Comparison of exercise models in an elderly population

The MIPAM trial: a 12-week intervention with motivational interviewing and physical activity monitoring to enhance the daily amount of physical activity in community-dwelling older adults - a study protocol for a randomized controlled trial

BACKGROUND

Physical Activity Monitors (PAMs) have been shown to effectively enhance level of physical activity (PA) in older adults. Motivational interviewing is a person-centred model where participants are guided using self-reflection and counselling, and addresses the behavioural and psychological aspects of why people initiate health behaviour change by prompting increases in motivation and self-efficacy. The addition of motivational interviewing to PA interventions may increase the effectiveness of PAMs for older adults.

METHODS

This motivational interviewing and PA monitoring trial is designed as an investigator-blinded, two arm parallel group, randomized controlled superiority trial with primary endpoint after 12 weeks of intervention. The intervention group will receive a PAM-based intervention and motivational interviewing and the control group will only receive the PAM-based intervention. The primary outcome is PA, objectively measured as the average daily number of steps throughout the intervention period. Secondary outcome measures include self-reported PA health-related quality of life, loneliness, self-efficacy for exercise, outcome expectancy for exercise, and social relations. The outcomes will be analysed with a linear regression model investigating between-group differences, adjusted for baseline scores. Following the intention to treat principle, multiple imputation will be performed to handle missing values.

DISCUSSION

A moderate effect of daily PA measured using PAMs is expected in this superiority RCT investigating the effect of adding motivational interviewing to a PAM intervention. According to the World Health Organization, walking and cycling are key activities in regular PA and should be promoted. To increase the general public health and lower the burden of inactivity in older adults, cost-beneficial solutions should be investigated further. If this RCT shows that motivational interviewing can enhance the effect of PAM-based interventions, it might be included as an add-on intervention when appropriate. No matter what the results of this study will be, the conclusions will be relevant for clinicians as the dependence on technology is increasing, especially in relation to public health promotion.

TRIAL REGISTRATION

NCT03906162 , April 1, 2019.

Understanding Activity Limitations in Depression

Behavioral activation plays an important role in the treatment of depression. Although the development of activation treatments has made important progress in the past decades, effects are still low to moderate. This paper illustrates how the understanding and treatment of activity limitations in depression can be improved through the integration of theories from health psychology. One of the leading theories is the health action process approach (HAPA; Schwarzer, Lippke, & Luszczynska, 2011 ). In accordance with the HAPA, we argue that reasons for activity limitations can be divided into problems of intention formation (motivational problems) and problems of intention implementation (volitional problems). To date, depression research has primarily focused on motivational deficits. With regard to the HAPA, we discuss different aspects of motivational deficits by reviewing common constructs such as negative thoughts, learned helplessness, loss of reinforcers, or self-efficacy. In addition, we demonstrate that volitional deficits are also important for explaining activity limitations and should be taken into account more. Volitional deficits in depression are documented by behavior studies focusing on self-regulation and procrastination; additionally, evidence of volitional deficits has been found in research on executive functions and in neurobiology. In conclusion, the HAPA contributes to a better understanding of activity limitations in depression: The reviewed literature demonstrates that depression is associated with motivational and volitional deficits. Each of these two kinds of deficits should be treated with a different intervention technique (e.g., values assessment vs. activity scheduling). Beyond this relevance for clinical psychology, implications for health psychology are discussed.

Predictors of longitudinal changes in older adults' physical activity engagement

The study aimed to investigate factors influencing older adults' physical activity engagement over time. The authors analyzed 3 waves of data from a sample of Israelis age 75-94 (Wave 1 n = 1,369, Wave 2 n = 687, Wave 3 n = 154). Findings indicated that physical activity engagement declined longitudinally. Logistic regressions showed that female gender, older age, and taking more medications were significant risk factors for stopping exercise at Wave 2 in those physically active at Wave 1. In addition, higher functional and cognitive status predicted initiating exercise at Wave 2 in those who did not exercise at Wave 1. By clarifying the influence of personal characteristics on physical activity engagement in the Israeli old-old, this study sets the stage for future investigation and intervention, stressing the importance of targeting at-risk populations, accommodating risk factors, and addressing both the initiation and the maintenance of exercise in the face of barriers.