Perceived social integration predicts future physical activity through positive affect and spontaneous thoughts

What helps older people persevere with yoga classes? A realist process evaluation of a COVID-19-affected yoga program for fall prevention

Background

Falls among older people are a major global health concern. This process evaluation investigates the experience of participants aged 60+ in a yoga program aimed at preventing falls which transitioned from studio-based classes to online classes in response to COVID-19 restrictions. We sought to understand how the Successful AGEing (SAGE) yoga program functioned in both settings and as a hybrid program, and to explain why it worked well for most participants.

Methods

Realist process evaluation was used to explore the factors that facilitated a successful transition for most participants, and to consider why it did not work for a minority. This approach develops program theories that describe which mechanisms an intervention is (or is not) activating, and how this is mediated by context to generate process outcomes. Data included interviews with participants (n = 21) and yoga instructors (n = 3), self-report feedback forms (n = 46), observation of classes and routine process measures.

Results

Factors that facilitated a successful transition for most participants included the quality of yoga instruction, the program format and inherent characteristics of yoga. Gains in transitioning online included continuity and greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. There were greater challenges for people struggling with pain and in disadvantageous home environments. We identified six program theories configured around 16 mechanisms: 1. It’s worth the effort and 2. In expert hands (these had the same mechanisms: value expectancy, therapeutic alliance and achievement/mastery), 3. A communal experience (these mechanisms were shared experience, social connection, social comparison and peer checking), 4. Putting yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability and continuity), and 6. Yoga’s special properties (embodiment and mindfulness).

Conclusions

This study showed that online delivery of a yoga program for people aged 60+ retained much of the value of a face-to-face program for the majority of participants, and increased the value for some. The structured, communal nature of an organised group program delivered by a skilled instructor, together with yoga’s intrinsic focus on mindfulness, facilitated continued engagement and perceived health benefits, despite the change in delivery mode.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12818-5.

Using Realist Evaluation to Understand Process Outcomes in a COVID-19-Impacted Yoga Intervention Trial: A Worked Example

Realist evaluation offers a valuable way to understand how interventions function and thus how they can be improved and locally adapted. Consequently, realist evaluation is increasingly conducted in parallel with intervention trials. It comprises a clear philosophical foundation and view of causality, pragmatic mixed data collection methods, and a theory-driven approach in which hypothesised program theories are tested and refined. However, detailed methods for data analysis are seldom well-described in realist studies and no clear method for analysing and presenting realist evaluation data has yet emerged. In this methodological paper we use the worked example of our realist process evaluation of the SAGE yoga trial to illustrate an applied process of data analysis and presentation of findings. We show how we drew on other realist studies for ideas, provide examples of six key tasks involved in conducting a realist process evaluation (including coding data and structuring results) and describe strategies that did not work and our rationale for rejecting them. This detailed account of the decisions and methods that worked for us is intended to provide a practical and informed point of departure for researchers conducting a realist evaluation.

Understanding Engagement in and Affective Experiences During Physical Activity: The Role of Meditation Interventions

OBJECTIVE

Meditation interventions promote an array of well-being outcomes. However, the way in which these interventions promote beneficial outcomes is less clear. Here, we expanded on prior work by examining the influence of mindfulness and loving-kindness meditation on a key health behavior: physical activity.

METHODS

To test our hypotheses, we drew upon two randomized intervention studies. In the first study, 171 adults (73.0% female) received 6 weeks of training in either mindfulness meditation or loving-kindness meditation, or were assigned to a control condition. In the second study, 124 adults (60.0% female) were assigned to a 6-week mindfulness or loving-kindness meditation group.

RESULTS

Study 1 demonstrated that individuals who received mindfulness training reported sustained levels of physical activity across the intervention period (Pre: mean [standard deviation], or M [SD] = 4.09 [2.07]; Post: M [SD] = 3.68 [2.00]; p = .054), whereas those in the control (Pre: M [SD] = 3.98 [2.25]; Post: M [SD] = 3.01 [2.07]; p < .001) and loving-kindness (Pre: M [SD] = 4.11 [2.26]; Post: M [SD] = 3.45 [1.96]; p < .001) conditions reported lower levels. Study 2 demonstrated those who received mindfulness training experienced increases in positive emotions during physical activity from preintervention to postintervention (Pre: M [SD] = 6.06 [2.51]; Post: M [SD] = 6.54 [2.43]; p = .001), whereas those trained in loving-kindness meditation experienced decreases in positive emotions during physical activity (Pre: M [SD] = 6.45 [2.35]; Post: M [SD] = 6.09 [2.46]; p = .040).

CONCLUSIONS

These results suggest mindfulness training (but not loving-kindness training) promotes sustained physical activity, and one plausible reason why this occurs is enhanced positive emotion during physical activity.

Rationale and Design of the Women's Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women's Physical Activity

BACKGROUND

Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment.

OBJECTIVE

The overarching goal of Project WHADE (Women's Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women's psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual).

METHODS

Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims.

RESULTS

Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020.

CONCLUSIONS

Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women's PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19044.