Examination of the Validity of a Stages of Exercise Change Algorithm

Transtheoretical Model for Exercise: Measure Redevelopment and Assessing the Role of Barriers in a Diverse Population

PURPOSE

To redevelop and improve Transtheoretical Model (TTM) exercise measures for Black and Hispanic/Latinx adults. The redeveloped scales will address barriers to exercise potentially relevant to populations of color in the United States (US).

DESIGN

Cross-sectional, split-half measure development.

SETTING

Online survey in the US.

SUBJECTS

450 Black and/or Hispanic/Latinx adults.

MEASURES

Demographics, exercise engagement (IPAQ-SF), stage of change (SOC), decisional balance (DCBL), self-efficacy (SE), and barriers to exercise.

ANALYSIS

Split-half exploratory (EFA) and confirmatory factor analyses (CFA) were executed to establish measurement structure and fit, followed by multivariate analyses to assess constructs by SOC.

RESULTS

EFA/CFA for DCBL revealed three factors (α = .85, .70, .75) which represented Pros of exercise, Cons of exercise related to time and safety, and Cons of exercise related to physical or emotional discomfort. Model fit was adequate (CFI = .89). For SE, two factors (α = .85, .77) resulted with good model fit (CFI = .91). These factors reflected self-efficacy to exercise when confronted with generally challenging situations, and self-efficacy to exercise when specifically experiencing affective difficulties, such as depression or anxiety. Lastly, a novel Barriers measure resulted in three factors (α = .82, .77, .76), representing barriers encountered due to family responsibilities, work obligations, and health challenges, with good model fit (CFI = .95). Shifts in the core TTM constructs by SOC largely mapped onto the theoretical trends expected under the TTM.

CONCLUSION

This study produced systematically developed TTM exercise measures for Black and Hispanic/Latinx adults in the US that address and incorporate important barriers to exercise. This research represents an important step forward in broadening the inclusion of diverse populations to TTM measure development processes and may lead to a better understanding of relevant factors impeding exercise engagement in the US.

Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility

PURPOSE

To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention.

METHODS

The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5-10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m²), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion.

RESULTS

Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05-1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01-1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3-13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04).

CONCLUSIONS

Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support.

TRIAL REGISTRATION

The LIFEstyle study was registered at the Dutch trial registry (NTR 1530; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530 ).

The efficacy of a self-managed Acceptance and Commitment Therapy intervention DVD for physical activity initiation

OBJECTIVES

Initiating and maintaining physical activity presents the individual with challenges of inconvenience, discomfort, and counteractive energy. Addressing these challenges requires an intervention that elicits motivation to engage in this activity, minimizes the direct relationship between unwanted internal experiences and inaction, and is also in itself accessible and convenient. Accordingly, this study investigated the efficacy of a self-managed Acceptance and Commitment Therapy (ACT) intervention delivered via DVD and tailored for physical activity initiation.

DESIGN AND METHODS

Fifty-nine minimally active community participants were randomly allocated to receive a 12-week pedometer-based walking programme, or the same walking programme with the additional provision of the ACT DVD. The primary outcome was overall physical activity level (assessed at baseline and post-intervention), and the secondary outcome was pedometer-assessed step count (measured at 4-weekly intervals throughout the intervention period).

RESULTS

Participants who received the ACT DVD achieved a significantly greater increase in physical activity levels post-intervention, were more likely to achieve the goals specified in the programme, and reported a higher average step count than participants who received the walking programme in isolation.

CONCLUSIONS

The ACT intervention, delivered via DVD for the promotion of physical activity, proved a simple, efficient, and accessible method to encourage positive short-term increases in an important health-promoting behaviour. Statement of contribution What is already known? ACT interventions can increase physical activity levels through augmenting initiatory self-regulatory control. Face-to-face delivery presents challenges of accessibility and feasibility for community implementation. There is a need for effective interventions that maximize impact while minimizing inconvenience. What does this study add? Supplementing a walking programme with a self-managed ACT DVD produced significant increases in physical activity. The ACT DVD is a convenient, accessible, and potentially cost-effective approach to physical activity initiation. ACT lends itself to implementation as a self-managed electronically delivered intervention.

Assessing the Stages of Change Among African American Women in a Weight Management Program

The objective of this study was to assess the relationship between stage of change (SOC) and behavioral outcomes among African American women entering obesity treatment in two settings. Fifty-five overweight/obese (body mass index = 26.50-48.13), but otherwise healthy African American women, 23 to 56 years old, attended a 13-week weight loss-treatment program that took place at churches (n = 36) or a university (n = 19). Participants were weighed, completed SOC measures, and had a physical fitness test at pre- and posttreatment. Pretreatment measures of SOC placed 47% of the participants as actors, 31% as contemplators, and 22% as maintainers. Of the 45 women who reported posttreatment SOC, 7% regressed, 44% did not change, and 31% progressed in SOC. Pretreatment SOC predicted posttreatment weight loss in the church setting but not in the university setting. At churches, contemplators lost more weight than actors and maintainers. The church may be a more conducive setting for weight change behaviors for African American women who are categorized as contemplators in the SOC model.

Increasing the motivation for physical activity in obese patients

OBJECTIVE

In this randomized controlled study, a standardized motivation intervention was compared with a relaxation intervention with regard to its effectiveness in decreasing dropout rates and increasing physical activity in a sample of obese patients.

METHOD

Thirty-eight obese participants were randomly assigned to a one-session motivation or relaxation intervention. Thereafter, both groups participated in an 8-week aerobic program. Adherence, physical activity, motivational stage of change, and body mass index (BMI) were assessed during intervention and at 3- and 6-month follow-ups.

RESULTS

During the aerobic program, the motivation group showed significantly fewer dropouts but comparable adherence if only completers were considered. Moreover, their weekly minutes of physical activity increased over time before leveling off, whereas steady decreases were observed in the relaxation group. For motivational stage of change and BMI, no significant group differences were observed.

DISCUSSION

The importance and efficacy of motivational interventions in enhancing the high dropout rates in obesity treatment is underlined.

A tailored Internet-plus-email intervention for increasing physical activity among ethnically-diverse women

OBJECTIVE

To evaluate the feasibility and efficacy of an individually tailored, Internet-plus-email physical activity intervention designed for adult women.

METHOD

Healthy and ethnically-diverse adult females (N=156) (mean age=42.8 years, 65% Caucasian) from California were randomly assigned to an intervention (access to a tailored website and weekly emails) or wait-list control group. Participants completed web-based assessments of physical activity, stage of behavior change, and psychosocial variables at baseline, one month, two months, and three months. Data were collected during 2006-2007. Multilevel random coefficient modeling examined group differences in rates of change.

RESULTS

As compared to the control condition, the intervention group increased walking (+69 versus +32 min per week) and total moderate-to-vigorous physical activity (+23 versus -25 min per week) after three months. The intervention did not impact stage of behavior change or any of the other psychosocial variables.

CONCLUSION

A tailored, Internet-based intervention for adult women had a positive effect on walking and moderate-to-vigorous physical activity in an ethnically-diverse sample. However, given the lack of comparable research contact in the control group, these findings should be taken cautiously.