Group cohesion in older adult exercisers: prediction and intervention effects

Using theory knitting to conceptualize social phenomena in the design and evaluation of dance programs for people living with Parkinson's disease

Dance programs for people living with Parkinson's disease (PwPD) offer participants an opportunity to exercise, engage in artistic self-expression, and form new relationships. While it is understood that the social dimension of dance programs for PwPD contributes to dancer satisfaction and program sustainability, the social mechanisms instrumental to program success are under-examined. Engaging with theory from wider disciplines, or "theory knitting" can help program designers and evaluators examine the mechanisms and contextual factors that make classes socially meaningful with greater detail and specificity. This study identified and examined three theoretical frameworks that program planners and evaluators could use to conceptualize social engagement in dance for PwPD contexts and inform practice. Each theory was assessed for fit using the T-CaST theory comparison and selection tool developed by Birken et al. (2018). As an example, we used anthropologist Victor Turner's (1970; 1977) theory of liminality and communitas to identify five key areas for fostering a sense of social connection in dance for PwPD contexts: (1) selecting a meaningful dance space (2) creating a joyous atmosphere (3) marking entrance into the liminal time and space with rituals (4) embodying liminality and anti-structure and (5) inverting power relations and embracing fluid roles.

The ESCAPE trial for older people with chronic low back pain: Protocol of a randomized controlled trial

BACKGROUND

Low-back pain is one of the most common health conditions worldwide. It is defined as pain below the costal margin and above the inferior gluteal folds. Current guidelines recommend management of chronic health (e.g., low back pain) conditions in older people at primary health care settings using active strategies (e.g., exercise). In non-specific low back pain, high quality evidence supports active strategies for general population. However, the management of non-specific low back pain in the older people has been overlooked and evidence is limited to a small number of low powered randomized controlled trials with high risk of bias.

METHODS

This is a prospectively registered, open, two-arm randomised controlled trial comparing the group-based exercise and waiting list in pain intensity (11-item Pain Numerical Rating Scale) and disability (Roland Morris questionnaire) of older people (i.e., 60 years old or over) with chronic non-specific low back pain. One hundred and twenty patients will be recruited from Diamantina, Brazil. Follow-ups will be conducted in post-treatment (8 week) and 6- and 12-months post-randomisation.

DISCUSSION

Our hypothesis is that group-based exercise will be better than waiting list in reducing pain intensity and disability in older people with chronic non-specific low back pain.

IMPACT

The practice of individualized exercise has been studied for the management of chronic non-specific low back pain in older people. However, the group exercise, even showing high quality evidence for the improvement of several important outcomes in this population, has been ignored until now. Thus, the results of this study have the potential to indicate a viable and accessible strategy for managing chronic non-specific low back pain in the older people.

TRIAL REGISTRATION

The study was prospectively registered at www.ensaiosclinicos.gov.br (RBR-9j5pqs). Date-11/18/2020.

Make Movement Your Mission: Evaluation of an online digital health initiative to increase physical activity in older people during the COVID-19 pandemic

Objective

To formatively evaluate the Make Movement Your Mission (MMYM) digital health initiative to promote physical activity (PA) levels and help avert the negative consequences of sedentary behaviours in older adults during the SARS-CoV2 pandemic.

Methods

Mixed-method study to explore activity levels, changes in physical function and Activities of Daily Living (ADLs), quality-of-life, social engagement, technology use, and accessibility. Survey data were analysed descriptively. Qualitative interviews were analysed using framework analysis.

Results

Forty-one respondents completed the survey (Mean age 68.4 (8.9) years; 34 Female), 68% aged ≥ 65 years. Average attendance was 14.3 sessions per week (3.5 h). 73% had been with MMYM for >1 year, 90% reported they were engaging in more movement on a typical day, and 75% reported improvement in ability to perform moderate PA. Since starting MMYM, participation in activities targeting strength, balance and flexibility increased (by 48%, 73% and 75%, respectively). 83% met strength and 90% balance PA guidelines for health (≥ 2x per week). Between 18% and 53% of respondents reported improvements in ADLs, 53% reported better quality-of-life, and 28% increased use of the internet.

Eight participants were interviewed (Mean age 70.7 (6.7) years; 7 Female). Activity levels were promoted by having direct support from the instructor through Facebook messages pre and post live sessions, having group expectation about quality and level of engagement, having a sense of control and encouragement from others, MMYMs regularity, choice around level of engagement and accessibility. Noticing short-term outcomes in balance and posture helped boost confidence and continued participation.

Conclusion

Clinical trials need to robustly assess its effectiveness and acceptability.

Health Educator Participation in Virtual Micro-Credentialing Increases Physical Activity in Public Health Competencies

Background: Physical activity is an important component of leading a healthy life. Public health is one of the nine major sectors for disseminating information about physical activity and increasing the physical activity of the general public.

Purpose: Increase competency among Cooperative Extension agents (i.e., public health workers) on selecting, delivering, and evaluating physical activity programs through a theory-based online training program.

Methods: Cooperative Extension agents from two states were invited to participate via statewide listservs. Participants were invited to attend sessions, complete competency checks, and between-session assignments each week. The study was conducted using a video conferencing platform. The intervention was 9 weeks from June to July 2020 and had 130 participants. Pre- and post-program surveys included physical activity competencies and validated scales for flourishing and physical activity status. Data for competencies pre and post were analyzed using the Wilcoxon signed rank test, p < 0.01. Physical activity and flourishing pre and post were compared using t-tests, p < 0.05.

Results: Physical activity in public health competency increased significantly (p < 0.00) as did agents' personal physical activity levels (p < 0.05). Changes in flourishing were not significant (p < 0.09) but trended in the hypothesized direction.

Conclusions: The online competency-based training program significantly improved Cooperative Extension agents' knowledge of physical activity guidelines and physical activity program implementation. Future work is needed related to the scalability of the training program.

Dancing Against falls iN Community-dwElling older adults (DANCE): a study protocol of a stratified, block-randomised trial

Background

Unintentional falls among older adults are of primary importance due to their impact on quality of life. Falling accounts for 95% of hip fractures, leading to an approximately six times increased risk of death within the first 3 months. Furthermore, physical and cognitive parameters are risk factors for falls. The purpose of this study is to examine the effect of a 6-month salsa dance training intervention, compared with regular fitness circuit training and a control group.

Methods

This study will include 180 older adults: 90 healthy patients and 90 patients with osteoporosis. Participants will be allocated randomly in either of the groups, stratified according to age. Training groups will receive 2 weekly 1-hour training sessions, continuously through 6 months. Participants will be tested at baseline and 6 and 18 months post baseline. Primary outcome will be number of falls and secondary outcomes include bone mineral density, body composition, pain evaluation, weekly physical activity, single-task and dual-task gait patterns, balance, Fullerton Functional Fitness Test and assessment of the mini-BESTest.

Discussion

This study will investigate the effects of a specially designed dance training programme (Dancing Against falls iN Community-dwElling older adults (DANCE)) to reduce the risk of falling among older adults. The study will investigate the effect against an active and passive comparator, resulting in the possibility to state, if DANCE training should be an alternative to traditional training.

Trial registration number

NCT03683849.

Experiences With Social Participation in Group Physical Activity Programs for Older Adults

Little is known about how social participation can be facilitated among older adults in group physical activity and its psychosocial benefits that contribute to successful aging. This study aimed to understand older adults' experiences with social participation in group physical activity programs. Using interpretive description methodology, 16 observations, eight focus groups, and two interviews with participants unable to attend focus groups were conducted with adults 55 years and older attending programs across four recreation facilities. Group programs were found to influence social participation through (a) a meaningful context for connecting and (b) instructors' expectations of social interaction. Social participation in these programs addressed psychosocial needs by (c) increasing social contact and interaction, (d) fostering social relationships and belonging, and (e) promoting regular engagement. Training for instructors should include balancing the physical aspects of program delivery with the social, while also considering older adults' diverse needs and preferences for social interaction.

Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach

Background

Physical inactivity is a global issue that affects people’s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence.

Objective

This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results.

Methods

This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants’ adherence level to exercise plans. By analyzing users’ usage patterns, we could verify, correct, and enhance the mHealth app design principles.

Results

In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001).

Conclusions

This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research.

Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability

Background

The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE.

Methods

Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90–100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.

Results

In both formats, participants (N = 30, 22 women, n_gLiFE = 15, n_LiFE = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.

Conclusion

This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.

Trial registration

ClinicalTrials.gov, NCT03462654. Registered on March 12, 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01991-0.

The Impact of a Dementia-Friendly Exercise Class on People Living with Dementia: A Mixed-Methods Study

Exercise has multiple benefits for people living with dementia. A programme of group exercise classes for people with dementia and their family carers has been established in a University sports centre. This study aims to explore the impact of this programme on participants with dementia and their carers. A mixed-methods design including a prospective, repeated measures cohort study followed by focus groups was employed. Physiological and cognitive outcome measures were repeated at baseline and three months in a cohort of people with dementia attending a group exercise class. Focus groups on the participants’ experiences and their perceptions of the impact of the exercise class on their lives were then conducted. The results were analysed and mapped on a model, to illustrate the components that most likely promote participation. Sixteen participants (n = 8 with dementia, and n = 8 carers) were recruited, and completed both baseline and follow up assessments. Positive mean differences were found in physical activity (4.44), loneliness (1.75), mood (1.33) and cognition (1.13). Ten participants were included in the focus groups, which found that accessibility of the exercise venue, opportunities for socialisation and staff who were experienced working with people living with dementia were key to participants reporting benefits. The four key themes from the focus group data were synthesised to produce a model outlining the components that might generate a positive impact of the exercise classes and promote participation. Exercise classes for people with dementia can be delivered with success in novel environments such as University sports centres. There is some indication of improvement over a short period of time. The model derived from this study will inform strategies to promote attendance at dementia-friendly exercise classes.

Using Integrated Research-Practice Partnerships to Move Evidence-Based Principles Into Practice

The implementation of evidence-based physical activity interventions is improved when integrated research-practice partnerships are used. These partnerships consider both research- and practice-based evidence that moves beyond only assessing program efficacy. Our novel hypothesis is that integrated research-practice partnerships may lead to interventions that are practical and effective, reach more participants, and are more likely to be sustained in practice.

Cohesion and adherence in exercise groups of patients with chronic heart diseases - a prospective study

Objective: In cardiac rehabilitation, long-term adherence to exercise prescription is an important prerequisite to reduce mortality and the risk of recurrent cardiac events. Cohesion seems to be an important predictor of adherence when exercise is conducted in prevention settings, but in clinical settings, this relationship is currently unknown. To address this gap, the goal of this study was to determine the relationship between group cohesion and adherence in cardiac rehabilitation programs considering the duration of membership as a moderator.Design: The study was conducted with 474 participants (21.7% women), in three rehabilitation centres in North Rhine Westphalia, Germany, assessing cohesion, adherence and group membership in outpatient cardiac exercise groups.Main Outcome Measures: Cohesion was assessed using the KIT-FG and adherence was operationalized as the total number of sessions attended over a 7-week period.Results: Moderated hierarchical stepwise regression analyses revealed that perceptions of the social dimension of group cohesion significantly predicted adherence behaviour only for members with a rather long duration of membership.Conclusion: Our findings suggest that cohesion might have a differential effect on an individual's decision to regularly participate in exercise, depending on the duration of membership in the group.

A Group Dynamics-Based Exercise Intervention to Improve Physical Activity Maintenance in Breast Cancer Survivors

BACKGROUND

To maintain increases in physical activity (PA), interventions that implement group dynamics principles and strategies with the intent of enhancing group cohesion may be advantageous. This study examined group cohesion and PA following a group dynamics-based PA intervention among breast cancer survivors.

METHODS

The study was designed as a pilot randomized controlled trial comparing an 8-week group dynamics-based intervention with an individually supervised intervention. Group cohesion was measured by the Physical Activity Group Environment Questionnaire, and PA was measured at baseline, post-intervention, and 3-month follow-up using a self-report questionnaire and pedometer.

RESULTS

Group cohesion levels were high following the intervention and positively associated with PA at 3-month follow-up (ranger = .182-.555). At 3-month follow-up, 91.7% of participants in the group-dynamics-based intervention (n = 12) were classified as moderately active or greater, compared with 54.5% in the individually supervised intervention (n = 11).

CONCLUSIONS

These results suggest that, for breast cancer survivors, peer support and fostering group cohesion as part of an exercise program may help to support PA following the completion of a structured intervention. A larger trial with longer follow-up is needed to establish comparative efficacy for a group-dynamics-based exercise intervention to enhance long-term PA adherence in breast cancer survivors.

A 12-Week Pilot Exercise Program for Inactive Adults With Celiac Disease: Study Protocol

Background

Individuals with celiac disease must follow a strict gluten-free diet (GFD) in order to avoid negative short- and long-term health consequences. Unfortunately, many people with celiac disease report poor quality of life (QoL) despite following a strict GFD, and up to 30% still report negative symptoms (eg, gastrointestinal upset).

Purpose

The purpose of the MOVE-C (understanding the relationship between the MicrobiOme, Vitality, and Exercise in Celiac disease) pilot study is to explore the effects of a 12-week supervised progressive high-intensity interval training (HIIT) and lifestyle intervention on physiological, behavioral, and psychosocial outcomes among inactive adults with celiac disease.

Methods/Design: Sixty inactive adults diagnosed with celiac disease will be randomized to HIIT+ or waitlist control (WLC). Participants in the HIIT+ will engage in a 12-week HIIT + lifestyle education program. HIIT sessions will be comprised of 2 workouts per week, working up to 14 × 30-second intervals at 90% maximal heart rate (HRmax) followed by 2 minutes recovery at 50% HRmax. The 6 biweekly lifestyle sessions will involve education on the promotion of a whole foods GFD, sleep hygiene, psychosocial coping skills (eg, self-compassion), and self-regulatory skills to master changes in behaviors. Assessments will occur at pre and post 12-week intervention and 3-month follow-up. WLC participants will be offered a 12-week HIIT program + online lifestyle education sessions after completing the final assessment. The primary outcomes are QoL and gut microbiota composition assessed with 16S rRNA sequencing. The secondary outcomes are markers of metabolic syndrome (waist circumference, fasting glucose, serum lipids, blood pressure, and body composition), gastrointestinal symptoms, sleep quality, adherence to a GFD, exercise behavior, self-regulatory efficacy, and self-compassion. It is hypothesized that participants in the HIIT+ will experience improvements in all outcomes when compared to those in the WLC. These improvements are expected to be maintained at the 3-month follow-up.

Discussion

The findings from this study will advance the knowledge regarding the effects of HIIT and lifestyle education on key outcomes for an at-risk chronic disease population. Furthermore, the findings can be used to inform future programs to improve fitness and physical and mental health outcomes for people with celiac disease.

Use of an Integrated Research-Practice Partnership to Improve Outcomes of a Community-Based Strength-Training Program for Older Adults: Reach and Effect of Lifelong Improvements through Fitness Together (LIFT)

Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to reach older adults and impact strength training behaviors. Scalability and sustainability of these interventions is directly linked with setting-level buy-in. Adapting an intervention through an integrated research-practice partnership may improve individual and setting-level outcomes. The purpose of this study was to evaluate the initial reach and effect of a locally adapted, health educator-led strength-training intervention; Lifelong Improvements through Fitness Together (LIFT). LIFT was compared to an evidence-based exercise program, Stay Strong; Stay Healthy (SSSH). Intervention dose and mode were the same for LIFT and SSSH, but LIFT included behavioral change strategies. Older adult functional fitness was assessed before and after the 8-week strength training intervention. Health educators who delivered LIFT and SSSH were able to reach 80 and 33 participants, respectively. Participants in LIFT were able to significantly improve in all functional fitness measures whereas SSSH participants were only able to significantly improve in 5 of the 7 functional fitness measures. In conclusion, this study provides preliminary evidence that the locally adapted program reached more individuals and had improvements in functional fitness.

Measuring Cohesion and Self-Disclosure in Psychotherapy Groups for Patients with Advanced Cancer: An Analysis of the Psychometric Properties of the Group Therapy Experience Scale

Objectives

Understanding the group process informs group interventions. However, there is little systematic research on group process variables in psychotherapy groups for patients with cancer.

Methods

We analyzed the psychometric properties of the Group Therapy Experience Scale and evaluated its potential importance in advanced cancer therapy groups.

Results

The GTES demonstrated good internal consistency (coefficient alpha=.84). An exploratory factor analysis with varimax rotation yielded four factors. Although all four models were explored, the 1- and 2-factor models appeared to provide the best fit for the data. The GTES total score was negatively correlated with group size and positively correlated with number of groups attended by participants. Furthermore, the GTES total score was correlated with post-intervention spiritual well-being, benefit finding, post-traumatic growth and quality of life.

Perceptions of group exercise courses and instructors among Quebec adults

BACKGROUND

Group exercise courses are popular among adults, but dropout rates are high. Studies of relationships between participants' perceptions and their participation might highlight factors to target to improve adherence and re-enrolment.

METHODS

We used a mixed-methods approach to analyse perceptions of group exercise courses and instructors among 463 adults. Participants completed the Exercise Barriers and Benefits Scale, questionnaires on perceptions of the instructor and course, and non-participation. We assessed participation from weeks 2-4 and 5-10, and re-enrolment. We analysed relationships between perceptions and re-enrolment using linear regression and mediation analyses. We conducted group interviews with 11 participants.

RESULTS

Predictors of re-enrolment included early participation (β=0.11, P=0.029) and perceptions of the group social climate (P=0.027). Perceptions of the group mediated the relationship between early participation and re-enrolment (95% CI 0.0036 to 0.0471): early participation predicted more positive perceptions (β=2.11, P=0.003), which predicted re-enrolment (β=0.01, P=0.006). Qualitative analyses highlighted instructors' roles in promoting social exchange and integrating participants into the group.

CONCLUSIONS

The social climate of group exercise courses is a key factor predicting re-enrolment. Early participation predicts re-enrolment on its own, and also promotes positive perceptions of the group. Instructors can target these factors by sensitising participants to the importance of early participation, and promoting social exchange.

Framing new pathways in transformative exercise for individuals with existing and newly acquired disability

PURPOSE

This paper describes a continuum of customized exercise options for people with an existing and newly acquired disability or diagnosis referred to as the Transformative Exercise Framework.

BACKGROUND

The period directly after rehabilitation is a critical juncture where many individuals return to life with high rates of sedentary behavior. After rehabilitation discharge, people with newly acquired disability or diagnoses often never make the transition into usage of community-based exercise services that are tailored, safe and effective.

METHODS

Narrative review.

RESULTS

The Transformative Exercise Framework supports a patient-to-participant, rehab-to-wellness model that emphasizes a linkage between physical and occupational therapists and community-based exercise trainers. The four focus areas - Rehabilitation, Condition-specific Exercise, Fitness and Lifetime Physical Activity - emphasize a range of options for people with newly acquired disability and diagnoses, or for people with existing disability and/or chronic health conditions who have a new injury, secondary condition or are severely deconditioned.

CONCLUSION

The concept of transformative exercise is to support people with disabilities and diagnoses with a seamless restore-improve-prevent continuum of programs and services. This continuum connects individuals to rehabilitation and exercise professionals in a dynamic framework, which maximizes the expertise of both sets of professionals and provides the most effective interventions to achieve the greatest gains in health and function and/or to avoid future health decline. Implications for Rehabilitation Patients discharged from rehabilitation should be transformed into participants in lifelong physical activity through a continuum of health services, which we refer to as Transformative Exercise. Transformative exercise is a continuum of individually tailored exercise strategies/programs that aims to improve the function of underperforming systems, which inhibit community and/or lifelong physical activity participation. The Transformative Exercise Framework can be used by a therapist or exercise trainer to design a program that maximizes performance and time and is based on a specific process for identifying short and long term goals.

Cohesion as Shared Beliefs in Exercise Classes

The purpose of the study was to determine if perceptions of cohesion in exercise classes demonstrated sufficiently high consensus and between-group variance to support a conclusion that exercise classes are groups. Participants (N = 1,700) in 130classes were tested on either the Group Environment Questionnaire (GEQ) or the Physical Activity Group Environment Questionnaire (PAGEQ). Results showed that exercise classes satisfied the statistical criteria necessary to support a conclusion that they are true groups; that is, they exhibited acceptable levels of consensus about cohesion within classes and acceptable differences in cohesion between classes. In addition, index-of-agreement values were significantly greater for participants completing the PAGEQ than for participants completing the GEQ. Finally, consensus was greatest when participants evaluated how the exercise class satisfied their own personal task needs (i.e., individual attractions to the group-task), and second greatest when participants evaluated the collective unity around the task objectives (i.e., group integration-task).

Investigating the Mediational Relationship of Leadership, Class Cohesion, and Adherence in an Exercise Setting

The purpose of this study was to determine if older adults’ perceptions of class cohesion serve as a mediator between exercise class leader behavior and adherence (operationally defined as attendance and perceived exertion) in exercise programs. Participants were enrolled in recreational exercise programs. Each participant completed a questionnaire that assessed cohesion (individual attractions to the group-task [ATG-T] and -social, group integration-task [GI-T] and group integration-social), class leader behaviors (enthusiasm, availability, motivation, and instruction), and perceived exertion. Attendance was obtained from records maintained by the instructors. Four specific mediation relationships were found: (a) ATG-T mediated the relationship between class leader motivation and perceived exertion, (b) ATG-T mediated the relationship between class leader availability and perceived exertion, (c) ATG-T mediated the relationship between class leader enthusiasm and attendance, (d) GI-T mediated relations between class leader enthusiasm and attendance. A number of aspects related to specific results were discussed.

Group Cohesion in a Formal Exercise Program Composed of Predominantly Older Men

Individuals reporting high group cohesion are less likely to discontinue participation in group exercise programs. A validated measure of group cohesion, the Physical Activity Group Environment Questionnaire (PAGEQ), is untested in older men. The PAGEQ was administered to, and questions about demographics and frequency and duration of participation were asked of, the Walk A Mile or More (WAMM) exercise group, which was composed of U.S. military Veterans. Forty participants (mean age = 62 years, 77.5% male) completed surveys. Cronbach's alpha for the overall PAGEQ was 0.976. Although no significant relationship was found between group cohesion scores and frequency of attending WAMM sessions, there was a trend for individuals who had participated for a longer time to report more group cohesiveness, particularly regarding the task (i.e., exercise) itself. The PAGEQ was easily administered and internally consistent in this group of older men, and provides a useful benchmark for future gerontological researchers. [Journal of Gerontological Nursing, 42(8), 18-23.].

Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes

: Exercise classes provide a range of benefits to older adults, reducing risk of illness, promoting functional ability and improving well-being. However, to be effective and achieve long-term outcomes, exercise needs to be maintained. Adherence is poor and reporting of adherence differs considerably between studies.

OBJECTIVE

To explore how adherence to exercise classes for older people is defined in the literature and devise a definition for pooling data on adherence in future studies.

DESIGN

Methodological review of the approaches used to measure adherence.

METHODS

A review of the literature was carried out using narrative synthesis, based on systematic searches of MEDLINE, EMBASE, CINAHL and PsychINFO. 2 investigators identified eligible studies and extracted data independently.

RESULTS

37 papers including 34 studies were identified. 7 papers (7 studies) defined adherence as completion (retention). 30 papers (27 studies) identified adherence using attendance records. 12 papers (11 studies) based adherence on duration of exercise and 5 papers (4 studies) specified the intensity with which participants should exercise. Several studies used multiple methods.

CONCLUSIONS

There was little consensus between studies on how adherence should be defined, and even when studies used the same conceptual measure, they measured the concept using different approaches and/or had different cut-off points. Adherence related to health outcomes requires multiple measurements, for example, attendance, duration and intensity. It is important that future studies consider the outcome of the intervention when considering their definition of adherence, and we recommend a series of definitions for future use.

Perceptions of the activity, the social climate, and the self during group exercise classes regulate intrinsic satisfaction

Engaging in regular physical activity is a challenging task for many adults. Intrinsic satisfaction with exercise classes is thought to promote adherence to physical activity. This study examined the characteristics of exercise classes that impact within-person changes in intrinsic satisfaction over the course of an extended group exercise program. A 30-week physical activity trial was conducted with assessments at the end of each class. Community-living adults (n = 29) were instructed to complete at least six group exercise classes each week and, following each exercise class, complete a questionnaire asking about the characteristics of the class and the participant's evaluation of the class. Intrinsic satisfaction was high, on average, but varied as much within-person from class-to-class as it did between exercisers. Participants reported the greatest intrinsic satisfaction when classes placed greater emphasis on exercisers' involvement with the group task, feelings of competence, and encouragement from the instructor. For the most part, exercise classes that were more intense than usual were perceived by exercisers as less intrinsically satisfying. Some overall characteristics of the exercise classes were also associated with intrinsic satisfaction. The social and motivational characteristics of group exercise classes contribute to exercisers' intrinsic satisfaction with classes and attention to those dynamics, as well as the intensity of the exercise, may improve adherence for exercise regimens.

Leader Behaviors, Group Cohesion, and Participation in a Walking Group Program

INTRODUCTION

Less than half of all U.S. adults meet the 2008 Physical Activity Guidelines. Leader behaviors and group cohesion have been associated with increased participation or adherence in sports team and exercise class settings. Physical activity interventions in community settings that encompass these factors may enhance intervention adherence. The purpose of this study is to examine the impact of Community Health Promoter leader behaviors and group cohesion on participation in a walking group intervention among racially/ethnically diverse adults in low to moderate-income communities in Detroit, Michigan.

DESIGN

Data for the current study were drawn from the Walk Your Heart to Health (WYHH) data set. WYHH was a multisite cluster RCT with a lagged intervention and outcome measurements at baseline and 4, 8, and 32 weeks. Pooled survey data from both intervention arms were used for the current study. Data were analyzed between August 2013 and October 2014.

SETTING/PARTICIPANTS

A total of 603 non-Hispanic black, non-Hispanic white, and Hispanic adults across five cohorts that began the 32-week WYHH intervention between March 2009 and October 2011.

INTERVENTION

The intervention was a 32-week walking group program hosted by community- and faith-based organizations and facilitated by Community Health Promoters. Walking groups met three times per week for 90 minutes per session. To promote participation in or adherence to WYHH, Community Health Promoters used evidence-based strategies to facilitate group cohesion. Group members assumed increasing leadership responsibility for facilitating sessions over time.

MAIN OUTCOME MEASURES

Participation in WYHH as measured by consistency of attendance.

RESULTS

Community Health Promoter leader behaviors were positively associated with participation in WYHH. Social but not task cohesion was significantly associated with consistent participation. Social cohesion may mediate the relationship between leader behaviors and walking group participation.

CONCLUSIONS

Providing leaders with training to build socially cohesive groups may help motivate individuals to continue participation in community-based physical activity programs.

GrOup based physical Activity for oLder adults (GOAL) randomized controlled trial: study protocol

BACKGROUND

Physical activity has health benefits across the lifespan, yet only 13 % of Canadian older adults are sufficiently active. Results from a number of observational studies indicate that adults display positive preferences for exercising with others of a similar age and same gender, and that intra-group age- and gender-similarity are associated with elevated exercise adherence. However, research has yet to experimentally examine the extent to which intra-group age- and gender-related similarity affect exercise adherence behaviors.

METHODS/DESIGN

The GrOup-based physical Activity for oLder adults (GOAL) trial is a three-arm randomized control trial that will examine the efficacy of two different group-based exercise programs for older adults (informed by the tenets of self-categorization theory) in relation to a standard group-based exercise program. Within this manuscript we outline the design and proposed evaluation of the GOAL trial. The first arm is comprised of exercise groups made up of participants of a similar-age and of the same gender; the second arm consists of groups with similar-aged mixed gender participants; the control arm is comprised of mixed-aged mixed gender participants. We aim to compare the adherence rates of participants across conditions, as well as potential moderation effects and mediating mechanisms.

DISCUSSION

Results from this trial will inform intervention designs to improve the exercise adherence behaviors of older adult. At a systems-level, should support be derived for the efficacy of the interventions tested in this trial, changing group composition (i.e., age, gender) represents a feasible program adaptation for physical activity centers.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT02023632 . Registered December 13, 2013.

Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention

OBJECTIVES

The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012.

METHOD

WYHH was a 32-week community health promoter-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers.

RESULTS

Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (β = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks.

CONCLUSION

The WYHH community health promoter-facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.

The change in motivating factors influencing commencement, adherence and retention to a supervised resistance training programme in previously sedentary post-menopausal women: a prospective cohort study

Background

Understanding motivators for exercise participation in post-menopausal women may impact retention to exercise programmes and inform intervention trial designs. The purpose of this investigation was to assess self-reported motivational factors influencing adherence and retention to a 24-week progressive resistance training programme.

Methods

Post-menopausal females (n = 34) were passively recruited to undertake a 24-week progressive resistance training protocol, in small-group sessions, on three non-consecutive days of the week. Attendance was recorded by the researcher. Qualitative reports were sourced from the sample for four phases of the study: pre-study (prior to week 1), recruitment (week 1), during study (weeks 2 – 24), and post-intervention (beyond week 24). Responses were categorised according to ten descriptors: specific health index improvement, education, flexibility of time, social contact, conscience (loyalty to the researcher), wellness, weight management, organisation parameters (pertaining to the study programme) and enjoyment of the exercises.

Results

Of the initial sample, 76.5% (n = 26) met the specified ≥80% attendance criterion. The primary findings were that motivation to volunteer for the study was driven by a perceived need for a structured exercise programme (50% of respondents). A commitment to the researcher was the primary motivator for continued adherence to the study for 50% of participants. Social contact with other participants was cited by 60% of the sample as the primary reason for adherence for the full duration of 24 weeks. A desire to maintain the “wellness” derived from the programme was cited by 60% as a reason for continuing an exercise routine post-study.

Conclusion

This study identified that routine and supervision initially attract women to exercise programmes, while social cohesion of the group setting contributes to retention over time. Understanding the changing nature of motivating factors may contribute to better overall adherence and retention to exercise programmes and interventions.

Redefining racial residential segregation and its association with physical activity among African Americans 50 years and older: a mixed methods approach

Physical inactivity is one of the factors contributing to disproportionate disease rates among older African Americans. Previous literature indicates that older African Americans are more likely to live in racially segregated neighborhoods and that racial residential segregation is associated with limited opportunities for physical activity. A cross-sectional mixed methods study was conducted guided by the concept of therapeutic landscapes. Multilevel regression analyses demonstrated that racial residential segregation was associated with more minutes of physical activity and greater odds of meeting physical activity recommendations. Qualitative interviews revealed the following physical activity related themes: aging of the neighborhood, knowing your neighbors, feeling of safety, and neighborhood racial identity. Perceptions of social cohesion enhanced participants' physical activity, offering a plausible explanation to the higher rates of physical activity found in this population. Understanding how social cohesion operates within racially segregated neighborhoods can help to inform the design of effective interventions for this population.

Multiple levels of influence on older adults' attendance and adherence to community exercise classes

Purpose: To examine the influence of individual participant, instructor, and group factors on participants’ attendance and adherence to community exercise classes for older adults. Design and Methods: Longitudinal data from 16 instructors, 26 classes, and 193 older participants within those classes (aged 60–100 years) were examined. Data were collected using questionnaires on individual participants’ demographics, attitudes, health perceptions and conditions, and group cohesion. Instructors’ demographics, training, background, experience, attitudes, and personality were collected. Group factors included class type, cost, transport, and whether the class was held in an area of deprivation. Outcomes (attendance/adherence) were collected through attendance records. Results: Multilevel modelling (MLwiN) revealed both instructor and individual participant variables were important in understanding attendance and adherence. Individuals’ housing, education, mental well-being, group cohesion, and attitudes were important predictors of attendance at 3 and 6 months. Instructors’ age, gender, experience, and motivational training were important at 3 months, whereas instructor personality was important at both 3 and 6 months. Having attended longer than 6 months at baseline, participants’ attitudes, weeks offered, instructors’ personality, and experience were associated with adherence at 6 months. Implications: Results suggest that instructors’ characteristics alongside individual participant factors play a role in influencing participants’ attendance to exercise classes. These factors should be considered when setting up new programs.

Long-Term Adherence to Health Behavior Change

The utility of lifestyle-based health promotion interventions is directly impacted by participant adherence to prescribed behavior changes. Unfortunately, poor adherence to behaviors recommended in lifestyle interventions is widespread, particularly over the long-term; thus, the "adherence problem" represents a significant challenge to the effectiveness of these interventions. The current review provides an overview of the adherence problem and describes a theoretical framework through which the factors that impact adherence can be understood. To further understand the difficulties individuals face when adhering to health behavior changes, we focus our discussion on challenges associated with adherence to lifestyle behaviors recommended for weight loss and healthy weight management (i.e., reductions in dietary intake and increases in physical activity). We describe strategies that improve long-term adherence to health behaviors related to healthy weight management, including the provision of extended care, skills training, improving social support, and strategies specific to maintaining changes in dietary intake and physical activity. Finally, we discuss difficulties involved in implementing long-term weight management programs and suggest practical solutions for providers.

Generalizing the findings from group dynamics-based physical activity research to practice settings: what do we know?

The general purpose of this secondary analysis of a prior systematic review was to determine the degree to which group dynamics-based physical activity interventions align with research processes and outcomes that are more likely to facilitate the translation of research into practice. To accomplish this, a systematic search was conducted within Science Citation Index Expanded, Social Sciences Citation Index, Arts and Humanities Citation Index, and MEDLINE databases to identify articles published prior to 2010 that used at least one group dynamics-based strategy (e.g., group interaction, group goal setting) in physical activity promotion. These 17 intervention studies were identified and coded based on the reach, effectiveness, adoption, implementation, maintenance framework and Pragmatic-Explanatory Continuum Indicator Summary (for trial design characteristics). Reporting was infrequent for external validity factors (i.e., representativeness, adoption, cost, maintenance) but more frequent for internal validity factors (e.g., inclusion criteria). Intervention costs were not reported. Studies were more likely to be pragmatic (i.e., designed to determine the effects of an intervention under the usual conditions in which it will be applied) in areas of participant compliance and practitioner adherence and explanatory (i.e., designed to determine the effects of an intervention under ideal conditions) and in areas of practitioner expertise and flexibility of intervention protocol. While a number of these interventions were tested in more pragmatic settings, external validity factors were still underreported.

Investigating group contingencies to promote brief abstinence from cigarette smoking

In contingency management (CM), monetary incentives are contingent on evidence of drug abstinence. Typically, incentives (e.g., "vouchers" exchangeable for goods or services) are contingent on individual performance. We programmed vouchers contingent on group performance to investigate whether these contingencies would promote brief abstinence from cigarette smoking. Thirty-two participants were divided into small teams (n = 3 per team). During three 5-day within-subject experimental conditions, participants submitted video recordings of breath carbon monoxide (CO) measures twice daily via Motiv8 Systems, an Internet-based remote monitoring application. During the interdependent contingency condition, participants earned vouchers each time they and their teammates submitted breath CO samples indicative of abstinence (i.e., negative samples). During the independent contingency condition, participants earned vouchers each time they submitted negative samples, regardless of their teammates' performance. During the no vouchers condition, no monetary incentives were contingent on abstinence. In addition, half of the participants (n = 16) could communicate with their teammates through an online peer support forum. Although forum access did not appear to promote smoking abstinence, monetary incentives did promote brief abstinence. Significantly more negative samples were submitted when vouchers were contingent on individual performance (56%) or team performance (53%) relative to when no vouchers were available (35%; F = 6.9, p = .002). The results show that interdependent contingencies can promote brief abstinence from cigarette smoking. Moreover, the results suggest that these contingencies may help lower treatment costs and promote social support.

Group physical therapy for veterans with knee osteoarthritis: study design and methodology

Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that cost-effectively extend PT services for patients with this condition. This manuscript describes a randomized clinical trial of a group-based physical therapy program that can potentially extend services to more patients with knee OA, providing a greater number of sessions per patient, at lower staffing costs compared to traditional individual PT. Participants with symptomatic knee OA (n = 376) are randomized to either a 12-week group-based PT program (six 1 h sessions, eight patients per group, led by a physical therapist and physical therapist assistant) or usual PT care (two individual visits with a physical therapist). Participants in both PT arms receive instruction in an exercise program, information on joint care and protection, and individual consultations with a physical therapist to address specific functional and therapeutic needs. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and the secondary outcome is the Short Physical Performance Test Protocol (objective physical function). Outcomes are assessed at baseline and 12-week follow-up, and the primary outcome is also assessed via telephone at 24-week follow-up to examine sustainability of effects. Linear mixed models will be used to compare outcomes for the two study arms. An economic cost analysis of the PT interventions will also be conducted.

A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial

BACKGROUND

Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults. This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming. The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults.

METHODS

Thirty-one participants (mean age ± SD: 86.2 ± 4.6 years), residents of two Swiss hostels for the aged, were randomly assigned to either the dance group (n = 15) or the control group (n = 16). The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming. The control group performed only the strength and balance exercises during this period. Outcome measures were foot placement accuracy, gait performance under single and dual task conditions, and falls efficacy.

RESULTS

After the intervention between-group comparison revealed significant differences for gait velocity (U = 26, P = .041, r = .45) and for single support time (U = 24, P = .029, r = .48) during the fast walking dual task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy.

CONCLUSIONS

There was a significant interaction in favor of the dance video game group for improvements in step time. Significant improved fast walking performance under dual task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program.

TRIAL REGISTRATION

This trial has been registered under ISRCTN05350123 (www.controlled-trials.com)

Construct and convergent validity and repeatability of the Questionnaire d'Activité Physique pour les Personnes Âgées (QAPPA), a physical activity questionnaire for the elderly

OBJECTIVES

To investigate repeatability, and construct and convergent validity of the Questionnaire d'Activité Physique pour les Personnes Âgées (QAPPA), a self-reported physical activity questionnaire for the elderly.

STUDY DESIGN

Cross-sectional and prospective (1-year follow-up) data from two postal surveys among members of the medical insurance scheme of the French national education system.

METHODS

A questionnaire on general health and the QAPPA were sent out twice, with a 1-year interval. Participants were ≥60 years of age (sample size varied from 225 to 393 according to the analysis). Intraclass correlations, Bland-Altman plots (continuous variables) and kappa coefficients (categorical variable) were used for repeatability analyses. Comparison tests were performed (Wilcoxon rank sum test and Kruskal-Wallis test) for construct validity. Chi-squared test and correlation coefficients were used to establish the convergent validity of the QAPPA.

RESULTS

The QAPPA had acceptable repeatability with a 1-year interval, with moderate test-retest correlation coefficients (from r = 0.46 to r = 0.64) and a fair-to-good kappa coefficient (κ = 0.44). It discriminated between individuals by age group (with younger persons being more physically active than older persons) and exercise behaviour (with regular exercisers being more active than non-exercisers). The QAPPA was negatively associated with decline in physical function and comorbidity, and was positively associated with self-reported health and satisfaction with body functioning.

CONCLUSION

This study found that the QAPPA is a valid tool for assessing the physical activity of older adults. It could be used for research purposes as well as for epidemiological surveillance.

Mood Disorders among Older Adults Participating in Individual and Group Active Environments: "Me" versus "Us," or Both?

Involvement in physical activity is associated with improved mental health including better social skills, coping mechanisms, and lower rates of depression. However, evidence on whether group or individual active environments better facilitate these benefits remains inconsistent. This cross-sectional cohort study examined the mental health reports of older adults (aged 50+) in relation to participation in group or individual active environments. Logistic multivariate regression analyses were conducted on the Canadian Community Health Survey (cycle 4.1, 2007-2008, n = 44, 057). Results illustrated that those active in both group and individual environments were 59% less likely to have a mood disorder than those who were not participating in either (P < 0.001). Also, those active in both environments were 31% less likely to have a mood disorder than those active in an individual environment (P < 0.001). Participating in only group or only individual environments had a similar effect compared to individuals not active in any environments for reducing rates of reported mood disorders (22% and 28%, resp.). However, the findings related to only group environments were not significant. These findings reveal that participating in both group and individual physical activities may have important implications for maintaining older adults' mental health status.

The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study

BACKGROUND

This randomized controlled pilot study aimed to explore whether a cognitive-motor exercise program that combines traditional physical exercise with dance video gaming can improve the voluntary stepping responses of older adults under attention demanding dual task conditions.

METHODS

Elderly subjects received twice weekly cognitive-motor exercise that included progressive strength and balance training supplemented by dance video gaming for 12 weeks (intervention group). The control group received no specific intervention. Voluntary step execution under single and dual task conditions was recorded at baseline and post intervention (Week 12).

RESULTS

After intervention between-group comparison revealed significant differences for initiation time of forward steps under dual task conditions (U = 9, P = 0.034, r = 0.55) and backward steps under dual task conditions (U = 10, P = 0.045, r = 0.52) in favor of the intervention group, showing altered stepping levels in the intervention group compared to the control group.

CONCLUSION

A cognitive-motor intervention based on strength and balance exercises with additional dance video gaming is able to improve voluntary step execution under both single and dual task conditions in older adults.

Mediating effects of group cohesion on physical activity and diet in women of color: health is power

PURPOSE

To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention.

DESIGN

Longitudinal design.

SETTING

Harris County and Travis County, Texas.

PARTICIPANTS

Community-dwelling African-American and Hispanic or Latina women.

INTERVENTION

Three hundred ten women were randomized to a PA (n  =  204) or VF (n  =  106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption.

MEASURES

Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention.

ANALYSES

The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis.

RESULTS

Women were middle aged (mean  =  44.4 years) and overweight or obese (mean body mass index  =  34.0 kg/m(2)). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p < .05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes.

CONCLUSIONS

Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.

Improving participation rates for women of color in health research: the role of group cohesion

Adherence to physical activity and dietary interventions is a common challenge. Interventions that use group cohesion strategies show promise for increasing adherence, but have not been tested among women of color. The purpose of this study was to determine whether dimensions of group cohesion mediate the association between intervention condition and attendance within a community physical activity program for women of color. African American and Hispanic or Latina women (N = 310) completed measurements at baseline and post-intervention and participated in a social cohesion intervention to improve physical activity and dietary habits. Women were assigned to a physical activity or fruit and vegetable intervention group. Social and task cohesion was measured using the Physical Activity Group Environment Questionnaire (PAGE-Q). Attendance was recorded at each of six intervention sessions. Women were generally middle-age (M age = 46.4 years, SD = 9.1) and obese (M BMI = 34.4 kg/m2, SD = 7.7). The estimate of the mediated effect was significant for all group cohesion constructs, indicating both task constructs-attraction to the group's task (SE = 0.096, CI: -0.599 to -0.221) and group integration around the task (SE = 0.060, CI: -0.092 to -0.328)-and social constructs-attraction to the group's social aspects (SE = 0.046, CI: -0.546 to -0.366) and group integration around social aspects (SE = 0.046, CI: -0.546 to -0.366)-significantly mediated the association between group assignment and attendance. Both task and social constructs are important to improve attendance in health promotion interventions for women of color.

Examining a therapeutic yoga program for prostate cancer survivors

BACKGROUND

In the earlier stages of prostate cancer, effective treatments have created a need for research to focus on practices that may improve quality of life throughout survivorship. Physical activity is a significant supportive care management strategy for prostate cancer survivors, though the optimal modality is not yet understood.

HYPOTHESES

The authors hypothesized that yoga would be a feasible physical activity option for prostate cancer survivors and their support persons and that the incorporation of social support would increase physical activity adherence.

METHODS

This 14-week feasibility study involved a 7-week class-based yoga program (adherence phase), followed by 7 weeks of self-selected physical activity (maintenance phase). Demographic information, physical activity behavior, quality of life, fatigue, stress, mood, and fitness variables were assessed at 3 time points. Prostate cancer survivors' perceived social support was rated during yoga and after yoga.

RESULTS

Class attendance was 6.1 and 5.8 for prostate cancer survivors (n = 15) and their support persons (n = 10), respectively, for the 7 classes. Levels of perceived social support were higher for those who brought a support person. Significant improvements with regard to stress, fatigue, and mood before and after yoga class (all Ps < .05) were reported by all participants. No clinically significant changes were noted on prostate cancer survivor's quality of life or fatigue over the course of the 14-week study.

CONCLUSIONS

Yoga is a feasible physical activity option for prostate cancer survivors. The program had a promising uptake rate, high program adherence rate, and there were acute program benefits with regard to stress, fatigue, and mood for all participants. Future examination is warranted with regard to chronic benefits and group cohesion influences on levels of perceived social support.

Motivators, barriers, and beliefs regarding physical activity in an older adult population

BACKGROUND AND PURPOSE

Regular physical activity (PA) plays an important role in improving and maintaining one's health, especially as one ages. Although many older Americans are aware of the benefits of regular PA, the majority do not participate in regular PA that meets recommended guidelines. The purpose of this study was to gain insight into the motivators, barriers, and beliefs regarding PA of independent-living older adults with easy access to fitness facilities.

METHODS

In this qualitative design, focus group interviews were used to explore the individual perceptions of physically active and inactive older adults regarding PA and exercise. Thirty-one older adults, over age 60 participated in focus group discussions regarding PA beliefs and behaviors. Groups were homogenous based on current PA behaviors. Demographic information was collected. Discussions were audiotaped and transcribed verbatim and deidentified. Two researchers independently coded for emergent themes. Interrater reliability was established (κ = 0.89). Peer review was used to further ensure trustworthiness and credibility.

RESULTS

No significant differences were noted in age, body mass index, or educational levels between the physically active and inactive groups. Differences in perceptions were noted between the groups regarding the construct of PA, barriers to participation in regular PA, and the components of an ideal PA program. Physically inactive persons had much lower fitness expectations of a physically active older adult, more perceived barriers to regular PA, and required individual tailoring of a PA program if they were going to participate. In addition, inactive persons were intimidated by the fitness facilities and concerned about slowing others down in a group exercise setting. Both groups shared similar motivators to participate in PA, such as maintaining health and socialization; however, inactive persons also described PA as needing to be purposeful and fun.

DISCUSSION AND CONCLUSION

Physically inactive persons perceived themselves to be physically active, as their perception of PA was grounded in a social context. Although both groups shared some barriers to regular PA participation, physically active individuals developed strategies to overcome them. Issues relating to self-efficacy and stages of change need to be explored to address the individual perceptions and needs of inactive older adults if initiation or long-term adherence to a PA program is to be achieved.

Internet-based group contingency management to promote abstinence from cigarette smoking: a feasibility study

BACKGROUND

In contingency management (CM) interventions, monetary consequences are contingent on evidence of drug abstinence. Typically, these consequences are contingent on individual performance. Consequences contingent on group performance may promote social support (e.g., praise).

METHODS

Thus, to combine social support with the monetary incentives of CM, we integrated independent and interdependent group contingencies of reinforcement into an Internet-based intervention to promote smoking abstinence. Breath carbon monoxide (CO) measures were compared between treatment conditions and a baseline control condition. Thirteen participants were divided into 5 groups or "teams" (n=2-3 per team). Each participant submitted video recordings of CO measurement twice daily via the Internet. Teammates could monitor each other's progress and communicate with one another through an online peer support forum. During a 4-day tapering condition, vouchers exchangeable for goods were contingent on gradual reductions in breath CO. During a 10-day abstinence induction condition, vouchers were contingent on abstinence (CO≤4ppm). In both treatment conditions, concurrent independent and interdependent group contingencies were arranged (i.e., a mixed contingency arrangement).

RESULTS

Less than 1% of CO samples submitted during baseline were≤4ppm, compared to 57% submitted during abstinence induction. Sixty-five percent of participants' comments on the online peer support forum were rated as positive by independent observers. Participants rated the intervention favorably on a treatment acceptability questionnaire.

CONCLUSION

The results suggest that the intervention is feasible and acceptable for promoting abstinence from cigarette smoking.

Health is Power: an ecological, theory-based health intervention for women of color

OBJECTIVE

Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. This manuscript describes the rationale, design and methodology of Health Is Power (HIP), a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity and improve dietary habits in African American and Hispanic or Latina women in Houston and Austin, Texas.

METHODS

The intervention development was guided by group dynamics principles anchored within an ecologic model.

RESULTS

Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods - integrated into strategies to promote group cohesion - framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests.

CONCLUSIONS

Neighborhood contextual and environmental measures are described to test ecologic factors that may contribute to behavioral maintenance. Theoretically guided interventions that account for multiple levels of influence in behavior initiation and maintenance stand to improve health outcomes in vulnerable populations.

First impressions count: perceptions of surface-level and deep-level similarity within postnatal exercise classes and implications for program adherence

The purpose of this study was to examine the extent to which perceptions of surface-level (i.e. age, ethnicity, physical condition) and deep-level (i.e. attitudes, beliefs, values) similarity, as assessed shortly after group formation, predict participants' subsequent attendance behaviors within postnatal physical activity classes. Women (N = 136) enrolled in 21 postnatal exercise classes participated in this prospective observational study. Perceptions of surface-level similarity, in particular with regard to other group members' ages, predicted women's subsequent adherence to their respective exercise classes. The results of this study suggest that perceptual similarity may have noteworthy implications for mothers' involvement within postnatal physical activity classes.

Investigating the relationship between leader behaviours and group cohesion within women's walking groups

Early research has shown that leadership behaviour is viewed as a crucial factor in successfully developing team cohesion, effectively resulting in greater team satisfaction and more positive team outcomes. However, little is understood if these same factors have an impact on physical activity groups.

OBJECTIVE

The purpose of this study was to investigate the relationship between leader behaviours and group cohesiveness within women's physical activity groups.

DESIGN

Participants (N = 95) included a sub-sample of adult women who were previously involved in a women's physical activity/walking program.

METHODS

Participants assessed their groups' leader behaviour using items pertaining to enthusiasm, motivation, instruction and availability, and their groups' cohesiveness using the Physical Activity Group Environment Questionnaire (PAGEQ). Canonical correlation analysis was used to determine the strength of association between the four concepts of group cohesion (ATG-T, ATG-S, GI-T and GI-S) and the four items pertaining to leadership behaviour.

RESULTS

A significant multivariate relationship was revealed between group cohesion and leadership behaviour, Wilks' lambda = 0.43, F(16,170) = 5.16, p < 0.001. The canonical correlation for this function was R(C) = 0.74, indicating a strong relationship. Simply stated, group leaders who were perceived as being highly enthusiastic, have the ability to motivate, are able to provide personal instruction and who are available outside of the group's regular activities were associated with higher levels of group cohesion.

CONCLUSIONS

Although a cause-effect relationship cannot be determined, the current study can serve as a valuable template in guiding future research in examining potential mechanisms that may assist with physical activity sustainability.

Physical activity behaviours of Culturally and Linguistically Diverse (CALD) women living in Australia: a qualitative study of socio-cultural influences

Background

Australia continues to witness rising levels of immigration by individuals from Culturally and Linguistically Diverse (CALD) origins. With this rapidly growing diverse population, Australia faces a number of population health challenges. In particular, CALD women have been shown to be at an increased risk of chronic diseases such as cardiovascular disease, diabetes, and poor mental health. Despite the high risk of these diseases, women from CALD groups are less likely to be proactive in accessing health care or undertaking preventative behaviours, such as physical activity participation. The purpose of this study was to examine the socio-cultural influences on the physical activity behaviours of CALD women living in Australia by identifing the barriers, constraints and possible enablers to physical activity participation for this population.

Methods

Twelve focus group sessions were undertaken with CALD women (N = 110) from Bosnian, Arabic speaking, Filipino and Sudanese communities in three regions: New South Wales, Victoria, and Queensland. In a semi-structured, open table discussion, participants were encouraged to share their opinions, perceptions and beliefs regarding socio-cultural influences on their physical activity behaviours. Common and ethnic-specific themes emerged from the discussions.

Results

Common themes included: knowledge of physical activity, differing physical activity levels, and the effects of psychological and socio-cultural factors, environmental factors, and perceptions of ill-health and injury, on physical activity behaviours. Ethnic-specific themes indicated that post-war trauma, religious beliefs and obligations, socio-economic status, social isolation and the acceptance of traditional cultural activities, greatly influenced the physical activity behaviours of Bosnian, Arabic speaking, Filipino and Sudanese women living in communities throughout Australia.

Conclusions

This study demonstrates that attitudes and understandings of health and wellbeing are complex, and have a strong socio-cultural influence. The findings of the present study can be used not only to inform further health promotion initiatives, but also as a platform for further research with consumers of these services and with those who deliver such services.

Processes associated with participation and adherence to a 12-month exercise programme for adults aged 70 and older

This study investigated the processes associated with the engagement of adults aged 70 years and older in a 12-month long research-based structured exercise programme. A sample of 21 participants (Mean age (SD) 75.8 (3.9); 14 females) and six exercise class leaders or researchers involved in the programme participated in individual semi-structured interviews. Transcripts were analysed with the principles of interpretive qualitative analysis. Our findings suggest that a programme that runs locally, provides individual attention/tailoring, delivers meaningful benefits, offers a staged approach to efficacy building, creates a sense of ownership, and provides intergenerational support and opportunities for social interaction, facilitates exercise engagement in later life.