Determinants of physical activity maintenance: a systematic review and meta-analyses

Determinants of physical activity habit formation: a theory-based qualitative study among young adults

PURPOSE

Engagement in physical activity significantly contributes to reducing the onset and severity of chronic diseases. Nonetheless, establishing habits around this behaviour remains a persistent challenge. This research endeavours to discern the determinants influencing the formation of physical activity habit among young adults in Israel, drawing upon a socio-ecological model.

METHODS

A qualitative approach with phenomenological-hermeneutical method was used. In-depth interviews were carried to cover four levels of the socio-ecological model.

RESULTS

Interviewees were categorized into three subgroups according to their physical activity habit strength: Habitually physically active (n = 8), Variably physically active (n = 11), and physically inactive (n = 6). The content analysis yielded four overarching themes associated with physical activity habit formation. Intrapersonal determinants encompassed personal traits, perceptions and attitudes, perceived benefits, and emotional responses related to physical activity. Interpersonal determinants encompassed social support, modelling support, and peer pressure. Community determinants pertained to social norms, resource availability, and accessibility. Finally, public policy considerations encompassed educational policies as well as workplace policies and cultural influences.

CONCLUSIONS

This study highlights the unique determinants contributing to the formation of physical activity habit. As intrapersonal and interpersonal factors are significant determinants, interventions should focus on these elements in order to promote this behaviour among young adults.

What stops us and what motivates us? A scoping review and bibliometric analysis of barriers and facilitators to physical activity

INTRODUCTION

Physical inactivity is a major global health concern, contributing to the rising non-communicable disease burden. Elucidating barriers and facilitators influencing participation is critical to promoting activity. This study aimed to synthesize the literature and analyze the extent of research on determinants of physical activity engagement.

METHODS

Scoping review methodology guided the synthesis of 272 publications on factors influencing physical activity. Bibliometric analysis examined publication trends, productivity, influential studies, content themes, and collaboration networks.

RESULTS

Since 2010, the United States has led a significant increase in research output. Highly cited articles identified physiological limitations and psychosocial determinants as key barriers and facilitators. Extensive focus was seen in clinical medicine and exercise science journals. Analysis revealed predominant attention to psychosocial factors, physiological responses, and applications in respiratory disease. Gaps remain regarding policy and environmental factors.

CONCLUSION

This review showed major advances in elucidating determinants while revealing the remaining needs to curb the pandemic of inactivity globally. Expanding international collaboration, contemporary theoretical models, and tailored mixed-methods approaches could promote progress through greater global participation. Addressing knowledge gaps across populations and disciplines should be a priority.

It's about time to exercise: development of the Exercise Participation Explained in Relation to Time (EXPERT) model

A perceived 'lack of time' is consistently the most commonly reported barrier to exercise. However, the term fails to capture the multifaceted nature of time-related factors. Recognising the need for a more comprehensive analysis of 'lack of time' as a barrier to exercise, the aim of this study was to develop the exercise participation explained in relation to time (EXPERT) model. The model was developed through a sequential process including (1) an umbrella literature review of time as a barrier, determinant, and correlate of physical activity; (2) a targeted review of existing temporal models; (3) drafting the model and refining it via discussions between eight authors; (4) a three-round Delphi process with eight panel members; and (5) consultations with seven experts and potential end-users. The final EXPERT model includes 31 factors within four categories: (1) temporal needs and preferences for exercise (ie, when and how long does an individual need/want to exercise), (2) temporal autonomy for exercise (ie, autonomy in scheduling free time for exercise), (3) temporal conditions for exercise (ie, available time for exercise) and (4) temporal dimensions of exercise (ie, use of time for exercise). Definitions, examples and possible survey questions are presented for each factor. The EXPERT model provides a comprehensive framework for understanding the multi-dimensional nature of 'time' as it relates to exercise participation. It moves beyond the simplistic notion of 'lack of time' and delves into the complexity of time allocation in the context of exercise. Empirical and cross-cultural validations of the model are warranted.

DE-PASS best evidence statement (BESt): determinants of adolescents' device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis

BACKGROUND

Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents' device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings.

METHODS

A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents' device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked.

PROSPERO ID

CRD42021282874.

RESULTS

Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual-psychological, four individual-behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found.

CONCLUSIONS

Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents' device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents' PA/SB, including policy and environmental variables.

Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study

BACKGROUND

Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions.

OBJECTIVE

This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults.

METHODS

Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (-4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data.

RESULTS

Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement.

CONCLUSIONS

MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition.

Associations of smart device apps with and without a perceived self-efficacy component in a physical activity context with BMI

Smart device apps can be used to promote physical activity, decrease sedentariness, or increase self-efficacy to get active in college students, possibly reducing their obesity risk. This study assessed associations of college students' smart device use with body mass index (BMI), expecting associations between physical activity parameters and self-efficacy with BMI, moderated by app type. In an online survey, app data of a week from student's devices, weight, height, physical activity, and self-efficacy to get active were collected from 120 students. Apps were categorized "physical activity," "physical activity with a self-efficacy component," or "unrelated." Use time of physical activity apps is not associated with BMI, while self-efficacy app time show negative and unrelated app time positive associations. Self-efficacy may be an important component in app design for obesity risk reduction of college students. Test economy was low, which is why future studies need to concentrate on better data extraction methods.

Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts

Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a "coach approach" to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.

Comparing preferences to evaluations of barrier self-efficacy for two strength training programs in US older adults

BACKGROUND/OBJECTIVES

Engagement in regular physical activity is one of the best strategies for older adults to remain healthy. Unfortunately, only 35% of older adults meet guidelines for muscle strengthening activities. Eliciting participant preferences is one possible way to improve physical activity engagement. However, other sources of participant input to improve uptake and maintenance remain uninvestigated. This study compared preferences to self-efficacy ratings for two strength training programs.

METHODS

We conducted a national cross-sectional survey of 611 US adults over age 65. We compared two participant evaluations (the preferred program and the program for which they had higher barrier self-efficacy) of two hypothetical strength training programs (45 minutes performed three times per week (traditional) and 5 minutes performed daily (brief)).

RESULTS

Most participants (68%) preferred the brief strength training program. The difference in self-efficacy ratings was an average of 1.2 (SD = 0.92). One in five participants preferred a strength training program for which they had less self-efficacy; nearly all of these participants (92%) preferred the traditional strength training program but had more self-efficacy for the brief strength training program.

CONCLUSION

Older adults reported preferring and having more self-efficacy for a brief compared to a traditional strength training program. Differences in self-efficacy ratings between the two strength training programs were large. Preferences were often not congruent with ratings of self-efficacy.

SIGNIFICANCE/IMPLICATIONS

Preferences for strength training programming may not always reflect the program most likely to be maintained. Future investigations should evaluate differences in behavioral uptake, maintenance, and outcomes from two comparative strength training interventions using preferences and self-efficacy.

Quantifying Area-Level Physical Activity Offerings in Social Context: A Novel Concept That Goes Beyond Walkability and Access to Open Spaces

BACKGROUND

Social support is a crucial factor influencing the sustainability of physical activity (PA). This proof-of-concept study presents the development of a Social Physical Activity Index for Area (SPAIFA) an indicator reflecting opportunities for individuals to actively participate as part of a group within which opportunities for social interaction can be developed.

METHODS

Six government councils in the state of New South Wales, Australia, were selected encompassing 174 suburbs. Using 2 search engines' map tools, we identified PA venues for each suburb (eg, park, studios, etc). To enumerate activities per suburb, we used (1) venue websites, (2) New South Wales Office of Sport website, (3) national websites of grassroots PA for nonorganized activity (eg, parkrun, meetup, etc), and (4) social media. The database was linked to the suburb demographic profile, the area disadvantage score, walkability and open space scores, and the proportion of insufficiently active residents. Spatial analysis techniques were used to identify SPAIFA clusters.

RESULTS

SPAIFA councils' average was 9.9 activities per 10,000 people (ranging from 6.6/10,000 to 16.2/10,000). SPAIFA-Old (ie, activities specific to older adults) varied significantly (ranging from 11.7/10,000 to 0.8/10,000 seniors). Disadvantaged areas and a high proportion of insufficiently active residents were associated with being classified as low SPAIFA (P < .01). Three clusters of low SPAIFA were identified, and 17 high-risk areas where low SPAIFA was compounded by poor environmental support.

CONCLUSIONS

SPAIFA can be used by councils and policymakers as an indicator for monitoring and intervening in areas where natural and/or urban design is not conducive for PA.

Differential correlates for aerobic physical activity and resistance training: a systematic review

Worldwide, physical inactivity is a major public health concern. Both aerobic physical activity (PA) and resistance training (RT) are forms of exercise that provide numerous health benefits. The present systematic review aimed to examine the evidence among studies that have formally compared the correlates of both aerobic PA and RT in the same sample. Literature searchers were concluded in April 2022 using four common databases. Eligible studies were selected from English language peer-reviewed journals which reported at least a bivariate correlation between the correlate and aerobic PA and RT. Findings were grouped by the correlate in accordance with the capability, opportunity, motivation, behavior (COM-B) model. The analysis identified 18 studies with 16 independent samples. Overall, evidence suggest that there are many similarities between aerobic PA and RT participation. There were positive associations for both aerobic PA and RT for physical and psychological capabilities, reflective and reflexive motivation. There were mixed associations for environmental opportunities, and social opportunities had no association for aerobic PA but mixed evidence for RT. The analyses emphasized that comparative research is lacking in certain areas, principally for environmental opportunity and reflexive motivation.

Technology Usage, Physical Activity, and Motivation in Patients With Heart Failure and Heart Transplantation

The cross-sectional study enrolled 231 patients with heart failure (n = 115; 60.87% were men; mean age, 74.34 ± 12.70 years) and heart transplantation (n = 116; 72.41% were men; mean age, 56.85 ± 11.87 years) who self-reported their technology usage, physical activity, and source of motivation for exercise. Patients with heart failure were significantly older ( P = .0001) than patients with heart transplantation. Physical activity levels in patients with heart failure decreased as the New York Heart Association classification increased. Patients with heart failure reported significantly lower physical activity than patients with heart transplantation ( P = .0008). Smartphones were the most widely used electronic device to access the Internet in both groups. Patients with heart transplantation seemed to use more than one device to access the Internet. In both groups, patients reporting more technology usage also reported higher levels of physical activity. Patients who accessed the Internet daily reported lower levels of physical activity. Whereas patients with heart failure identified encouragement by family members as a source of motivation for exercise, patients with heart transplantation reported that they were likely to exercise if motivated by their healthcare provider. Patients with heart failure and heart transplantation have unique technological and motivational needs that need consideration for mobile health-driven interventions.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Portuguese Physical Literacy Assessment for adolescents (15-18 years): validation using confirmatory factor and composite analyses

Objective

The aim of this study was to assess the construct validity and reliability of the Portuguese Physical Literacy Assessment (PPLA) instruments (a questionnaire and a tool using teacher-reported data). We also investigated the conceptual and practical implications of reflective vs. formative measurement of Physical Literacy using the PPLA.

Methods

Multiple Confirmatory Factor Analysis (CFA) and Confirmatory Composite Analysis (CCA) models were used complementarily to assess construct validity in a sample of 521 grade 10-12 Portuguese students from Lisbon, Portugal. Bifactor model-based indices (ω), Explained Common Variance (ECV), and Percentage of Uncontaminated Correlations (PUC) were used to assess score reliability and adequacy.

Results

Using CFA, an asymmetrical bifactor model (S*1-1) provided the best fit to the data [Robust Comparative Fit Index = 97, Robust Root Mean Square Error Of Approximation = 0.05 (0.04-0.06), Standardized Root Mean Square Residual (SRMR) = 0.04], while CCA resulted in the best absolute fit for single first-order composite models (d_G, d_L, and SRMR below or borderline of their 95% critical value). Through a reflective paradigm, the total PL score should not be used in isolation (ECV = 0.49, ω_H = 0.71, lower than recommended 0.80). Subscales for the Physical, Psychological, and Social domains attained acceptable reliability scores (ω_s = 0.76, 0.82, 0.80, and 0.60).

Conclusions

A general trait of PL accounts for considerable variance in all indicators. We advise calculation of a total summed PL score and domain scores, which should be interpreted conjointly in applied settings. Despite both paradigms being tenable, future research efforts should use a bifactor measurement model, which permits disentanglement of the variance attributed to the general PL trait and its domains. Overall, evidence supported the construct validity and reliability of the PPLA for its intended use as an integrated tool to measure PL as a multidimensional construct in 15- to 18-year-old Portuguese students in a physical education setting.

Effects of Face-to-Face and eHealth Blended Interventions on Physical Activity, Diet, and Weight-Related Outcomes among Adults: A Systematic Review and Meta-Analysis

An increasing number of studies are blending face-to-face interventions and electronic health (eHealth) interventions to jointly promote physical activity (PA) and diet among people. However, a comprehensive summary of these studies is lacking. This study aimed to synthesize the characteristics of blended interventions and meta-analyze the effectiveness of blended interventions in promoting PA, diet, and weight-related outcomes among adults. Following the PRISMA guidelines, PubMed, SPORTDiscus, PsycINFO, Embase, and Web of Science were systematically searched to identify eligible articles according to a series of inclusion criteria. The search was limited to English language literature and publication dates between January 2002 and July 2022. Effect sizes were calculated as standardized mean difference (SMD) for three intervention outcomes (physical activity, healthy diet, and weight-related). Random effect models were used to calculate the effect sizes. A sensitivity analysis and publication bias tests were conducted. Of the 1561 identified studies, 17 were eligible for the systematic review. Studies varied in participants, intervention characteristics, and outcome measures. A total of 14 studies were included in the meta-analyses. There was evidence of no significant publication bias. The meta-analyses indicated that the blended intervention could lead to a significant increase in walking steps (p < 0.001), total PA level (p = 0.01), and diet quality (p = 0.044), a significant decrease in energy intake (p = 0.004), weight (p < 0.001), BMI (p < 0.001), and waist circumferences (p = 0.008), but had no influence on more moderate-to-vigorous physical activity (MVPA) or fruit and vegetable intake among adults, compared with a control group. The study findings showed that blended interventions achieve preliminary success in promoting PA, diet, and weight-related outcomes among adults. Future studies could improve the blended intervention design to achieve better intervention effectiveness.

Psychological Correlates of Perceived Physical Activity Engagement During the COVID-19 Pandemic Among Previously Active Individuals

The COVID-19 pandemic altered daily life in the United States and disrupted how people engage in routine health behaviors, such as physical activity (PA). This study investigates factors that may have helped people sustain recommended levels of moderate to vigorous PA (MVPA) during this time. Using a cross-sectional design, we recruited from Amazon's Mechanical Turk in April/May 2020 a sample of individuals who reported that they had met recommended PA guidelines (≥ 150 weekly MVPA minutes; N = 397) prior to structural changes brought about by COVID-19. We assessed via self-report whether these individuals were meeting recommended levels of MVPA during the COVID-19 pandemic, their intrinsic motivation and identified regulation for exercise, exercise self-efficacy, perceived disruption to their exercise routine, and access to resources for PA. Higher identified regulation, self-efficacy, access to PA resources, and lower perceived disruption were associated with meeting PA guidelines during COVID-19. These findings provide insight into factors that may be important for continued engagement in MVPA when one experiences major disruptions to their exercise routine.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1929811 .

Psychosocial Determinants of Hand Hygiene, Facemask Wearing, and Physical Distancing During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

BACKGROUND

Hand hygiene, facemask wearing, and physical distancing play a crucial role in the prevention of the COVID-19 pandemic. Identifying the key psychosocial determinants of these precautionary behaviors contributes to effective intervention and policymaking for COVID-19 and future pandemics.

PURPOSE

This study aimed to systematically review and meta-analyze available evidence on psychosocial determinants of the general population's practice of three precautionary behaviors, based on the Risk, Attitudes, Norms, Abilities, and Self-regulation (RANAS) framework.

METHODS

Literature was identified by searching seven databases and relevant review papers. Observational and experimental studies targeting the general population (≥18 years) published between January 2020 to September 2021 were included. Pooled effect sizes were calculated with the inverse-variance method using random-effects models.

RESULTS

A total of 51 studies (64 samples) were included in the qualitative synthesis, of which 30 studies (42 samples) were included in the meta-analysis. RANAS-based constructs including knowledge, pros attitudes, and perceived norms were identified as significant determinants of all three behaviors in the meta-analysis. Perceived susceptibility and cons attitudes showed no significant associations with any behaviors. Perceived severity, perceived control, self-efficacy, and behavioral intention were significantly associated with one or two behaviors. Country (western vs. eastern hemispheres) significantly moderated the effects of certain risk and ability factors.

CONCLUSIONS

More research is needed with respect to the intention-behavior relationship, self-regulatory and reflexive factors of precautionary behaviors, as well as the exploration of the potential moderating effect of sociodemographic factors.

Determinants of Physical Activity in the Cardiac Population: Protocol for a Systematic Review

BACKGROUND

Lack of physical activity is a critical contributing risk factor to cardiovascular disease. Hence, regular physical activity is a mainstay in the primary and secondary prevention of cardiovascular disease. Despite the extensive promotion of physical activity in both primary and secondary prevention programs, including cardiac rehabilitation, physical activity levels in the cardiac population remain low. Therefore, it is crucial to understand critical determinants that influence physical activity behavior.

OBJECTIVE

This study aims to deliver a systematic review of studies with collated observational data exploring the association between determinants and physical activity behavior in the target population. These new insights inform the design of future interventions targeted at lasting heart-healthy physical activity behavior in the cardiac population.

METHODS

Primary studies with observational quantitative data on determinants and their association with physical activity behavior in the cardiac population will be included. Information on relevant primary studies will be retrieved from various databases, including Embase, CINAHL, MEDLINE, PsycInfo, and Web of Science Core Collection. Six reviewers will independently double-screen articles. Studies will be selected according to the prespecified inclusion and exclusion criteria. Data will be extracted and entered into suitable worksheets. The US-based National Heart, Lung, and Blood Institute's Study Quality Assessment Tool for Observational Studies will be used to assess the quality of all eligible primary studies. The results will be presented in a descriptive and narrative synthesis. If the type and quality of data are suitable, meta-analyses will be conducted. Study reporting will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.

RESULTS

Data collection started in September 2020, and the literature search was updated in July 2021. Data synthesis is ongoing, and the literature search will be updated in October 2022.

CONCLUSIONS

This review will be valuable to relevant stakeholders, including clinicians and health care professionals, intervention developers, and decision makers in health care. It lays a comprehensive foundation for understanding the determinants of physical activity to inform the design of secondary prevention interventions relevant to the cardiac population.

TRIAL REGISTRATION

PROSPERO CRD42020206637; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206637.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/39188.

Factors influencing adults who participate in a physical activity coaching intervention: a theoretically informed qualitative study

OBJECTIVE

Behaviour change interventions targeting changes in physical activity (PA) can benefit by examining the underlying mechanisms that promote change. This study explored the use of the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to code and contextualise the experiences of participants who completed a PA coaching intervention underpinned by motivational interviewing and cognitive-behavioural therapy.

DESIGN

Semistructured interviews were conducted with a purposive sample of participants.

SETTING

Interviews were conducted in a tertiary hospital in regional Victoria, Australia.

PARTICIPANTS

Eighteen participants who completed a PA coaching intervention were interviewed. The participants were recruited into the coaching intervention because they were insufficiently physically active at the time of recruitment.

RESULTS

Thirteen (72%) participants were women and the average age of participants was 54 (±5) years. Four participant themes mapped directly onto five components of the COM-B model, and ten of the TDF domains. Increases in PA were influenced by changes in motivation and psychological capability. The autonomy-supportive PA coaching intervention helped to evoke participants' own reasons (and motives) for change and influenced PA behaviours. Participants reflected on their own social and/or professional strengths, and used these skills to set appropriate PA goals and action plans. The structure of the PA coaching intervention provided clarity on session determinants and a framework from which to set an appropriate agenda. Relational components (eg, non-judgemental listening, collaboration) were continually highlighted as influential for change, and should be considered in future behaviour change intervention design.

CONCLUSIONS

We demonstrate the beneficial effect of using theory-informed behaviour change techniques, and delivering them in a style that promotes autonomy and relatedness. The views of participants should be a key consideration in the design and implementation of PA coaching interventions TRIAL REGISTRATION NUMBER: ACTRN12619000036112. Post-results analysis.

The roles of motivational interviewing and self-efficacy on outcomes and cost-effectiveness of a community-based exercise intervention for inactive middle-older aged adults

Increasing physical activity (PA) among inactive middle-older aged adults in rural communities is challenging. This study investigates the efficacy of a PA intervention supporting inactive adults in rural/semirural communities. Inactive participants enrolled on either a single signposting session (n =427) or a multisession pathway combining signposting with motivational interviewing (MI; n = 478). Pre-post outcomes data assessed activity levels (International Physical Activity Questionnaire-Short Form; Single Item Sport England Measure), self-efficacy (New General Self-Efficacy scale [NGSE]) and well-being (five-item World Health Organization Well-Being Index [WHO-5]). Measures were repeated at longitudinal time points (26, 52 weeks) for the MI pathway. Outcomes were contrasted with results from an unmatched comparison group receiving treatment as usual (TAU). Cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) were estimated for short (5 years), medium (10 years) and long (25 years) time horizons. Both pathways significantly increased participants' PA. The MI pathway resulted in significantly greater increases in PA than signposting-only and TAU. Improvements in psychological outcomes (NGSE; WHO-5) were significantly greater in the MI pathway than TAU. Longitudinal results indicated MI pathway participants sustained increases in light-intensity PA at 52 weeks (p < 0.001; ηp2  = 0.16). Regression analyses found baseline self-efficacy predicted increased PA at 52 weeks, while baseline well-being did not. The relationship between self-efficacy and PA increased successively across time points. However, magnitude of participants' increased self-efficacy did not predict PA at any time point. Both pathways were cost-effective and cost -saving for participants aged ≥61 years from the short time horizon, with the MI pathway having greater ROI estimates. Overall, MI increased efficacy of a signposting PA intervention and was cost-saving for older adults.

Community living after in-hospital specialized rehabilitation in patients with severe disability after stroke: a long-term follow-up after a randomized controlled trial

PURPOSE

Physical functioning after discharge from specialized rehabilitation is a concern. The purpose of this study was to investigate functioning and health after a long period of community living in participants with severe disability after stroke.

MATERIALS AND METHODS

An observational, longitudinal follow-up design was used to investigate 60 participants from a randomized controlled trial. Assessment tools: Short Form 36 health-survey, Functional Ambulation Categories, EU Walking, 10 Meter Walk Test, and questions concerning health and walking ability.

RESULTS

Forty-seven participants (78%) responded, mean age 51.2 years. Non-respondents demonstrated poorer function at hospital discharge. At follow-up, median 11.9 months after discharge, all but three respondents lived in their own home, and 85% received physiotherapy. Twenty-nine (64%) perceived their health as good to excellent, while four (9%) reported poor health. Activities requiring substantial strength and endurance were typically restricted. Most participants (83%) were independent walkers, and fewer (a 27% reduction) used a wheelchair. Among independent walkers, mean walking speed improved by 0.14 m/s. Time elapsed since hospital discharge was not found to correlate with change in walking speed.

CONCLUSIONS

This study demonstrates maintenance or progress in important aspects of functioning and health in most participants at long-term follow-up, but not in all.Implications for rehabilitationPatients with severe disability after stroke may maintain or improve their physical functioning and health after a long period of community living, when they receive continuous individualized rehabilitation including physiotherapy.Patients who maintain or improve walking ability and walking speed after living for a long time in the community, may still need assistance with daily activities, especially if they require substantial muscle strength and endurance.Expectations to long-term functional outcomes after institutional followed by community rehabilitation for patients after stroke, should be considered in light of functional status at hospital discharge.

Physical Activity Patterns among Individuals with Prediabetes or Type 2 Diabetes across Two Years-A Longitudinal Latent Class Analysis

Background: This study aimed to identify distinct profiles of physical activity (PA) patterns among individuals with prediabetes or type 2 diabetes participating in a two-year PA trial and to investigate predictors of the profiles. Methods: Data (n = 168, collected 2013–2020) from the cohort of a randomized trial aimed at increasing PA in individuals with prediabetes and type 2 diabetes were used. PA and sedentary behaviours were assessed by waist-worn ActiGraph GT1M accelerometers at baseline and at 6, 12, 18 and 24 months. Fifteen PA and sedentary variables were entered into a latent class mixed model for multivariate longitudinal outcomes. Multinominal regression analysis modelled profile membership based on baseline activity level, age, gender, BMI, disease status and group randomisation. Results: Two profiles of PA patterns were identified: “Increased activity” (n = 37, 22%) included participants increasing time in PA and decreasing sedentary time. “No change in activity” (n = 131, 78%) included participants with no or minor changes. “Increased activity” were younger (p = 0.003) and more active at baseline (p = 0.011), compared to “No change in activity”. No other predictor was associated with profile membership. Conclusions: A majority of participants maintained PA and sedentary patterns over two years despite being part of a PA intervention. Individuals improving PA patterns were younger and more active at baseline.

Adherence and Health-Related Outcomes of Beginner Running Programs: A 10-Week Observational Study

Purpose: This study aimed to explore the determinants of adherence and assess changes in fitness and health outcomes in participants of group-based beginner running programs. Methods: Participants completed adherence diaries (n = 34) during the 10-week program, and underwent fitness and health testing (n = 20) at the program start and end. Diaries included weekly visual analogue scales of enjoyment, motivation, confidence, fatigue, satisfaction, and support along with a record of training sessions. Space was provided for free-text comments. Fitness was assessed by the multi-stage 20-m shuttle run test, and measurements were taken of resting heart rate, blood pressure, body composition, and free-living physical activity. Results: Overall adherence to the 10-week program was 53 ± 27% with injury the most common reason for missing sessions and for discontinuing training. Adherence to group sessions was positively correlated with enjoyment, motivation, confidence, satisfaction with progress, and social support. Qualitative analysis of diary entries indicated three distinct themes (self-awareness, social support, personal challenge) underlying progression through the program. Significant changes were observed after 10 weeks in distance run on the fitness test (+189 ± 133 m), body mass index (-0.54 ± 0.72 kg/m²), and percentage body fat (-1.5 ± 1.6%). Blood pressure, resting heart rate, and physical activity were unchanged. Conclusion: Engagement in beginner running programs was associated with improvements in cardiorespiratory fitness and body composition within 10 weeks. A larger and longer-term study is required to determine if these programs can lead to sustained engagement in running and additional health benefits.

Perspectives of health practitioners and adults who regained weight on predictors of relapse in weight loss maintenance behaviors: a concept mapping study

Background

Preventing people from relapsing into unhealthy habits requires insight into predictors of relapse in weight loss maintenance behaviors. We aimed to explore predictors of relapse in physical activity and dietary behavior from the perspectives of health practitioners and persons who regained weight, and identify new predictors of relapse beyond existing knowledge.

Methods

We used concept mapping to collect data, by organizing eight concept mapping sessions among health practitioners (N=39, five groups) and persons who regained weight (N=21, three groups). At the start of each session, we collected participants’ ideas on potential predictors. Subsequently, participants individually sorted these ideas by relatedness and rated them on importance. We created concept maps using principal component analysis and cluster analysis.

Results

43 predictors were identified, of which the majority belonged to the individual domain rather than the environmental domain. Although the majority of predictors were mentioned by both stakeholder groups, both groups had different opinions regarding their importance. Also, some predictors were mentioned by only one of the two stakeholder groups. Practitioners indicated change in daily structure, stress, maladaptive coping skills, habitual behavior, and lack of self-efficacy regarding weight loss maintenance as most important recurrent (mentioned in all groups) predictors. Persons who regained weight indicated lifestyle imbalance or experiencing a life event, lack of perseverance, negative emotional state, abstinence violation effect, decrease in motivation and indulgence as most important recurrent predictors.

Conclusions

For several predictors associations with relapse were shown in prior research; additionally, some new predictors were identified that have not been directly associated with relapse in weight loss maintenance behaviors. Our finding that both groups differed in opinion regarding the importance of predictors or identified different predictors, may provide an opportunity to enhance lifestyle coaching by creating more awareness of these possible discrepancies and including both points of view during coaching.

What Happens When the Party is Over?: Sustaining Physical Activity Behaviors after Intervention Cessation

Although extensive research suggests that behavior change interventions can improve physical activity (PA) over the course of an intervention, the maintenance of these improvements beyond intervention termination is less clear. The purpose of this study was to determine, through meta-analysis, whether behavior change interventions produce sustained improvements in PA after interventions conclude. Studies were retrieved from a recent (2019) meta-analysis of 224 interventions. Studies that measured PA at baseline, post-intervention, and a follow-up timepoint were included in this updated review. We examined the effects of these interventions in terms of changes in PA from baseline to post-intervention, baseline to follow-up, and post-intervention to follow-up (relative to control groups). We also examined whether the inclusion of theory and behavior change techniques (BCTs) within interventions as well as the length of time between PA assessments moderated these effects. Thirty-nine interventions (17% of interventions from the previous review) from 31 studies were included in the meta-analysis. Significant improvements in PA were found from baseline to follow-up (d = 0.32). In general, these effects resulted from significant increases in PA from baseline to post-intervention (d = 0.46), followed by significant decreases from post-intervention to follow-up (d = -0.18). Effect sizes did not vary between theory-based and no-stated-theory interventions. The positive effects from baseline to post-intervention and negative effects from post-intervention to follow-up were more pronounced as the length of time between assessments increased. In conclusion, behavior change interventions improve PA over the course of the intervention; however, these improvements are generally not sustained after the intervention concludes.

The IMAGINE Intervention: Impacting Physical Activity, Body Fat, Body Mass Index, and Dietary Inflammatory Index

Background

Many behavior-change interventions focused on nutrition and physical activity (PA) have been implemented to prevent disease and promote optimal health.

Purpose

This study examined changes in PA with Energy-adjusted Dietary Inflammatory Index (E-DII™) and chronic disease risk factors in participants of a multicomponent intervention.

Methods

Data from the Inflammation Management Intervention (IMAGINE) were used. Participants self-selected into the intervention or control group. At baseline and 12 weeks (post-intervention), participants completed three unannounced 24-hour dietary recalls (24HR), anthropometric measures (height, weight), and a dual x-ray absorptiometry scan. PA was measured using Sensewear^® armbands. E-DII scores were calculated from the 24HR. Descriptive statistics and t-tests summarized variables and multiple regression assessed relationships between PA and body mass index (BMI), total body fat percent, and E-DII scores.

Results

Intervention participants increased moderate-to-vigorous PA (MVPA) and lowered BMI, total body fat, and E-DII scores compared to controls. Every 10-minute increase in post-intervention MVPA was associated with 1.6 kg/m² lower BMI (p<0.01) and 2.4% lower body fat percent (p<0.01) among control participants, after adjusting for covariates. Every 10-minute increase in post-intervention MVPA was associated with 0.3 lower (i.e., less inflammatory) post-intervention E-DII (p=0.01) scores among intervention participants, after adjusting for covariates.

Conclusion

Participants who changed dietary intake changed PA. While changes were in expected directions, this intervention's emphasis on dietary behaviors compared to PA may have attenuated the relationship between PA and study outcomes.

Predictors of lapse and relapse in physical activity and dietary behaviour: a systematic search and review on prospective studies

OBJECTIVE

Behaviour change maintenance seems to be difficult for many people. To prevent people from relapsing, insight into determinants of relapse is needed. We synthesized the evidence on predictors of lapse and relapse in physical activity and dietary behaviour change.

DESIGN

Prospective studies in adults aged ≥18 years were identified from systematic searches in PsycINFO, PubMed and Cinahl. Methodological quality was analysed, and data were synthesized narratively.

MAIN OUTCOME MEASURES

Lapse and relapse in physical activity and dietary behaviour.

RESULTS

37 articles were included. For several predictors, evidence for an association was found, with self-efficacy as the only consistent predictor across the different outcomes, predicting both lapse and relapse in physical activity, and relapse in dietary behaviour. For most other variables, evidence for prospective relationships with lapse and relapse was insufficient.

CONCLUSION

Most predictors on lapse and relapse were not examined frequently enough to draw conclusions from; many predictors were studied only once or had inconclusive evidence. To be able to provide more substantiated conclusions, more high-quality research is needed. Practitioners and intervention programs could focus on sustainability of behaviour change, by targeting the outcome of interest and its relevant predictors by using behaviour change techniques that have proven effective.

Mind the gap: Habit and self-determined motivation predict health behaviours in middle-aged and older adults

OBJECTIVES

Physical activity and fruit and vegetable consumption are two key health behaviours associated with the health and well-being of middle-aged and older adults. The present research investigated how habit and self-determined motivation interact with intention to prospectively predict physical activity and fruit and vegetable consumption in middle-aged and older adults.

DESIGN

A prospective correlational design (two data collection points) was used.

METHODS

A convenience sample of 195 adults completed online questionnaires measuring intention, habit, and self-determined motivation. One week later, 177 participants (67.2% female), aged 52-87 years (M = 61.50, SD = 5.90), completed self-report measures of physical activity and fruit and vegetable consumption over the previous week.

RESULTS

Separate hierarchical multiple regression analyses were conducted. For physical activity, the model explained 46% of the variance in behaviour, F(8, 168) = 17.88, p < .001 and a large effect size (ƒ2  = .85). Two-way interactions contributed an additional 3.70% of unique variance in physical activity, F(3, 165) = 4.07, p = .008, ƒ2  = .04. For fruit and vegetable consumption, the model explained 19.20% of the variance in behaviour, F(5, 171) = 8.13, p < .001 and a medium effect size (ƒ2  = .24). Two-way interactions did not significantly improve the model, F(3, 168) = 1.68, p = .174.

CONCLUSIONS

Habit and self-determined motivation were both important in narrowing the intention-behaviour gap for two key health behaviours, and combining these processes may better inform strategies to support people's intentions to improve these health behaviours.

Predicting Decisional Determinants of Physical Activity Among Older Adults: An Integrated Behavior Approach

The present study applied the Integrated Behavior Change Model to investigate how behavioral decisions are predicted, namely, intention, planning, and habits, with respect to physical activity. Methods: Participants were older adults (ages 65+) residing in the U.S. (N = 667) who completed online measures of behavioral determinants (autonomous motivation, perceived behavioral control, subjective norms, attitudes, intention, habit, and consistency), in addition to past behavior. Results: A structural equation model revealed that intention was predicted by past behavior and social-cognitive determinants. Social cognitive determinants mediated between past behavior and habit, as well as between autonomous motivation and habit. Intention mediated between past behavior and planning. Discussion: This study highlights the importance of multiple processes (social cognitive, habit/automatic, and post-intentional/planning) that formulate physical activity intentions. Mediation pathways revealed the importance of autonomous motivation for establishing intentions and habit. Facilitating these processes among older adults could be effective for promoting physical activity.

Predictors of physical activity behavior change based on the current stage of change-an analysis of young people from Hawai'i

This study investigated the corresponding change between psycho-social predictors and physical activity (PA) behavior and if these relationships were dependent on the stages of change from the Transtheoretical Model in Minority American adolescents. We conducted a longitudinal field study with N = 357 students aged 13-18 years (M = 14.24 years, SD = 0.88); predominantly Filipino (61.2%) using a test-retest design assessing psycho-social PA predictors (enjoyment, self-efficacy, family support, friends' support, knowledge, stage of change) and moderate-to-vigorous physical activity (MVPA) at two time points over six months. Hierarchical regression results indicated that a positive change of enjoyment, knowledge about PA and family support predicted a change of MVPA, independently of stage. The time-varying covariation showed the importance of the current stage of change for enjoyment, self-efficacy and support of friends for a change of MVPA. Overall, our findings suggest that an individual's current stage of change should be considered to determine individually appropriate starting points and goals for designing interventions to promote PA among Minority American adolescents.

Forming Habits, Overcoming Obstacles, and Setting Realistic Goals: A Qualitative Study of Physical Activity Maintenance Among Latinas

BACKGROUND

The impact of physical activity interventions for Latina women can be enhanced by identifying and implementing strategies to achieve long-term physical activity maintenance. Physical activity promotion research has mainly focused on physical activity initiation and we know little regarding individual, interpersonal, or environmental factors that influence maintenance of physical activity. This study aimed to qualitatively explore and understand factors associated with maintenance and non-maintenance of physical activity among Latinas.

METHODS

Semi-structured individual interviews were conducted with 21 Latinas who increased their physical activity as a result of an intervention, and who completed a 3-month maintenance period without contact from research staff. Data were analyzed using thematic analysis.

RESULTS

Important facilitators of physical activity maintenance described by participants included having made physical activity a habit; the ability to proactively overcome obstacles to engaging in physical activity, and satisfaction with outcomes obtained from engaging in physical activity. Additional facilitators mentioned by both maintainers and non-maintainers included having motivation, social support, and opportunities to be active. Both maintainers and non-maintainers reported high self-efficacy for PA maintenance in the future.

CONCLUSIONS

Guiding intervention participants to form habits and to set realistic expectations could help them to independently continue engaging in physical activity upon completion of physical activity interventions. Teaching them skills to proactively overcome obstacles may also be important for physical activity maintenance.

Role of received social support in the physical activity of coronary heart patients: The Health Action Process Approach

Physical activity (PA) plays a crucial role in the management of coronary artery disease (CAD). The Health Action Process Approach provides a useful framework for understanding and predicting the process of health behaviors. The aim of the current study was to unveil the role of received social support in the HAPA model, concerning the physical activity of CAD patients. A longitudinal sample of 117 CAD patients filled out a questionnaire during three measurement points (baseline, 2 months, and 6 months later). The constructs within the model were measured by the previously validated HAPA scales. PA was assessed with four items, which were also included in the HAPA questionnaire. To test the direct and indirect associations between the variables, structural equation modeling with latent variables was employed. Received social support was proven to have a significant and strong effect on both action planning and action control, suggesting a synergistic effect on the individual factors, as well as increasing the explained variance of PA. Results confirmed the important role of received social support in the PA of CAD patients. It could be presumed that strengthening the social support from family and friends could support the regular physical activity of CAD patients.

Severity of Overuse Injury Impacts Self-Efficacy and Quality of Life in Runners: A 2-Year Prospective Cohort Study

CONTEXT

While 55 million Americans incorporate running into their exercise routines, up to 65% of runners sustain an overuse injury annually. It has been consistently shown that regular physical activity positively impacts quality of life (QOL), an essential public health indicator; however, the impact of running-related injuries on QOL is unknown. This study seeks to determine whether overuse injury severity impacts QOL in recreational runners, and if self-efficacy mediates this relationship.

DESIGN

Community-based prospective cohort study of 300 runners who had been running injury free for at least 5 miles/wk in the past 6 months.

METHODS

Self-efficacy for running and QOL measures (Short Form-12 Physical Component and Mental Component, Satisfaction with Life, Positive Affect and Negative Affect) were assessed at baseline, time of injury, and follow-up visits. Over 2 years of observation, overuse injuries were diagnosed by an orthopedic surgeon and injured runners were referred to a physical therapist.

RESULTS

Injury severity was significantly (P < .01) related with 2 indices of QOL, such that the effect of injury severity was -2.28 units on the Short Form-12 physical component and -0.73 units on positive affect. Self-efficacy accounted for 19% and 48% of the indirect effects on Short Form-12 physical component and positive affect, respectively.

CONCLUSIONS

Since self-efficacy is a modifiable factor related to decreased QOL, these findings have important clinical implications for rehabilitation interventions.

"Why would you not listen? It is like being given the winning lottery numbers and deciding not to take them": semi-structured interviews with post-acute myocardial infarction patients and their significant others exploring factors that influence participation in cardiac rehabilitation and long-term exercise training

PURPOSE

Despite the clinical benefits, coronary artery disease patient participation rates in cardiac rehabilitation (CR) and long-term exercise are poor. This study explored the factors related to participation in these interventions from the perspectives of post-acute myocardial infarction (AMI) patients and their significant others.

METHODS

Semi-structured interviews were performed with post-AMI patients (number (n) = 10) and their significant others (n = 10) following phase-III and phase-IV CR. Reflexive thematic analysis with an inductive orientation was utilised to identify themes within the dataset (ClinicalTrials.gov identifier: NCT03907293).

RESULTS

The overarching theme of the data was a perceived need to improve health, with the participants viewing health benefits as the principal motive for participating in CR and long-term exercise training. Three further themes were identified: motivation, extrinsic influences, and CR experience. These themes captured the underlying elements of the participants' decision to take part in CR and long-term exercise training for the purpose of health improvements.

CONCLUSION

An AMI collectively impacts the attitudes and beliefs of patients and their significant others in relation to CR participation, long-term exercise, and health. The factors identified in this study may inform strategies to promote patient enrollment in CR and adherence to long-term exercise.IMPLICATIONS FOR REHABILITATIONPost-AMI patients and their significant others reported that health benefits were the primary motive for participating in CR and long-term exercise, with aspects related to motivation, extrinsic influences, and CR experience underpinning the decision.Healthcare professionals should supply information about health benefits during the CR referral process, with insights into the experiences of CR graduates potentially improving the strength of recommendation.CR facilitators may promote long-term exercise adherence by assisting patients with the identification of an enjoyable exercise modality.Healthcare professionals should include significant others in the CR referral process, which may enable these individuals to support the patients' decisions.

A Study of Leisure Walking Intensity Levels on Mental Health and Health Perception of Older Adults

Research suggests that different levels of intensity of leisure walking can affect the mental health of older adults. Unfortunately, insufficient evidence exists as to the recommended intensity levels of leisure walking for their health benefits. The purpose of this study was to investigate how leisure walking intensity levels are associated with the mental health and health perceptions of older adults. Using a purposive sampling method, the data of 4,737 adults over the age of 65 were drawn from the 2017 California Health and Interview Survey. The results of analysis of these data showed that older adults who engaged in moderate and vigorous leisure walking reported higher health perceptions than those involved in light leisure walking. In addition, older adults who participated in moderate leisure walking reported higher mental health than those who engaged in light leisure walking. This study suggests that moderate and/or vigorous leisure walking can increase the mental health and health perceptions of older adults.

Keep on running - a randomized controlled trial to test a digital evidence-based intervention for sustained adoption of recreational running: rationale, design and pilot feasibility study

BACKGROUND

This paper describes the rationale, intervention development, study design and results from the pilot feasibility study of the Keep On Running (KOR) trial. KOR aims to test a web-based brief theory-based intervention, targeting maintenance of recreational running behavior over time (i.e. relapse preventing).

METHODS

Intervention development was based both on Self-Determination Theory and on Self-Regulation Theory. As part of it, a pilot study was implemented (n=18) to measure intervention adherence and participant satisfaction in order to establish the feasibility and acceptability of the intervention toolkit. Furthermore, this pilot study was also used to test the feasibility and acceptability of the questionnaires selected to be part of the later RCT.

RESULTS

Pilot intervention acceptability was good, but overall adherence was low. Features such as feedback and social sharing should be added to the toolkit. The main trial should lessen questionnaire length and include data from usual monitoring gadgets and apps (APIs). The protocol of the RCT was adjusted to test the efficacy of the refined final version of the intervention, and the RCT that will test it, contributing to the understanding of recreational running sustainability, allowing the optimization of future interventions aimed at physical activity promotion.

Running prevalence in Portugal: Socio-demographic, behavioral and psychosocial characteristics

The purpose of this study was to cross-sectionally estimate the prevalence of recreational running in Portugal and describe characteristics of adult recreational runners. A random representative sample of 1068 Portuguese adults was selected. Socio-demographic information, physical activity habits and running behavior were assessed. Recreational runners’ training habits, motivations, barriers, vitality and flow were also assessed. The prevalence of recreational running in Portugal was 10.6%. It was higher in men (14.6% vs. 6.6%, p = .024) and in younger runners (13.6% vs. 7.7%, p = .026). Participants ran on average 3 times, 20 kilometers and 3 hours per week. General health orientation (88%), self-esteem (63%), and life meaning (57%) were the most predominant motives for running, while time was the most prevalent barrier (43%). This first Portuguese running prevalence representative study, indicates that almost 11% of adults ran regularly, and describes correlates of running, which can inform future running promotion interventions.

Adherence to and the Maintenance of Self-Management Behaviour in Older People with Musculoskeletal Pain-A Scoping Review and Theoretical Models

(1) Background: Adherence to and the maintenance of treatment regimens are fundamental for pain self-management and sustainable behavioural changes. The first aim was to study older adults’ (>65 years) levels of adherence to and maintenance of musculoskeletal pain self-management programmes in randomized controlled trials. The second aim was to suggest theoretical models of adherence to and maintenance of a behaviour. (2) Methods: The study was conducted in accordance with the recommendations for a scoping review and the PRISMA-ScR checklist. Capability, motivation and opportunity were used to categorize the behavioural change components in the theoretical models. (3) Results: Among the four studies included, components targeting adherence were reported in one study, and maintenance was reported in two studies. Adherence was assessed by the treatment attendance rates, and maintenance was assessed by the follow-up data of outcome measures. For adherence, the capability components were mostly about education and the supervision, grading and mastery of exercise to increase self-efficacy. The motivation components included the readiness to change, self-monitoring and goal setting; and the opportunity components included booster sessions, feedback and social support. For maintenance, the capability components consisted of identifying high-risk situations for relapse and problem-solving skills. The motivation components included self-regulation and self-efficacy for problem solving, and the opportunity components included environmental triggers and problem solving by using social support. (4) Conclusion: There are several behavioural change components that should be used to increase older adults’ levels of adherence to and maintenance of a pain self-management behaviour.

Maintenance motives for physical activity among older adults: a systematic review and meta-analysis

The purpose of this systematic review was to examine if the motives of satisfaction with outcomes, enjoyment of behavior, self-determination, and identity are related to physical activity (PA) maintenance in older adults. We also explored whether the strength of these associations varies as a function of sample characteristics (i.e., age, gender, physical health status) and maintenance context. Five electronic databases (PubMed, PsycINFO, SportDiscus, CINAHL, and ProQuest Dissertations and Theses) were searched, and sixteen studies (k) with a sample mean age ≥ 55 years were included. When the number of studies was ≥ 5 for a given motive, a pooled correlation coefficient was calculated using the inverse-variance method under the random-effects model assumption. Self-determination was positively associated with PA maintenance [r (95% CI) = 0.189 (0.127, 0.249); k = 11]. This association was stronger and more homogeneous for samples described as having a physical health condition (r = 0.212; k = 6) and studies judged to be at risk of bias due to missing data (r = 0.223; k = 8). Few studies (< 5) investigated satisfaction with outcomes, enjoyment of behavior, and identity, which precludes any summary judgment for these three motives. PROSPERO Registration Number: CRD42018088161.

Social support, adherence to Mediterranean diet and physical activity in adults: results from a community-based cross-sectional study

There is a growing recognition that social support can potentially exert consistent or opposing effects in influencing health behaviours. The present paper presents a cross-sectional study, including 2,064 adults from Italy, Spain and Greece, who were participants in a multi-centre randomised controlled trial (C4H study), aiming to examine whether social support is correlated with adherence to a healthy Mediterranean diet and physical activity. Social support data were available for 1,572 participants. The majority of the sample reported emotional support availability (84·5 %), financial support availability (72·6 %) and having one or more close friends (78·2 %). Mediterranean diet adherence was significantly associated with emotional support (P = 0·009) and social network support (P = 0·021). No statistically significant associations were found between participant physical activity and the social support aspects studied. In conclusion, emotional and social network support may be associated with increased adherence to the Mediterranean diet. However, further research is needed to evaluate the role of social support in adherence to healthy Mediterranean diet.

Motility in Frail Older Adults: Operationalization of a New Framework and First Insights into Its Relationship with Physical Activity and Life-Space Mobility: An Exploratory Study

In order to design effective interventions to prevent age-related mobility loss, it is important to identify influencing factors. The concept of "motility" by Kaufmann et al. subdivides such factors into three categories: "access", "skills", and "appropriation". The aim of this study was to assemble appropriate quantitative assessment tools for the assessment of these factors in frail older adults and to get first insights into their relative contribution for life-space and physical activity-related mobility. This is an exploratory cross-sectional study conducted with twenty-eight at least prefrail, retired participants aged 61-94. Life-space mobility was assessed using the "University of Alabama at Birmingham Life-space Assessment" (LSA) and physical activity using the "German Physical Activity Questionnaire" (PAQ50+). Factors from the category "appropriation", followed by factors from the category "skills" showed the strongest associations with the LSA. Factors from the category "access" best explained the variance for PAQ50+. This study's findings indicate the importance of accounting for and examining comprehensive models of mobility. The proposed assessment tools need to be explored in more depth in longitudinal studies with larger sample sizes in order to yield more conclusive results about the appropriateness of the motility concept for such purposes.

Young Adults' Short-Term Trajectories of Moderate Physical Activity: Relations With Self-Evaluation Processes

Young adults face numerous barriers that can undermine their engagement in healthy behaviors. For example, young adults on average experience disproportionally large declines in physical activity (PA) participation compared to other demographic groups. Self-evaluation processes may help explain these declines. This study investigated young adults’ weekly trajectories of moderate physical activity, exploring self-evaluation processes, including self-efficacy and shame as time-varying covariates. A total of 71 young adults (Mage = 21.25, SD = 1.18; 55% male) reported moderate physical activity, exercise self-efficacy, and anticipated shame toward exercise once a week for 5 weeks. Latent growth curve models showed that a linear slope fit these data better than alternative models. Parameters of the linear model revealed that these young adults reported engaging in 40 min of moderate PA approximately 3 days per week. However, there were physical activity differences in initial levels and rates of change. Exercise self-efficacy consistently predicted physical activity in a positive direction and with a small-to-medium magnitude. Anticipated shame was an inconsistent predictor of physical activity, showing a negative direction and small magnitude at time one and on average across the 5 weeks. These findings highlight considerable variability in young adults’ short-term trajectories of physical activity and underscore both positive and negative processes of exercise related self-evaluations. Future physical activity interventions targeting young adults should incorporate strategies that enhance self-efficacy (e.g., mastery experiences) and reduce feelings of shame (e.g., attribution training).

Determinants of physical activity maintenance during the Covid-19 pandemic: a focus on fitness apps

There are various health benefits of regular physical activity (PA) and health risks of sedentariness. The Covid-19 pandemic may have decreased PA and increased sedentariness for several reasons (e.g., closure of gyms, family-related time constraints, and reduced outdoor mobility). Yet, to date, there are no longitudinal studies that examined whether the pandemic affects PA levels and what factors help people remain physically active during lockdown. This study aims to investigate changes in U.S. residents’ PA during (vs. before) the Covid-19 pandemic and predictors of changes, with a focus on PA smartphone applications (apps) and their features (i.e., motivational, educational, or gamification related). The study utilized a two-wave longitudinal survey design with an online panel. Healthy adults (N = 431) from 45 U.S. states self-reported their PA levels before and during lockdown. PA app use and app feature ratings were assessed. t-tests and regression analyses were conducted. Moderate PA, vigorous PA, and PA measured in metabolic equivalent of task (MET) minutes per week decreased during lockdown (all p < .01). Controlling for PA before lockdown and individuals’ PA intentions, PA app use was positively related to overall change in PA, measured in MET minutes per week (β = 15.68, standard error = 7.84, p < .05). PA decreased less with increasing app use frequency. When app features were added to the model, a buffering effect for gamification features was identified. The Covid-19-caused lockdown decreased U.S. residents’ PA levels by 18.2%. The use of PA apps may help buffer the decline, and gamification-related app features may be particularly helpful in this context.

Do children's expectations about future physical activity predict their physical activity in adulthood?

Background

Much of the population fails to meet recommended physical activity (PA) levels, but there remains considerable individual variation. By understanding drivers of different trajectories, interventions can be better targeted and more effective. One such driver may be a person’s physical activity identity (PAI)—the extent to which a person perceives PA as central to who they are.

Methods

Using survey information and a unique body of essays written at age 11 from the National Child Development Study (N = 10 500), essays mentioning PA were automatically identified using the machine learning technique support vector classification and PA trajectories were estimated using latent class analysis. Analyses tested the extent to which childhood PAI correlated with activity levels from age 23 through 55 and with trajectories across adulthood.

Results

42.2% of males and 33.5% of females mentioned PA in their essays, describing active and/or passive engagement. Active PAI in childhood was correlated with higher levels of activity for men but not women, and was correlated with consistently active PA trajectories for both genders. Passive PAI was not related to PA for either gender.

Conclusions

This study offers a novel approach for analysing large qualitative datasets to assess identity and behaviours. Findings suggest that at as young as 11 years old, the way a young person conceptualizes activity as part of their identity has a lasting association with behaviour. Still, an active identity may require a supportive sociocultural context to manifest in subsequent behaviour.

Behavior Change Techniques Associated With Changes in Postintervention and Maintained Changes in Self-Efficacy For Physical Activity: A Systematic Review With Meta-analysis

BACKGROUND

Self-efficacy is an important determinant of physical activity but it is unclear how best to increase self-efficacy for physical activity and to maintain these changes.

PURPOSE

This systematic review aimed to identify which specific behavior change techniques (BCTs), BCT clusters, and number of BCTs were associated with changes in postintervention and maintained changes in self-efficacy for physical activity across all adult populations.

METHODS

A systematic search yielded 180 randomized trials (204 comparisons) which reported changes in self-efficacy. BCTs were coded using the BCT Taxonomy v1. Hierarchical cluster analysis explored the clustering of BCTs. Meta-analyses and moderator analyses examined whether the presence and absence of individual BCTs in interventions were associated with effect-size changes for self-efficacy.

RESULTS

Small intervention effects were found for postintervention self-efficacy for physical activity (d = 0.26; 95% CI: [0.21, 0.31]; I2 = 75.8 per cent). "Information about social, environmental, and emotional consequences" was associated with higher effect sizes, whereas "social support (practical)" was associated with lower effect sizes. Small and nonsignificant effects were found for maintained changes in self-efficacy for physical activity (d = 0.08; CI: [-0.05, 0.21]; I2 = 83.8 per cent). Lack of meaningful clustering of BCTs was found. A significant positive relationship was found between number of BCTs and effect sizes for maintained changes in self-efficacy for physical activity.

CONCLUSIONS

There does not appear to be a single effective approach to change self-efficacy for physical activity in all adults: different approaches are required for different populations. Interventions with more BCTs seem more effective at maintaining changes in self-efficacy for physical activity.

Results From the 2019 ParticipACTION Report Card on Physical Activity for Adults

BACKGROUND

The ParticipACTION Report Card on Physical Activity for Adults is a knowledge exchange tool representing a synthesis of the literature and data available at the national level. The purpose of this paper is to summarize the results of the inaugural 2019 edition.

METHODS

Thirteen physical activity indicators, grouped into 4 categories, were graded by a committee of experts using a process that was informed by the best available evidence. Sources included national surveys, peer-reviewed literature, and gray literature such as government and nongovernment reports and online content.

RESULTS

Grades were assigned to Daily Behaviors (overall physical activity: D; daily movement: C; moderate to vigorous physical activity: F; muscle and bone strength: INC; balance: INC; sedentary behavior: INC; sleep: B-), Individual Characteristics (intentions: B+), Settings and Sources of Influence (social support: INC; workplace: INC; community and environment: B-; health and primary care settings: C-), and Strategies and Investments (government: B-).

CONCLUSIONS

Generally, lower grades were given to behavior-related indicators (eg, overall physical activity) and better grades for indicators related to investments, community supports, and strategies and policies. Research gaps and future recommendations and directions are identified for each indicator to support future practice, policy, and research directions.

Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic

Background: From March to May 2020, lockdown measures were adopted in Italy to contain the epidemic of the novel Coronavirus. People were forced to restrict their movement and social contacts, therefore having a higher risk of inactivity. This study, carried out among Italian undergraduates, explored their sedentary and physical activities (PA) during the lockdown with respect to their previous habits. Methods: An electronic questionnaire was administered once to students attending three Italian universities after the end of lockdown. Results: A total of 1430 students (mean age 22.9 ± 3.5 years, 65.5% females) completed the questionnaire. All the sedentary behaviors increased significantly, and all the physical activities decreased significantly during the lockdown. Time spent using electronic devices showed the highest increase (+52.4 min/day), and walking the greatest decrease (-365.5 min/week). Being younger than 22 years old, female, and previously active, attending the universities of Naples and Rome and having at least one graduate parent were associated with the achievement of recommended levels of PA even during the lockdown. Conclusions: This study highlights the reduction of PA among Italian undergraduates in the course of home-confinement due to the CoViD-19 pandemic. The practice of adequate PA during the lockdown was mainly associated with the previous adoption of an active lifestyle. Promoting active lifestyles during the non-pandemic period may have had positive effects also in case of lockdown.

What Keeps Them Going, and What Gets Them Back? Older Adults’ Beliefs About Physical Activity Maintenance

Background and Objectives

The overall purpose of this article was to investigate beliefs related to physical activity maintenance among adults aged 60 years or older.

Research Design and Methods

Study 1 identified modal, salient behavioral, normative, and control beliefs using a free-response format. Study 2 was designed to gain a deeper understanding about these beliefs through in-depth semistructured interviews.

Results

Findings indicate that perceived physical and emotional benefits, scheduling and having a physical activity routine, social support, and features of indoor and outdoor locations are facilitating of maintenance. Some beliefs appear more relevant to sustained engagement in physical activity, while others may be more helpful for reengagement after 1 week of inactivity.

Discussion and Implications

This investigation raises new hypotheses for future research and provides insight for the use and adaptation of behavior change strategies that are potentially more acceptable and effective for the promotion of physical activity maintenance for older adults.

Motivational factors for initiating and maintaining physical activity among adults aged over fifty targeted by a tailored intervention

Objective: To provide insight into the motivational working mechanisms (i.e. mediators) of an effective physical activity (PA) intervention for adults aged over fifty.Design: The mediation model (N = 822) was investigated in an RCT for the total intervention population, participants who were not norm-active at baseline (targeting PA initiation) and norm-active participants (targeting PA maintenance) separately.Main Outcome Measures: Potential mediators (attitude, self-efficacy, intention, action planning and coping planning) of the effect on PA (6-months) were assessed at baseline, 3 and/or 6 months.Results: The intervention resulted in a decrease in intention (B= -.209; p=.017), and an increase in action planning (B=.214; p=.018) and PA (B=.220; p=.002). Intention and action planning did not mediate the effect on PA. Self-efficacy, although not significantly influenced by the intervention, was found to be the only motivational variable that predicted change in PA (B=.164; p=.007). These results were confirmed among participants initiating PA. Among norm-active participants no significant intervention effects were identified.Conclusion: The motivational factors cannot explain the intervention effect on PA. Most likely, the effect can be explained by an interaction between the motivational factors together. Differences between participants initiating versus maintaining PA, highlight the importance of performing mediation analyses per subgroup.

Novel Digital Architecture of a "Low Carb Program" for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes

Globally, the burden of noncommunicable diseases such as type 2 diabetes is crippling health care systems. Type 2 diabetes, a disease linked with obesity, affects 1 in every 30 people today and is expected to affect 1 in 10 people by 2030. Current provisions are struggling to manage the trajectory of type 2 diabetes prevalence. Offline, face-to-face education for patients with type 2 diabetes has shown to lack long-term impact or the capacity for widespread democratized adoption. Digitally delivered interventions have been developed for patients with type 2 diabetes, and the evidence shows that some interventions provide the capacity to support hyperpersonalization and real-time continuous support to patients, which can result in significant engagement and health outcomes. However, digital health app engagement is notoriously difficult to achieve. This paper reviews the digital behavior change architecture of the Low Carb Program and the application of health behavioral theory underpinning its development and use in scaling novel methods of engaging the population with type 2 diabetes and supporting long-term behavior change.