The Impact of Web-Based Physical Activity Interventions on Depression and Anxiety Among College Students: Randomized Experimental Trial

Background Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment. Objective This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students. Methods The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks. Results The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; η2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; η2=0.052). There was no significant main effect of group or interaction effect of time with group for depression. Conclusions College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students’ depression and anxiety during a pandemic.

The CONSORT-EHEALTH checklist is intended for authors of randomized trials evaluating web-based and Internet-based applications/interventions, including mobile interventions, electronic games (incl multiplayer games), social media, certain telehealth applications, and other interactive and/or networked electronic applications. Some of the items (e.g. all subitems under item 5 -description of the intervention) may also be applicable for other study designs.
The goal of the CONSORT EHEALTH checklist and guideline is to be a) a guide for reporting for authors of RCTs, b) to form a basis for appraisal of an ehealth trial (in terms of validity) CONSORT-EHEALTH items/subitems are MANDATORY reporting items for studies published in the Journal of Medical Internet Research and other journals / scientific societies endorsing the checklist.
As the CONSORT-EHEALTH checklist is still considered in a formative stage, we would ask that you also RATE ON A SCALE OF 1-5 how important/useful you feel each item is FOR THE PURPOSE OF THE CHECKLIST and reporting guideline (optional).
Mandatory reporting items are marked with a red *. In the textboxes, either copy & paste the relevant sections from your manuscript into this form -please include any quotes from your manuscript in QUOTATION MARKS, or answer directly by providing additional information not in the manuscript, or elaborating on why the item was not relevant for this study. yes: all primary outcomes were significantly better in intervention group vs control partly: SOME primary outcomes were significantly better in intervention group vs control no statistically significant difference between control and intervention potentially harmful: control was significantly better than intervention in one or more outcomes inconclusive: more research is needed Other: not submitted yet -in early draft status not submitted yet -in late draft status, just before submission submitted to a journal but not reviewed yet submitted to a journal and after receiving initial reviewer comments submitted to a journal and accepted, but not published yet If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms tracking number can be found in the submission acknowledgement email, or when you login as author in JMIR. If the paper is already published in JMIR, then the ms tracking number is the four-digit number at the end of the DOI, to be found at the bottom of each published article in JMIR) Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if offline products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms. Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").  T  R  A  C  T  :  S  t  r  u  c  t  u  r  e  d  s  u  m  m  a  r  y  o  f  t  r  i  a  l  d  e  s  i  g  n  ,  m  e  t  h  o  d  s  ,  r  e  s  u  l  t  s  ,  a  n  d  c  o  n  c  l  u  s  i  o  n  s   N  P  T  e  x  t  e  n  s  i  o  n  :  D  e  s  c  r  i  p  t  i  o  n  o  f  e  x  p  e  r  i  m  e  n  t  a  l  t  r  e  a  t  m  e  n  t  ,  c  o  m  p  a  r  a  t  o  r  ,  c  a  r  e  p  r  o  v  i  d  e  r  s  ,  c  e  n  t  e  r  s  ,  a  n  d  b  l  i  n  d  i  n  g  s  t  a  t  u  s  . subitem not at all important a  t  u  r  e  s  /  f  u  n  c  t  i  o  n  a  l  i  t  i  e  s  /  c  o  m  p  o  n  e  n  t  s  o  f  t  h  e  i  n  t  e  r  v  e  n  t  i  o  n  a  n  d  c  o  m  p  a  r  a  t  o  r  i  n  t  h  e  M  E  T  H  O  D  S  s  e  c  t  i  o  n  o  f  t  h  e  A  B  S  T  R  A  C  T Mention key features/functionalities/components of the intervention and comparator in the abstract. If possible, also mention theories and principles used for designing the site. Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Human involvement is implied ("Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks") Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Recruitment and assessment not mentioned in abstract due to character limits  I  N  T  R  O  D  U  C  T  I  O  N   2  a  )  I  n  I  N  T  R  O  D  U  C  T  I  O  N  :  S  c  i  e  n  t  i  f  i  c  b  a  c  k  g  r  o  u  n  d  a  n  d  e  x  p  l  a  n  a  t  i  o  n  o  f  r  a  t  i  o  n  a  l  e subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "It has been well-documented that mental health issues are increasing within a college student population. This increase in mental health problems, such as anxiety and depression, seems to have been exacerbated by the onset of the COVID-19 pandemic" Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In Italy, research has found that 27.8% of 400 analyzed college students and employees displayed notable depressive symptoms and 34.3% displayed notable anxiety symptoms [3].
In the United States, 44% of 195 interviewed college students reported an increase in depressive symptoms, whereas 71% of the same sample of students reported an increase in stress and anxiety symptoms [4]. In a meta-analysis examining the percentage increases in self-reported anxiety and depression worldwide, researchers found an increase in anxiety from 19% to 37% and an increase in depression from 21% to 54% after March 1, 2020" Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In addition, the impact of the COVID-19 pandemic on the average mental health status of college students may have complicated the ways in which mindfulness and physical activity interventions interact with anxiety and depression symptoms, furthering the need to understand the utility of these interventions. To the best of our knowledge, there is a lack of research on the effects of web-based aerobic and resistance exercises or yoga with mindfulness on college student depression and anxiety in a midpandemic environment. Therefore, this study aims to compare the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness intervention (WeMindful) on depression and anxiety in college students during the winter semester of 2021" Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "As seen in Figure 1, after the pre-evaluation, 77 participants attended the 8-week intervention components and completed the postintervention test.... On the basis of our previous study's adherence rate of >90% and an estimated program dropout rate of 10%, we needed to recruit a targeted sample size of 57 college students. Our sample size of 77 participants exceeded the required sample size of 57." subitem not at all important Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. offline), e.g., from an open access website or from a clinic, and clarify if this was a purely webbased trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasi-anonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email confirmation, phone calls) were used to detect/prevent these. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both intervention groups were asked to attend two 30-minute group exercise classes via Zoom twice per week. Participants opted to attend 1 synchronized Zoom exercise lesson and 1 asynchronized lesson or 2 asynchronized lessons that were Zoom-recorded and uploaded to the University Canvas study-related website. The asynchronous recording contained the same lesson content from the synchronous live session, meaning content was repeated for the second session each week. In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes." Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The intervention lasted for 8 weeks over the course of the winter 2021 semester. Before the intervention started, participants were given 1 week to complete a preintervention Qualtrics survey that included anxiety and depression measures. Immediately after the intervention period, the participants were again given 1 week to complete a postintervention Qualtrics survey that included the same anxiety and depression measures used in the preintervention survey.... All participants in the study have provided written informed consent to participate in the study." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The participants were instructed to attend two 30-minute exercise classes via Zoom per week for 8 weeks. The class duration was set to 30 minutes to maximize participant retention while still allowing participants to achieve an amount of exercise that has been shown to be beneficial [17]. The lessons were taught by a student instructor who had previously taken the University of Michigan Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.  Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both intervention groups were asked to attend two 30-minute group exercise classes via Zoom twice per week. Participants opted to attend 1 synchronized Zoom exercise lesson and 1 asynchronized lesson or 2 asynchronized lessons that were Zoom-recorded and uploaded to the University Canvas study-related website. The asynchronous recording contained the same lesson content from the synchronous live session, meaning content was repeated for the second session each week. In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes." Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The lessons were taught by a student instructor who had previously taken the University of Michigan classes Methods of Instruction for Exercises and Fundamentals of Strength and Conditioning. In addition, the WeActive student instructor was a certified strength and conditioning specialist and a graduate student with ≥5 years of experience in personal training.... The lessons were taught by a student instructor who had previously taken the University of Michigan classes Methods of Instruction for Exercises and Fundamentals of Strength and Conditioning. In addition, the WeMindful student instructor was a junior undergraduate student studying movement science with 3 years of experience teaching yoga and dance classes." Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scientific reporting. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both intervention groups were asked to attend two 30-minute group exercise classes via Zoom twice per week. Participants opted to attend 1 synchronized Zoom exercise lesson and 1 asynchronized lesson or 2 asynchronized lessons that were Zoom-recorded and uploaded to the University Canvas study-related website. The asynchronous recording contained the same lesson content from the synchronous live session, meaning content was repeated for the second session each week. In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both intervention groups were asked to attend two 30-minute group exercise classes via Zoom twice per week. Participants opted to attend 1 synchronized Zoom exercise lesson and 1 asynchronized lesson or 2 asynchronized lessons that were Zoom-recorded and uploaded to the University Canvas study-related website. The asynchronous recording contained the same lesson content from the synchronous live session, meaning content was repeated for the second session each week. In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes." "The objectives of the WeActive intervention were to help the participants engage in at least 150 minutes of moderate to vigorous physical activity per week and improve their abilities to achieve the recommended amount of weekly moderate to vigorous physical activity minutes throughout the intervention. The participants were instructed to attend two 30-minute exercise classes via Zoom per week for 8 weeks. The class duration was set to 30 minutes to maximize participant retention while still allowing participants to achieve an amount of exercise that has been shown to be beneficial " "The WeMindful group was instructed to participate in two 30-minute web-based yoga mindfulness classes per week for 8 weeks. The use of yoga, which incorporates movement with breathing and self-awareness, as a primary mindfulness exercise has been supported by previous research" "To facilitate the participants to attend the WeActive or WeMindful exercise lessons and to provide ongoing emotional, informational, and appraisal support for them, we offered all participants in both groups with four 30-minute peer coaching sessions conducted via Zoom, with 1 session every 2 weeks." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both intervention groups were asked to attend two 30-minute group exercise classes via Zoom twice per week. Participants opted to attend 1 synchronized Zoom exercise lesson and 1 asynchronized lesson or 2 asynchronized lessons that were Zoom-recorded and uploaded to the University Canvas study-related website. The asynchronous recording contained the same lesson content from the synchronous live session, meaning content was repeated for the second session each week. In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes." "The objectives of the WeActive intervention were to help the participants engage in at least 150 minutes of moderate to vigorous physical activity per week and improve their abilities to achieve the recommended amount of weekly moderate to vigorous physical activity minutes throughout the intervention. The participants were instructed to attend two 30-minute exercise classes via Zoom per week for 8 weeks. The class duration was set to 30 minutes to maximize participant retention while still allowing participants to achieve an amount of exercise that has been shown to be beneficial " "The WeMindful group was instructed to participate in two 30-minute web-based yoga mindfulness classes per week for 8 weeks. The use of yoga, which incorporates movement with breathing and self-awareness, as a primary mindfulness exercise has been supported by previous research" Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes.... the WeMindful student instructor was a junior undergraduate student studying movement science with 3 years of experience teaching yoga and dance classes.... lessons were taught by a student instructor who had previously taken the University of Michigan classes Methods of Instruction for Exercises and Fundamentals of Strength and Conditioning. In addition, the WeActive student instructor was a certified strength and conditioning specialist and a graduate student with ≥5 years of experience in personal training." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "To facilitate the participants to attend the WeActive or WeMindful exercise lessons and to provide ongoing emotional, informational, and appraisal support for them, we offered all participants in both groups with four 30-minute peer coaching sessions conducted via Zoom, with 1 session every 2 weeks. Each peer coaching session included experience and feedback sharing from participants, barrier or challenge reflections, and participant suggestions for class content. The focus of the first peer coaching session was on orienting and introducing participants to the session formatting, which included goal-setting prompts, self-regulation prompts, self-monitoring reflection, and time for social support. The second, third, and fourth peer coaching sessions delved deeper into obtaining participant feedback on any challenges or preferences they had during the main intervention group components, along with continued goal-setting, self-regulation, and self-monitoring exercises. The peer coaching sessions were led by 1 doctoral student and 1 other undergraduate student of the research team. In addition to peer coaching sessions, all participants were instructed to complete weekly journals that asked participants to provide their weekly attendance for both synchronous and asynchronous classes. In addition, participants received encouraging messages on the web from the research team every Thursday, with content including praise and motivational phrasing." subitem not at all important for participants to self-rate their anxiety symptoms. The GAD-7 questionnaire measures anxiety symptoms occurring within the past 2 weeks on a 4-point scale, ranging from 0 (not at all) to 3 (nearly every day). The 7 items were added together to provide a total anxiety score. The scores for the questionnaire ranged from 0 to 21. A score between 5 and 9 indicated mild anxiety, a score between 10 and 14 indicated moderate anxiety, and a score above 15 indicated severe anxiety [34]. In this study, the Cronbach α coefficients of the GAD-7 scale at baseline test and after the test were .794 and .795, respectively, indicating acceptable internal consistency. for participants to self-rate their anxiety symptoms. The GAD-7 questionnaire measures anxiety symptoms occurring within the past 2 weeks on a 4-point scale, ranging from 0 (not at all) to 3 (nearly every day). The 7 items were added together to provide a total anxiety score. The scores for the questionnaire ranged from 0 to 21. A score between 5 and 9 indicated mild anxiety, a score between 10 and 14 indicated moderate anxiety, and a score above 15 indicated severe anxiety [34]. In this study, the Cronbach α coefficients of the GAD-7 scale at baseline test and after the test were .794 and .795, respectively, indicating acceptable internal consistency. Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator". Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both intervention groups were asked to attend two 30-minute group exercise classes via Zoom twice per week. Participants opted to attend 1 synchronized Zoom exercise lesson and 1 asynchronized lesson or 2 asynchronized lessons that were Zoom-recorded and uploaded to the University Canvas study-related website. The asynchronous recording contained the same lesson content from the synchronous live session, meaning content was repeated for the second session each week. In addition, all participants were asked to attend synchronous, researcher-led peer coaching sessions that took place once every 2 weeks for 30 minutes.
The intervention lasted for 8 weeks over the course of the winter 2021 semester. Before the intervention started, participants were given 1 week to complete a preintervention Qualtrics survey that included anxiety and depression measures. Immediately after the intervention period, the participants were again given 1 week to complete a postintervention Qualtrics survey that included the same anxiety and depression measures used in the preintervention survey." subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The preintervention and postintervention data were analyzed using SPSS 26 software (IBM Corporation), with statistical significance set at P<.05 for the tests. Of the 77 students who completed both the preintervention and postintervention surveys, 74 were included in the final analysis (46 from WeActive and 28 from WeMindful). Overall, three participants (2 from WeActive and 1 from WeMindful) were excluded from the final analysis because of a lack of adequate participation. The mean scores of the GAD-7 and MDI tests were compiled and used for dependent variable analysis. Descriptive statistics of each intervention at baseline were calculated, and 2-tailed independent t tests were used to determine any significant differences in the dependent variables of each intervention group. A mixed-design analysis of variance repeated measure was used to examine the effect of either intervention group on depression and anxiety measures. Depression and anxiety scores were the main dependent variables in this study, with univariate tests separately for each variable. In this study, the between-factor was the analysis of the WeActive intervention group against the WeMindful intervention group. The within-subject factor was the comparison of the preintervention test against the postintervention test. In the analysis of covariance (ANCOVA) tests, if sphericity was violated, the Greenhouse-Geisser correction was applied.
The results showed no significant differences in the preintervention mean scores for X3month_exercise, X3month_yoga, MDI score, GAD-7 score, education, race, and age, with the only significant difference between groups coming from the X3month_therapist variable (F1=15.083; P=.01). Therefore, ANCOVA was used to determine the intervention effects on anxiety and depression while controlling for covariates. The between-subject factor for analysis was the intervention group, comparing the WeActive group with the WeMindful group, and the within-subject factor was time, comparing the baseline test scores with the posttest scores." Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4] Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Of the 77 participants who completed the preintervention and postintervention surveys, 3 were excluded from the final data analysis because of poor participation. The final data set included 46 participants from the WeActive intervention and 28 participants from the WeMindful intervention, for a total of 74 participants." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study ""The preintervention and postintervention data were analyzed using SPSS 26 software (IBM Corporation), with statistical significance set at P<.05 for the tests. Of the 77 students who completed both the preintervention and postintervention surveys, 74 were included in the final analysis (46 from WeActive and 28 from WeMindful). Overall, three participants (2 from WeActive and 1 from WeMindful) were excluded from the final analysis because of a lack of adequate participation. The mean scores of the GAD-7 and MDI tests were compiled and used for dependent variable analysis. Descriptive statistics of each intervention at baseline were calculated, and 2-tailed independent t tests were used to determine any significant differences in the dependent variables of each intervention group. A mixed-design analysis of variance repeated measure was used to examine the effect of either intervention group on depression and anxiety measures. Depression and anxiety scores were the main dependent variables in this study, with univariate tests separately for each variable. In this study, the between-factor was the analysis of the WeActive intervention group against the WeMindful intervention group. The within-subject factor was the comparison of the preintervention test against the postintervention test. In the analysis of covariance (ANCOVA) tests, if sphericity was violated, the Greenhouse-Geisser correction was applied.
The results showed no significant differences in the preintervention mean scores for X3month_exercise, X3month_yoga, MDI score, GAD-7 score, education, race, and age, with the only significant difference between groups coming from the X3month_therapist variable (F1=15.083; P=.01). Therefore, ANCOVA was used to determine the intervention effects on anxiety and depression while controlling for covariates. The between-subject factor for analysis was the intervention group, comparing the WeActive group with the WeMindful group, and the within-subject factor was time, comparing the baseline test scores with the posttest scores."" Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "This study was reviewed and approved by the University Institutional Review Board-Health Sciences and Behavioral Sciences (IRB-HSBS) (HUM00189120). We conducted this study in accordance with the principles of the Declaration of Helsinki. All participants in the study have provided written informed consent to participate in the study." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Consent procedures were not outlined in this manuscript, but were conducted electronically Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The final WeActive group consisted of 48 participants, with a mean age of 23.02 (SD 4.83) years. The final WeMindful group consisted of 29 participants, with a mean age of 24.31 (SD 7.48) years. Both groups had similar educational and racial distributions... As seen in Table  2, the mean scores of depression in both groups were similar, with the WeActive mean scores of 16.89 falling slightly lower than that of WeMindful at 17.75. Both scores are in the nondepressed classification range through the MDI, which is classified as a score under 20. According to the MDI criteria, both groups' scores indicated no or doubtful levels of depression at baseline. Both groups presented similar scores in the anxiety measure, with WeActive at 7.15 and WeMindful at 7.79. These scores placed both groups within the mild anxiety range (score between 5 and 9) through the GAD-7. The mean scores of an overall health rating, 3-month history of exercise, and 3-month history of yoga were similar across both groups. Only the measure of the past 3-month therapist visits differed to a notable extent, with WeMindful averaging a higher score at 0.48 compared with the 0. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Yes -available in CONSORT diagram (Fig 1) subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Not applicable (no digital divide involved in this study), but demographics provided in Table  1 subitem not at all important Report multiple "denominators" and provide definitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at specific pre-defined time points of interest (in absolute and relative numbers per group). Always clearly define "use" of the intervention. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "For the anxiety measure, while controlling for the past 3-month therapist visit, the results of ANCOVA with repeated measures indicated no significant main effect of time and group and no significant interaction between time and group. However, the main effect of time was close to a significant level (F=3.485; P=.07; η2=0.047), indicating that the 2 groups had a marginally significant decrease in anxiety over time. The resulting GAD-7 classification for both groups after the intervention was still considered within the mild range for anxiety severity. The results also showed that the past 3-month therapist visit was a significant covariate of anxiety (F=8.629; P=.004; η2=0.108).
With regard to the depression measure, the results of ANCOVA with repeated measures yielded a significant main effect of time (F=3.892; P=.05; η2=0.052), while controlling for the past 3-month therapist visit. The results indicated that the 2 groups showed a significant reduction in depressive symptoms from baseline to after the intervention. In contrast, the ANCOVA with repeated measures revealed no significant main effect of group and no significant interaction effect of time with group. The resulting MDI classification for both groups after the intervention was still considered within the no or doubtful range for depression severity. Similarly, the 3-month therapist visit was a significant covariate for depression (F=7.007; P=.01; η2=0.090)." subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "For the anxiety measure, while controlling for the past 3-month therapist visit, the results of ANCOVA with repeated measures indicated no significant main effect of time and group and no significant interaction between time and group. However, the main effect of time was close to a significant level (F=3.485; P=.07; η2=0.047), indicating that the 2 groups had a marginally significant decrease in anxiety over time. The resulting GAD-7 classification for both groups after the intervention was still considered within the mild range for anxiety severity. The results also showed that the past 3-month therapist visit was a significant covariate of anxiety (F=8.629; P=.004; η2=0.108).
With regard to the depression measure, the results of ANCOVA with repeated measures yielded a significant main effect of time (F=3.892; P=.05; η2=0.052), while controlling for the past 3-month therapist visit. The results indicated that the 2 groups showed a significant reduction in depressive symptoms from baseline to after the intervention. In contrast, the ANCOVA with repeated measures revealed no significant main effect of group and no significant interaction effect of time with group. The resulting MDI classification for both groups after the intervention was still considered within the no or doubtful range for depression severity. Similarly, the 3-month therapist visit was a significant covariate for depression (F=7.007; P=.01; η2=0.090 In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational definitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is defined (e.g., timeout after idle time) [1] (report under item 6a Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study D  I  S  C  U  S  S  I  O  N   2  2  )  I  n  t  e  r  p  r  e  t  a  t  i  o  n  c  o  n  s  i  s  t  e  n  t  w  i  t  h  r  e  s  u  l  t  s  ,  b  a  l  a  n  c  i  n  g  b  e  n  e  f  i  t  s  a  n  d  h  a  r  Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "This study aims to examine the effects of a web-based aerobic resistance exercise (WeActive) intervention and web-based yoga mindfulness (WeMindful) intervention on college students' anxiety and depression levels. Both the 8-week interventions were hypothesized to have positive effects on anxiety and depression, with greater positive effects predicted in the WeActive group. As expected, the participants in the 2 groups experienced a significant decrease in depression scores over the 8-week period. Although not statistically significant, the participants experienced a decrease in anxiety scores as well. Contrary to our second hypothesis, there were no significant interactions between group and time, indicating that the WeActive group did not experience greater improvements in mental health scores than the WeMindful group over time" subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "future research could benefit from exploring single modality interventions, such as aerobic exercise compared with resistance training or yoga compared with meditation. This study suggests that both the combination of aerobic resistance training and the combination of yoga mindfulness exercises are associated with a reduction in college student depression scores over an 8-week period. As the findings from our study indicate the potential efficacy of WeActive and WeMindful interventions in improving student mental health measures, this study design could be a useful resource for colleges and mental health treatment providers."