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Behavioural therapy and pharmaceutical treatments are typically recommended first treatment approaches for depression. However, more than half of patients do not achieve remission after first-line antidepressant treatment, and about 30% do not reach remission after multiple treatment trials (Rush et al., 2006). Repetitive transcranial magnetic stimulation (rTMS) is a well-tolerated and promising neuromodulatory approach for patients with treatment resistant depression (Milev et al., 2016). It has shown success in treating traditional treatment-resistant individuals with MDD (Sehatzadeh et al., 2019). Furthermore, through depression treatment, habitual physical activity may increase and serve as a behavioral marker of successful treatment (Yun et al., 2020). This possibility has received little research attention. As Cuijper and colleagues (2014) noted, it is remarkable that there is so little evidence on whether treatments for depression among adults have an impact on physical activity and whether changes in physical activity mediate the outcomes of these treatments. Future work should systematically examine the role of PA before, during and after depression treatments as important synergistic mechanisms may be at play in the treatment of MDD (Fagan et al., 2019). One mechanism through which physical activity may confer mental health benefits is by improving affect. Positive activated affect is described as a subjective mental state of positive energy and engagement. In two well-cited meta-analyses, both acute (Reed & Ones, 2006) and regular aerobic physical activity (Reed & Buck, 2009) are associated with a moderate increase in self-reported positive activated affect. Simply, exercise can help people “feel good” in the right circumstances. Demonstrating a bidirectional relationship, evidence suggests that individuals who experience higher levels of positive incidental affect are more likely to be physically active (Liao et al., 2015). We are not aware of any research examining the physical activity-affect relationship among individuals receiving treatment for depression. Accordingly, this study will first examine changes in physical activity during a six-week r-TMS treatment period and identify when and how (minutes of light, moderate-to-vigorous physical activity) changes in physical activity occurs among responders (individuals who have a 50% reduction in depressive symptoms at the end of treatment) compared to non-responders. Second, we will examine the bidirectional relationship between affect and physical activity during the treatment period.

There is a high prevalence of anxiety in children and adolescents, however, having a disability may further heighten the risk of developing an anxiety disorder. Physical activity may be one way for children and adolescents with disabilities to alleviate anxiety, yet, little is known about the relationship between anxiety and physical activity among this population. For children and adolescents with disabilities, physical activity may lessen the effect of anxiety, assist in anxiety symptom management, or act as a protective mechanism through decreasing the likelihood of developing anxiety disorders later in life. This review will synthesize the available evidence in order to identify future research priorities concerning the relationship between anxiety and physical activity in children and adolescents with disabilities.

A scoping review protocol to systematically map the emerging evidence on the impact of COVID-19 on the physical activity, sleep and sedentary behaviour of children and youth.

Mood disorders, also known as affective disorders, are the leading causes of disability in Canada and globally. The Diagnostic and Statistical Manual of Mental Disorder (DSM-5-TR; American Psychiatric Association & PsychiatryOnline Premium Package, 2022) distinguishes between two major categories of mood disorders: depressive and bipolar disorders. It is estimated that 4.4% of individuals globally experience depression each year (World Health Organization, 2017), and 1% experience type I or type II bipolar disorder (BD；Merikangas et al., 2011). The lifetime prevalence of depression is estimated to be even higher in Western industrialized nations, such as Canada (9.9%；Patten et al., 2015) and the United States (20.6%；Hasin et al., 2018)). It is generally acknowledged that all types of mood disorders are negatively correlated with quality of life (Cramer et al., 2010). Moreover, Cavanagh et al. (2003) reported that 90% of all suicide-related deaths occur among people who are experiencing mental disorders, especially bipolar disorder and depression. A subsequent meta-analysis concluded that suicide attempts are prevalent both among individuals with BD I (36.3%) and BD II (32.4%) (Dennehy et al., 2011). The heavy burden of mood disorders on individuals, families, and society warrants effective and cost-effective treatments. There is strong evidence for bidirectional relationships between the movement behaviours (physical activity, sedentary behaviour and sleep; Ross et al., 2020) and mental health. On one hand, engagement in movement behaviours has been found to promote mental health; whereas insufficient engagement is associated with poor mental health (Baglioni et al., 2011; Rollo et al., 2020). Regular physical activity has been recommended to treat mild-to-moderate depression in Canada (Ravindran et al., 2016), and has been suggested to be effective in the treatment of BD (Miranda-Pettersen et al., 2020). Moreover, it is well known that physical inactivity, high levels of sedentary behaviour, especially high volumes of screen time, and sleep problems have been linked to increased risk of depression and BDs (Franzen & Buysse, 2022; Kandola et al., 2019; Kandola et al., 2021; Schuch et al., 2018). On the other hand, being ‘mentally healthy’ may also be an important antecedent of engaging in optimal doses of those movement behaviours. For example, symptoms such as fatigue, psychomotor retardation, and anhedonia may actively discourage engagement in physical activity (Glowacki et al., 2017). Canada’s 24-hour movement guidelines for adults and older adults (Ross et al., 2020) recommend that adults (1) accumulate of at least 150 minutes of moderate-vigorous physical activity (MVPA) per week and (2) participate in muscle strengthening activities at least twice a week. Additionally, older adults are encouraged to participate in activities that challenge balance. Children and youth are encouraged to accumulate at least 60 minutes of MVPA per day (Tremblay et al., 2016). Sedentary behaviour, defined as waking activity characterized by a sitting, reclining, or lying posture that requires low energy expenditure (i.e., less than 1.5 metabolic equivalents), should be limited 8 hours per day or less for adults. Screen-based activities are common contributors to sedentary behaviour in many populations (Leask et al., 2015; Rideout et al., 2010; Thorp et al., 2011). Not only might these behaviours independently influence health outcomes, but they have also potential impacts on sleep behaviour (Costigan et al., 2013). Adults should also aim for 7 to 9 hours of good-quality sleep on a regular basis, with consistent bed and wake-up times. Both individually and collectively, the movement behaviours have been shown to provide numerous health benefits. An important aspect of the guidelines is recognition that the four movement behaviours interact to influence health. Movement behaviours are characterized by temporal variability and are influenced by a range of dynamic psychological processes (e.g., affect) and co-occurring events (e.g., social/environmental factors, interpersonal dynamics) (Ruissen et al., 2021). Problematic fluctuations of affect are one of the common features of mood disorders. People with depression (Wichers et al., 2007) and BDs (Curtiss et al., 2019; Havermans et al., 2010) have showed altered patterns in affective responses to stressors. A previous meta-analysis suggested that exercise has been associated with elevated positive affect (Reed & Ones, 2006). Also, insufficient sleep is believed to increase negative emotion (van der Helm & Walker, 2010). However, much research employs cross-sectional designs using one-time assessments of affective phenomena (affect, emotion, and mood) and movement behaviours. Such designs cannot address the dynamic nature of interactions between movement behaviours and affective phenomena, and are not able to reveal the directional associations among these variables (Kanning et al., 2013; Shiyko & Ram, 2011; Wilson et al., 1982). Recent years has seen increased interest in ecological momentary assessment (EMA) as a tool for real-time data capture for examining temporal relationships between adaptive behaviours and mental health (Hamaker & Wichers, 2017). EMA allows researchers to capture data immediately or within a short amount of time after an event occurs, therefore improving the precision of relationship evaluations (Stone & Shiffman, 1994; Wenze & Miller, 2010). In conjunction with advanced statistical modelling techniques (Ruissen et al., 2021), there is great potential in using EMA to tease apart relationships between movement behaviours and affective phenomena among individuals with mood disorders. Moreover, Wenze and Miller (2010) have suggested that it is feasible to use EMA methodology among people with mood disorders. Understanding the temporal relationships between affective phenomena and movement behaviours may inform clinical management and well-being intervention development including just-in-time adaptive interventions (Hardeman et al., 2019). To the best of our knowledge, no previous reviews have examined the temporal relationships between affective phenomena and movement behaviours among people with mood disorders. Thus, the purpose of this scoping review was to both synthesize what have been done and examine how research was conducted on this topic (Munn et al., 2018; Sabiston et al., 2022). Results have the potential to inform whether a systematic review is needed and guide future research about the use of EMA in evaluating relationships between affective phenomena and movement behaviours among people with mood disorders. Methods: This scoping review will follow the six-stage framework for conducting scoping reviews, developed by Arksey and O'Malley (2005), and later revised by Levac et al. (2010). This study will report the results and outcomes following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-ScR) (Tricco et al., 2018). Stage 1: Identifying the research questions The objective of this review is to summarize current evidence regarding the use of EMA methodology among people with mood disorders in studies exploring the relationship between movement behaviours and affective phenomena. Notably, affective phenomena including mood, emotion, and affect, have been interchangeably used in previous literature, which may cause pitfalls (Ekkekakis, 2013, p. 33). In this review, emotion is a short-term reaction to a personally-significant stimuli, whereas mood refers to a more general and sustained disposition toward a particular emotion, and can occur without a specific stimulus. In short, emotion is a state, whereas mood is a trait. Affect is a less consistently defined concept in the literature. Niven (2013) defined affect as an umbrella concept which includes both mood and emotion. Note that, in clinical settings, it is also sometimes used to refer to a person’s emotional expression. Whereas, Ekkekakis (2013) suggested that affect is a momentary and dimensional (positive or negative) feeling that could constantly exist alone or be part of emotion or mood. Kirkland and Cunningham (2011) also considered affect as a necessary but insufficient component of emotions. Research questions: The purpose of this scoping review is to summarize the application of EMA in examining the association between the affective phenomena (mood, emotion, affect) and movement behaviour (physical activity, sedentary behaviour, sleep). Specifically, this scoping review will examine: 1. What is known about the relationship between movement behaviours and mood/emotion/affect among individuals with mood disorders? 2. How are the constructs of mood/emotion/affect conceptually and operationally defined within included studies? 3. What EMA technologies have been utilized? 4. What methodologies are typically adopted? For example: Duration of EMA monitoring, EMA prompts frequency, mental health screening tools, and use of comparison groups. 5. What is participant retention? 6. What methodological limitations have been identified? 7. What are recommended future research directions? Stage 2: Identifying relevant studies Searches will be conducted in the eight following electronic databases: PubMed, Medline (via Ovid), Embase (via Ovid), PsycINFO (via EBSCO), CINAHL (via EBSCO), SPORTDiscus (via EBSCO), Scopus, and Web of Science from their inception to June 10th, 2022. The databases will be searched using controlled vocabulary (e.g., MeSH terms in Medline) and keywords. Relevant terms included keywords related to EMA (e.g., experience sampling), mood disorders (e.g., depression, bipolar disorders) and movement behaviours (e.g., physical activity, exercise, sleep, screen time, sedentary behaviour). The search strategy was drafted by YL, and was refined based on the discussion with a university librarian and team members (Appendix 1). Reference lists of included studies will also be checked for identifying additional studies. Stage 3: Study selection Covidence, a review management software, will be employed to remove duplicates and conduct the selecting processes. Two authors will independently conduct the title and abstract screening. Full-texts will be independently reviewed by two authors for the remaining articles that passed title and abstract screening. Conflicts will be resolved by discussion. When necessary, a third author will be consulted for reaching a consensus. Inclusion and exclusion criteria: Peer-reviewed publications will be included if they were: 1) written in English, 2) include participants diagnosed with a mood disorder (e.g., major depressive disorder, bipolar I disorder) or using validated clinical scales, 3) use EMA to assess mood/emotion/affect, 4) include a measure of movement behaviours (e.g., minutes of physical activity), and 5) assess the relationships between mood/emotion/affect and movement behaviours. Only quantitative studies will be considered. Grey literature, theses/dissertations, reviews, qualitative studies and case studies will be excluded. Additionally, studies that do not quantify the amount of movement behaviours will be excluded: for example, studies that examine perceived sleep quality rather than amount of sleep. There are no restrictions with regard to participant gender, age, or the measurements of movement behaviours (self-reported or device-based). Stage 4: Data charting A data-charting form will be developed by one author and will be further refined by other authors by discussion. The following items will be extracted by two authors independently: 1) authors and year, 2) country, 3) methodological approach, 4) participant characteristics (e.g., sample size, age, gender, diagnosis), 5) EMA characteristics (e.g., schedule, device, attrition rate), 6) measurement of affect, 7) definitions of mood/emotion/affect, 8) measurements of movement behaviours, 9) main findings, and 10) future research directions. Disagreements will be solved by discussion. The extraction spreadsheet will be managed using Microsoft Excel. 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