Behavioural Regulation in Exercise Questionnaire in people with schizophrenia: construct validity of the Portuguese versions

Feasibility and effectiveness of a 24-weeks outdoor exercise program on the physical and mental health of persons with schizophrenia

Outdoor exercise can be a novelty and effective therapeutic strategy to achieve positive physical and mental health outcomes in persons with schizophrenia. The aim of this study was to assess the feasibility and effectiveness of a 24-weeks outdoor exercise program in the physical and mental health of persons with schizophrenia. Fifty-two outpatients with schizophrenia were conveniently assigned to a 24-weeks walking/jogging combined with cycling outdoor program (n = 23, male = 14) or control group (n = 29, male = 20). Demographic and clinical measures were collected. Physical health was evaluated using anthropometric measures, 6 min walk test, Eurofit and accelerometer. Mental health was evaluated using self-esteem, motivation for exercise and quality of life questionnaires. Attendance rate to the outdoor program was 92 %. The exercise program significantly decreased participant's body mass index and improved functional exercise capacity and balance. No effects were reported in the self-esteem, motivation for physical activity and quality of life. Significant decreases were found in abdominal strength, hand grip and self-esteem levels of the control group. The outdoor exercise combining walking/jogging and cycling was an effective intervention to decrease body mass index and to improve physical fitness. It can be suggested as a therapeutic approach with an important impact on the management of schizophrenia.

Role of Sport Activity on Quality of Life in Charcot-Marie-Tooth 1A Patients

The present study aims to investigate the benefits induced by physical activity/practiced sport in Charcot-Marie-Tooth 1A (CMT1A). Patients were divided into sport and no-sport groups according to their sports performance habit. Thirty-one patients were enrolled, of which 14 practiced sports and 17 did not. Clinical assessments were administered to evaluate disability, self-esteem, depression, quality of life, and pain. Statistical analysis revealed significant differences in terms of gender in the no-sport group compared to the sport group (p = 0.04). Regarding the quality of life, physical function (p = 0.001), general health (p = 0.03), social function (p = 0.04), and mental health (p = 0.006) showed better patterns in the sport group than no-sport group. Moreover, neuropathic pain was reduced in the sport group according to the Neuropathic Pain Symptom Inventory (p = 0.001) and ID-PAIN (p = 0.03). The other administered questionnaires showed no significant differences. Our study confirms that CMT1A patients, who practice sports, with a similar severity of disability, may have a better physical quality of life while suffering less neuropathic pain than their peers who do not practice sports. Results recommend the prescription of sport in CMT1A patients.

Is a female physical empowerment campaign effective in improving positive body image, motivation for physical activity, and physical activity behavior in young female adults? A two-study experimental test of "This Girl Can"

This Girl Can is a campaign designed to empower women to increase physical activity. The campaign uses images/videos of women of diverse body weights/shapes, ages and ethnicities being physically active, emphasizing body functionality. First, we examined the effects of multi-session (N = 3) exposures to This Girl Can on body functionality, body appreciation and self-compassion (Study 1). Second, we explored if autonomous motivation for physical activity mediated effects of This Girl Can on physical activity (Study 2). Women (Study 1: N = 186, M (SD) age = 27.55 (14.01); Study 2: N = 153, M (SD) age = 28.31 (11.70)) were randomized to This Girl Can, or control videos/images depicting idealized women of thin/athletic body types being physically active (Study 1), or control videos highlighting physical activity benefits (Study 2). Outcomes were measured at baseline, post-test and 1-week follow-up. Study 1 results showed significant group by time interactions for body functionality (decreasing in the control group), body appreciation and self-compassion (both increased only in the experimental conditions). In Study 2, path analysis revealed no statistically significant mediation effect (ab = 13.18, 95 % CI [-107.92, 152.59]) of autonomous motivation. Future interventions designed to promote positive body image and self-compassion should incorporate media focusing on diverse women engaging in self-chosen physical activity.

Examining the psychometric properties of the Chinese Behavioral Regulation in Exercise Questionnaire-3: A bi-factor approach

The Behavioral Regulation in Exercise Questionnaire (BREQ) was revised to its third iteration (BREQ-3) and has been widely used to measure different types of exercise motivation, including amotivation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic motivation. However, the Chinese version has not been similarly revised. The aim of this study was to develop and examine the psychometric properties of the Chinese BREQ-3 using alternative structural equation models. Specifically, this study aimed to translate the English BREQ-3 into Chinese to examine the best representation of the factor configuration of Chinese BREQ-3, measurement invariance for the best-fitted model, and the concurrent validity evidence and reliability for the Chinese BREQ-3. Undergraduate students (N = 825) from mainland China completed a battery of online questionnaires. After including two general motivation factors (controlled motivation and autonomous motivation), we discovered that the majority of items on the identified regulation, integrated regulation, and intrinsic motivation subscales no longer loaded on or had very low loadings on their specific factors, implying that these items essentially represent a unidimensional construct. Invariance testing supported the comparison between latent factor means across gender based on the bi-factor exploratory structural equation model (BESEM). Concurrent validity evidence was found for amotivation, controlled motivation, and autonomous motivation. The hierarchical omega, explained common variance (ECV), item explained common variance (I_ECV), and percentage of uncontaminated correlations (PUC) indicated that the external regulation and introjected regulation subscales had a multidimensional structure, while the identified regulation, integrated regulation, and intrinsic motivation subscales had a unidimensional structure (autonomous motivation). We advocate calculating amotivation, external regulation, introjected regulation, and a single autonomous motivation (excluding item 19) score when utilizing the Chinese BREQ-3.

Study protocol for a pilot high-intensity interval training intervention in inpatient mental health settings: a two-part study using a randomised controlled trial and naturalistic study design

BACKGROUND

Severe mental illnesses (SMI), including schizophrenia spectrum disorder, bipolar disorder and major depressive disorder, are associated with physical health comorbidities and premature mortality. Physical activity and structured exercise have a beneficial impact on cardiometabolic risk and ameliorate mental health symptomology and cognition. This protocol describes a feasibility study for a high-intensity interval training (HIIT) intervention among inpatients with SMI, to improve their physical and mental health.

METHODS

The feasibility study follows a two-part design owing to COVID-19-related adaptations to project design: (a) a non-blinded randomised controlled trial (RCT) of 12 weeks of bicycle-based HIIT, delivered twice weekly in a face-to-face, one-to-one setting, compared to treatment as usual (TAU) and (b) a naturalistic study of inpatient HIIT; eligible participants will be invited to two sessions of HIIT per week, delivered by the research team remotely or in person. Additionally, participants in the naturalistic study may use the bike to conduct self-directed sessions of their chosen length and intensity. We will measure the feasibility and acceptability of the HIIT intervention as primary outcomes, alongside secondary and tertiary outcomes evaluating the physical, mental and cognitive effects of HIIT. The study aims to recruit 40 patients to the RCT and 6-8 patients to the naturalistic design.

DISCUSSION

Exercise is a modifiable lifestyle barrier that can reverse cardiometabolic disease risk. If HIIT is found to be feasible and acceptable in inpatients with SMI, there would be scope for large-scale work to evaluate the clinical, cost and implementation effectiveness of HIIT in inpatient mental health settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03959735 . Registered June 22, 2019.

Comparison of the printed and online administration of the Behavioral Regulation in Exercise Questionnaire (BREQ-2)

OBJECTIVE

To compare the traditional printed form of the Behavioral Regulation in Exercise Questionnaire with a proposed online form in terms of validity, reliability, and applicability.

METHODS

A crossover design study was conducted with 157 undergraduate students. Half of the sample answered the printed questionnaire first and then answered the online questionnaire 7 days later, while the other half of the sample did the inverse. Cronbach's alpha was used to analyze the internal consistency of both the online and printed questionnaires. The construct validity was analyzed by confirmatory factor analysis, using a weighted least square mean and adjusted variance estimation and oblique rotation. The quality of the model was tested with fit indices.

RESULTS

The confirmatory factor analysis showed the 19-item structure with five factors: χ2 of 230.718; degrees of freedom of 142; χ2/degrees of freedom of 1.625; comparative fit index of 0.978 and root mean square error of approximation of 0.073. All items presented factorial loads above 0.5. There was also excellent consistency between the formats of administration in all dimensions, with Cronbach's alpha values above 0.70. The stability between the formats of administration varied between 0.78 (95%CI: 0.69-0.85) and 0.84 (95%CI: 0.77-0.89), suggesting desirable confidence between both formats of administration.

CONCLUSION

The five-factor model of the online Behavioral Regulation in Exercise Questionnaire shows internal consistency both in terms of the scale dimensions as well as in terms of the total items.

Motivational Regulations Across the Stages of Change for Exercise in the General Population of Monterrey (Mexico)

Few studies have examined exercise adherence in the Mexican population using self-determination theory proposals and the stages of change model. The objectives of this study were:(a) to translate and adapt the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3) to Mexican Spanish and examine its internal consistency and factorial structure (six dimensions); and (b) to analyse variations in behavioral regulations using the stages of change model. This study included 530 participants between 11 and 76 years old who lived in the metropolitan area of the city of Monterrey, Nuevo Leon, Mexico. The Mexican version of the BREQ-3 presented an acceptable six-factor model that agrees with the theory and has good internal consistency. Results showed that the less self-determined regulations (i.e., external and amotivation) predominated in the first stages of change (i.e., pre-contemplation and contemplation) and decreased in the last stages (i.e., action and maintenance); by contrast, the more self-determined regulations (i.e., intrinsic, integrated, and identified) predominated in the last stages (i.e., action and maintenance) and were lower in the first stages (i.e., pre-contemplation and contemplation). Linking these two theoretical constructs contributes to understanding physical exercise adherence.

The Behavioral Regulation in Exercise Questionnaire (BREQ-3) Portuguese-Version: Evidence of Reliability, Validity and Invariance Across Gender

This study has as prime objective to analyze the psychometric properties of the Behavioral Regulation Exercise Questionnaire (BREQ-3) in a sample of Portuguese exercisers and invariance across gender. Two independent samples (448 calibration; 374 validation), aged between 16 and 78 years (M = 40.29; SD = 16.24), of both gender, (495 female; 327 male) were enrolled in this study. The results show that the original model (six factors; 24 items) did not fit to the data in a satisfactory way (χ² = 977.49; df = 237; B-S p < 0.001; SRMR = 0.07; NNFI = 0.80; CFI = 0.83; RMSEA = 0.08; 90% CI = 0.08-0.09). After removing six items (one for each factor), the model (six factors; 18 items) adjustment improved in a satisfactory way in both samples: calibration (χ² = 331.86; df = 120; B-S p < 0.001; SRMR = 0.06; NNFI = 0.91; CFI = 0.93; RMSEA = 0.06; 90% CI 0.06-0.07) and validation (χ² = 254.08; df = 120; B-S p < 0.001; SRMR = 0.04; NNFI = 0.93; CFI = 0.95; RMSEA = 0.06; 90% CI = 0.05-0.06). Results also showed model invariance across gender (ΔCFI ≤ 0.01). The Portuguese version of BREQ-3 (six factors; 18 items) is a valid and reliable measurement instrument to measure behavior regulation underlying self-determination theory in the exercise domain. However, the evidence also indicated that additional studies are needed to address the fragilities of the original model (six factors; 24 items).

Autonomous motivation and quality of life as predictors of physical activity in patients with schizophrenia

AIM

Being physically active is a complex behaviour in patients with schizophrenia. Several factors were identified as barriers to achieving active behaviours in this population. Therefore, the purpose of this study was to investigate among a number of barriers what predicts the most on physical activity (PA) in patients with schizophrenia.

METHODS

A total of 114 patients (28♀) with schizophrenia were included. Body mass index (BMI) was calculated. Autonomous and controlled motivation (Behavioural Regulation in Exercise Questionnaire - 3), self-esteem (Rosenberg Self-esteem scale), quality of life (World Health Organization Quality of Life Scale - Brief version) and functional exercise capacity (6-minute walk test - 6MWT) were evaluated. Multiple Regression Analysis was applied to assess the effect of these variables on Total PA per week (International Physical Activity Questionnaire - short version).

RESULTS

Autonomous motivation and domains of quality of life were positively correlated with Total PA per week. Stepwise multiple regression analyses showed that of all the candidate factors to predict PA, autonomous motivation and global domain of quality of life were found as significant predictors.

CONCLUSION

Our findings help to understand the importance of autonomous motivation and quality of life for PA in patients with schizophrenia. Knowledge about these predictors may provide guidance to improve PA behaviour in this population.