The effect of psychological and exercise interventions on college students’ well-being and ill-being: a meta-analysis of randomized controlled trials

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Edited by: D.A.A. Scientific Section
Martos (Spain)
editor@journalshr.com
Received: 15-3-2015
Accepted: 9-7-2015
Correspondence to:
Barrantes-Brais. Kristy
Universidad Nacional de Costa Rica
P.O. Box 83-3000 Heredia, Costa Rica
kristy.barrantes.brais@una.cr
Journal of Sport and Health Research 2016, 8(1):75-92
J Sport Health Res ISSN: 1989-6239
75
Review
EL EFECTO DE INTERVENCIONES PSICOLÓGICAS Y DE
EJERCICIO EN EL BIENESTAR Y MALESTAR DE ESTUDIANTES
UNIVERSITARIOS: UN META ANÁLISIS DE ESTUDIOS
CONTROLADOS ALEATORIZADOS
THE EFFECT OF PSYCHOLOGICAL AND EXERCISE
INTERVENTIONS ON COLLEGE STUDENTS’
WELL-BEING AND ILL-BEING: A META-ANALYSIS
OF RANDOMIZED CONTROLLED TRIALS
Barrantes-Brais, Kristy1 ; Sánchez-Ureña, Braulio 1; Ureña-Bonilla, Pedro 1.
1Universidad Nacional, Costa Rica
Barrantes-Brais, K.; Sánchez-Ureña, B.; Ureña-Bonilla, P. (2016). The effect of psychological and
exercise interventions on college students’ well-being and ill-being: a meta-analysis of randomized
controlled trials. Journal of Sport and Health Research. 8(1):75-92.

Journal of Sport and Health Research 2016, 8(1):75-92
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RESUMEN
Propósito: Examinar el efecto de intervenciones
experimentales (psicológicas y de ejercicio) en el
bienestar y malestar de estudiantes universitarios.
Método: Se revisó la literatura pertinente encontrada
mediante los motores de búsqueda PubMed, Ebsco
Academic Search Complete, SportDiscus y Science
Direct, incluyendo únicamente ensayos controlados y
aleatorizados. Dieciséis estudios publicados entre
1987 y 2012 (con un total de 1342 participantes)
cumplieron con los criterios de selección.
Resultados: Las intervenciones psicológicas y de
ejercicio mostraron efectos positivos globales, sin
diferencias significativas entre sí. Los tamaños de
efecto respectivamente fueron 0.48; CI al 95% [0.39,
0.56] y 0.57; CI al 95% [0.42, 0.72], con intervalos
de confianza que confirman efectos significativos.
Los resultados mostraron heterogeneidad, el análisis
de variables moderadoras no explicó la variabilidad.
Conclusiones: Las intervenciones psicológicas y de
ejercicio impactan de manera similar el bienestar de
estudiantes universitarios, encontrándose
disminuciones en los indicadores de ansiedad y
depresión. Solo las intervenciones psicológicas
modifican el afecto negativo. Implicaciones: Se
recomienda realizar estudios confirmatorios y de
rentabilidad, así como investigaciones sobre el efecto
combinado de intervenciones psicológicas y de
ejercicio.
Palabras clave: (educación superior, salud mental,
ansiedad, depresión, afecto negativo, movimiento
humano).
ABSTRACT
Objective: To examine the effect of experimental
interventions (psychological and exercise-based) on
well-being and ill-being related variables in college
students.
Methods: A systematic literature search was
conducted using PubMed, Ebsco Academic Search
Complete, SportDiscus and Science Direct, including
only randomized controlled trials (RCT). Sixteen
studies published between 1987 and 2012 (totaling
1342 individuals) met the selection criteria.
Results: Both psychological, effect size= 0.48; 95%
CI [0.39, 0.56], and exercise interventions, effect
size= 0.57; 95% CI [0.42, 0.72] yielded overall
positive effects. No differences were found between
types of intervention. Results are heterogeneous;
moderator analyses did not explain the variability.
Conclusion: Psychological and exercise
interventions are similarly effective in impacting
higher education students’ well-being and ill-being.
Decreases in anxiety and depression were found after
both types of interventions. Only psychological
strategies effectively change negative affect.
Confirmatory trials and cost-effectiveness studies in
college settings are recommended. Future research on
strategies combining exercise and psychological
approaches is needed.
Keywords: (higher education, mental health, anxiety,
depression, negative affect, human movement).

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INTRODUCTION
The promotion of well-being in college settings has
increased over the past few decades, focusing on the
potential benefits of different types of interventions
such as exercise-based and psychological approaches
(Conley, Durlak, & Dickson, 2013; Parks, 2011).
Well-being in students is a strong predictor for good
physical health (Pettit, Kline, Gencoz, Gencoz, &
Joiner Jr, 2001), is positively associated with better
adjustment to educational settings (Shoshani &
Slone, 2013) and is inversely related to illicit drug
use and sexual risk behavior (Schwartz et al., 2011).
In general, experiences related with well-being have
shown positive associations with overall health
measured through functional and physiological
markers (Howell, Kern, & Lyubomirsky, 2007; Ryff,
Singer, & Dienberg Love, 2004; Steptoe, Dockray, &
Wardle, 2009).
Well-being is a complex construct that concerns
optimal experience and functioning (Ryan & Deci,
2001), includes a balance of satisfaction with life and
positive/negative affect (subjective well-being)
(Diener, Suh, Lucas, & Smith, 1999) and notions of
meaning, self-actualization, growth and optimal
functioning (psychological well-being) (Ryff, 1995).
This concept provides a more comprehensive
approach to mental health issues, compared to the
focus on addressing illness and disorders (M. E.
Seligman & Csikszentmihalyi, 2000).
On the other hand, ill-being related conditions such
as depression and anxiety would potentially
jeopardize students’ well-being by limiting their
abilities to enjoy positive experiences, to thrive and
grow. Numbers of college students diagnosed with
depression and anxiety show a steady increase in the
last few years (ACHA, 2014). Prevention and
treatment of these conditions in college settings
become relevant when considering that onset ages
tend to coincide with the first years of college life for
most students (Cukrowicz & Joiner Jr, 2007).
Even though there are reports on results of specific
interventions in college student population, aiming to
reduce symptoms of illness or increase well-being
indicators (S. Brown & Schiraldi, 2004; Deckro et
al., 2002; Hurley & Kwon, 2012; Kanji, White, &
Ernst, 2006; Mailey et al., 2010; Sheldon &
Lyubomirsky, 2006), there are no meta-analyses that
determine and compare the effect of different types
of interventions in this particular population.
Previous reviews and meta-analyses have reported
effects of psychological and exercise-based
treatments on outcomes like anxiety, depression and
psychological/subjective well-being. Psychological
interventions on anxiety showed low (Duijts, Faber,
Oldenburg, van Beurden, & Aaronson, 2011; Goyal
et al., 2014), moderate (Hofmann, Sawyer, Witt, &
Oh, 2010) and high effects (Cape, Whittington,
Buszewicz, Wallace, & Underwood, 2010; Noordik,
van der Klink, Klingen, Nieuwenhuijsen, & van Dijk,
2010). Depression symptoms improved after
psychological treatments in a variety of settings
(Bolier et al., 2013; Cape et al., 2010; Cuijpers, van
Straten, & Smit, 2006; Duijts et al., 2011; Goyal et
al., 2014; Jakobsen, Hansen, Storebo, Simonsen, &
Gluud, 2011; Sin & Lyubomirsky, 2009). Using
well-being as the main outcome, a recent meta-
analysis found small effect sizes for subjective and
psychological well-being (Bolier et al., 2013). Some
mechanisms associated with the effectiveness of
psychological interventions include de-activation of
hypervalent dysfunctional schemas and more
reflective mode of thought and behavior, as well as
reduced activation of the amygdalohippocampal
subcortical regions implicated in the generation of
negative emotion and increased activation of higher-
order frontal regions involved in cognitive control of
negative emotion (Clark & Beck, 2010).
Interventions using different modes of exercise
regarded this approach as an effective way to reduce
anxiety. Meta-analytic reviews reported low or
moderate effects (Conn, 2010; Wegner et al., 2014;
Wipfli, Rethorst, & Landers, 2008). Exercise
interventions on depression also seem to be effective,
meta-analyses indicate small (J. C. Brown et al.,
2012; Duijts et al., 2011; Rimer et al., 2012),
moderate (Cooney et al., 2013; Wegner et al., 2014)
and high effects (Lawlor & Hopker, 2001; Rethorst,
Wipfli, & Landers, 2009; Robertson, Robertson,
Jepson, & Maxwell, 2012). One meta-analysis
reported significant changes in positive affect after
exercise interventions (Reed & Buck, 2009). Several
hypotheses linking neurobiological, psychological,
social and developmental factors to the
antidepressive and anxiolytic effects of exercise have
been outlined (Daley, 2008; Strohle, 2009).

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Evaluation of different intervention approaches in
college students is regarded imperative (Miller &
Chung, 2009) in order to broaden current
understanding of interventions and provide higher
education institutions with valuable information to
enhance campus services to optimize student success
in psychosocial and academic domains (Conley et al.,
2013). Considering the two main approaches used to
increase well-being and narrowing down the target
population to college students, the purpose of this
study was to examine the effect of experimental
(psychological and exercise-based) interventions
well-being and ill-being related variables in college
students.
METHODS
Search strategy
A systematic literature search was carried out in
Academic Search Complete, SportDiscus, Science
Direct and PubMed. Combination of the following
terms (both in English and Spanish) were used to
conduct the search: “college students”,
“intervention”, “exercise”, “psychological”,
“therapy”, “cognitive”, “behavioral”, “well-being”,
“mental health”, “positive affect”, “negative affect”,
“mood”, “anxiety” and “depression”. Searches in
reference lists from previous meta-analysis and in
Medicine & Science in Sport & Exercise were also
conducted. If an article was not available from
databases an email was sent to the corresponding
author requesting for the full-text.
Selection of Studies
The inclusion criteria are described in Table 1 and the
process of selection is outlined in Figure 1. Exercise
interventions were included if fulfilled the definition
of the American College of Sport Medicine: planned,
structured and repetitive bodily movement done to
improve or maintain one or more components of
physical fitness (ACSM, 2013). Psychological
interventions included cognitive, behavioral and
psychoeducational strategies.
Records identified through initial
databases search
(n = 2106)
Abstracts screened
(n = 129)
Records excluded
(n = 2009)
Unrelated to area of interest
Duplicates
Full text articles screened
(n = 45)
Abstracts excluded
(n = 84)
No RCT= 51
Review or descriptive articles= 14
Language (no English or Spanish)= 9
Outcomes different from those in inclusion
criteria=7
Not college students=3
Full text articles excluded
(n = 29)
Data needed for meta-analysis not reported = 25
Inadequate randomization= 3
Data reported elsewhere =1
Articles included in meta-analysis
(n = 16)
Psychological interventions
(n = 11)
Exercise interventions
(n = 5)
Other records from
reference lists
(n =32)
Data extraction and coding
Data were extracted for: type of intervention
(psychological, exercise or control), outcomes
reported and their scores (pre and post intervention),
length of intervention (weeks), total number of
sessions, length of sessions (minutes per session),
frequency (times/week), mode (group or individual),
time of post measurement (endpoint or follow-up),
mean age of subjects. Two reviewers coded the data
independently; disagreements between the reviewers
were resolved by consensus. The inter-rater reliability
was 0.90.
Component
Criteria
Interventions
Psychological or exercise-based
Outcomes
Psychological well-being or its components
Subjective well-being or its components
Mental Health
Anxiety
Depression
Target
population
College students
Design/reports
Presence of a control group
Randomization (subjects, not groups)
Reporting statistics to calculate effect sizes
Reporting measures pre and post
intervention
Published in a peer reviewed journal
Figure 1. Flow diagram. Selection of studies
Table 1. Selection criteria

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Data analysis
Effect sizes (ES) were calculated using Cohen’s d,
corrected with Hedges’ g (Thomas & French, 1986)
and adjusted for total variance with a fixed effects
model (Cooper, Hedges, & Valentine, 2009).
Significance of ES was determined by calculation of
Z and 95% confidence intervals (Cooper et al., 2009;
Thomas & French, 1986). Heterogeneity was
assessed using Cochran’s Q and I2 (Borenstein,
Hedges, Higgins, & Rothstein, 2009). Moderator
analyses were run with Student’s t (for categorical
variables) and Pearson’s r (for numeric variables) in
SPSS 21.
RESULTS
Description of the studies
Sixteen studies (including 1342 individuals)
published between 1987 and 2012 met the selection
criteria, 11 used psychological interventions ((Calvo,
Betancort, & D. Díaz, 2009; Church, De Asis, &
Brooks, 2012; Deckro et al., 2002; Fresco, Moore,
Walt, & Craighead, 2009; Hurley & Kwon, 2012;
Kanji et al., 2006; McMakin, Siegle, & Shirk, 2011;
Pace & Dixon, 1993; Sheldon & Lyubomirsky, 2006;
Steinhardt & Dolbier, 2008; Yazdani, Rezaei, &
Pahlavanzadeh, 2010)) and five focused on exercise
((Hopkins, Davis, Vantieghem, Whalen, & Bucci,
2012; Kubitz & Landers, 1993; Roth, 1989; Roth &
Holmes, 1987; Russell & Newton, 2008)). Outcomes
from these studies are: anxiety, depression, positive
affect and negative affect. 96 effect sizes were
calculated (51 experimental and 45 in control
groups). See Table 6 for details on the characteristics
of the studies.
Effect of interventions on well-being and ill-being
related variables
Both psychological and exercise interventions
yielded overall positive effects in the analyzed
variables (pooled effect for anxiety, depression,
positive and negative affect). ES were 0.48; 95% CI
[0.39, 0.56] and 0.57; 95% CI [0.42, 0.72] for
psychological and exercise approaches respectively.
Control groups also showed effect, but it is much
lower than the interventions and might be considered
trivial: 0.13; 95% CI [0.06, 0.21] according to
Cohen’s classification, ES< 0.20= no effect .
Effect of interventions by outcome
Psychological interventions show positive effects on
anxiety, depression and negative affect (Figure 2);
whereas effect of exercise interventions is only
significant on anxiety and depression (Figure 3).
There was not sufficient data available to calculate
ES for positive affect.
Further information on effect sizes, significance and
heterogeneity is outlined in Tables 2 (psychological
interventions) and 3 (exercise interventions). High
heterogeneity was found for anxiety and depression
results in both types of interventions.
Figure 2. Effect sizes of psychological interventions, by
outcome
Figure 3. Effect sizes of exercise interventions, by
outcome

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n studies
n ES
ES
95% CI
Z
Q
I2
Overall effect
11
32
0.48
[0.39, 0.56]
10.97*
184.74**
95.13
Outcome measure
Anxiety
4
9
0.62
[0.46, 0.77]
7.96*
41.05**
92.69
Depression
7
9
0.70
[0.54, 0.87]
8.46*
68.36**
91.22
Positive affect
4
7
0.12
[-0.07, 0.31]
1.27
Negative affect
4
7
0.32
[0.13, 0.51]
3.36*
6.24
51.91
Note. CI= confidence interval. * = p<.05. ** = p<.01. I2 > 75%=
high heterogeneity.
n studies
n ES
ES
95% CI
Z
Q
I2
Overall effect
5
19
0.57
[0.42, 0.72]
7.37*
124.67**
96.79
Outcome measure
Anxiety
4
8
0.97
[0.71, 1.23]
7.20*
76.25**
96.07
Depression
3
5
0.73
[0.45, 1.02]
5.01*
9.35**
78.62
Negative affect
2
6
0.12
[-0.12, 0.36]
0.98
Note. Insufficient data to calculate ES for Positive affect. CI=
confidence interval. * = p<.05. ** = p<.01. I2 > 75%= high
heterogeneity.
Moderator analyses
Moderator analyses were conducted when
heterogeneity was found. The analyses provide no
plausible explanation for the high variation in the
results. Tables 4 and 5 show the results after
statistical analyses.
COMMENT
Using meta-analytic techniques, this study analyzed
the effect of psychological and exercise interventions
on well-being and ill-being outcomes in college
student population. Sixteen randomized controlled
studies (11 for psychological and five for exercise
interventions) met the inclusion criteria. Both types
of interventions show moderate to high effects on
anxiety and depression; no differences between
exercise and psychological interventions were found
for those variables. Only psychological interventions
have a small effect on negative affect.
When compared to previous meta-analytic data,
psychological interventions showed similar (Duijts et
al., 2011; Goyal et al., 2014; Hofmann et al., 2010;
Noordik et al., 2010) and lower (Cape et al., 2010)
ES, anxiety being the outcome measure and
considering confidence intervals. Anxiety/depression
comorbidity is rather common and it has been
reported that treatments designed to impact one of the
conditions could potentially affect the other
(Hofmann & Smits, 2008). In this meta-analysis, ES
from psychological and exercise interventions were
similar for anxiety and depression; no differences
between exercise and psychological (cognitive)
treatments have been reported elsewhere (Lawlor &
Hopker, 2001). However, compared to prior meta-
analytic published results (Bartley, Hay, & Bloch,
2013; Petruzzello, Landers, Hatfield, Kubitz, &
Salazar, 1991; Wegner et al., 2014; Wipfli et al.,
2008), anxiolytic effects of exercise appeared higher
in the present study.
Results for depression ES in this meta-analysis are
higher than those previously reported from some
psychological (Bolier et al., 2013; Sin &
Lyubomirsky, 2009) and exercise interventions (J. C.
Brown et al., 2012; Duijts et al., 2011). Only one
study presented higher ES (Jakobsen et al., 2011);
this effect might be influenced by the fact that all
interventions included were delivered to patients
diagnosed with major depressive disorder. Results
from other meta-analysis were similar to the present
study (Cape et al., 2010; Hofmann et al., 2010;
Lawlor & Hopker, 2001; Rethorst et al., 2009;
Wegner et al., 2014). Quality of studies, number of
studies included and diversity in target populations
might explain the differences. ES produced by this
meta-analysis are obtained exclusively from college
students, who seem to benefit from the analyzed
interventions, regardless of the type, and, in most
cases, report higher effects than other groups of target
subjects (e.g. inpatients, older adults, cancer
survivors, mixed population).
Mechanisms underlying the beneficial effects of
psychological interventions include changes in
explanatory style, hopelessness, self-esteem, and
dysfunctional attitudes (M. E. P. Seligman,
Schulman, DeRubeis, & Hollon, 1999) and brain
Table 2. Effect of psychological interventions. Overall
and by outcome measure
Table 3. Effect of exercise interventions. Overall and
by outcome measure

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structural changes in areas involved in negative
emotion control (Clark & Beck, 2010).
Regarding exercise and its antidepressive and
anxiolytic effect, some of the physiological
hypothesis refer to the monoamine and opioid
systems, hypothalamic-pituitary-adrenal axis,
neurotrophic factors and neuroimmune effects
(Anderson & Shivakumar, 2013; Eyre, Papps, &
Baune, 2013; Peluso & Guerra de Andrade, 2005;
Wipfli et al., 2008). Psychosocial hypothesis point to
anxiety sensitivity and exposure factors, the
distraction hypothesis, self-esteem, self-efficacy and
social support (Anderson & Shivakumar, 2013;
Pickett, Yardley, & Kendrick, 2012; Rethorst et al.,
2009).
Publications that appropriately measure and report
effect on other measures of well-being are scarce.
Positive and negative affect, as components of
subjective well-being (Diener et al., 1999), were
included as outcomes; negative affect was the only
variable with significant results (positively impacted
by psychological interventions), with an ES similar to
one reported by Bolier et al. (2013) for subjective
well-being. The fact that positive affect is not
influenced by interventions might indicate that this
variable is less susceptible to change (subjects might
be more sensitive to improvements in negative
mood); meaning that some mechanisms, such as
cognitive restructuring and reappraisal (Clark &
Beck, 2010) act more effectively in regulating
negative affect than in increasing positive feelings.
Moderator analyses did not provide sufficient
information to account for high heterogeneity in the
ES nor for anxiety or depression. Some trend was
observed in variables related to intervention (length
of the intervention, total number of sessions, length
of sessions and frequency), in most cases, they
showed some inclination to be inversely correlated to
ES. This tendency was previously noted by Reed and
Buck (2009) with regards to program duration, where
the effects appear to diminish for programs > 13
weeks; habituation was thought to play a role in this
phenomenon.
The evidence of psychological and exercise
interventions’ efficacy for improving well-being and
ill-being related outcomes in college population is
relevant in the context of increasing attention to
promotion and prevention programs for higher
education (Conley et al., 2013; Oades, Robinson,
Green, & Spence, 2011). These interventions are
feasible to deliver to a large number of students
through classroom settings or open group modalities,
which would represent an alternative to the less cost-
effective one-to-one type of intervention and may
become a strong strategy for primary prevention
(Albee & Gullotta, 1986; S. Brown & Schiraldi,
2004).
Post meta-analytical confirmatory studies to integrate
and compare the effects of well-designed
psychological and exercise-based interventions are
recommended. Follow-up measures should be
considered. Measuring, targeting and reporting a
wide range of well-being measures (mental health,
satisfaction with life, positive affect, negative affect,
psychological well-being) would provide a much
better understanding of the actual contribution of
treatments, currently limited by some bias to studying
illness-related outcomes.

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Anxiety
Depression
n studies
n ES
t
p
r
p
n studies
n ES
t
p
r
p
4
9
7
9
Related to intervention
Length (weeks)
3
8
-0.30
0.46
7
9
0.02
0.96
Total number of sessions
3
8
-0.40
0.32
6
8
-0.03
0.93
Length of sessions (min.)
4
9
-0.45
0.21
6
8
-0.07
0.86
Frequency (times/week)
4
9
-0.12
0.76
3
5
-0.67
0.22
Mode
na
na
-0.41
0.70
Individual
4
5
Group
3
4
Time of measurement
1.62
.15
0.07
0.94
Endpoint
4
6
5
7
Follow-up
2
3
2
2
Related to subjects
Age
3
5
-0.18
0.76
5
7
-0.42
0.35
Note. p= significance. t= Student’s t. r= Pearson’s r. na= not applicable due to insufficient data
Anxiety
Depression
n studies
n ES
r
p
n studies
n ES
r
p
4
8
3
5
Related to intervention
Length (weeks)
4
8
-0.5
0.2
3
5
-0.21
0.73
Total number of sessions
2
5
-0.45
0.44
2
3
0.78
0.42
Length of sessions (min.)
4
8
-0.48
0.22
3
5
0.59
0.28
Frequency (times/week)
3
7
-0.52
0.22
3
5
0.86
0.06
Note. Insufficient data for variables: mode, time of measurement and age. p= significance. r= Pearson’s’ r.
Table 4. Moderator analyses for psychological interventions
Table 5. Moderator analyses for exercise interventions

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Authors (year of
publication)
Type of intervention
(P=Psychological,
E=Exercise)
n
exp
n
control
Age
(mean)
Mode
G=Group,
I= Indiv.
Length
(weeks)
Total
number
of
sessions
Length of
sessions
(minutes)
Freq.
(times/week)
Outcome
(measure)
ES
Calvo, Betancort,
and D. Díaz (2009)
Automated Suggestive Brief
Relaxation Technique (P)
65
73
21.29
G
1
1
15
1
Anxiety
(STAI)
1.74
Church, De Asis,
and Brooks (2012)
Emotional Freedom
Techniques (P)
9
9
16.7
G
3
4
90
nr
Depression
(BDI)
5.59
Deckro et al. (2002)
Mind/Body Intervention
(Relaxation-response-based
skills & Cognitive
behavioral interventions) (P)
46
44
24
G
6
6
90
1
Anxiety
(STAI)
State
Trait
0.74
0.46
Fresco, Moore,
Walt, and
Craighead (2009)
Self-Administered Optimism
Training (P)
43
55
19.23
I
4
nr
nr
nr
Depression
(BDI)
0.22
Hopkins, Davis,
Vantieghem,
Whalen, and Bucci
(2012)
Treadmill (walking or
jogging)
(E)- 1
12
13
nr
I
4
nr
30
(min.)
4 (min.)
Anxiety
(STAI-Y1)
Depression
(BDI)
Negative
Affect
(PANAS)
-
0.32
1.58
-
0.51
Treadmill (walking or
jogging)
(E)- 2
14
15
nr
I
4
nr
30
(min.)
4 (min.)
Anxiety
(STAI-Y1)
Depression
(BDI)
Negative
Affect
0.63
1.40
-
1.06
Table 6. Description of studies

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(PANAS)
Hurley and Kwon
(2012)
Savoring the moment
intervention (P)
94
99
19.48
I
2
1
20
nr
Depression
(BDI)
Positive
Affect
(PANAS-X)
Negative
Affect
(PANAS-X)
0.33
0.14
0.40
Kanji et al. (2006)
Autogenic training (P)
32
31
nr
G
8
8
60
1
Anxiety
(STAI)
State,
endpoint
Trait,
endpoint
State, follow-
up
Trait, follow-
up
0.55
0.56
-
0.22
0.31
Kubitz and Landers
(1993)
Cyclo-ergometer (E)
13
11
nr
I
8
24
40
3
Anxiety
(STAI)
At baseline
After stressor
task
After
recovery
0.38
1.47
0.81
McMakin, Siegle,
and Shirk (2011)
Positive Affect Stimulation
and Sustainment (PASS) (P)
13
14
nr
I
2
3
20
nr
Depression
(BDI-II)
Positive
Affect
(PANAS)
Negative
Affect
(PANAS)
1.31
0.20
0.36

Journal of Sport and Health Research 2016, 8(1):75-92
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85
Pace and Dixon
(1993)
Cognitive Therapy (P)
31
43
22.54
I
5
7
45
1
Depression
(BDI)
Endpoint
Follow-up
2.32
2.27
Roth (1989)
Cyclo-ergometer (E)
40
40
20.8
I
1
1
20
1
Anxiety
(POMS)
Depression
(POMS)
3.59
0.39
Russell and Newton
(2008)
Interactive video game
exercise (cycling) (E)
Group 1 – Male
18
32
20.44
G
1
1
30
1
Negative
Affect
(PANAS)
0.43
Interactive video game
exercise (cycling) (E)
Group 2 - Female
38
24
21.32
G
1
1
30
1
Negative
Affect
(PANAS)
0.34
Cyclo-ergometer (E)
Group 1 - Male
28
32
23.39
G
1
1
30
1
Negative
Affect
(PANAS)
0.15
Cyclo-ergometer (E)
Group 2 - Female
28
24
22.04
G
1
1
30
1
Negative
Affect
(PANAS)
0.39
Sheldon and
Lyubomirsky (2006)
Gratitude exercise (P)
21
23
nr
I
4
nr
nr
nr
Positive
Affect
(PANAS)
Endpoint
Follow-up
Negative
Affect
(PANAS)
Endpoint
Follow-up
0.09
-
0.29
0.36
0.23

Journal of Sport and Health Research 2016, 8(1):75-92
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86
Note. BAI= Beck Anxiety Inventory, BDI=Beck’s Depression Inventory, BDI-II= Beck’s Depression Inventory (second version), CESD= Center for Epidemiologic Studies
Depression Index, DASS-42=Depression, Anxiety and Stress Scale, PANAS-X= Positive and Negative Affect Schedule-Expanded Form, POMS= Profile of Mood States, SIAS=
Social Interaction Anxiety Scale, STAI = State-Trait Anxiety Inventory, STAI-Y1 = State-Trait Anxiety Inventory (Form Y), nr= not reported, min= minimum.
Best possible selves exercise
(P)
23
23
nr
I
4
nr
20
nr
Positive
Affect
(PANAS)
Endpoint
Follow-up
Negative
Affect
(PANAS)
Endpoint
Follow-up
0.33
-
0.45
0.40
-
0.33
Steinhardt and
Dolbier (2008)
Resilience
psychoeducational
Intervention (P)
30
27
nr
G
4
4
120
1
Depression
(CESD)
Positive
Affect
(PANAS)
Negative
Affect
(PANAS)
0.52
0.62
0.51
Yazdani, Rezaei,
and Pahlavanzadeh
(2010)
Stress management training
program (P)
38
38
20.9
G
4
8
120
2
Anxiety
(DASS-42)
Endpoint
Follow-up
Depression
(DASS-42)
Endpoint
Follow-up
0.40
0.51
0.45
0.58

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LIMITATIONS
Most studies included in this meta-analysis did not
report data on possible moderators like delivery mode
of interventions, time of measurements, intensity of
exercise and age of participants. This lack of
information impairs the ability to explain variability
of the results. Another limitation concerns the final
number of studies included in the meta-analysis;
inclusion criteria were intended to dismiss studies
with limited quality, but this also resulted in a small
number of ES.
CONCLUSIONS
Psychological and exercise interventions are similarly
effective in impacting higher education students’
well-being and ill-being. Decreases in anxiety and
depression measures are reported after both types of
interventions. Exercise does not impact negative
affect results, but psychological strategies do. Since
mechanisms underlying the effect of the two types of
interventions do not seem to interfere with each other
(might actually complement), it is plausible that
initiatives that combine exercise and psychological
approaches result in increased enhancement of well-
being. Confirmatory trials and cost-effectiveness
studies in college settings are recommended.
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