Influence of Anxiety on Motor Learning and Motor Imagery Ability in Young Population
Condition: Anxiety
MeSH terms: Anxiety Disorders
Study type: Interventional

Summary: 
      In motor learning, to consider that movements are produced by the cooperation and combination
      of many brain structures and are influenced by the emotions to which individuals are
      subjected is essential. Several neural circuits have been identified that closely link the
      emotional system and the motion control system.

      Anxiety is defined by persistent and excessive worries that do not disappear even in the
      absence of the stressor. Anxiety has been found to produce inefficiencies in information
      processing, which can result in performance deficits, as well as self-reported anxiety has
      been linked to poorer working retrieval performance. In these stress and anxiety contexts,
      relaxation techniques have been widely used to reduce psychophysiological arousal levels.

      Understanding how movement, emotions and interactions are regulated is significant because of
      the large number of movements humans perform. Of these, manual tasks represent precise
      movements that require the integration of many elements by the nervous system to perform
      these tasks successfully. How anxiety influence the way manual tasks are learned is still
      unknown.

      On the other hand, motor imagery (MI) is a cognitive process that is an important contributor
      to how movements are planned and executed. The use of MI has been recommended to improve
      movement learning and task execution. Knowing MI capacity is essential for creating effective
      and individualized MI programs. However, how a relax intervention can affect the motor
      imagery ability in anxiety people is still unknown.

      The aim of our study was to find out whether a relaxation intervention prior to MI practice
      in subjects with anxiety can influence the learning of a precise manual task not previously
      trained on four parameters of fine motor control: time, error, speed, and accuracy. On the
      other hand, the aim is to determine if the ability of internal visual, external visual, and
      kinaesthetic imagery varies when the anxiety participants are subjected to relaxation.

      The investigators expect that participants with anxiety, to whom relaxation is induced, will
      show better motor performance on the fine motor task and better motor imagery ability. In
      contrast, the investigators expect that participants with anxiety, to whom relaxation is not
      induced, will show poorer motor performance on the fine motor task and poorer motor imagery
      ability.
    

Detailed description: 
      In order to meet the study objectives of determining and quantifying the effects of relax in
      anxiety people on learning a precise manual task and on motor imagery ability, this study
      will be conducted. The development of the study will take place in a conditioned room
      belonging to the University of Alcalá, the Complutense University of Madrid, the European
      University of Madrid, or Claude Bernard University Lyon 1. The study may also be carried out
      in other Spanish and international university centers, subject to the consent and permission
      of the respective centres. The study will be carried out by all national and international
      laws, regulations, and recommendations.

      The study design will be longitudinal, experimental, randomized, and double-blind, as
      specified in the present registry.

      The study population will be composed of participants who are undergraduate and postgraduate
      students at the university centers where the study will be carried out, from which the
      participants will be recruited. All participants included in the study must meet the study
      selection criteria and participate voluntarily after reading the information sheet and
      signing the informed consent form.

      The study will consist of two intervention groups, both groups will have anxiety measured
      with the State-Trait Anxiety Inventory (STAI) and then be randomized to either the relaxation
      intervention group or the control group. Each group will consist of a minimum number of 20
      subjects to be able to study the desired effect.

      After each participant freely chooses to participate in the study, an initial questionnaire
      will be administered to ensure that the participants meet the criteria for inclusion in the
      study. At this point, the participants will be coded by assigning them a number, which will
      serve to identify each participant throughout the study. Participants will take the STAI, one
      of the most widely used instruments for the self-reported assessment of anxiety. Participants
      with scores indicative of anxiety will be included in the study. Included participants will
      be randomized through sealed envelopes stratified by gender to one of two experimental
      groups: relaxation or control. They will also take the Edinburgh Handedness Inventory (EHI)
      to determine the participant's laterality, and the Movement Imagery Questionnaire-3 (MIQ-3)
      to measure internal visual, external visual, kinaesthetic imagery capacity. At the same time
      of MIQ-3, the experimenter will record the execution and imagery times were recorded (for
      subsequent calculation of the time discrepancy between executed and imagery as a measure of
      temporal congruence between them).

      Depending on the group to which the participants have been assigned, the participants of the
      relaxation group will perform a relaxation intervention using the Abbreviated Progressive
      Muscle Relaxation technique (APMR). This intervention consists of a standardized 20 min
      session in which subjects are asked to sequentially tense and relax various muscle groups. To
      do so, participants will listen to an audio with relaxation instructions while seated in a
      reclining seat and dimmed lighting. Despite its brevity, this relaxation technique has been
      shown to be effective in reducing anxiety and has been shown to produce cognitive,
      behavioral, and physiological relaxation. On the other hand, participants in the control
      group did not receive a relaxation intervention. After the relaxation or control,
      participants will learn a precise manual task with the non-dominant hand. The task will
      consist of going over a 127 mm circumference on a graphics tablet at a rate of 2 seconds per
      lap, which will be set by a metronome using a wireless pen that will leave no trace of ink
      but will store the data in the MATLAB program via the graphics tablet. Thus, data from the
      acquisition process and short-term retrieval of the task will be recorded. Afterward, there
      will be a 20-minute break during which participants will perform the MIQ-3 and the
      experimenter will record the execution and imagery times again.

      In addition, during all experiments, electrodermal activity and heart rate variability will
      be recorded using the Empatica E4 physiological variable measurement wristband. This
      measurement of physiological variables will serve to confirm a significant relax effect has
      been generated in the relaxation group.

      The analysis and processing of data from MATLAB version R2020b, and the Empatica E4 wristband
      will be performed using Rstudio statistical software and Kubios HRV software (for HRV
      analysis).

      First, appropriate statistical analyses will be performed to see if the data are distributed
      according to a standard curve and to assess the influence of sex and age.

      Subsequently, the descriptive analysis of the relative and absolute frequencies for the
      qualitative variables of gender and age will be carried out, and their homogeneity will be
      tested using the Chi-square test. The descriptive analysis of the quantitative variables of
      time, error, speed, accuracy, electrodermal activity, heart rate variability, motor imagery
      capacity and discrepancy times also be carried out. If the variable conforms to the normal,
      the mean, range, and standard deviation shall be calculated. If the variables do not conform
      to the normal, non-parametric tests will be performed.

      Comparative analysis will be performed using mixed ANOVA to see the differences in the mean
      values respective to motor control (time, error, speed, and accuracy). A further ANOVA
      analysis will take place for imagery ability (motor imagery capacity and discrepancy times),
      comparing the results obtained at the two respective points during the experiment.

      The effect of learning between laps will be analyzed by repeated-measures ANOVA comparing
      each motor control measurement parameter with respect to the lapping factor. Electrodermal
      activity, and heart rate variability during the relaxation intervention will also be studied
      by repeated-measures ANOVA.

      For hypothesis testing, a significance level of 0.05 will be set.
    

Intervention name(s): Relaxation; Control
Intervention type(s): Other; Other
Intervention description(s): This group will perform the APMR. This intervention consists of a standardized 20 min session in which subjects are asked to sequentially tense and relax various muscle groups. To do so, participants will listen to an audio with relaxation instructions while seated in a reclining seat and dimmed lighting.; No intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: As participants complete the State-Trait Anxiety Inventory, and are found to be anxiety, they will be randomised in parallel to one of the two intervention groups.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Basic Science
Keywords: Anxiety; Motor Learning; Memory; Motor Imagery Ability