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This study aims to investigate whether higher levels of depression predict increased physical frailty over time and whether worsening physical frailty predicts higher levels of depression over time, at both the between-person and within-person levels.
A longitudinal study.
A total of 269 patients who underwent cardiac surgery were included in this study at T1 (admission). We followed up depression and physical frailty at T2 (the seventh day after surgery), T3 (the day before discharge), and T4 (the three-month follow-up). To determine the temporal order of the association between depression and physical frailty at both between-person or within-person levels, we employed the cross-lagged panel model (between-person effects), and random intercept cross-lagged panel model (within-person effects).
The cross-lagged panel model findings revealed a time-dependent shift in directionality: physical frailty initially predicted depression between T1 and T2, whereas depression subsequently emerged as a significant predictor of physical frailty from T2 to T4. These between-person effects suggest that the dominant direction of influence may vary across different perioperative stages. Notably, the random intercept cross-lagged panel model results identified a robust unidirectional within-person effect, indicating that increases in depression consistently predicted subsequent increases in physical frailty over time, while the reverse pathway was not statistically significant. This finding underscores the potential causal role of depression in driving physical frailty progression, beyond the influence of stable between-person characteristics.
This study advances understanding of the depression-physical frailty relationship in middle-aged and older cardiac surgery patients by delineating temporal precedence and disentangling within- and between-person effects. Depression emerges as a key driver of physical frailty, underscoring the need to prioritize its management in postoperative care protocols. Future research should explore mechanisms linking intraindividual depression to physical frailty progression and evaluate integrated psychosomatic interventions to optimize recovery outcomes.
We have adhered to the STROBE guideline.
This study did not include patient or public involvement in its design, conduct, or reporting.
Although multicomponent exercise is a popular nonpharmacological treatment, its effects on cognition vary across studies because of the diversities in exercise combinations. Identifying the most effective combination is of great importance to the prevention and treatment of cognitive impairment.
To compare and rank the efficacy of various multicomponent exercise interventions on cognition in people with cognitive impairment.
We searched PubMed, Web of Science, Embase, Cochrane, SPORTDiscus and PsycInfo databases up to April 2025 for eligible randomised controlled trials about multicomponent exercise interventions in people with cognitive impairment. Primary outcome was global cognition, with secondary outcomes being executive function and memory. Pairwise and network meta-analyses were performed using random-effects models.
Twenty-five trials involving 2298 participants were included. Pairwise meta-analyses showed multicomponent exercise interventions were effective on global cognition (standardised mean difference (SMD) = 0.59; 95% confidence interval (CI): 0.30, 0.89; p < 0.001) and executive function (SMD = 0.28; 95% CI: 0.12, 0.45; p < 0.001). Network meta-analyses revealed that aerobic exercise (AE) + balance & flexibility (BF) training had the highest probability (70.8%) of being the optimal exercise combination for global cognition (SMD = 1.07; 95% CI: 0.23, 1.90; p = 0.016), and AE + resistance exercise (RE) had the highest probability (43.1%) of being the optimal exercise combination for executive function (SMD = 0.56; 95% CI: 0.03, 0.10; p = 0.042). We did not observe significant effects of multicomponent exercise on memory.
AE + BF training is likely the most effective multicomponent exercise combination for global cognition, while AE + RE showed the optimal effect on executive function in people with cognitive impairment.
Our study contributes to guiding clinical professionals to design and conduct targeted multicomponent exercise interventions as per individual cognitive impairment characteristics to protect individual cognition.
No patient or public contribution applies to this work.
The study protocol was registered with PROSPERO (CRD42023489517).
This study aims to examine the chain-mediating effects of affective reactions and burnout on the relationship between workplace violence and work performance among nurses while distinguishing between physical and psychological violence.
A longitudinal study was conducted between October 2020 and October 2022. The study took place in four tertiary hospitals of Shandong Province, China. A total of 1086 nurses were recruited.
Workplace psychological violence, workplace physical violence, work performance, affective reactions (including anxiety and depressive symptoms) and burnout were assessed using self-report questionnaires. Data were analysed using multiple linear regressions and structural equation modelling on SPSS and AMOS.
The STROBE checklist was used for this study.
Workplace psychological violence, but not physical violence, was associated with nurses' work performance. Burnout mediates the relationship between workplace psychological violence and work performance. Affective reactions and burnout play serial intermediary roles in the relationship between workplace psychological violence and work performance.
Interventions aimed at reducing anxiety, depressive symptoms, and burnout among nurses who have experienced psychological violence may enhance their work performance.
Hospital administrators should prioritise the development of strategies to prevent psychological violence (e.g., anti-bullying training and counselling support) and enhance nurse performance through burnout screening and targeted interventions.
This study was conducted in Shandong Province, China, and relied on self-reported data, which may be subject to social desirability bias.
No patient or public contribution.
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