sense of awareness of our body and improve the communication between the body and mind.

While Dr. He helps his athletes refine their internal communications and reduce the mental noise through powerful music, film and stories. He also employs specific exercises to develop the ability to tune out distractions, like a random number identification game where players have to find a specific number under different scenarios — with no noise, with someone watching, and with lots of crowd noise.

There are a number of ways to train the mind to focus on the present moment and weed out distractions. Mindful Breathing Take a few minutes a day in the morning or before you engage in an athletic event or exercise to pay attention to your breath , which can bring on a calm and clear state of mind.

Physiologically, this can help to regulate your breathing if it becomes shallow. Sit comfortably, close your eyes, and start to deepen your breath. Inhale fully and exhale completely. Focus on your breath entering and exiting your body. Start with five minutes and you can build up from there.

Body Scan Practice a body scan to help release tension, quiet the mind, and bring awareness to your body in a systematic way. Lie down on your back with your palms facing up and legs relaxed. Close your eyes. Start with your toes and notice how they feel.

Are they tense? Are they warm or cold? Focus your attention here for a few breaths before moving on to the sole of your foot.

Repeat the process as you travel from your foot to your ankle, calf, knee and thigh. Both of the latter conditions consist of a string of Chinese color-words [i. During the Stroop task, the participants were asked to ignore the meaning of each word and to verbally name the color of the ink in which each word was presented as rapidly and accurately as possible, going from top to bottom and left to right.

If the participant being tested made a mistake, he or she was asked to try again until the correct color was named. The reaction times were recorded from the first stimulus to the final stimulus in each condition as the score indexing the cognitive performance.

The general mindfulness level of each participant was measured using the Chinese version of the Mindful Attention Awareness Scale CMAAS Chang et al. The CMAAS is a item questionnaire that uses a 6-point Likert scale ranging from 1 almost never to 6 almost always for each item.

The athletic mindfulness level of each participant was measured using the Chinese version of the Mindfulness Inventory in Sport CMIS Peng and Shen, , a revised version of the original Mindfulness Inventory in Sport MIS developed by Thienot et al. The CMIS consists of two sub-dimensions, attentional control and non-judgment, and is intended to assess mindfulness levels associated with sports contexts.

The attentional control sub-dimension consists of ten items e. The CMIS thus has a total of 15 items, with a 6-point Likert scale ranging from 1 rarely to 6 every time used for each item.

Higher scores indicate greater athletic mindfulness levels. The Chinese version of the Multidimensional Rumination Questionnaire CMRQ Tu and Hsu, , a revised version of the original Multidimensional Rumination Questionnaire MRQ developed by Fritz , was utilized to assess each participant's level of rumination.

The CMRQ is designed to measure three sub-dimensions, namely, emotional-focused rumination 13 items regarding thinking about thoughts, feelings, or affect in relation to negative experiences , meaning-searching rumination 7 items regarding searching for the meaning of negative experiences or events , and instrumental rumination 5 items regarding thinking about what approach can be used to address negative events , with a 5-point Likert scale ranging from 1 almost never to 5 almost always used for each item.

The Mindfulness-Based Peak Performance MBPP program utilized in the current study was adopted from the mindfulness components of MBSR Kabat-Zinn, , i. The MBPP program consisted of a total of eight min sessions conducted twice per week over 4 weeks, the aim of which was to enhance mindfulness levels and performance.

The sessions covered two fundamental concepts, namely, mindfulness in general and mindfulness in sports contexts, and included six core modules regarding various findings of brain science related to successful performance, such as findings about habits, stress, rest, attention, emotion, and executive functioning.

Additionally, the MBPP sessions also focused on mindfulness exercises, which included mindful check-ins, the raisin exercise, mindful breathing, body scanning, seated meditation, mindful walking, mindful listening, and mindful Bagua Dǎo yin, with each exercise corresponding to the given session topic.

The MBPP course was conducted by a scholar with a Ph. in sport and exercise psychology and three certificated instructors with master's degrees in sport psychology. Each session of the MBPP program started with a brief story about performance aimed at inducing the learning motivation of the participants, after which the content of the preceding session and associated homework were reviewed and discussed, followed by a theoretical discussion introducing a new topic and then a mindfulness exercise.

Finally, each session concluded with a discussion of the specific application of mindfulness concepts and skills during sports competition situations e. To enhance adherence Zhang et al.

Moreover, all of the athletes received an MBPP program handbook that included a scheduled timetable and notes regarding the mindfulness exercises.

The MBPP program was conducted in a classroom of National Taiwan University of Sport. The Appendix I presents a summary outline of the MBPP program protocol. A one-group pretest-posttest design was employed to examine the effects of the MBPP program on the shooting performance of the participating archers.

An orientation was conducted to thoroughly explain the nature of the study so that both the coach and athletes would understand the experimental procedure. The first data collection i. MBPP sessions started at p. and p. Participants were also asked not to consume caffeine for at least 3 h before testing.

In addition, so as to avoid the practice effect from tests Chen et al. SPSS software version Descriptive statistics were utilized to calculate the means and standard deviations of the demographic data. Normal distribution confirmation was used by applying the Shapiro-Wilk test, and all of the data were normally distributed across each of the time points.

A paired sample t -test was conducted to compare the pre-test and post-test shooting score and cognitive function performances. The respective results of the three psychological outcome measures i. Cohen's d and partial eta-squared η p 2 are presented was used to estimates the effect size for t -test and one-way ANOVA, respectively.

In addition, Pearson correlation analysis was performed for post-test to assess the relationships among the shooting score, cognitive function performances, and the three psychological outcomes. Figure 1. Sport and cognitive function performance results in the pre-test and the post-test following the mindfulness-based peak performance MBPP program.

A Comparison of shooting score M ± SE results between the pre-test and post-test and B Comparison of Stroop task condition results between the pre-test and post-test. One of 23 participants was unable to complete the Stroop task, which resulted in total sample of 22 participants for the final analysis.

Figure 2. Changes in mindfulness levels across three time points before, at the mid-point of, and after the mindfulness-based peak performance MBPP program.

A Comparison of the scores M ± SE on the Chinese version of the Mindful Attention Awareness Scale CMAAS across the three time points, B Comparison of the total scores on the Chinese version of the Mindfulness Inventory in Sport CMIS scale across the three time points, and C Comparison of the scores for the attentional control sub-dimension of the CMIS across the three time points.

Figure 3. Changes in rumination score across three time points M ± SE before, at the mid-point of, and after the mindfulness-based peak performance MBPP program. A Comparison of the scores for the emotional-focused rumination EFR sub-dimension and B comparison of the scores for the meaning-searching rumination MSR sub-dimension.

The present study sought to determine the effects of an MBPP program on fine motor sport performance, to examine the potential role of psychological status, and to investigate the optimal dose of an MBI program for achieving desired changes in archery. The primary results revealed higher post-test shooting scores, cognitive function performances, and both general and athletic mindfulness levels compared to those for the pre-test.

Additionally, decreased negative ruminations has revealed since the middle-test. Lastly, a positive correlation between the shooting scores and the mindfulness levels induced by the MBPP program was also observed. The finding of the present study that the MBPP program resulted in improvements in shooting performance was consistent with those of previous studies that utilized dart throwing Zhang et al.

Notably, the strength of this study was that performance in a simulated athletic competition was adopted as an objective assessment that provides a better understanding of the beneficial effects of MBI on performance, including better ecological validity Gross et al.

In a contrasting example, a previous study by Kaufman et al. Taken together with the results of our study, the results of that earlier study imply that the effects of MBIs can be more effectively evaluated with objective assessments that reflect the reality of athletic performance rather than with subjectively biased self-reports.

The archers who participated in the present study showed enhanced Stroop task performances across all the Stroop conditions i.

These results are crucial because better basic information processing e. The improved inhibitory control induced by an MBI may be affected by reducing conflict monitoring in neural processes. For instance, Nien et al. Additionally, a neuroimaging study also found that, compared with relaxation training, an MBI increased the resting-state functional connectivity among EF-related brain networks i.

Our results showed non-significant correlations between the investigated cognitive functions and shooting performance, which is inconsistent with previous studies Verburgh et al.

It should be noted that the majority of those past reports were focused on gross motor sport performance e. Jacobson and Matthaeus have suggested that different types of sport experiences may moderate the sport effects on cognitive performance.

Moreover, the nature of the cognitive tests used may also result in differences. For example, several studies have employed the stop-signal task to detect motor inhibition Verburgh et al.

Further studies are thus suggested in order to better understand the relevance of the sport and cognitive assessments applied.

The findings that the archers exhibited greater general as well as athletic mindfulness levels in the post-test compared to the pre-test not only support previous findings regarding the beneficial effects of MBIs in athletes Bühlmayer et al.

The results also imply that the MBPP program used is effective in increasing mindfulness levels in athletes. Furthermore, a positive correlation between athletic mindfulness, but not general mindfulness, and shooting performance, was demonstrated, suggesting that athletic mindfulness levels may be considered a potential mediator affecting fine motor sport performance, a finding which extends to past studies that employed basketball free throw performance Gooding and Gardner, and middle-distance running performance Jones and Parker, This result may implicate that athletic mindfulness is more suitable for assessing the sport performance of athletes, compared with general mindfulness Josefsson et al.

On the other hand, the results showed a significant increase in the mindfulness level, which means archers improved their ability to concentrate on their present-moment experiences, which may improve the archer's coping skills, relative to a variety of sport-related challenges from internal and external events Josefsson et al.

Furthermore, the MBPP program reduced the negative rumination levels of the participating archers, a result that is consistent with those of previous studies using MBSR and mindfulness-based cognitive therapy programs Campbell et al. Decreased rumination has been linked to increases in mindful attention and enables individuals to focus their attention on present-moment environmental cues Campbell et al.

Reduced rumination has also been found to be associated with superior cognitive performance De Lissnyder et al. Indeed, decreases in negative ruminations are also highly relevant to coping skills for athletic performance, and reducing the manifesting of unwanted emotion Josefsson et al.

Notably, both emotional-focused and meaning-searching aspects of ruminations were improved following the MBPP program in this study, and given that these two dimensions of rumination may be related to the emotional regulation of stressors in competitions Rood et al. Specifically, the athletes who have a relatively higher mindfulness level and less negative ruminative thoughts, and who may experience a lower intensity of negative emotions at the same time, by achieving such balanced mental states could perhaps be better enabled to focus completely on goal-directed behaviors, in order to achieve their optimal performance in the competitions Thompson et al.

Taken together, the results of this study indicate that a reduction of rumination can be induced by MBIs, providing additional evidence that athletes should be encouraged to engage in MBIs to prevent negative emotions and achieve optimal athletic performance. One of the strengths of the present study was that it examined the dose-response relationship between an MBI and its associated changes of psychological status i.

Both general and athletic mindfulness levels were improved at the post-test, meaning that the improvements of mindfulness have occurred in the late stage of the MBPP program. Nevertheless, this result does not correspond with findings of the previous clinical study by Roos et al.

The inconsistent findings might result from the differences in components of the programs and characteristics of their practitioners. Contrarily, decreased ruminations were observed just after middle-test and maintained until the end of the MBPP program, suggesting that the rumination levels could have been improved only in the early stage of the MBPP program.

This finding was found to be partly similar to results of Roos et al. It should be noted that although a 4 weeks program was used in this study, the frequency of sessions was set at twice per week, for an overall dose that was similar to those of past studies Creswell, ; Roos et al.

These findings provide an initial explanation of the dose-response relationships of the MBPP program, in terms of training frequency and overall length, on different psychological outcomes in athletes.

Alterative dose-response relationships associated with session duration and frequency may be presented. In contrast to Kaufman et al. The difference may be associated with session duration, in which studies have suggested that long mindfulness sessions may produce hindrances e.

These findings suggest that mindfulness programs with short duration and more frequency may lead to a larger effect on performance, and this requires further investigation. The strengths of the present study include the fact that its examination of the effects of the MBPP program on athletic performance had better ecological validity than some previous studies, as well as its investigation of many aspects of psychological status and the dose-response relationship of the MBPP program through multiple assessments.

However, our results should be also interpreted cautiously for several reasons. First, the lack of a control group prevents the drawing of any cause-effect interpretations. Additionally, given the relatively small number and unbalance of gender of the elite level participants engaged in a specific sport, which may limit statistical power, and cause the generalizability of the findings to be limited.

As such, in order to better understand how the MBPP program might affect the investigated outcomes, further studies using quasi-experimental designs or randomized controlled trials with larger sample sizes from more sport types are needed in the future.

Another limitation is that the present study did not administer the structured post intervention follow-up, which may not adequately measure the effectiveness of the MBPP program across the entire training progress of participants, and its carry-over effects.

Future research should employ a longitudinal design with a follow-up, in order to better understand the efficacy and effectiveness of the MBPP program for athletes. Third, despite the simulated competition having been adopted for the purpose of assessing the participants' performances objectively, the limited authenticity of the simulated archery competition may mean that the study results are not generalizable to any highly competitive genuine competitions.

Lastly, despite that each session in the MBPP program included a discussion section, the data of running the program e. It would be required to use qualitative methods so as to better and more deeply understand the applications of the MBPP program in future works.

The present study provides empirical and preliminary evidence that supports the benefits of an MBPP program for archers in terms of shooting performance, multiple cognitive functions, and psychological outcomes. Additionally, the MBI ameliorated mindfulness and ruminations in the late-stage and middle-stage, respectively.

Lastly, the MBPP program may be a promising approach for enhancing athletic performance, suggesting that athletes and coaches could integrated the MBPP program into sport training routines. However, further studies considering performance-relevant outcomes, and implemented with high-quality methodology, are needed in order to replicate the findings of the present study.

The studies involving human participants were reviewed and approved by Center for Research Ethics of National Taiwan Normal University. T-YW, Y-CC, H-CC, and Y-KC contributed to the conception of the work. T-YW, Y-CC, H-CC, and Y-KC contributed to the design of the work. J-TN, GK, C-HW, and H-CC conducted the literature search, selection, data extraction, and analysis.

T-YW, J-TN, GK, and C-HW wrote the first draft of the manuscript with support from H-CC. All authors contributed to the manuscript revisions and agreed with final approval of the version. This work was supported by part of a grant from Ministry of Science and Technology in Taiwan MOST HMY3 and National Taiwan Normal University from the Higher Education Sprout Project by the Ministry of Education MOE in Taiwan to Y-KC.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Allen, M. Cognitive-affective neural plasticity following active-controlled mindfulness intervention. doi: PubMed Abstract CrossRef Full Text Google Scholar. Audiffren, M. The exercise-cognition relationship: a virtuous circle.

Sport Health Sci. CrossRef Full Text Google Scholar. Banerjee, M. A qualitative study with healthcare staff exploring the facilitators and barriers to engaging in a self-help mindfulness-based intervention.

Mindfulness 8, — Birrer, D. Mindfulness to enhance athletic performance: theoretical considerations and possible impact mechanisms.

Mindfulness 3, — Brown, K. The benefits of being present: mindfulness and its role in psychological well-being. Bühlmayer, L. Effects of mindfulness practice on performance-relevant parameters and performance outcomes in sports: a meta-analytical review.

Sports Med. Campbell, T. Impact of mindfulness-based stress reduction MBSR on attention, rumination and resting blood pressure in women with cancer: a waitlist-controlled study. Chang, J. Psychometric properties of the Chinese translation of mindful attention awareness scale CMAAS.

Chen, F. Effects of exercise training interventions on executive function in older adults: a systematic review and meta-analysis. Chen, Z. The neural mechanisms of semantic and response conflicts: an fMRI study of practice-related effects in the Stroop task.

Chu, C. Creswell, J. Mindfulness interventions. Mindfulness training and physical health: mechanisms and outcomes. Cuijpers, P. How much psychotherapy is needed to treat depression? A metaregression analysis. Dawson, A.

Mindfulness-based interventions for university students: a systematic review and meta-analysis of randomised controlled trials. Health Well Being 12, — De Lissnyder, E.

The association between depressive symptoms and executive control impairments in response to emotional and non-emotional information. Diamond, A. Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not.

Etnier, J. Exercise, cognitive function, and the brain: advancing our understanding of complex relationships. Fritz, H. The role of rumination in adjustment to a first coronary event. B Sci. Google Scholar.

These reports included factors like their levels of stress and anxiety, amount of sleepiness, tendency to ruminate over certain events, and if they used mindfulness techniques. They were able to stay asleep with less time spent awake throughout the night.

This may be due to lower stress levels and less ruminating thoughts before bedtime, since participants were encouraged to practice mindfulness daily before nighttime sleep.

That was also good to see because sleep questionnaires are not strongly interrelated with emotion questionnaires, so we felt confident that those were tapping into two different things. The improvement in sleep correlated with the improvements in mindfulness as assessed with the mindfulness questionnaire.

This study shows that proper training in mindfulness techniques and steady practice can help us to manage the stress in our daily lives, which in turn can improve interconnected elements like sleep and mental health.

These findings concur with previous studies that showed mindfulness interventions on athletes improved coping skills as well as self- and team-efficacy beliefs.

Future topics for exploration include the use of deep concentration and mindful attention to elements of an exercise routine that could increase power or endurance. For example, external cues in rowing could include keeping an eye on your average rate of speed, total distance, and setting performance goals as your workout progresses.

Body sensations could be your respiratory rate, muscle exertion, or overall fatigue. A more dissociative strategy that many athletes use is to listen to music and tune out during a difficult evaluative test. We know that students are not getting enough sleep, that they have a lot going on, and they're stressed…I think there's a lot of room to help those issues and improve their well-being.

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February 9, The MBPP program consisted of a total of eight min sessions conducted twice per week over 4 weeks, the aim of which was to enhance mindfulness levels and performance. The sessions covered two fundamental concepts, namely, mindfulness in general and mindfulness in sports contexts, and included six core modules regarding various findings of brain science related to successful performance, such as findings about habits, stress, rest, attention, emotion, and executive functioning.

Additionally, the MBPP sessions also focused on mindfulness exercises, which included mindful check-ins, the raisin exercise, mindful breathing, body scanning, seated meditation, mindful walking, mindful listening, and mindful Bagua Dǎo yin, with each exercise corresponding to the given session topic.

The MBPP course was conducted by a scholar with a Ph. in sport and exercise psychology and three certificated instructors with master's degrees in sport psychology. Each session of the MBPP program started with a brief story about performance aimed at inducing the learning motivation of the participants, after which the content of the preceding session and associated homework were reviewed and discussed, followed by a theoretical discussion introducing a new topic and then a mindfulness exercise.

Finally, each session concluded with a discussion of the specific application of mindfulness concepts and skills during sports competition situations e. To enhance adherence Zhang et al. Moreover, all of the athletes received an MBPP program handbook that included a scheduled timetable and notes regarding the mindfulness exercises.

The MBPP program was conducted in a classroom of National Taiwan University of Sport. The Appendix I presents a summary outline of the MBPP program protocol. A one-group pretest-posttest design was employed to examine the effects of the MBPP program on the shooting performance of the participating archers.

An orientation was conducted to thoroughly explain the nature of the study so that both the coach and athletes would understand the experimental procedure. The first data collection i. MBPP sessions started at p.

and p. Participants were also asked not to consume caffeine for at least 3 h before testing. In addition, so as to avoid the practice effect from tests Chen et al.

SPSS software version Descriptive statistics were utilized to calculate the means and standard deviations of the demographic data. Normal distribution confirmation was used by applying the Shapiro-Wilk test, and all of the data were normally distributed across each of the time points.

A paired sample t -test was conducted to compare the pre-test and post-test shooting score and cognitive function performances. The respective results of the three psychological outcome measures i. Cohen's d and partial eta-squared η p 2 are presented was used to estimates the effect size for t -test and one-way ANOVA, respectively.

In addition, Pearson correlation analysis was performed for post-test to assess the relationships among the shooting score, cognitive function performances, and the three psychological outcomes. Figure 1. Sport and cognitive function performance results in the pre-test and the post-test following the mindfulness-based peak performance MBPP program.

A Comparison of shooting score M ± SE results between the pre-test and post-test and B Comparison of Stroop task condition results between the pre-test and post-test.

One of 23 participants was unable to complete the Stroop task, which resulted in total sample of 22 participants for the final analysis. Figure 2. Changes in mindfulness levels across three time points before, at the mid-point of, and after the mindfulness-based peak performance MBPP program.

A Comparison of the scores M ± SE on the Chinese version of the Mindful Attention Awareness Scale CMAAS across the three time points, B Comparison of the total scores on the Chinese version of the Mindfulness Inventory in Sport CMIS scale across the three time points, and C Comparison of the scores for the attentional control sub-dimension of the CMIS across the three time points.

Figure 3. Changes in rumination score across three time points M ± SE before, at the mid-point of, and after the mindfulness-based peak performance MBPP program. A Comparison of the scores for the emotional-focused rumination EFR sub-dimension and B comparison of the scores for the meaning-searching rumination MSR sub-dimension.

The present study sought to determine the effects of an MBPP program on fine motor sport performance, to examine the potential role of psychological status, and to investigate the optimal dose of an MBI program for achieving desired changes in archery.

The primary results revealed higher post-test shooting scores, cognitive function performances, and both general and athletic mindfulness levels compared to those for the pre-test.

Additionally, decreased negative ruminations has revealed since the middle-test. Lastly, a positive correlation between the shooting scores and the mindfulness levels induced by the MBPP program was also observed.

The finding of the present study that the MBPP program resulted in improvements in shooting performance was consistent with those of previous studies that utilized dart throwing Zhang et al.

Notably, the strength of this study was that performance in a simulated athletic competition was adopted as an objective assessment that provides a better understanding of the beneficial effects of MBI on performance, including better ecological validity Gross et al.

In a contrasting example, a previous study by Kaufman et al. Taken together with the results of our study, the results of that earlier study imply that the effects of MBIs can be more effectively evaluated with objective assessments that reflect the reality of athletic performance rather than with subjectively biased self-reports.

The archers who participated in the present study showed enhanced Stroop task performances across all the Stroop conditions i. These results are crucial because better basic information processing e.

The improved inhibitory control induced by an MBI may be affected by reducing conflict monitoring in neural processes. For instance, Nien et al.

Additionally, a neuroimaging study also found that, compared with relaxation training, an MBI increased the resting-state functional connectivity among EF-related brain networks i.

Our results showed non-significant correlations between the investigated cognitive functions and shooting performance, which is inconsistent with previous studies Verburgh et al.

It should be noted that the majority of those past reports were focused on gross motor sport performance e. Jacobson and Matthaeus have suggested that different types of sport experiences may moderate the sport effects on cognitive performance.

Moreover, the nature of the cognitive tests used may also result in differences. For example, several studies have employed the stop-signal task to detect motor inhibition Verburgh et al.

Further studies are thus suggested in order to better understand the relevance of the sport and cognitive assessments applied. The findings that the archers exhibited greater general as well as athletic mindfulness levels in the post-test compared to the pre-test not only support previous findings regarding the beneficial effects of MBIs in athletes Bühlmayer et al.

The results also imply that the MBPP program used is effective in increasing mindfulness levels in athletes. Furthermore, a positive correlation between athletic mindfulness, but not general mindfulness, and shooting performance, was demonstrated, suggesting that athletic mindfulness levels may be considered a potential mediator affecting fine motor sport performance, a finding which extends to past studies that employed basketball free throw performance Gooding and Gardner, and middle-distance running performance Jones and Parker, This result may implicate that athletic mindfulness is more suitable for assessing the sport performance of athletes, compared with general mindfulness Josefsson et al.

On the other hand, the results showed a significant increase in the mindfulness level, which means archers improved their ability to concentrate on their present-moment experiences, which may improve the archer's coping skills, relative to a variety of sport-related challenges from internal and external events Josefsson et al.

Furthermore, the MBPP program reduced the negative rumination levels of the participating archers, a result that is consistent with those of previous studies using MBSR and mindfulness-based cognitive therapy programs Campbell et al.

Decreased rumination has been linked to increases in mindful attention and enables individuals to focus their attention on present-moment environmental cues Campbell et al. Reduced rumination has also been found to be associated with superior cognitive performance De Lissnyder et al.

Indeed, decreases in negative ruminations are also highly relevant to coping skills for athletic performance, and reducing the manifesting of unwanted emotion Josefsson et al. Notably, both emotional-focused and meaning-searching aspects of ruminations were improved following the MBPP program in this study, and given that these two dimensions of rumination may be related to the emotional regulation of stressors in competitions Rood et al.

Specifically, the athletes who have a relatively higher mindfulness level and less negative ruminative thoughts, and who may experience a lower intensity of negative emotions at the same time, by achieving such balanced mental states could perhaps be better enabled to focus completely on goal-directed behaviors, in order to achieve their optimal performance in the competitions Thompson et al.

Taken together, the results of this study indicate that a reduction of rumination can be induced by MBIs, providing additional evidence that athletes should be encouraged to engage in MBIs to prevent negative emotions and achieve optimal athletic performance.

One of the strengths of the present study was that it examined the dose-response relationship between an MBI and its associated changes of psychological status i.

Both general and athletic mindfulness levels were improved at the post-test, meaning that the improvements of mindfulness have occurred in the late stage of the MBPP program.

Nevertheless, this result does not correspond with findings of the previous clinical study by Roos et al. The inconsistent findings might result from the differences in components of the programs and characteristics of their practitioners.

Contrarily, decreased ruminations were observed just after middle-test and maintained until the end of the MBPP program, suggesting that the rumination levels could have been improved only in the early stage of the MBPP program. This finding was found to be partly similar to results of Roos et al.

It should be noted that although a 4 weeks program was used in this study, the frequency of sessions was set at twice per week, for an overall dose that was similar to those of past studies Creswell, ; Roos et al.

These findings provide an initial explanation of the dose-response relationships of the MBPP program, in terms of training frequency and overall length, on different psychological outcomes in athletes. Alterative dose-response relationships associated with session duration and frequency may be presented.

In contrast to Kaufman et al. The difference may be associated with session duration, in which studies have suggested that long mindfulness sessions may produce hindrances e. These findings suggest that mindfulness programs with short duration and more frequency may lead to a larger effect on performance, and this requires further investigation.

The strengths of the present study include the fact that its examination of the effects of the MBPP program on athletic performance had better ecological validity than some previous studies, as well as its investigation of many aspects of psychological status and the dose-response relationship of the MBPP program through multiple assessments.

However, our results should be also interpreted cautiously for several reasons. First, the lack of a control group prevents the drawing of any cause-effect interpretations. Additionally, given the relatively small number and unbalance of gender of the elite level participants engaged in a specific sport, which may limit statistical power, and cause the generalizability of the findings to be limited.

As such, in order to better understand how the MBPP program might affect the investigated outcomes, further studies using quasi-experimental designs or randomized controlled trials with larger sample sizes from more sport types are needed in the future. Another limitation is that the present study did not administer the structured post intervention follow-up, which may not adequately measure the effectiveness of the MBPP program across the entire training progress of participants, and its carry-over effects.

Future research should employ a longitudinal design with a follow-up, in order to better understand the efficacy and effectiveness of the MBPP program for athletes.

Third, despite the simulated competition having been adopted for the purpose of assessing the participants' performances objectively, the limited authenticity of the simulated archery competition may mean that the study results are not generalizable to any highly competitive genuine competitions.

Lastly, despite that each session in the MBPP program included a discussion section, the data of running the program e. It would be required to use qualitative methods so as to better and more deeply understand the applications of the MBPP program in future works.

The present study provides empirical and preliminary evidence that supports the benefits of an MBPP program for archers in terms of shooting performance, multiple cognitive functions, and psychological outcomes.

Additionally, the MBI ameliorated mindfulness and ruminations in the late-stage and middle-stage, respectively. Lastly, the MBPP program may be a promising approach for enhancing athletic performance, suggesting that athletes and coaches could integrated the MBPP program into sport training routines.

However, further studies considering performance-relevant outcomes, and implemented with high-quality methodology, are needed in order to replicate the findings of the present study.

The studies involving human participants were reviewed and approved by Center for Research Ethics of National Taiwan Normal University. T-YW, Y-CC, H-CC, and Y-KC contributed to the conception of the work.

T-YW, Y-CC, H-CC, and Y-KC contributed to the design of the work. J-TN, GK, C-HW, and H-CC conducted the literature search, selection, data extraction, and analysis. T-YW, J-TN, GK, and C-HW wrote the first draft of the manuscript with support from H-CC. All authors contributed to the manuscript revisions and agreed with final approval of the version.

This work was supported by part of a grant from Ministry of Science and Technology in Taiwan MOST HMY3 and National Taiwan Normal University from the Higher Education Sprout Project by the Ministry of Education MOE in Taiwan to Y-KC. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Allen, M. Cognitive-affective neural plasticity following active-controlled mindfulness intervention. doi: PubMed Abstract CrossRef Full Text Google Scholar. Audiffren, M. The exercise-cognition relationship: a virtuous circle. Sport Health Sci.

CrossRef Full Text Google Scholar. Banerjee, M. A qualitative study with healthcare staff exploring the facilitators and barriers to engaging in a self-help mindfulness-based intervention. Mindfulness 8, — Birrer, D. Mindfulness to enhance athletic performance: theoretical considerations and possible impact mechanisms.

Mindfulness 3, — Brown, K. The benefits of being present: mindfulness and its role in psychological well-being. Bühlmayer, L. Effects of mindfulness practice on performance-relevant parameters and performance outcomes in sports: a meta-analytical review.

Sports Med. Campbell, T. Impact of mindfulness-based stress reduction MBSR on attention, rumination and resting blood pressure in women with cancer: a waitlist-controlled study. Chang, J. Psychometric properties of the Chinese translation of mindful attention awareness scale CMAAS.

Chen, F. Effects of exercise training interventions on executive function in older adults: a systematic review and meta-analysis. Chen, Z. The neural mechanisms of semantic and response conflicts: an fMRI study of practice-related effects in the Stroop task.

Chu, C. Creswell, J. Mindfulness interventions. Mindfulness training and physical health: mechanisms and outcomes. Cuijpers, P. How much psychotherapy is needed to treat depression?

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In a contrasting example, a previous study by Kaufman et al. Taken together with the results of our study, the results of that earlier study imply that the effects of MBIs can be more effectively evaluated with objective assessments that reflect the reality of athletic performance rather than with subjectively biased self-reports.

The archers who participated in the present study showed enhanced Stroop task performances across all the Stroop conditions i. These results are crucial because better basic information processing e.

The improved inhibitory control induced by an MBI may be affected by reducing conflict monitoring in neural processes. For instance, Nien et al. Additionally, a neuroimaging study also found that, compared with relaxation training, an MBI increased the resting-state functional connectivity among EF-related brain networks i.

Our results showed non-significant correlations between the investigated cognitive functions and shooting performance, which is inconsistent with previous studies Verburgh et al.

It should be noted that the majority of those past reports were focused on gross motor sport performance e. Jacobson and Matthaeus have suggested that different types of sport experiences may moderate the sport effects on cognitive performance.

Moreover, the nature of the cognitive tests used may also result in differences. For example, several studies have employed the stop-signal task to detect motor inhibition Verburgh et al.

Further studies are thus suggested in order to better understand the relevance of the sport and cognitive assessments applied. The findings that the archers exhibited greater general as well as athletic mindfulness levels in the post-test compared to the pre-test not only support previous findings regarding the beneficial effects of MBIs in athletes Bühlmayer et al.

The results also imply that the MBPP program used is effective in increasing mindfulness levels in athletes. Furthermore, a positive correlation between athletic mindfulness, but not general mindfulness, and shooting performance, was demonstrated, suggesting that athletic mindfulness levels may be considered a potential mediator affecting fine motor sport performance, a finding which extends to past studies that employed basketball free throw performance Gooding and Gardner, and middle-distance running performance Jones and Parker, This result may implicate that athletic mindfulness is more suitable for assessing the sport performance of athletes, compared with general mindfulness Josefsson et al.

On the other hand, the results showed a significant increase in the mindfulness level, which means archers improved their ability to concentrate on their present-moment experiences, which may improve the archer's coping skills, relative to a variety of sport-related challenges from internal and external events Josefsson et al.

Furthermore, the MBPP program reduced the negative rumination levels of the participating archers, a result that is consistent with those of previous studies using MBSR and mindfulness-based cognitive therapy programs Campbell et al.

Decreased rumination has been linked to increases in mindful attention and enables individuals to focus their attention on present-moment environmental cues Campbell et al. Reduced rumination has also been found to be associated with superior cognitive performance De Lissnyder et al.

Indeed, decreases in negative ruminations are also highly relevant to coping skills for athletic performance, and reducing the manifesting of unwanted emotion Josefsson et al. Notably, both emotional-focused and meaning-searching aspects of ruminations were improved following the MBPP program in this study, and given that these two dimensions of rumination may be related to the emotional regulation of stressors in competitions Rood et al.

Specifically, the athletes who have a relatively higher mindfulness level and less negative ruminative thoughts, and who may experience a lower intensity of negative emotions at the same time, by achieving such balanced mental states could perhaps be better enabled to focus completely on goal-directed behaviors, in order to achieve their optimal performance in the competitions Thompson et al.

Taken together, the results of this study indicate that a reduction of rumination can be induced by MBIs, providing additional evidence that athletes should be encouraged to engage in MBIs to prevent negative emotions and achieve optimal athletic performance.

One of the strengths of the present study was that it examined the dose-response relationship between an MBI and its associated changes of psychological status i. Both general and athletic mindfulness levels were improved at the post-test, meaning that the improvements of mindfulness have occurred in the late stage of the MBPP program.

Nevertheless, this result does not correspond with findings of the previous clinical study by Roos et al. The inconsistent findings might result from the differences in components of the programs and characteristics of their practitioners.

Contrarily, decreased ruminations were observed just after middle-test and maintained until the end of the MBPP program, suggesting that the rumination levels could have been improved only in the early stage of the MBPP program.

This finding was found to be partly similar to results of Roos et al. It should be noted that although a 4 weeks program was used in this study, the frequency of sessions was set at twice per week, for an overall dose that was similar to those of past studies Creswell, ; Roos et al.

These findings provide an initial explanation of the dose-response relationships of the MBPP program, in terms of training frequency and overall length, on different psychological outcomes in athletes. Alterative dose-response relationships associated with session duration and frequency may be presented.

In contrast to Kaufman et al. The difference may be associated with session duration, in which studies have suggested that long mindfulness sessions may produce hindrances e. These findings suggest that mindfulness programs with short duration and more frequency may lead to a larger effect on performance, and this requires further investigation.

The strengths of the present study include the fact that its examination of the effects of the MBPP program on athletic performance had better ecological validity than some previous studies, as well as its investigation of many aspects of psychological status and the dose-response relationship of the MBPP program through multiple assessments.

However, our results should be also interpreted cautiously for several reasons. First, the lack of a control group prevents the drawing of any cause-effect interpretations.

Additionally, given the relatively small number and unbalance of gender of the elite level participants engaged in a specific sport, which may limit statistical power, and cause the generalizability of the findings to be limited.

As such, in order to better understand how the MBPP program might affect the investigated outcomes, further studies using quasi-experimental designs or randomized controlled trials with larger sample sizes from more sport types are needed in the future.

Another limitation is that the present study did not administer the structured post intervention follow-up, which may not adequately measure the effectiveness of the MBPP program across the entire training progress of participants, and its carry-over effects.

Future research should employ a longitudinal design with a follow-up, in order to better understand the efficacy and effectiveness of the MBPP program for athletes.

Third, despite the simulated competition having been adopted for the purpose of assessing the participants' performances objectively, the limited authenticity of the simulated archery competition may mean that the study results are not generalizable to any highly competitive genuine competitions.

Lastly, despite that each session in the MBPP program included a discussion section, the data of running the program e. It would be required to use qualitative methods so as to better and more deeply understand the applications of the MBPP program in future works.

The present study provides empirical and preliminary evidence that supports the benefits of an MBPP program for archers in terms of shooting performance, multiple cognitive functions, and psychological outcomes. Additionally, the MBI ameliorated mindfulness and ruminations in the late-stage and middle-stage, respectively.

Lastly, the MBPP program may be a promising approach for enhancing athletic performance, suggesting that athletes and coaches could integrated the MBPP program into sport training routines.

However, further studies considering performance-relevant outcomes, and implemented with high-quality methodology, are needed in order to replicate the findings of the present study. The studies involving human participants were reviewed and approved by Center for Research Ethics of National Taiwan Normal University.

T-YW, Y-CC, H-CC, and Y-KC contributed to the conception of the work. T-YW, Y-CC, H-CC, and Y-KC contributed to the design of the work. J-TN, GK, C-HW, and H-CC conducted the literature search, selection, data extraction, and analysis. T-YW, J-TN, GK, and C-HW wrote the first draft of the manuscript with support from H-CC.

All authors contributed to the manuscript revisions and agreed with final approval of the version. This work was supported by part of a grant from Ministry of Science and Technology in Taiwan MOST HMY3 and National Taiwan Normal University from the Higher Education Sprout Project by the Ministry of Education MOE in Taiwan to Y-KC.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Allen, M. Cognitive-affective neural plasticity following active-controlled mindfulness intervention. doi: PubMed Abstract CrossRef Full Text Google Scholar.

Audiffren, M. The exercise-cognition relationship: a virtuous circle. Sport Health Sci. CrossRef Full Text Google Scholar. Banerjee, M. A qualitative study with healthcare staff exploring the facilitators and barriers to engaging in a self-help mindfulness-based intervention.

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Bühlmayer, L. Effects of mindfulness practice on performance-relevant parameters and performance outcomes in sports: a meta-analytical review. Sports Med. Campbell, T.

Impact of mindfulness-based stress reduction MBSR on attention, rumination and resting blood pressure in women with cancer: a waitlist-controlled study. Chang, J. Psychometric properties of the Chinese translation of mindful attention awareness scale CMAAS.

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Chen, Z. The neural mechanisms of semantic and response conflicts: an fMRI study of practice-related effects in the Stroop task.

Chu, C. Creswell, J. Mindfulness interventions. Mindfulness training and physical health: mechanisms and outcomes. Cuijpers, P. How much psychotherapy is needed to treat depression? A metaregression analysis. Dawson, A. Mindfulness-based interventions for university students: a systematic review and meta-analysis of randomised controlled trials.

Health Well Being 12, — De Lissnyder, E. The association between depressive symptoms and executive control impairments in response to emotional and non-emotional information. Diamond, A. Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not.

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B Sci. Google Scholar. Frostadottir, A. The finding that MT was also better than PST in these measures implies that the changes were due to the specific content of the mindfulness workshops and cannot be explained simply by the fact that any intervention has taken place.

Thus, in our workshop setting it seemed easier to teach the other two aspects of mindfulness. In order to change acting with awareness , it would probably have required more formal mindfulness training.

In consequence, MT passed the manipulation check with the exception of one scale. This last result may be related to the fact that techniques to control attention were trained much more explicitly in the PST program e. Overall, the PST clearly passed the manipulation check.

Regarding the use of some techniques i. We did not expect this shared effect. In goal setting , a possible explanation is that MT led the athletes to approach their training and competition with the goal to stay in the present, and in activation and relaxation , an explanation could be the improved perception of inner states through mindfulness and a corresponding adaptation of the state to current needs.

Mindfulness is, in itself, a technique to handle emotions, which may explain corresponding changes in MT when it comes to the use of techniques to deal with emotions. In sum, there appeared to be differential intervention effects: whereas PST improved psychological skills, MT improved mindfulness.

However, we also saw a broad treatment effect especially for MT, which was indicated by the use of individual psychological techniques that were also improved in the MT. The mean effect of PST on all psychological skills and use of techniques was. The mean effect of MT on all three aspects of mindfulness was.

The lower number is due to the acting with awareness scale that did not show any changes. The observed effect-posterior means were. The emotional control scale of the TOPS essentially measures whether emotions interfere with athletic performance in training and competition. This can be interpreted as an example of the shared effect of different forms of mental training.

Our results seem to show that athletes can reach the same goal non-interference of emotions using different strategies, i. This made sense since mindfulness interventions aim to help people to feel all experiences, including the unpleasant ones, without avoiding them.

This is underlined by the observed effect-posterior means. A possible explanation for these changes, although acceptance was not addressed during the PST intervention, could be group effects. For example, when participants in the workshops saw that other athletes had similar emotions to their own, they may have been able to see their own feelings as normal and have been more likely to accept them.

This is another example of the shared effect of different forms of mental training, and apparently, there are several ways to improve attention PST and MT. The results regarding cognitive interference were mixed. Results were clearer for interference by performance worries and negative cognitions.

Both MT and PST therefore appeared to have a shared effect on certain aspects of cognitive interference i. As expected, we also saw a clear pattern for the increase of decentering in favor of MT, i.

MT seemed to help athletes to distance themselves more easily from internal processes such as thoughts or feelings. The observed effect-posterior means for action orientation were. The HPD interval was the largest for action orientation and state orientation , indicating more uncertainty about where the true effect lies.

Thus, both interventions had a similar probability for effects on action and state orientation. This is yet another example of a shared effect of different forms of mental training.

In this study, we investigated the effect of two forms of mental training on different psychological parameters relevant to athletic performance.

It is the first RCT to include a mindfulness training intervention MT , a psychological skills training intervention PST and a waitlist control group WL. Both interventions passed the manipulation check, that is, MT led to an increase in mindfulness, and PST led to an increased use of psychological strategies in the respective sports.

Both interventions had the expected positive effects on performance-related factors, such as the handling of emotions and the control of attention. We found both differential and shared effects.

By differential effects, we mean that only one of the two mental training forms was effective i. By shared effects, we mean that both interventions were effective for a certain outcome variable. As expected, we found shared effects in dealing with emotions, in attention control, and in dealing with mistakes.

All concepts were assessed using self-report questionnaires. In detail, we found that both interventions led to an improved handling of emotions, which was indicated by our results that emotions were less likely to interfere with performance in training and competition.

Both, MT and PST also led to an increase in attention control. This indicates that after these interventions athletes in training and competition were less distracted by internal or external events and better able to maintain their focus.

The effect of improvement in attention control was somewhat lower in both interventions compared with the improved handling of emotions. Thus, it appeared that our interventions had a greater impact on the handling of emotions than on attention control.

We also saw a tendency for improvements by the interventions regarding action vs. state orientation the latter considered being less helpful , although the results were less clear than for the other variables. This may be related to the constructs of action vs.

state orientation being less closely related to the interventions compared with the other outcome variables and were possibly influenced by other factors than mental training. For some variables, we found shared effects that we did not expect. These results suggest that sport psychological interventions often seem to have effects that are not directly intended.

Future research should investigate these effects in more detail. Psychotherapy research could serve as a model here. For some time, psychotherapy research has been investigating which factors, apart from the psychotherapeutic approach itself, influence the outcome of the therapy [ 27 ]. Common examples of such common factors are the therapeutic alliance, affective experiencing or patient engagement [ 37 ].

We found differential effects for some variables. For these variables, only one of the two interventions was effective. This was evident in the use of self-talk, where we only found effects for the PST. In contrast, we found differential effects in favor of MT in the ability to look at internal processes from a certain distance, without judging and without avoiding unpleasant processes.

This clarity and acceptance of inner experiences seems to be fostered especially through MT. If these two processes prove to be particularly performance relevant in sport, sport psychologists are well advised to promote them in their interventions.

However, further research is needed to highlight this possible impact. The differential effects we observed in this study were not surprising in that they were very close to the intervention itself. Future research could investigate whether there are other outcome variables on which various forms of mental training have differential effects.

One such variable would be well-being. Mindfulness interventions seem to be more likely to have effects on well-being and other mental health parameters than psychological skills training interventions [ 18 ]. The present study has certain limitations, the most important of which is study planning and implementation.

As shown in the supplementary material, we were not able to implement everything as planned. It is particularly significant that we did not record specific indicators for physical performance.

This means that we cannot determine whether the psychological variables being recorded and declared as relevant to performance really promote athletic performance.

Future research should therefore not only include psychological variables but also indicators of athletic performance objective measures as well as external and self-assessment of performance. In addition, our results solely rely on self-report data, which increases the risk of method biases [ 29 ].

While our study investigated which mental training works for which outcome, future research should additionally consider potential moderators. This would mean to also investigate which mental training works for whom and under what circumstances.

A disadvantage of conducting the workshop in the way we did was that our method proved to be very time-consuming and was limited regarding time and place. It would be instructive to examine alternative forms of interventions that do not have these disadvantages, for example, forms of online interventions [ 35 ].

We conclude that both forms of mental training lead to expected changes in performance-relevant psychological factors. Both interventions enhanced attention control, handling of emotions, and the functional behavior after failure.

MT seems to have advantages over PST when it comes to a distanced perspective to once inner experience i. Sport psychologists may not ask themselves whether they should do either mindfulness or psychological skills training. Instead, they should consider the demands of the respective sport as well as which outcome they want to target and choose the most appropriate interventions based on empirical evidence, their personal training and their and the athletes preferences.

The study slightly deviates from the study protocol in a few ways. We have submitted an overview of the changes in the supplementary material section.

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Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Hayes SC, Strosahl K, Wilson KG. Arguing against this idea is that the health education intervention was designed for this study so that it would not specifically target cognition eg, it did not include a mindfulness or exercise regimen.

Further, if cognitive performance increases represented true benefits, one would expect to see a reflection of those benefits in brain structures ie, increase or attenuated decrease in the size of hippocampus and DLPFC, structures involved in episodic memory, and executive function , yet both structures showed longitudinal declines with all conditions, consistent with age-related atrophy not attenuated by the interventions.

In addition, the combination of MBSR and exercise showed no greater change than each intervention alone. Thus, the increases in cognitive performance likely reflect expectancy or practice effects from repeated exposure to the assessments.

Another potential cause of the null findings was failure in target engagement ie, failure in having the desired effect from the interventions , which could result from poor participant adherence, low intervention fidelity by instructors, low intensity of interventions, or low reliability of outcome measures.

However, none of these problems were apparent: participants demonstrated high adherence and retention in the study, instructors were trained and supervised for fidelity, the intensity of interventions was similar to that in prior trials, and outcome reliability was good.

Furthermore, per-protocol analyses of participants that were more highly adherent to the interventions showed no significant differences from the overall sample. In the exercise intervention, physiological and performance changes suggest participants benefited from exercise.

Thus, the findings are similar to the Lifestyle Interventions and Independence for Elders Study, which showed a beneficial effect of 24 months of exercise on disability prevention, but not cognitive performance.

Another possibility accounting for lack of detectable effect of interventions is that participants were generally healthy and potentially insufficiently sedentary at baseline, thereby limiting potential for benefiting from lifestyle interventions. To test this, subgroup analyses of those who showed the greatest changes in physiological or performance variables posited to underlie cognitive health eg, improved insulin sensitivity were conducted.

These analyses found that, even when the interventions produced beneficial changes in these putative mechanisms, they still did not lead to significant cognitive benefits. Thus, the health of the participants does not appear to explain the null results.

As a whole, these results suggest that the underlying hypothesis is unsupported. This study has several limitations. First, the participants were largely White and the majority were college-educated; this limited diversity reduces generalizability of findings. Fourth, the study focused on healthy older adults who were objectively cognitive intact; some studies have found beneficial effects of exercise on cognitive function in more physically or cognitively ill and frail older adults, 34 as well as benefits of MBSR in older adults with depression and anxiety.

These and other potentially remediable mechanisms beyond cortisol, insulin sensitivity, and aerobic fitness were not examined in this study and should be considered in future research. Among older adults with subjective cognitive concerns, mindfulness training, exercise, or both did not result in significant differences in improvement in episodic memory or executive function composite scores at 6 months.

Corresponding Author: Eric J. Lenze, MD, Washington University School of Medicine, Healthy Mind Lab, Department of Psychiatry, S Euclid Ave, Box , St Louis, MO lenzee wustl.

Author Contributions: Dr Lenze had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Lenze, Miller, Ances, Balota, Barch, Depp, Foster, Head, Hershey, Tate, Wing, Wu, Wetherell.

Acquisition, analysis, or interpretation of data: Voegtle, Miller, Barch, Depp, Diniz, Eyler, Foster, Gettinger, Hershey, Klein, Nichols, Nicol, Nishino, Patterson, Rodebaugh, Schweiger, Shimony, Sinacore, Snyder, Twamley, Wing, Wu, Yang, Yingling, Wetherell. Drafting of the manuscript: Lenze, Voegtle, Miller, Balota, Depp, Diniz, Schweiger, Sinacore, Wetherell.

Critical revision of the manuscript for important intellectual content: Lenze, Miller, Ances, Barch, Depp, Diniz, Eyler, Foster, Gettinger, Head, Hershey, Klein, Nichols, Nicol, Nishino, Patterson, Rodebaugh, Shimony, Sinacore, Snyder, Tate, Twamley, Wing, Wu, Yang, Yingling, Wetherell.

Administrative, technical, or material support: Barch, Depp, Diniz, Eyler, Foster, Gettinger, Klein, Nicol, Nishino, Rodebaugh, Schweiger, Shimony, Sinacore, Snyder, Tate, Wu, Wetherell.

Supervision: Lenze, Ances, Balota, Foster, Schweiger, Shimony, Sinacore, Tate, Wu, Wetherell. Other - Design, implementation, and evaluation of exercise intervention: Nichols. Other - Data analysis concerning insulin kinetics and sensitivity: Patterson. Conflict of Interest Disclosures: Dr Lenze receiving personal fees from Boehringer Ingelheim, IngenioRx, Merck, Pritikin ICR, and Prodeo and grants from COVID Early Treatment Fund, Fast Grants, and Janssen Biotech, outside the submitted work.

Dr Barch reported receiving grants from the National Institute of Mental Health and the National Institute on Drug Abuse during the conduct of the study. Dr Foster reported receiving grants from the National Institutes of Health during the conduct of the study and grants from the American Occupational Therapy Foundation and Washington University School of Medicine outside the submitted work.

Dr Gettinger reported receiving grants from the National Institutes of Health during the conduct of the study and personal fees from Pritikin ICR for consulting outside the submitted work. Dr Head reported receiving grants from the National Institutes of Health, McKnight Brain Research Foundation, and Taylor Family Institute for Innovative Psychiatric Disorders at Washington University during the conduct of the study.

Dr Nichols reported receiving grants from UC San Diego during the conduct of the study. Dr Nicol reported receiving grants from Alkermes, personal fees from Alkermes and Novartis, and nonfinancial support from Usona outside the submitted work.

Dr Nishino reported receiving grants from the National Institute on Aging during the conduct of the study. Dr Patterson reported receiving grants from Washington University in St Louis during the conduct of the study. Dr Rodebaugh reported receiving grants from the National Institutes of Health during the conduct of the study.

Dr Schweiger reported grants from the National Institutes of Health during the conduct of the study. Dr Snyder reported receiving grants from Washington University for National Institutes of Health funding for this research during the conduct of the study. Dr Tate reported receiving grants from the National Institutes of Health during the conduct of the study.

Dr Wing reported receiving grants from the National Institute of Mental Health during the conduct of the study. Dr Wetherell reported receiving grants from the National Institutes of Health during the conduct of the study and receiving a salary from the Department of Veterans Affairs outside the submitted work.

No other disclosures were reported. Additional funding was from the Taylor Family Institute for Innovative Psychiatric Disorders at Washington University, and NIH grants P50MH, P50 HD, P30 DK Washington University Nutrition and Obesity Research Center , and UL1 TR Washington University Institute of Clinical and Translational Sciences.

Dr Eyler was additionally supported by the Desert-Pacific VA Mental Illness Research Education and Clinical Center and Dr Twamley was additionally supported by a VA Rehabilitation Research and Development Research Career Scientist Award.

Data Sharing Statement : See Supplement 3. Additional Contributions: We express appreciation to the MEDEX trial participants, members of the data and safety monitoring board Paul Newhouse, MD [Vanderbilt University School of Medicine; chair]; Eric Rodriguez, MD [University of Pittsburgh Medical Center; safety officer]; Elizabeth Hoge, MD [Georgetown University Medical Center]; Helena Kraemer, PhD [Stanford University School of Medicine]; and Jeffrey Burns, MD [University of Kansas Medical Center] , and the entire MEDEX research team.

MEDEX trial participants and the research team received compensation for their role in the study. The data and safety monitoring board members did not receive compensation.

full text icon Full Text. Download PDF Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusions Article Information References. Visual Abstract. Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults.

View Large Download. Figure 1. Participant Flow in a Study of the Effect of Mindfulness-Based Stress Reduction MBSR and Exercise on Cognitive Function. Figure 2. Memory and Executive Function Composite Changes Over 18 Months. Figure 3. Structural Brain Changes Over 18 Months.

Baseline Characteristics by Intervention Group. Supplement 1. Statistical analysis plan. Supplement 2. eMethods and eResults. Supplement 3. Data sharing statement.

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