Preparing for physical activity: pedometer acquisition as a self-regulatory strategy

Salutogenesis intervention improves cardio-cerebrovascular health in at-risk office workers: A quasi-experimental study

OBJECTIVE

Cardio-cerebrovascular disease is the major cause of work-related deaths. Salutogenesis indicates individual differences in health levels occur owing to differences in the sense of coherence (SOC). A salutogenesis-based intervention may promote cardio-cerebrovascular health at work. This study examined the effects of a SOC promotion program based on salutogenesis.

DESIGN

Quasi-experimental study.

SAMPLE

Fifty-six office workers who were above the "low risk" of cardio-cerebrovascular disease from two workplaces were included in the final analysis.

MEASUREMENTS

Data collected pre- and postintervention. To determine the intervention's effectiveness, repeated-measures analysis of variance was used.

INTERVENTION

The intervention group was provided with the SOC promotion program, whereas the control group was provided with educational materials alone for 12 weeks.

RESULTS

Generalized resistance resources (GRRs; knowledge of cardio-cerebrovascular disease prevention, stress-coping strategies, and social support) and SOC significantly improved in the intervention group. The intervention group showed significant improvements in occupational stress, physical activity, dietary behavior, total cholesterol level, fasting glucose level, hemoglobin A1C level, body mass index, waist circumference, diastolic and systolic blood pressure, and cardio-cerebrovascular risk.

CONCLUSIONS

Systematic salutogenesis-based SOC promotion programs should be established to enhance the cardio-cerebrovascular health of office workers at-risk of cardio-cerebrovascular diseases.

TRIAL REGISTRATION

Trial Registration Number is KCT0007029. The date of registration is February 23, 2022.

Interventions to increase physical activity level in patients with whole spectrum chronic kidney disease: a systematic review and meta-analysis

Background: Little is known about effective interventions to increase physical activity levels in this population. This systematic review and meta-analysis evaluated the effectiveness of different interventions for physical activity levels in whole-spectrum CKD patients.Methods: In this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from inception to December 2022, with an update in March 2023. Studies of clinical interventions based on assessing physical activity outcomes (e.g., daily steps, time spent doing physical activity) in patients with whole-spectrum CKD were included. The pooled effect size was calculated using a restricted maximum likelihood method and reported as a standardized mean difference (SMD) with 95% confidence interval (95% CI).Results: The systematic review included 2,156 participants (59.9 ± 8.7 years) from 35 studies. Interventions aimed at modifying physical activity were associated with significantly higher physical activity levels in patients with CKD (SMD = 0.22; 95% CI: 0.08 to 0.36; I2 = 55%). Exercise-based interventions and real-time step feedback increased physical activity by 0.26 (95% CI: 0.07 to 0.45; I2 = 59%) and 0.36 (95% CI: 0.12 to 0.60; I2 = 0%) standard deviations, respectively. Effect sizes did not vary by disease stage or study duration; however, there was evidence of small study or publication bias for the primary analysis.Conclusion: In this systematic review and meta-analysis, intervention strategies aimed at modifying physical activity were associated with significantly increased physical activity levels in patients with whole-spectrum CKD.

A randomized study to evaluate the effect of exercise on fatigue in people with relapsing-remitting multiple sclerosis treated with fingolimod

Background

Fatigue is a major symptom of multiple sclerosis (MS) in patients, and it has been shown to improve with physical exercise. Although fingolimod might lessen fatigue, it is unclear how patients treated with fingolimod react to physical activity regarding fatigue.

Objective

This study evaluated the effect of an exercise intervention on fatigue in relapsing–remitting MS patients receiving fingolimod.

Methods

People with MS (PwMS) were randomized to either a structured internet-based exercise program (e-training) or no e-training intervention. The primary endpoint was the change in the Modified Fatigue Impact Scale (mFIS) after six months.

Results

The primary analysis showed no statistically significant difference between groups in the mFIS change. Subgroup analyses revealed a beneficial effect of physical exercise for PwMS with low aerobic capacity and with low aerobic capacity plus more severe fatigue. The incidence of adverse events was similar in both groups. No cardiovascular events were reported. The majority of PwMS were relapse free.

Conclusion

Physical exercise benefits on fatigue may depend on the physical capacity of the patient and requires individualized training. Consistent with previous studies, these results suggest that physical exercise generally does not impose a risk and that this holds true also for patients receiving fingolimod.

Trial registration: ClinicalTrials.gov, NCT01490840.

From action planning and plan enactment to fruit consumption: moderated mediation effects

OBJECTIVES

Sufficient fruit consumption is beneficial for a healthy live. While many Dutch adults intent to eat the recommended amount of fruit, only 5-10% of the population actually adheres to the recommendation. One mechanism that can help to narrow this gap between intention and actual fruit consumption is action planning. However, action planning is only assumed to be effective if plans are enacted. This study assessed which action plans are made and enacted, and further aimed to investigate two main hypotheses: 1. the effect of action planning (at T1) on fruit consumption (at T2) is mediated by plan enactment (at T3); 2. positive intentions (2a), high self-efficacy (2b) and a strong habit to eat fruit (2c) enhance the mediation of plan enactment, whereas a strong habit to eat snacks (2d) hinders the mediation of plan enactment.

METHODS

This study was a self-reported longitudinal online survey study. A total of 428 participants filled in a survey, measuring demographic factors (e.g. gender, age, education level), several socio-cognitive constructs (i.e. attitudes, self-efficacy, habit, action planning, plan enactment), and fruit consumption, at three points in time (baseline, after 1 month, and after 3 months). Mediation and moderated mediation analyses were used to investigate the planning-plan enactment- fruit consumption relationship.

RESULTS

Up to 70% of the participants reported to have enacted their T1 action plans at T2. Action planning on fruit consumption was fully mediated by plan enactment (Hypothesis 1). All four proposed moderators (i.e. intention, self-efficacy, habit to consume fruit, and habit to consume snacks) significantly influenced the mediation (Hypotheses 2a-2d). Mediation of plan enactment was only present with high levels of intention, high levels of self-efficacy, strong habits to eat fruit, and weak habits to eat snacks.

CONCLUSION

The study suggests the importance of plan enactment for fruit consumption. Furthermore, it emphasizes the necessity of facilitating factors. High levels of intention, self-efficacy and a strong habit to consume fruit clearly aid the enactment of action plans. This suggests that when these factors are moderately low, plan enactment may fail and thus an intervention may require first steps to foster these moderating factors.

Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial

Background

Pulmonary rehabilitation programs often fail to substantially enhance long-term physical activity in patients with chronic obstructive pulmonary disease (COPD). The reasons for successful physical activity changes in patients with COPD are not well understood. The need to better understand the determinants of physical activity in patients with COPD and effective rehabilitation strategies to improve physical activity is evident.

Methods/design

The STAR study (Stay Active after Rehabilitation) investigates, in a randomized controlled trial, the additional effect of a pedometer-based behavior-change intervention during inpatient pulmonary rehabilitation on objectively measured physical activity 6 weeks and 6 months post rehabilitation. The intervention uses the behavior-change techniques (1) instruction on how, where and when to perform the behavior, (2) prompt goal setting for physical activity, (3) prompt self-monitoring of behavior, and (4) feedback on behavior. The primary outcome of physical activity will be measured using a physical activity monitor (Actigraph wGT3X-BT) for a period of 7 days, firstly 2 weeks before rehabilitation begins (t0) as well as 6 weeks and 6 months after rehabilitation (t3, t4). Additionally, to predict physical activity progression after rehabilitation, a complex personal diagnostics battery, including questionnaires as well as functional assessments, is to be carried out at the start and end of rehabilitation (t1, t2). This battery is based on the foundational ideas of the Physical Activity-Related health Competence model.

Five hundred and two patients with COPD, aged 18 years or older and admitted for an approved pulmonary rehabilitation, will be enrolled in the STAR study.

Discussion

The STAR study is designed as a randomized controlled trial to gain a better understanding of the personal determinants of physical activity in patients with COPD and to evaluate a pedometer-based physical activity-change intervention in the context of inpatient pulmonary rehabilitation. The results enable the future identification of patients with COPD who will find it difficult to engage in long-term physical activity after rehabilitation. Based on this, intervention strategies to promote physical activity in the content of pulmonary rehabilitation can be optimized.

Trial registration

Clinicaltrials.gov, ID: NCT02966561. Registered retrospectively after the start of the recruitment in June 2016 on 22 November 2016. All protocol modifications will be registered in the trial registry.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2124-z) contains supplementary material, which is available to authorized users.

Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive

Background

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems. Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Methods

The OncoActive intervention was developed through systematic adaptation of a proven effective, evidence-based, computer-tailored PA intervention for adults over fifty, called Active Plus. The Intervention Mapping (IM) protocol was used to guide the systematic adaptation. A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed. Change objectives, theoretical methods and applications and the actual program content were adapted to address the specific needs, beliefs and cancer-related issues of prostate and colorectal CPS. Intervention participants received tailored PA advice three times, on internet and with printed materials, and a pedometer to set goals to improve PA. Pre- and pilot tests showed that the intervention was highly appreciated (target group) and regarded safe and feasible (healthcare professionals). The effectiveness of the intervention is being evaluated in a randomized controlled trial (RCT) (n = 428), consisting of an intervention group and a usual care waiting-list control group, with follow-up measurements at three, six and twelve months. Participants are recruited from seventeen hospitals and with posters, flyers and calls in several media.

Discussion

Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Trial registration

The study is registered in the Dutch Trial Register (NTR4296) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4296.

Integrating Mobile Fitness Trackers Into the Practice of Medicine

Mobile fitness trackers are increasingly used by patients as a means to become more involved in their own self-care; however, these devices measure disparate outcomes that may have equivocal relevance to true health status. It is vital for physicians to interpret both the quality and accuracy of the information that these trackers provide, and it is important to delineate which role, if any, these devices may serve in promoting quality patient care in the future. Potential benefits of mobile fitness trackers include the ability to motivate patients toward a healthier lifestyle, to develop a community of like-minded individuals seeking to improve their health, as well as to create an environment of sustainability and accountability for long-term promotion of health maintenance. However, limitations include the fact that mobile fitness trackers are not regulated by the Food and Drug Administration, that the employed metrics are not necessarily the best surrogates for true health status, and that the accuracy of measured endpoints has not yet been proven. As mobile fitness trackers both continue to rise in popularity and become increasingly sophisticated, physicians must be equipped to interpret and use this technology to better serve patients within an ever-changing, more technology-reliant health care system.

Self-efficacy, planning, and preparatory behaviours as joint predictors of physical activity: A conditional process analysis

OBJECTIVE

Planning can bridge the gap between intentions and action, but what bridges the gap between planning and action? This study helps to answer the question by disentangling the interrelationships between self-efficacy, planning and preparatory behaviours in predicting physical activity. Preparatory behaviours are tested as a working mechanism of planning. Moreover, it is tested whether the utility of preparatory behaviours depends on an individual's level of self-efficacy.

METHODS

A survey assessed planning, self-efficacy and preparatory behaviours for physical activity. Adults (N = 166) provided data at two measurement points. In a longitudinal model, preparatory behaviours were specified as a mediator between planning and physical activity. Self-efficacy was specified as a possible moderator at two points in the model.

RESULTS

Preparatory behaviours mediated the relationship between planning and physical activity. An interaction between self-efficacy and preparatory behaviours on physical activity was found, indicating that individuals with low self-efficacy beliefs were more active if they engaged more frequently in preparatory behaviours.

CONCLUSION

Planning seems to stimulate preparatory behaviours, which in turn make future physical activity more likely. Furthermore, as performing preparatory behaviours represent a step forward towards the enactment of behavioural goals, preparatory behaviours may be particular beneficial for individuals afflicted by self-doubts regarding physical activity.

Preparatory Behavior for Condom Use Among Heterosexual Young Men

Objective. Motivation is not sufficient to actually use condoms, as self-regulatory processes are needed to translate motivation into action. Buying condoms and carrying them constitute preparatory behaviors that may serve as proximal predictors of action. Whether or not such preparatory behaviors operate as mediators between intention and action within a broader behavior change framework has been examined. Method. A sample of 150 heterosexual men between ages 18 and 25 years responded at three points in time to a computer-based survey that assessed behavior as well as social-cognitive antecedents. A structural equation model was specified that included preparatory behaviors and self-efficacy as mediators at Time 2. Results. Preparatory behaviors were the most proximal predictors of condom use, and they were, themselves, predicted by self-efficacy and intention. The latter was partly determined by positive emotional outcome expectancies. Conclusion. To bridge the intention-behavior gap, preparatory behaviors play a mediating role, and they represent a side of planning that constitutes the most proximal predictor of condom use.