Hundeverordnung (‘Dog Act’) recognizes that not only every hound but even a skinny, shaking Chihuahua contains, somewhere deep inside, an ancestral wolf.Soon, German dog-owners will be legally required to walk their dogs for a total of at least an hour each day. The most pampered Pomeranian, though it has grown used to couches and carpets, must now be allowed to answer the call of the wild by moving its little body through the park. The new Exercised: Why Something We Never Evolved to Do Is Healthy and Rewarding.Of course, the wolf, unlike the Chihuahua, didn’t need government-mandated doses of exercise. To survive, the wolf hunted, and to hunt, the wolf ran. Yet, its great-great-grand-pup, the domesticated dog, must be regularly and intentionally exercised to maintain its health. This is no less true for the domesticated human, as Daniel Lieberman explains in his myth-busting and fascinating new book, Lieberman uses both anatomical and anthropological evidence to show how our speed, strength, and endurance developed to help us forage, fight, and hunt—activities our forebears had no choice but to do on a regular basis. Chasing down antelope, trekking long distances for wild plants and occasionally outrunning predators ensured the propagation of our genes. Thus, what is now called ‘physical fitness’ was once closely aligned with what scientists call ‘evolutionary fitness’—whether an organism is sufficiently adapted to its environment to survive and reproduce. Today, however, most of us have no urgent need to run down a meaty ungulate or walk ten miles to dig up tubers. Calories are plentiful and chairs abound.So why move? Isn’t exercise a slap in the face of all our hard-won human progress, of civilization itself? Well, coming from a cardiologist, my answer may not be a surprise: Regular, vigorous, sustained activity can save your life! But my experience with patients—and with myself—shows that a wide gulf separates knowing and doing.In fact, Lieberman explains, there’s a good reason so many of us view the gym as a house of horrors designed by a master torturer. Spoiler alert: It’s evolution’s fault. For most of human existence, calories were scarce and exertion inevitable, so there was little need for natural selection to incentivize exercise by making it, you know, feel good.Some will be disappointed to learn that the book doesn’t stop with this ironclad excuse for getting out of gym class (signed by evolution itself!). Instead, Lieberman goes on to explain how and why exercise, that flagrant waste of calories and of civilization’s labor-saving advances, is nonetheless critical to improving our health and to combating aging, and even how we might trick ourselves into doing it.It would seem difficult to deliver this message in a way that doesn’t feel both familiar and insufferable, but Lieberman manages, partly because of his writing’s warmth and empathy. That empathy springs from his own lived experience of the old conundrum: we know we should exercise, but we don’t want to.Born to Run). He has even outrun horses in an endurance race over mountains! But he doesn’t boast about his athletic prowess, like those ostentatiously grunting gym bros who seem to be exercising not near you but at you. In fact, Lieberman has a term for them, and for the ‘runners’ who look down their noses (or behind their backs) at mere ‘joggers’, and for the rest of their arrogant ilk: exercists. Unlike the holier-than-thou exercists, who view a lack of fitness as a moral failing, Lieberman is at pains to normalize not wanting to exercise.Once a scrawny kid picked last for teams, Lieberman is now an accomplished marathon runner as well as a popularizer of barefoot running  sound new is because he approaches the topic from a new angle—or rather a very old one. As an evolutionary biologist and anthropologist, he has long studied how the human body evolved in tandem with certain behaviors. He uses these two lenses—how humans behaved and how they evolved—to put into perspective the exhaustive, and exhausting, the literature on exercise.is optimal. He finds that not only do most Westerners average seven hours a night, but that hunter-gatherer people average even less (6.5–7), and that numerous studies have found higher mortality rates for people who sleep less or more than seven hours on average. He repeatedly offers this sort of careful and clear evaluation of health and exercise studies that can be challenging to interpret for not only patients but many physicians as well.For instance, rather than join the chorus lamenting how Westernized people often fail to get the optimal 8 h of sleep, he looks at observational studies questioning whether 8 h actually expensive—not in terms of gym memberships, but calorically. To maintain his impressive physique, the Rock puts away more than 5000 calories a day, spread across seven meals. On average, he eats 12 eggs and more than two pounds of cod per day—a diet he probably couldn’t maintain for long in our ancestors’ hardscrabble environments.As the ‘eight hours a night’ example suggests, the book often proceeds by debunking widely held beliefs. For example, were our hunter-gatherer ancestors actually huge, muscled strongmen, as many evangelists of paleo-fitness plans like CrossFit argue? Of course not, Lieberman says. Look at contemporary hunter-gatherer people like the Hadza of Tanzania, the San of the Kalahari, or the Aché of the Amazon—they are certainly fit, but also lean, and unlikely to beat Dwayne ‘The Rock’ Johnson in an arm-wrestling contest. Again, this makes sense in environments where energy is at a premium, since big muscles are As a physician and science writer myself, I was deeply impressed by Lieberman’s straightforward synthesis of a mass of research on human health and exercise that is messy, confusing, and often self-contradictory. He cuts through the morass of studies  to overturn conventional wisdom and offer readers (including this cardiologist) unusually digestible insights.Moby Dick, or to the all-night balls of Jane Austen .A 339-page book could seem like a marathon itself, but these pages never plod. The many illustrative stories are one big reason why. Drawn from different eras and areas, they consistently provide historical, cultural, and sometimes scientific context for understanding important concepts. Sometimes he flexes his literary muscles with references to the co-sleeping arrangements of Ishmael and Queequeg in Anecdotes from his own experience do a lot of heavy lifting, too. Writing on whether sitting is unhealthy, he recalls with a shiver days he spent sitting on a sled jouncing across Greenland in −30˚F cold. On the subject of sprinting, he bravely admits how he set his own personal speed record—ingloriously dashing away from a hyena who wandered up to him in Kenya.  These moments add to his arguments both self-effacing humor and a first-person authority.males with heart disease.Another unexpected but very welcome feature of the book is the consistent inclusion of women’s experiences and health issues.  Historically, such attention to women has been all too rare in the scientific and medical literature. For instance, until the NIH Revitalization Act was passed in 1993, NIH-funded studies were not required to include women. As a result, for decades all we knew about heart disease was really only what we knew about Born to Run), he begins with the ariwete, the women’s event. Again and again, whether in Mexico, Kenya, Tanzania or Ethiopia, he turns his attention to movement and athleticism among both men and women.Thanks in part to the swelling ranks of female researchers, this imbalance is slowly being improved. Admirably, Lieberman is putting his shoulder to the wheel, too. In fact, the book begins with him schlepping a treadmill to remote Pemja, Kenya, to study the running and walking movement of Kalenjin women. When describing the Tarahumara endurance races in Mexico . Without fanfare, he upends a gendered assumption and simultaneously presents a mechanism by which activity in later life may promote longevity.Lieberman’s concern for differing experiences is evident throughout the book, as his lack of interest in one-size-fits-all prescriptions for exercise. He asks at one point, ‘Do we really expect the same action plan to work for people who are overweight or thin, shy or outgoing, insecure or confident, men or women, college graduates or less educated, rich or poor, urban or rural, stubborn or docile?’ Instead, he distills the research on exercise’s benefits so different people can use it as they see fit.Exercised, and its clear-eyed approach to a complex subject.Interestingly, that German dog-walking law that requires dogs to get an hour of exercise per day already faces backlash due to its inflexibility. People are complaining about the lack of exceptions for old or sick dogs, or pointing out that an hour may be too long for some dogs to spend outside on hot days. Those German legislators—exercists for dogs—might have benefited from reading Hundeverordnung.In particular, they might have learned something from Lieberman’s proposal to make physical education mandatory at universities. Though he generally favors a carrot-and-stick approach over coercion, he makes an exception for college, where students are still developing lifelong habits. Even here, though, his proposal takes into account the wide range of human abilities by offering flexible options—unlike the Exercised uses empathy, humor, storytelling and careful reasoning to help readers come to their own conclusions. Understanding how and why we moved in our ancestral past can help us think more clearly about how and why we should move now. If we’re lucky, it won’t involve hyenas.In treating the complicated topic of human fitness, Lieberman has managed to demystify, and demythify, the swirl of evidence about exercise’s benefits and risks. While careful not to be explicitly prescriptive,


Ulipristal acetate (UPA) is an effective drug for the treatment of symptomatic uterine fibroids. The drug is highly effective in controlling bleeding control and in the recovery of anemia. Here, we report the case of a woman with severe menorrhagia due to a uterine fibroid and with concomitant pulmonary embolism, a serious life-threatening condition. UPA was shown to be effective in reducing fibroid volume and controlling symptoms, without worsening the underlying embolic disease. No adverse events were observed, and the patient has completely recovered. Uterine fibroids are common tumors of the uterus occurring in 20–75% of women of reproductive age, and they are rarely symptomatic in about half of the cases , 2. CommA 38-year-old woman, overweight BMI = 28), with a history of anemia and bleeding complaints due to a uterine fibroid Figures  and 2, h8, with aThe patient was in a critical condition due to heavy vaginal bleeding and to a very severe anemia (Hb = 6 g/dl) which did not resolve even after transfusion of two blood bags. A symptomatic intramural fibroid (90 × 88 × 89 mm in diameter) was detected and identified as the main cause of symptoms. The proposed emergency hysterectomy was refused by the patient, during the consent informing session, because of the high surgical risks in her critical conditions.After appropriate counselling, the patient shared the decision to start a daily oral treatment with UPA . Already during the first treatment cycle (12 weeks), an excellent bleeding control was observed; the patient had persistent amenorrhea starting on the fifth day of treatment. Hemoglobin values improved to normal values after three months of treatment with UPA, despite concomitant therapy with high doses of anticoagulants. Concurrently, the fibroid showed a significant reduction in volume. The ultrasonography examination showed a reduction in fibroid diameters, which measured 72 × 70 × 71 mm after treatment. Endometrium was 8 mm depth, with an hyperechoic aspect. The therapy was well tolerated, and there were no adverse events, nor interactions with the concomitant anticoagulant therapy, or exacerbation of underlying pathology.Given the significant improvement in the patient's clinical condition after the first course of therapy, we decided to continue with a second cycle of daily UPA for three months, starting at the beginning of the second menstrual cycle after the end of the first course of therapy.At the end of the second course of treatment, normal menstrual bleeding was restored.In ultrasound, the fibroid had diameters of 40 × 38 × 39 mm, showing about 90% of volume reduction with respect to baseline. Endometrium has a normal proliferative appearance .The patient was asymptomatic and in good general condition, and it was decided to follow a “wait and watch” approach. The medical treatment with UPA resulted well toleratant without any adverse reaction and changes in liver enzyme levels.To date, after more than one year without any treatment for heavy menstrual bleeding, the patient is asymptomatic. At an ultrasound scan performed one year after the end of UPA, the fibroid showed a volume of 31 × 23 × 21 mm and endometrium was normal . No surgIn this case report, it has been reported, for the first time, the effective and safe use of UPA in a women with severe anemia and heavy vaginal bleeding due to a symptomatic fibroid and affected by a concomitant pulmonary embolism, a serious and life-threatening condition.per se the mortality risk.The patient refused surgical treatment (hysterectomy) due to high surgical risks in relation to both anemia and pulmonary embolism. It is well known that a major surgical intervention, like hysterectomy, in a patient with severe anemia and concomitant pulmonary embolism, is a life-threatening condition that enhances The use of Gonadotropin Releasing Hormone analogues  was considered, but these compounds need longer time to induce amenorrhea (2–4 weeks), and furthermore, they may show the well-known flare-up , whiDuring clinical development trials , 4, UPA The mechanism of UPA is completely different with respect to the GnRH analogues: there is no flare-up, and its action is prevalent as antiprogestogen, antagonizing the proliferative effect of progesterone on fibroid growth , with noUPA belongs to the SRPMs family, synthetic compounds exerting either an agonistic or antagonistic effect on target tissues, by their binding to progesterone receptors. As selective modulators, they depend on recruitment of cofactors that regulate both transcription along the genomic pathways and nongenomic interactions with other signaling pathways ; their eDuring clinical development of the UPA, no changes in coagulation parameters emerged , nor indUlipristal acetate is a very well-tolerant drug with few reported serious side effects during developmental trials. Coagulation parameters were evaluated in detail up to four courses of treatment, and they were found unchanged; no cases of venous thromboembolism were reported in any of the four PEARL studies .In 2018, ESMYA® has been evaluated by EMA's Pharmacovigilance Risk Assessment Committee (PRAC), following reports of serious liver injury. After considering all the evidence, the PRAC concluded that the benefits of the drug outweigh its risks and that the medicine must not be used in women with liver disease. All patients may start treatment only with regular liver tests .In our case, UPA achieved success in stopping bleeding and restoring hemoglobin levels, without interfering with the underlying pathology and anticoagulant therapy. The patient completely recovered without needing further surgery.The clinical case presented here highlights the effectiveness of UPA treatment in bleeding control and in reduction of fibroid volume in a woman with symptomatic fibroids and with a serious life-threatening concomitant condition like pulmonary embolism. For the first time, it has reported the use of the drug in this special condition, showing that UPA could be considered a safe option even in women with a pathology in whom traditional therapies are contraindicated or considered at very high risk for life.


Tailored, wEb-based, psychosocial and physical activity (PA) self-Management PrOgram called TEMPO. TEMPO was accessed by a convenience sample of 19 men with prostate cancer and their caregivers (n = 18), as well as six health care professionals (HCPs). User feedback was gathered via semi-structured qualitative interviews. Data were analyzed using thematic analysis. Most dyads were satisfied with TEMPO, particularly with the dyadic feature of TEMPO, the focus on goal setting to integrate self-management, and the extensive health library. The patients and caregivers motivated each other as they worked through TEMPO. Most goals to achieve during TEMPO pertained to increasing PA, followed by learning physical symptom management. One unanticipated benefit of TEMPO for the dyads was improved communication. HCPs agreed that TEMPO was a novel approach to online cancer self-management and they echoed the benefits reported by dyads. Key suggestions for improving TEMPO were to reduce repetition, tailor content, add more exercise ideas, and have more printing options. This study provides a strong foundation on which to plan a larger trial.Caregivers of men with prostate cancer report high burden, and there is a need to develop cost-effective programs to support them in their roles. This study reports on the acceptability of a dyadic,  Despite the improvement in survival rates, a prostate cancer diagnosis still elicits negative reactions and confronts both patients and their caregivers with a wide range of physical and psychosocial challenges ,2,3. ThoIn light of caregivers’ challenges and the importance of them being able to maintain their vital roles, a number of interventions (mostly based in the principles of psycho-education and self-management) have been developed to support caregivers and improve their quality of life (QOL) ,12,13. TWith the recognition of the physical and psychological benefits of physical activity (PA) for the general population , regularTo date, the existing research  highlighTailored, wEb-based, psychosocial and PA self-Management PrOgram (TEMPO) for men with prostate cancer and their caregivers. As an individual’s acceptance of the technology is a strong predictor of future adoption,  help you with all of these things, then we thought, well let’s just […] put our-our goals as the exercise since you’re sending us this exercise stuff anyway. And-and let’s just focus on it and hopefully it-it’ll help us work through some of the other things .A few patients set their SMARTT goals to learn self-management strategies to cope with symptoms, including anxiety, fatigue, or incontinence, dealing with erectile dysfunction, and controlling hypertension and/or diabetes. A couple of dyads set their SMARTT goals pertaining to improving communication with HCPs, including “obtaining more information to our answers from the doctor” .Half of the dyads acknowledged that they viewed their goals as dynamic and revised them as time progressed:Caregiver: […] after we did module three, we went back and refined some of the things that we felt we’d already accomplished […].Patient: […] we have to review our goals, but we may need to set new goals, and also revise the action plan. So, it’s not a static model (11019-12019-2).The reasons for changing goals included: accomplishing initial goals sooner than anticipated, changing the type of PA due to challenges experienced, and making goals more realistic. Although most dyads set two SMARTT goals, several mentioned that there should be more explicit guidance on setting goals that addressed caregivers’ concerns or permit more than two goals, as goals tended to remain focused on patients.Most dyads were satisfied with TEMPO. The participants described their overall experience as “smooth” (31054-32054-H), “easy” , and were “glad we’re doing it” . They felt TEMPO was “well done”  and “well organized and well laid-out” . A few participants referred to TEMPO as “holistic” , as it included information on a range of topics (in one place) and focused on both patients and caregivers. From HCPs’ perspectives, TEMPO was “novel” (HCP-3303) and “an exceptional tool” (HCP-53005). However, there was consensus among HCPs that dyads needed to “invest the time” and “do the work” (HCP-83003). HCPs highlighted that those who “connect” (HCP-53002) with TEMPO and remained “committed” (HCP-53005) would most likely implement the skills learned. All HCPs would recommend TEMPO and use it in routine care.The self-directed format was overall endorsed. A few participants who had experienced challenges with group or gym-based exercise routines expressed enthusiasm about exercising at their own pace and in the comfort of their own homes. However, a couple of dyads suggested that reminders and progress indicators would support the self-directed format. Although the online delivery of the intervention was acceptable to all dyads, a third of them wanted more options to print the materials. HCPs thought TEMPO was an efficient way to offer services to a larger number of people, and to people who might not have access to psychosocial services. However, they felt that TEMPO would be most appropriate following an in-person needs assessment, or as an additional resource to gain further information on topics discussed during medical consultations.Most of the dyads allocated specific times to work on modules together and went through them sitting in front of the computer (at the same time). These dyads either had both partners entering information, or one participant responding to questions and discussing the choices with the other person sitting nearby. Only one caregiver said that she did not read any of the modules.The dyadic nature of TEMPO also seemed to help patients and caregivers in coaching each other to achieve their goal. One patient explained: “So let’s say, for example, I have a down day […] she encouraged me to […] just go walk the block or […] do something in the backyard […] just to get some exercise” .The focus on the dyad was endorsed by HCPs, particularly the focus on addressing sensitive topics , as dyads may be less likely to introduce these during medical consultations. One HCP (53005) said:I especially like that it included information not only for the patients but the caregivers and the opportunity for them to participate […] A couple sitting down to complete [the program] and perhaps the question about libido or sexual function would prompt further discussion amongst themselves.The dyads felt that the order of the modules was logical and that their length and the information included were appropriate: “[E]ach module […], linked itself to the one before it or linked itself to the two before it, so everything ran pretty evenly from start to finish” . As time progressed, several dyads re-visited modules to refresh their memory, to ensure they were completing tasks properly, and/or to learn about alternative methods to accomplish goals. Half of the dyads said that the modules should be released all at once or that the delay between modules needed to be shorter. One dyad that completed several modules in one sitting explained: “Because I was busy sometimes, we were doing two modules in a row. So, we were sitting down, [partner’s name] and I, on a Saturday or a Sunday at our place up north and we were doing this, right” .One HCP also emphasized the logical sequence of modules: “I like how it’s broken down into the various modules” (53005). This approach was praised for providing dyads with opportunities to discuss cancer-related issues, and apply the skills taught. In addition, improving the “fluidity between the modules” (HCP-53005) by not forcing the dyads to complete a module before the next one is unlocked was discussed by HCPs.The worksheets most consistently filled out were the needs assessment and the setting of priority needs in Module 1. Most dyads agreed that, despite being long, the needs assessment was relevant and covered their main challenges. Almost all dyads stated that completion of the needs assessment would either be preceded or followed by a conversation on the areas of concern, to share feelings or to discuss what they learned:We would sit at the computer together and […] sometimes, you know, he’d put down something […] and I’d say to him “Really, is that all you ...” you know or he’d say to me “I didn’t know that was happening” or—so we shared it. We shared our responses and what we were going to say .Only a couple of dyads had disagreements when completing the needs assessment, and in all instances the final answer prioritized the patients’ wishes. Although many dyads completed the SMARTT goal worksheet for the first goal, it was not consistently completed for the second goal. Despite this, goal setting was identified as one of the most useful aspect of TEMPO:The SMARTT goals were really good. That was a good thing to work through, and understanding what SMARTT meant, and going through it step by step […]. We did print the action plan and filled it out, and thus far we seem to be on track .One HCP, however, noted that completing the SMARTT goal worksheet “almost felt like homework. I think the motivated type A personality will do it. […] But then if you’re trying to get the non-motivated person then they’re not going to be motivated” (HCP-53001).A little more than half of the dyads used the coping plan in Module 3 to overcome setbacks in meeting goals. A similar proportion of dyads completed worksheets in the subsequent modules. Of note, it is not because the dyads did not complete the worksheets online that these were not used. Several dyads preferred to take notes and to print certain pieces of information, whereas a few others chose to complete the worksheets orally (not writing anything down). The majority of dyads used the mood-monitoring tool included in Modules 2–5.The length of time needed to go through modules varied but regardless of the actual time, was deemed appropriate by most. The dyads took anywhere between 10 min to several evenings to complete Module 1; 15 min to several days to complete Module 2; 15 min to two evenings to complete Module 3; 15 min to an hour and a half to complete Module 4; and 15 min to an hour to go through Module 5.Along with the goal setting in Module 2, the health library was one of the most appreciated aspects of TEMPO. All dyads used the health library, to various extents. The dyads were generally satisfied with the clarity, relevance, and comprehensiveness of the information included:I think being able to access the library is great […] Because that brings all the resources […] to me that’s brilliant, and it should be something that should be pushed out there to the people […] Because it hits a lot of the important emotional points and different stages of learning about cancer, going through deciding what to do, how to deal with it, getting resources, etc. .Most dyads reported navigating back and forth between the modules and the health library and focused only on the information that was relevant to them. Three sections of the health library were particularly appreciated: communicating with your health care team, supporting one another, and wanting to feel more fit and healthy. However, several dyads revealed that some of the information was not new, albeit it was a good “refresher” . The contents of TEMPO were deemed to be complementary to the information received from HCPs: “Many groups are teaching about exercise, nutrition etc., but I think it being repeated over and over and over again is very good because there’s a little bit of learning at each time” .The usefulness of information contained in TEMPO was also underscored by HCPs: “[O]verall I think it would be helpful simply because it is a fairly vulnerable population that really doesn’t get enough perhaps attention” (HCP-53002). HCPs spoke of the impressive “breadth” (HCP-53005) of information, and highlighted the value of the information on navigating the health care system and connecting/communicating with HCPs. However, there was some concern that the amount of material could be overwhelming, especially for people with low literacy and lower English proficiency . Conversely, there was recognition that TEMPO is an informational resource that could be used in a targeted way: “You can […] pay attention to the things that impact you and ignore the things that don’t” (HCP-53005).The majority of the dyads felt that TEMPO was generic, and not tailored to their specific needs, but acknowledged that personalizing it would be challenging due to variability in cancer trajectories, age, fitness levels, and personal circumstances. Several dyads felt that TEMPO was more geared towards patients as opposed to caregivers. A few participants observed that TEMPO was not personalized based on treatment trajectory and treatment outcome, and that it was cancer-centric and did not address co-morbidities such as diabetes. Similarly, a few HCPs called for more tailoring of TEMPO.Almost three quarters of dyads referred to using the pedometers and/or resistance bands supplied, at times in combination with other exercises that they had been accustomed to such as weight training. The majority of the dyads tracking their step counts with the pedometers did so to compare their step count to build a healthy competition or to make sure they were meeting their goals. One dyad explained:When we got the pedometers, we realized that well, a half an hour walk isn’t getting us close to our 10 000 steps. And so, […] we changed our goal really from a half an hour walk to walking to get our 10 000 steps .About half of the dyads appreciated the sailing metaphor and argued that it facilitated learning: “I thought the analogy of sailing was really good, because it is like that. It’s kind of, like sometimes you have a smooth ride, sometimes you have a rough ride, sometimes it’s up and down” . Some dyads felt it diminished the seriousness of the illness: “Come on, we got cancer here. We’re dealing with something serious. Let’s not try to make it a vacation” . Others felt that they could not relate to the notion of sailing and would have preferred a camping metaphor. Similarly, one HCP (53005) stated that despite the fact that it made sense to include an analogy, the notion of sailing might be perceived as minimizing what the dyad is going through.n = 3); and those patients who are sicker or homeless. None of the participating dyads experienced major challenges in accessing TEMPO, but also acknowledged that some segments of the population might not be able to access TEMPO.All HCPs recognized the limitations of TEMPO in reaching particular sub-groups, namely, those with low health literacy or who speak a language other than English; those of older age; those with limited computer literacy . Most dyads exercised together:But I think the good thing, which we’ve enjoyed with TEMPO, is that […] we were always doing things independently, and for the first time in 45 years of marriage, we’re actually doing things together .Walking was typically the initial exercise, but as time progressed, participants described a wider range of exercises . Almost two thirds of the dyads described challenges to continued PA, including cancer-related obstacles , lack of motivation or inability to maintain discipline, physical limitations unrelated to cancer, managing conflicting demands of day-to-day life, weather, low energy/too tired, and lack of time. In response to these setbacks, the dyads described active perseverance , sticking with goals, idleness , getting motivation from their partner, planning to engage in dyadic exercise to maintain accountability, and/or being satisfied with progress despite setbacks. One caregiver explained:I go out when I feel good enough to go out and I ride my bike when I don’t feel good enough to go out. And I stay home and look after myself otherwise. And I don’t feel badly about that .Dyads who described high levels of PA prior to TEMPO recognized its benefits in keeping them “disciplined” (21023-22023-3), allowing them to “focus on goals” (31053-32053-3), and “working together a[t] physical activity” (21037-22037-2). Both patients and caregivers further described concrete health benefits as a consequence of their increased PA levels, including improvements in cancer “brain fog” (81019), fewer episodes of incontinence, increased energy level, reduced pain, improved strength, and improved sleep.Although most dyads did not set out to work on their communication at the beginning of TEMPO, this was a benefit the majority of dyads did not expect. Completing TEMPO helped dyad “focus discussions” , tackle “conversations that were […] a bit uncomfortable” , and gain “insight into each other” . The needs assessment in Module 1 was identified as particularly beneficial in laying the foundation for further communication. Engaging in PA together also seemed to have encouraged communication. As described by one patient: “I would say it’s probably doubled or tripled […] both our exercise and our communication” . The caregivers often recognized this benefit before acknowledging the benefits of PA itself:We talk more to each when we’re out having a walk than we do if we’re sitting across from each other having supper for example. So for us, walking is probably the best stress reliever, communication means, simply because it seems [we’re] both more at ease when we’re walking .Aligned with the communication benefit, most dyads emphasized working more together, a benefit that was noted with continued use of TEMPO. For some participants, working together was “the best part of the program” . One dyad explained:Patient: Because it was important for us to be working together, but —Caregiver: I think there’s a benefit of a collective […] workload.Patient: Yeah. If we did it individually, one of us could easily drop off. You know, it’s like an accountability thing (21037-22037-2).Several participants described a process in which TEMPO helped the dyad “focus” or “narrow in” (81020-82020-1) on which aspects of the cancer were most important to address. As described by one patient, “the program’s set up like this, you need to establish a baseline, you need to establish something to focus in on because you can’t focus on everything” . Most dyads spoke of achieving their goals or “moving in the right direction” . One caregiver said: “I think the fact that we had goals to make and that we actually achieved them is a testament to the program” .Several dyads described emotional benefits of participating in TEMPO, including reduced anxiety/depression, improved stress/anger management, and addressing fears surrounding recurrence. One patient explained:I mean anxiety is awful, it was a new thing for me and there was so much anxiety at the beginning of the study, and it’s not completely gone, but I would say it’s 95% or 90% gone […] this study helped us out and they were putting the emphasis on physical activity to reduce the anxiety and it’s so true .n = 11) of information previously received at earlier stages of the cancer trajectory. One patient described that this information equipped him with “some ammunition” to tackle cancer related issues . Learned skills were engaging in PA, coping , SMARTT goal setting, and developing a question prompt list for the oncologist.TEMPO provided the participants with a centralized repertoire of information that they could consult as needed and apply in a meaningful way to their situation. Slightly more than half of the dyads said they benefited from new or useful information provided by TEMPO. Those participants who had been living with cancer longer, described that the information provided in TEMPO “was review as opposed to new” , and thereby acted as a reminder or a recap .Although most dyads expressed having the necessary support, they appreciated that TEMPO encouraged them to “take stock”  of these resources (particularly in Module 4) and acknowledged their potential usefulness to others:The participating dyads and HCPs identified concrete improvements to TEMPO, which are detailed in The results of this qualitative study provide support for the acceptability and satisfaction of TEMPO among prostate cancer dyads. An active engagement with TEMPO provided dyads with the necessary information that enabled them to identify and reflect on their needs and supported dyads as they learned and incorporated new self-management strategies (particularly PA) into their daily routines. Furthermore, the study findings offer preliminary insight into the perceived usefulness of TEMPO. The key findings that will be discussed are: (a) PA is an acceptable self-management strategy for several physical and emotional concerns for both patients and caregivers, (b) most dyads used TEMPO together, (c) the dyads coached each other in achieving their goals, and (d) the dyads perceived TEMPO as useful.PA was by far the dyads’ preferred self-management strategy, not only for its physical benefits, but also to help in the management of other challenges. Several studies document PA as acceptable to men with prostate cancer ,50,51. HTraditional models of stress and coping  typicallThe dyads were not instructed how to use TEMPO, and most decided to sit in front of the computer together. In comparison, a dyadic web-based intervention (CARES) for oral cancer survivors and their caregivers offered an alternative approach, in which separate log-ins and role-tailored content were offered . NonetheAlthough increased social support helps individuals to make positive behaviour changes , most stAccording to the Technology Acceptance Model (TAM) , the perOf note, after completing TEMPO, caregivers particularly seemed to value the focus on enhancing positive dyadic coping skills. Caregivers often assessed improvements in PA as a secondary (but complementary) benefit to the communication benefit. This is in line with Fife and colleagues  who founFinally, the dyads emphasized the usability of the TEMPO platform. Most participants felt that the platform was user-friendly and well organized, despite describing normal setbacks typically associated with learning to navigate a new interface. Nonetheless, dyads and HCPs alike generated a comprehensive list of suggested improvements, such as improving site navigation, improving the goal setting functions, and modifications to the lock-unlock feature of modules. Phase II of TEMPO consists of a multicentre, stratified, parallel, two-group pilot randomized control trial. Recruitment is ongoing, and concrete improvements to the TEMPO interface have been made based on these suggestions. Notably a “print feature” has been added, and modules become immediately available upon completion of the preceding module to further increase usability.We used rigorous data collection and analyses approaches. The majority of patients and caregivers in our sample were over the age of 60, retired, capable of engaging in medium to high intensity physical activity, and reporting supportive dyadic relationships. Therefore, more studies with younger, employed, less fit sub-groups, and those dyads who experience less positive dyadic coping are needed. Also, we did not measure digital literacy and it is not known the extent to which the sample was comfortable using a computer. In addition, in this first, acceptability phase, TEMPO was only available in English. Despite the fact that our sample included bilingual Francophones and other linguistically diverse participants, more data are required to assess the acceptability of TEMPO in patients and caregivers who do not understand English.Given the critical role that caregivers play in maintaining patients’ health and wellbeing, it is imperative that more studies test effective and sustainable methods to preserve or improve their QOL. Although the number of web-based, self-management interventions is growing, TEMPO is the first one specifically designed to address the needs of both patients and their caregivers; and thus fills a niche for caregivers who find it difficult to participate in programs with more structured requirements. TEMPO targets multiple risk factors to improve dyadic coping and combines the best evidence in terms of PA training and self-management. The participating prostate cancer patients, their family caregivers, and members of the health care community were in agreement that TEMPO has great potential in addressing the physical, emotional, and psychosocial challenges that accompany a cancer diagnosis; and that it achieves this in a way that facilitates translation into practice. This study has contributed to developing the knowledge base on TEMPO’s acceptability and usefulness that will directly contribute to the design of a larger trial.


A wealth of evidence has indicated that both students and teachers experience high levels of stress, burnout, and ultimately compromised well-being in the university context. Although numerous studies have investigated well-being among university students, and other studies have addressed well-being among university teachers, these lines of research are often conducted in isolation from one another. This is surprising, as the importance of considering reciprocal links between students and teachers has been suggested in several empirical studies. Additionally, when researching well-being in academia, the conceptualizations tend to differ from study-to-study. The present research therefore investigated how students and teachers conceptualize well-being at the university based on their personal experiences, as well as how student and teacher well-being interact. To examine this, six university students , and ten teachers  from Germany and the Netherlands participated in semi-structured interviews. Qualitative analysis using a multistage coding process revealed detailed insights concerning students’ and teachers’ perceptions of well-being that coincided with positive psychology, resilience, multifaceted, and basic psychological need fulfillment approaches. Moreover, an interaction between students’ and teachers’ well-being became apparent, including several factors such as the student-teacher relationship that in turn, contributed to both population’s well-being. The present findings lend evidence toward a more coherent conceptualization of well-being and are discussed in terms of suggestions for initiatives that simultaneously support both populations, for example, through the student-teacher relationship. Like- yeah REALLY. So, I was the one laying, late at night, thinking about how should we do this, and how can we make it to the deadline. And, and um (p), so tried very, various things, and I now end up thinking my, I think my role is rather limited. More limited than I originally thought.” (university teacher)For university students and teachers alike, academic environments can be stimulating, informative, and socially enriching; however, they can also be competitive and stressful. Therefore, the pursuit of success in academia constitutes a challenging process, making students and teachers susceptible to compromised well-being . In lineDespite university students and teachers both facing compromised well-being, this matter has, to the best of our knowledge, not yet been examined simultaneously within both populations. This is surprising, as numerous studies support the existence of reciprocal relations between aspects of student and teacher well-being in the school context e.g., , as wellThe current study stems from the positive psychology perspective , which is especially important as research thus far tends to focus on the negative side of well-being in academia. For instance, previous studies have primarily investigated factors causing academic distress e.g., . AdditioTaken together, the current study addresses two primary research goals. First, we investigate how both students and teachers perceive well-being in academia; second, we explore how their well-being might interact. To examine these aspects, we conducted semi-structured interviews with students and teachers regarding their views on and experiences with well-being at the university.Well-being constitutes a concept widely used in its various forms and interpretations. These range from an interplay of life satisfaction, absence of negative, and presence of positive emotions , or mastWithin this process of defining well-being, we use three well-established theoretical perspectives surrounding the conceptualization of well-being to guide our research. First, we consider well-being from a positive psychology perspective. Second, we incorporate the concept of resilience into our research, which is strongly intertwined with well-being . Lastly,To elaborate, the first aspect aligns with the World Health Organization’s (WHO) view on health, which depicts ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ . This deSecondly, well-being appears to go hand in hand with the concept of resilience in that it acts as an indicator of well-being . HoweverThirdly, well-being depicts a multifaceted construct , includiLastly, to investigate expected interaction effects between students’ and teachers’ well-being, the systemic approach, based on social constructivism , is a fiAs previously mentioned, university students frequently demonstrate impaired mental well-being. For students, psychological problems are more elevated compared to the general population in the same age group . FurtherFrom an academic perspective, students’ mental health seems to be of crucial relevance, in a negative, but also especially in a positive manner. Psychological distress impairs academic performance , whereasUniversity teachers hold numerous responsibilities in their role, including teaching students, conducting and publishing research, as well as completing administrative tasks. When combined with additional characteristics of the profession such as working significant overtime hours  and haviSimilar to student well-being, a large body of literature also examines university teacher well-being and aspects that contribute to it , these findings from the school context cannot be readily transferred to the university context, but require specific investigation see . HoweverConsidering the lack of consistency within the definitions of student and teacher well-being described in the literature, our first research aim was to investigate this conceptualization from a qualitative and positive perspective. To this end, we considered it essential to reflect both students’ and teachers’ thoughts about well-being in order to gain theoretical and practical insights contributing to a clearer definition of the construct within academia. Consequently, the first research aim was formulated by the following questions:RQ1.a. How do students and teachers conceptualize well-being at the university?b. How do students and teachers perceive well-being at the university?The second research aim addressed the knowledge gap surrounding the interaction between student and teacher well-being. Based on literature describing how student-teacher interactions impact certain emotional and psychological aspects of well-being in the academic context, we expected reciprocal relations. In other words, we expected students to mention that teachers were interconnected with their well-being, and vice-versa. It seems relevant to understand the underlying mechanisms of this interaction to gain clearer insights about how to enhance both student and teacher well-being in academia. Thus, our second research focus entailed the following questions:RQ2a. What are the direct associations between student and teacher well-being?b. How do factors contributing to student and teacher well-being relate?1.To investigate the research questions above, we conducted semi-structured interviews regarding the conceptualization, perception, and interaction of student and teacher well-being. During the process of conducting these interviews, the study was pre-registered through Open Science FrameworkDutch = 11, nGerman1 = 3, nGerman2 = 2), took part in the present interview study. The participants worked and studied at various faculties, including Education, Economics and Business, Behavioral and Social Sciences, Spatial Sciences, Arts, and the University Medical Center. Moreover, students had between 1 and 4 years of study experience, while teachers had between 1 and 32 years of teaching experience. The student sample additionally contained 50% international students, while the teacher sample contained 42% international teachers.To allow for a broad perspective on the topic and the inclusion of a range of well-being experiences, both the student and the teacher samples were heterogeneous in terms of age, gender, faculty, study or teaching experience, as well as the country in which the participants were from. Specifically, sixteen participants (six students between the ages of 22–29 and ten teachers between the ages of 26–57) from three public universities, one in the Netherlands and two in Germany . In general, the interview guide consisted of three parts. First, the questions focused on how student well-being is perceived and defined by the participants. Following this, the questions concentrated on teacher well-being, while the last questions concerned the interaction between teachers’ and students’ well-being in academia. A summary of the transcription was sent back to the participants so that they could report if any aspects were misunderstood and further decide to entirely or partly withdraw from the study.The interviews were conducted by two interviewers in a conversational style, and each interviewer used an interview guide to structure the interviews. The interview guide contained all questions and prompts to be asked, which slightly differed for students and teachers  was intertwined with experiencing study success despite being stressed. Consequently, experiencing stress as “challenging” can be considered functional, and may additionally foster creativity and innovation, as well as personal growth. The ‘personal growth’ code related to learning processes resulting from the experience of functional stress, and included obtaining competences and maturing, but also knowing how to act professionally despite being stressed. It seemed satisfying for teachers to witness this process and see their students successfully developing into skilled academics and adults who can use their personal potential to face future academic stressors.Next to growing personally, functional stress can also result in people growing in terms of becoming more resilient toward stress. This so-called ‘resilience growth’ relates to internal growth not only despite but also due to having experienced negative situations. Teachers were aware of such processes, and admitted that students “have to learn it by doing! That’s also experience. You’ll have to cross it and bounce back and be very tired and very, like, exhausted.” Students mentioned that this growth mechanism led to heightened coping competences due to negative and stressful experiences as well. One student, for instance, phrased her resilience growth in the following way:[…] one thing that made me cope better with my well-being was having like, like a few really [obscenity], awful things happen, and […] then getting mentally stronger from that. […] I’ve felt better and happier and stronger because I’ve learned to cope with them and deal with them, and I think that’s quite important as well in well-being. (university student)In line with the aforementioned coping strategies being regulatory in nature, participants frequently referred to regulating their well-being by means of work-life balance, self-regulation, motivation regulation, and emotion regulation. ‘Well-being as work-life balance’–keeping balance as well as detaching from work or studies with other engagements outside of academia—was emphasized by teachers and students equally as being crucial for their well-being. Although both groups highlighted the importance of activities outside of academia, for students, this also encompassed investing in development toward their future working-selves. Regarding the latter point, teachers admitted that “for university instructors, it’s easier to take a step back because you have other stuff, but for university students your job is to study, so it’s kind of hard.” In contrast, on the teacher side, although teachers acknowledged the difficulty of keeping boundaries between work and private life, this seemed to be more feasible and important to pay attention to: “So, I have learned to say to my students or my colleagues: ‘Sorry I have not been able to do this.’ Knowing that I had time at the weekend or in the evening to do it” (university teacher).Secondly, ‘self-awareness’ and ‘self-regulation’ appeared to be essential for regulating well-being. For instance, the interviewees reported learning the “things that’ll make you happy” (university student) as well as “what is causing the stress” (university teacher) and using this knowledge for coping. Moreover, a central insight for students was recognizing that their university outcomes and intelligence were independent from one another. Being aware of this discrepancy substantially contributed toward their feeling of well-being: “I really saw that it was, um, my way of learning and not my intelligence, that was-that was a bit of reassurance for me.” These reflective processes were mentioned frequently, including reflecting on the extent of involvement with students as a teacher or reflecting on personal development as a student. Generally, self-reflection appeared to lead to knowledge of one’s strengths, weaknesses, fears, and needs. This process of becoming aware of oneself seemed to be age-related and a skill learnable throughout adultery.Next, ‘motivation’ and ‘motivation regulation’ were mentioned as important aspects of well-being regulation; yet, they primarily referred to the students’ experiences. Here, they mentioned motivation to relate to their well-being when they could see themselves potentially succeeding in their studies. Therefore, students acknowledged the teacher’s role in stimulating and sparking motivation for specific subjects. Furthermore, being internally motivated due to developmental processes led to students being more persistent: “I kind of, I didn’t want to fail […] I want to pass and don’t want to quit.” However, students also reported experiencing demotivation, although less frequently. These statements referred to situations of feeling overwhelmed with self-responsibility, having too high of expectations, or feeling bored as a result of the teaching style. Finally, in terms of motivation regulation, students and teachers reported various motivational and cognitive strategies, including prioritizing and organizing, self-affirming talk, as well as creating small successes within the learning process.Lastly, a cluster surrounding ‘emotions’ and ‘emotion regulation’ emerged. Positive emotions covered emotional states such as appreciation, happiness, enjoyment, or excitement, all of which were mentioned equally often by students and teachers. In contrast, negative emotions ranged from feelings of unimportance, misery, and frustration, to anxiety and fear. These negative feelings were generally less frequently mentioned. Yet, primarily students reported them and mainly referred to experiences of failing, because “it never feels good to fail in anything, right?” (university student). Further on, emotion regulation referred to strategies used to regulate their negative emotional states. Examples of these strategies were similar for students and teachers and included exercising, paying attention to one’s lifestyle habits, as well as asking for help and social support. Moreover, most interviewees mentioned rationalizing one’s feelings as an important strategy, as illustrated in the following quote:I think about that nothing of this is really (p) life-threatening, for example, because these are also really small things, but they seem so big at the moment, and you think, you can’t cope with anything anymore, but if you calm down and think rationally, then you realize that it’s not life-threatening and then you-that you can (p) still do it. (university student)The multifaceted nature of well-being was illustrated by the ‘components of well-being’ theme, covering clusters of physical, mental, social, and eudaimonic well-being. Concerning ‘physical well-being,’ a considerable number of interviewees reported ‘personal care’ to constitute a central aspect. This care included how they looked after their bodies, such as being attentive toward sleep, nutrition, and exercise. To illustrate a contrasting example, one teacher commented on students during the exam period as “running around the library as ghosts. They didn’t sleep, […] and when they have a total overload with work, you see that physically.”Next, ‘mental well-being’ appeared to be equally important for students and teachers. This component, however, was mainly mentioned in a negative manner when reporting corresponding experiences. For instance, students reported a lack of mental well-being as a reason to either reach out for professional help or to consider quitting their studies. Furthermore, teachers reported experiences with students who faced mental illnesses as well, such as students becoming thinner in class or student assistants struggling with burnout.The third component, ‘eudaimonic well-being and engagement,’ referred to perceiving studying as fulfillment or being particularly engaged in study topics. Both appeared to be intertwined, as nearly every third statement coded as eudaimonic well-being co-occurred with well-being as engagement. Concerning engagement, the participants mainly described actively participating in and outside of class, wanting to contribute, as well as actively asking for feedback or further input. Moreover, engagement also seemed to be a central aspect of teachers’ well-being, as expressed by a teacher who described how connecting to the students helped him to engage more with his teaching role. Similarly, eudaimonic well-being illustrated studying or teaching, respectively, as self-realization and meaningfulness, which, in turn, related to personal growth along with intrinsic motivation. For example, one student stressed that it is “nice to, to get good grades and to pass exams and get some, um, feeling of fulfillment, or achievement.” For teachers, eudaimonic well-being also seemed to be important for their well-being and something they value in their jobs:[…] I like to invent my own things and create my own job and I do like to-to read and be intellectual. That’s just what I like. There’s nothing else I can. (laughing) That is what I have. And I do fit-my brain fits in, with how things work here, because I constantly have ideas and I-so. I never get bored. (university teacher)Finally, it seemed crucial for students to feel a sense of ‘belonging’ to their academic institution and the people within it, which contributed to their sense of ‘social well-being.’ The latter was described by a student as “how your social life affects you.” This social life included social relationships with friends and family, but also close working connections with fellow students or colleagues. Furthermore, the participants discussed social well-being in terms of taking care of each other, enjoying a socially positive atmosphere, and sharing their concerns. This social connection constituted an aspect that both students and teachers consistently emphasized throughout the interviews. Beyond that, the sense of belonging was just as important, namely, feeling recognized as part of the community and feeling “in the right place” at university (university student). Again, this aspect applied equally to students and teachers, as both groups should ideally “feel being part of the same community” (university teacher). For instance, one teacher stated:If you are feeling lonely and you-and a lot of students actually move to the city and try-try to start living here apart from their family. So, a lot of students feel disconnected, huh? Um, and have to find a new home or have to define a new home. (university teacher)Although the clusters of the three BPN, ‘competence,’ ‘autonomy,’ and ‘relatedness’ were not part of the theoretical conceptualization of well-being, we included them nonetheless as contributing factors. Within the interviews, they were specifically mentioned within as well as outside of the student-teacher interaction see . In the The need for competence referred to the belief of being able to achieve something and being of value to one’s academic community, which was mainly experienced by students. It appeared that these competence beliefs were highly related to positive feedback from others—both inside and outside of academia. Therefore, experiences of ‘success,’ another code within the competence cluster, strengthened one’s feeling of competence and resulted in a range of positive experiences, such as feelings of pride and motivation. Furthermore, the participants did not only equate success with their well-being, but also vice versa. This is why changes in students’ study outcomes seemed to depict an indicator of their well-being, as one teacher remarked when comparing students who are well to those who are not: “If someone used to be very good and then suddenly there’s a change and he’s delivering bad stuff, then you know something’s wrong.”Experiencing a lack of competence primarily referred to not knowing how to deal with unfamiliar tasks. Incidences of failing further reinforced these feelings of incompetence. Again, most statements applied to students experiencing and teachers acknowledging these insecurities. Yet, also teachers reported stress due to not knowing how to teach: “[…] when I started at the university as a teacher I was struggling a lot because I didn’t have any teaching experience […] and I didn’t know how to do that.” This perceived incompetence could result in stress, passiveness, and imbalance.A foundation for autonomy in academia comprised creating a certain ‘atmosphere’ and ‘environment,’ ‘having possibilities,’ and satisfying ‘fundamental contributors to quality of life.’ The latter comprised, among others, having adequate housing, financial security, as well as an appropriate office space. As an example, the following quote illustrated the general insecurity tied to being a university teacher: “Academia is a hard life. You get only temporary contracts, you have to earn your own money constantly, you have to constantly show yourself and be innovative-(sighs) crazy culture.” (university teacher).‘Personal relevance’ seemed to link the basis and the peak of academic autonomy, reflecting the feeling that what one was doing was personally meaningful and mattered. For example, having the impression that studies, or work in the case of teachers, contributed to one’s future could evoke the feeling of personal relevance. Accordingly, one student stated: “And I found it here to be more exciting, to be more (p) um, applicable […] I can do something with it, you know?” Not seeing the purpose of something, in contrast, led to lower motivation and persistence. However, this link applied primarily to the university students compared to teachers.Finally, ‘taking initiative’ referred to participants’ being ambitious, proactive, and autonomous, hence, taking certain matters into their own hands. Regarding this, teachers aimed to encourage students to take initiative, as illustrated with the following quote:[The students] should be the ones driving it forward and I should be the one who’s trying to push them to get there. Um, so that requires me sometimes, to, purposely full, take a step back—to let them take the, the, yeah, the steer. (university teacher)As seen in the previous quote, teachers suggested that by giving students control over what they are doing, students could develop a sense of ‘self-responsibility.’ This, in turn, was defined by being responsible for both one’s well-being as well as one’s studies or work, complementing freedom and autonomy in academia. For instance, one teacher highlighted autonomy in a classroom, telling his students: “Well that’s your responsibility I give you autonomy, but then it’s your responsibility as well. What do you think? And come forward with your conclusions.”When asked about who was responsible for student well-being, one teacher stated: “I’m responsible for my life. But I can use support from others of course.” This quote relates to the final BPN of relatedness, which was strongly associated with the aspect of ‘social support.’ Social support members included a range of social relationships, such as colleagues, friends, and family, or even one’s pet. The ways in which these support members provided social support to others were broad as well, including encouraging them to share, listening to their problems, as well as giving advice, motivation, and confidence.As illustrated in ‘Lack of social support’ was experienced when one’s efforts weren’t recognized, for example by neglecting the fact that working in academia encompasses more than attending or giving classes. Yet, also within the academic context, social support was vital and if lacking, led to adverse consequences. This issue was acknowledged by the participants as well: “If you don’t have this basic feeling of being supported and that you have a positive feeling about how things are going; how can we expect you to learn? How can we expect you to teach? Perform research?” (university teacher). Beyond that, a lack in social support was also apparent through various behavioral outcomes, one of which appeared to be ‘competition.’ Specifically, whereas students were struggling with social comparison, teachers competed for funding and promotion opportunities.4. A visual overview of the aspects tied to this research question can be found in To gain a more integrative picture of well-being in academia, we additionally wanted to understand how student and teacher well-being directly interact. Our interviews indicated that student and teacher well-being were not only “tied together very intimately” (university teacher), but also that this interaction was meaningful and prevalent. This interplay was described in terms of a positive direction, a negative direction, and a reciprocal feedback loop, as will be explained in the following sectionsOne frequently mentioned overlap consisted of teachers feeling that their well-being was reflected by their lesson planning and teaching practices, and thereby impacted their students’ well-being. For lesson planning, when teachers felt well, this enabled them to prepare “a well-prepared lecture or class, and that’s going to be more satisfying for the students.” Moreover, they also described feeling “more energetic and present” as well as “more interested” when teaching their lessons, which they believed positively impacted their students’ well-being.Another way in which teachers felt that their well-being positively impacted their students’ well-being appeared to be through direct interpersonal relations. Teachers stated that when they felt well, they experienced stronger and deeper relational ties with their students. One teacher, for instance, explained that she could not be a happy teacher if she taught her students as though she “doesn’t care about them.” This positive interaction was also described in terms of providing support and a warm environment to students such as “listening” or “being there,” which they felt responsible for.Other times, the positive direction of the interaction was elaborated on in a more general sense. That is, some teachers explained that when they felt well, they were “in a better place” and that there would then be “a high correlation to the students’ well-being.” This perception was strongly reflected in the following quote:[…] if we as instructors feel supported, taken care of, that everything we’re doing is manageable, that puts us in a position to do our jobs better. And if we can do our jobs better, then that means that we are supporting students in the way that they need and helping them to feel like everything is manageable. So, it’s kind of in that way a ripple effect. (university teacher)In contrast to the positive side of the interaction, when teachers felt unwell, this seemed to negatively impact their students’ well-being. Examples included feeling overwhelmed, stressed, or having “a bad day,” which seemed to be associated with the interviewees perceiving their lectures to be of lower quality, as well as feeling less connected to students, and having negative emotional experiences within the classroom. In this light, one teacher explained that “if the instructor is stressed or not well prepared or overworked, the students are not going to learn as effectively, which is part of their well-being.”Similarly, if teachers perceived that their students were not feeling well, this seemed to negatively impact their well-being. On one hand, this was described to occur in the classroom context, where if students were bored, weren’t communicating, or were disengaged, teachers tended to experience negative emotions. On the other hand, they also described having more general feelings of anxiety or worriedness about students who felt unwell, which could be taken home with them and integrated into their personal thoughts:[…] when they trust you, they tend to give you more information than you actually want. And for me that’s actually bad because I’m very worried and then I want to help and I want to make things good for them. (university teacher)Aside from single-direction interactions, it was also often mentioned that reciprocity existed between student and teacher well-being. When students seemed well, for example, by interconnecting with teachers or fellow students, participating in exercises, being engaged, or acting friendly and smiling, this positively impacted teachers’ well-being: “That definitely boosts my well-being, like 100%. Knowing that I’ve made a difference, I mean, that’s everything” (university teacher). Their enhanced well-being, in turn, was described as an enabling factor that allowed them to create an atmosphere that promoted student well-being. In contrast, when students explained that they were struggling or appeared to be stressed, withdrawn, or physically unwell, teachers reported having negative emotional experiences. These experiences, in turn, reinforced a negative atmosphere for students, as depicted in the following quote:[…] if I’m too impacted by their problems then it gets too close to me, it also impacts my well-being and that’s not a good thing. And on the other hand, […] if I’m struggling and if I didn’t sleep and if I’m not relaxed, then I can’t fulfill the expectations that I have for myself as a teacher. (university teacher)Thus, an important insight to be drawn is that student and teacher well-being appear to be connected through a reciprocal feedback loop. In particular, when one population experienced compromised well-being, this seemed to negatively impact the other population’s well-being, which thereby perpetuated a negative atmosphere. Moreover, when one population felt well, this positively impacted the other population’s well-being, resulting in a positive feedback loop.Aside from the direct interaction between student and teacher well-being, contributing factors also emerged. These factors were not explicitly defined as components of well-being but rather as aspects that influenced student or teacher well-being and pertained to the interaction. To this end, two main themes describing these factors emerged, namely ‘BPN’ and ‘role-conflicts’ see . RegardiThe cluster of competence in terms of the student-teacher interaction emerged through ‘control/transparency,’ ‘structure,’ and ‘feedback.’ Teachers seemed to promote these competence factors and, in turn, supported students’ sense of capability in their studies along with their overall well-being. For example, ‘feedback’ referred to gaining critical information about how one is performing. Specifically, teachers believed students would be more satisfied with and feel more competent in their studies if there were “more opportunities for feedback loops back and forth between instructors and students” (university teacher). This aspect was also mentioned frequently by students and is well-elaborated in the following quote:[…] you were pushed so hard and then never given feedback. You were just told to […] write your essay every week, and then you’d hand in the essays and then you wouldn’t get them back so you never really know what you had to improve on. (university student)The cluster of autonomy concerning the student-teacher interaction related to ‘choice/freedom,’ ‘flexibility,’ ‘attention to individual,’ and ‘individual well-being’ . Generally, teachers seemed to understand the importance of promoting a sense of autonomy in students through these factors which allowed students to feel more independent and ultimately more well. For example, choice/freedom referred to the ability to decide what, when, and how one does something. For students, this freedom appeared to be rather important in terms of feeling that they could complete tasks and assignments in the way they wanted to. One student explained this by stating “it’s up to you, how you-how you do it. And I mean that’s also, a really nice task in order to develop responsibilities and […] to take care of yourself.” Likewise, teachers believed that providing students with choice and freedom in their courses gave students a sense of autonomy which they believed to be “very important for […] students’ success” (university teacher).Lastly, the cluster of relatedness in reference to the student-teacher interaction was formed through the codes of ‘course size’ and ‘support,’ as well as the ‘student-teacher relationship’ . Here, teachers supported students’ feelings of social connectedness and their sense of being a part of a caring environment through these factors. Of particular relevance was the student-teacher relationship, which was mentioned in every interview. It appeared that through this relationship, a strong sense of connectedness and cooperation could positively impact both student and teacher well-being. Teachers, for example, described the feeling that they could connect on a deeper level with their students rather than seeing them as student numbers. This point was further elaborated on by a teacher who was asked what could be changed in order for students to be satisfied with their studies:It would look like the- I enter the building and there are a couple of students and we drink coffee together and […] (p), they have questions and we talk about our ideas about social problems that there are and how different theories apply to that. (university teacher)There were additionally numerous role conflicts described which were intertwined with the student-teacher interaction. This theme could be grouped into the clusters of ‘role conflict teacher–researcher,’ ‘ratio academic–human being,’ and ‘keeping social boundaries.’The teacher–researcher role conflict was described as the feeling of having difficulties maintaining a high status in both teaching and research, and a tendency to invest more effort into one over the other. Teachers reported that they aspired to be supportive teachers to their students, but that this could be difficult with their simultaneous desire to succeed in research, as implied in the following quote: “And um, it is competing with, of course, research, […] it is taking away time from something else. Just to be the teacher I want to be. And, yeah, that is a bit sad” (university teacher).The ratio academic–human role conflict referred to teachers thinking of their students as individual people having emotions and needs, rather than solely in an academic sense as ‘students.’ Teachers seemed to realize the importance of treating their students in a more personal and supportive manner. One teacher expressed that students “shouldn’t be a subject, they should be human beings with all their issues. This creates a more human relationship than just grading and saying why you passed or you failed.”Lastly, keeping social boundaries in terms of the student-teacher interaction constituted the feeling that teachers needed to maintain boundaries concerning their personal connection with students. Specifically, teachers seemed to be personally impacted by students’ problems. While most teachers desired to help their students and to listen, it was also important for them to uphold a “safeguard” to prevent them from lying awake at night thinking “how do we get to this deadline?” (university teacher), as elaborated on in the following quote:And my big problem is that I tend to be involved too much. Like when someone tells me about a problem or when I see my students suffering or struggling then it comes very close to me. And part of taking care of my well-being is to keep them at a distance. (university teacher)The overall aim of this paper was to better understand how students and teachers perceive well-being in academia, as well as how their well-being interacts. Within this, theoretically sound well-being perspectives were considered including positive psychology, the BPN, and resilience. To this end, important findings could be drawn concerning both research questions, which incorporated these perspectives. Strengths of the present work include having gathered comprehensive information from interview data, being able to incorporate results based on lived experiences into the literature, and addressing various research gaps such as a lack of positive psychology literature surrounding student and teacher well-being in higher education.One of the primary insights gained throughout the process of conceptualizing well-being was the fact that the clusters aligned with our theoretical assumptions of well-being. Therefore, we will focus on the four main findings concerning the conceptualization and perception of well-being: (1) the positive connotation of stress and well-being, (2) the role of resilience and well-being regulation, (3) the multifaceted components that were found to define well-being, as well as (4) the significance of the BPN.First, it was notable that despite mentioning negative aspects, the participants defined well-being and stress in academia largely in a positive light. For instance, emphasizing awareness of well-being and functional stress as well as personal growth underlines the importance of a positive approach in well-being research. However, experiencing the “right amount of stress” to function properly, as stressed by students and teachers, is not a novel concept: what we identified as functional stress may relate to prior theoretical approaches such as flow theory  or eustrSecondly, the emphasis on resilience growth constituted a relevant finding as well. Although the respondents did not refer to resilience specifically, resilience growth was mentioned throughout various interviews. Given the unlikeliness of participants to directly refer to such an abstract theoretical construct, it seems rather unsurprising that they did not mention resilience itself. According to As a third objective of the study, we wanted to identify the core components for conceptualizing well-being in academia, which emerged from the interviewees’ responses. Acknowledging the multidimensional approach of well-being, we expected various aspects of well-being to arise in our data. In line with this, we found an interplay between mental, physical, social, and eudaimonic well-being. In other words, students and teachers expressed that being well for them referred to being mentally healthy, taking care of themselves physically, feeling that they belonged to their institution, and being engaged in what they were doing. This definition coincides with the WHO’s conceptualization of well-being stated within the introduction , yet is Our core conceptualization appeared to be combined with the potential of personal growth due to functional stress as well as with effective regulation of one’s well-being resulting in resilience growth. In this light, related aspects that were not defined as core aspects of the definition were nonetheless strongly intertwined. For instance, aspects such as emotional well-being , which wLastly, we postulated that the BPN for competence, autonomy, and relatedness might play an essential role for perceiving well-being in academia. Indeed, all three BPN, autonomy, competence, and relatedness, can be considered as highly relevant when investigating well-being in academia. How autonomous students and teachers feel, how competent they perceive themselves to be, and how related they are to their social surroundings constitute central findings concerning the perception of well-being at the university. Taken together, this assumption reflects on previous research e.g.,  and shouIn addition to the conceptualization and perception of well-being, the present study also shed light on important aspects concerning the until now uninvestigated link between students’ and teachers’ multi-faceted well-being in academia. Firstly, in line with expectations, a strong interaction was found in that when university teachers had better or worse well-being, this was, in their perception, associated with better or worse well-being in their students as well. This interaction appeared to be both multifaceted and multidirectional. Regarding the former, in line with Aside from the interaction itself, it was found that through various factors, students and teachers could impact one another’s well-being. Although the student-teacher relationship has consistently been recognized as a powerful factor in higher education research , our stuAdding to this, the role conflicts described by teachers were also an interesting finding that emerged from our data. As mentioned by Despite the contributions that the present study makes to the literature, several limitations must be borne in mind when interpreting the findings. Firstly, we used a selective sample of university teachers and students and thus, our sample runs the risk of certain biases and causal relations cannot be drawn. Specifically, our sample voluntarily agreed to participate in the study, which likely reflects at least some levels of successful coping at the university in terms of well-being and interest in the topic. Thus, our findings might underestimate ill-being factors at universities; however, due to our positive focus on well-being and its facets, we do not consider this as problematic in terms of distorting our findings. Moreover, although an iterative process is commonly used in qualitative research , it can Given that well-being in educational contexts is becoming increasingly important due to heightened stress and burnout levels, as mentioned within the introduction, we aimed to contribute to a coherent definition of well-being in academia for future research. Our conceptualization, including its core components as well as its regulatory mechanisms and contributors, might contribute to finding a common understanding. Such an overall definition of well-being is expected to benefit future research and to help researchers to talk about the same concept when investigating well-being in academia.Adding to this, further relevant theoretical frameworks could be considered in future research on student and teacher well-being. First, the Job-Demands Resources Model , in whicDespite evidence of interaction effects between students and teachers, there exists far more research on initiatives to promote students’ well-being in academia than university teachers’ well-being . This teTaken together, the present study contributes to a better understanding of what well-being means for students and teachers in the university context as well as how their well-being interacts. In particular, our findings indicate that well-being encompasses the core elements of mental, physical, social, and eudaimonic well-being. These core elements were strongly intertwined with several important contributing and regulatory factors, such as the BPN and resilience growth, keeping a work-life balance, as well as emotion, motivation, and self-regulation. Moreover, the aspects within our conceptualization reflected a positive, resilience-based, multifaceted, and basic need fulfillment approach, as outlined in the results section. In line with these theoretical notions, indications of a pronounced and dynamic interplay between student and teacher well-being were found. Concrete next steps may involve quantitatively investigating the aspects found within this paper to further understand their impact on students’ and teachers’ well-being. This approach, in turn, might lead research and practical initiative efforts further in understanding how to promote well-being at the university and foster students’ and teachers’ well-being shoulder-to-shoulder.The datasets presented in this article are not readily available because sharing the data openly was not possible due to the sensitivity of the qualitative data. Requests to access the datasets should be directed to l.kiltz@rug.nl.The studies involving human participants were reviewed and approved by Ethics Committee of the Department Teacher Education, University of Groningen, Netherlands. The patients/participants provided their written informed consent to participate in this study.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.