Sources of Perceived Self-Efficacy as Predictors of Physical Activity in Older Adults

Satisfaction with the Exercise Program and Successful Aging Among Older Adults Who Exercise Regularly: The Multiple Mediation of Physical Self-Efficacy and Exercise Adherence

OBJECTIVES

As the Republic of Korea transitions towards a super-aged society, the health and mental well-being of older adults are emerging as critical issues. While many researchers are focusing on successful aging among older adults who participate in exercise, there is a research gap in the Korean literature regarding the preconditions that foster this outcome. Therefore, this study analyzed the relationship between satisfaction and exercise, physical self-efficacy (PSE), exercise adherence, and successful aging among Korean older adults who exercise regularly.

METHODS

The participants were 369 (234 male and 135 female) older adults aged 65 or older living in the Republic of Korea, with an average age of 69.91 years. Data were collected from March 2024 to June 2024 and analyzed using descriptive statistics, correlation analysis, and structural equation modeling.

RESULTS

There was no problem with the model fit. Satisfaction with exercise positively affected PSE (β = 0.317, p < 0.001), exercise adherence (β = 0.487, p < 0.001), and successful aging (β = 0.669, p < 0.001). PSE positively affected exercise adherence (β = 0.356, p < 0.001), and exercise adherence positively affected successful aging (β = 0.190, p < 0.05). Furthermore, PSE (β = 0.019, p < 0.01) and exercise adherence (β = 0.081, p < 0.05) mediated the relationship between satisfaction with exercise and successful aging.

CONCLUSIONS

Satisfaction with exercise is important for promoting successful aging among Korean older adults who exercise. Satisfaction with exercise can increase their efficacy for performing physical activities and encourage them to continue exercising. This can ultimately lead to a happy life in old age.

Volunteer-led online group exercise for community-dwelling older people: a feasibility and acceptability study

BACKGROUND

Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs.

METHODS

This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months.

RESULTS

Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37-67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, p = 0.13). Twenty volunteers, older adults, and staff were interviewed and found the intervention acceptable. The seated exercises were perceived as safe, manageable, and enjoyable.

CONCLUSIONS

Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff.

TRIALS REGISTRATION

NCT04672200.

Feasibility, Psychosocial Effects, Influence, and Perception of Elastic Band Resistance Balance Training in Older Adults

This study utilised feedback from older adults during balance-challenging, elastic band resistance exercises to design a physical activity (PA) intervention.

METHODS

Twenty-three active participants, aged 51-81 years, volunteered to perform a mini balance evaluation test and falls efficacy scale, and completed a daily living questionnaire. Following a 10 min warm-up, participants performed eight pre-selected exercises (1 × set, 8-12 repetitions) using elastic bands placed over the hip or chest regions in a randomised, counterbalanced order with 15 min seated rests between interventions. Heart rate (HR) and rate of perceived exertion (RPE) were measured throughout. Participant interview responses were used to qualify the experiences and opinions of the interventions including likes, dislikes, comfort, and exercise difficulty.

RESULTS

Similar significant (p < 0.01) increases in HR (pre- = 83-85 bpm, mid- = 85-88 bpm, post-intervention = 88-89 bpm; 5-6%) and RPE (pre- = 8-9, mid- = 10, post-intervention = 10-11) were detected during the PA interventions (hip and chest regions). Interview data revealed that participants thought the PA interventions challenged balance, that the exercises would be beneficial for balance, and that the exercises were suitable for themselves and others. Participants reported a positive experience when using the PA interventions with an elastic band placed at the hip or chest and would perform the exercises again, preferably in a group, and that individual preference and comfort would determine the placement of the elastic band at either the hip or chest.

CONCLUSION

These positive outcomes confirm the feasibility of a resistance band balance program and will inform intervention design and delivery in future studies.

Using wearables to promote physical activity in old age : Feasibility, benefits, and user friendliness

Background

Wearables provide new opportunities to promote physical activity also among older adults but data on effectiveness and user friendliness are rare.

Objective

The effects of a comprehensive self-regulative intervention on moderate to vigorous physical activity (MVPA) and number of steps were examined using commercially available activity trackers. Acceptance regarding the devices was analysed in various domains.

Methods

In this study 80 older adults (mean = 67.03 years, standard deviation = 3.97 years; 59% women) wore a Fitbit Charge HR for 21 days including a baseline, a postintervention and a follow-up week. The intervention comprised feedback, goal setting and planning and 50% of the participants were additionally randomized to a role model component. Social cognitive predictors based on the health action process approach (HAPA) and user experience were assessed via questionnaires.

Results

The MVPA increased by an average of 19 min per week and steps by 1317 per day. An additional benefit of the role model component could be observed for MVPA. In the follow-up, the intervention effect was still significant for the number of steps, while MVPA dropped back to baseline. Multilevel models including HAPA variables explained small but significant amounts of variance in MVPA (8% within-person, 26% between-person) and steps (11% within-person, 12% between-person). User experience was rated as very high.

Conclusion

Providing an intervention based on established behavior change techniques and self-monitoring via wearables seems to be effective for increasing physical activity among older adults. The HAPA variables seem to play a limited role to explain activity levels. Acceptance of wearables can be expected to be high.

Supplementary Information

The online version of this article (10.1007/s00391-022-02083-x) contains supplementary material, which is available to authorized users.

Telephone-based support for physical activity: Results and lessons learned during the COVID-19 pandemic

Physical activity is essential to maintain physical and mental well-being. During the COVID-19 pandemic, in-person physical activity opportunities were limited. This paper describes a telephone-based physical activity support strategy among racially/ethnically diverse patients during the COVID-19 pandemic. Adult patients at a large, Federally Qualified Health Center with an on-site exercise facility referral were eligible to transition to telephone support with personal fitness advisors during the pandemic stay-at-home orders. Baseline surveys assessed physical activity and environmental characteristics; follow-up phone calls used motivational interviewing and physical activity goal setting strategies. From March 23-July 23, 2020, 72 patients participated in 270 phone calls, or 3.8 (±2.1) calls per participant. Participants were, on average, aged 51.3 (±11.6) years, 87.5% female, 31.9% Hispanic/Latino, and 47.2% non-Hispanic Black. Patients meeting physical activity guidelines pre-pandemic reported more planned exercise (100.0% vs. 55.3%; p<0.001), exercise days at home (5.0 vs. 1.7; p<0.001), and accomplishment of personal physical activity goals (57.0% vs. 39.7%; p = 0.11) than patients not meeting guidelines pre-pandemic. Patients with a home treadmill participated in twice the rate of calls compared to those without (RR = 2.22; 95%CI:1.35,3.64), but no other home environmental characteristics predicted participation rate. Pre-pandemic physical activity behavior appeared to predict pandemic physical activity and telephone-based physical activity support was effective for maintaining physical activity for some participants. Long term applications of this work will support continuity of clinic-community partnerships for health behavior change and provide a model for patient physical activity support by community health centers without on-site exercise facilities.

The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial

Background

Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise.

Objective

This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment.

Methods

Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session.

Results

In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology.

Conclusions

The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments.

Trial Registration

German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759

Movement as medicine for cardiovascular disease prevention: A pilot feasibility study of a physical activity promotion intervention for at-risk patients in primary care (Preprint)

Background

Objective

Methods

Results

Conclusions

Trial Registration

Brain Vitality Enhancement (BRAVE) program to promote brain health among persons with mild cognitive impairment: A study protocol

AIM

This study aims to evaluate the effects of a community-based program entitled 'Brain Vitality Enhancement (BRAVE)' on the cognitive function, physical and mental well-being of persons with mild cognitive impairment.

STUDY DESIGN

This is a parallel wait list randomized controlled trial.

METHODS

The BRAVE program consists of two phases. Phase 1 is an empowerment workshop for training 50 peer mentors to be the exercise ambassadors, while Phase 2 is a supervised exercise program for 250 persons with mild cognitive impairment. They will be randomly allocated to intervention or wait list control groups. For the intervention group, the peer mentors and mentees will be matched according to gender and residential areas to form mentor-mentee groups to attend an 8-week supervised exercise training. The mentor-mentee groups will continue to participate mentor-directed exercise sessions in the community thereafter. A mobile application will be developed for self-directed learning. We hypothesize that persons with mild cognitive impairment receiving the BRAVE program will demonstrate better cognitive function and health-related quality of life than the control group who receive usual care. This study is funded by a grant from the Food and Health Bureau of the Government of Hong Kong Special Administrative Region in April 2018.

DISCUSSION

This study will empower a group of golden-aged adults to be the ambassadors to promote brain health in the community and persons with mild cognitive impairment to integrate moderate-intensity exercise into their lifestyle to achieve long-term beneficial effects on their cognition and well-being.

IMPACT

Given the population with mild cognitive impairment is growing rapidly and expected to keep escalating in coming decades and limited treatment options for cognitive decline and its significant burden on the health and social care system, this study is timely to promote active ageing in the society and reduce the burden associated with cognitive decline.

Efficacy for Dealing With Terrorism Precautionary Behavior: Laying the Groundwork for Communication Effectiveness

In order to formulate effective communication and intervention strategies to respond to the widespread lack of preparedness for public health crises resulting from natural and human-made disasters, researchers have developed models describing the interrelationships between factors associated with emergency preparedness decisions. Empirical research has generally assumed that two key elements of most health behavior theories-self-efficacy and response efficacy-additively influence the decision to prepare, despite compelling theoretical rationale for an interactive relationship. The few studies that have investigated interactions in preparedness outcomes have not tested the Social Cognitive Theory prediction that non-zero levels of both efficacy types are required before individuals will engage in any preparedness behavior. Based on the responses of 3,101 participants in the National Survey of Disaster Experiences and Preparedness, this study tested additive, interactive, and conditional main effect hypotheses about the influence of self-efficacy and response efficacy for dealing with terrorism on preparedness due to terrorism six years after the September 11, 2001, terrorist attacks. A significant self-efficacy × response efficacy interaction effect on preparedness was found, in addition to a significant response efficacy effect when perceived self-efficacy was zero, contrary to the expectation from Social Cognitive Theory. These results offer insights into the cognitive processes underlying individuals' decisions to prepare for disasters such as terrorist attacks, and highlight the importance of considering more complex theory-based cognitive interaction models in designing effective communication strategies to facilitate individual emergency preparedness.

Perceived somatic and affective barriers for self-efficacy and physical activity

According to Bandura's social-cognitive theory, perceptions of somatic and affective barriers are sources of self-efficacy. This longitudinal study compares general indicators of health barriers with measures of perceived somatic and affective barriers to predict self-efficacy and accelerometer-assessed physical activity in a subsample of n = 153 (selected at random from N = 310) community-dwelling German older adults. Perceived somatic and affective barriers longitudinally predicted physical activity mediated by self-efficacy, whereas general health barriers did not. Perceived health barriers to physical activity might be more important than more objective health barriers for older adults' physical activity levels.

The Role of Social Support and Self-efficacy for Planning Fruit and Vegetable Intake

OBJECTIVE

The aim of the current study was to examine the joint effect of self-efficacy, action planning, and received social support on fruit and vegetable intake.

DESIGN

The study used a longitudinal design with 3 waves of data collection.

SETTING

Major university campus in Beijing, China.

PARTICIPANTS

Young adults (n = 286).

VARIABLES MEASURED

Age, gender, body mass index, dietary self-efficacy, and baseline behavior were measured at time 1. Two weeks after time 1, received social support and action planning were assessed (time 2); 4 weeks after time 1, subsequent fruit and vegetable consumption was measured (time 3).

ANALYSIS

In a path analysis, action planning at time 2 was specified as a mediator between self-efficacy at time 1 and fruit and vegetable intake at time 3, controlling for age, gender, body mass index, and baseline behavior. In addition, in a conditional process analysis, received social support at time 2 was specified as a moderator of the self-efficacy-planning relationship.

RESULTS

Action planning mediated between self-efficacy and subsequent dietary behavior, and received social support moderated between self-efficacy and planning supporting a compensation effect. Action planning served as a proximal predictor of fruit and vegetable intake, and planning one's consumption was facilitated by dietary self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Through the identification of social cognitive factors influencing dietary planning, interventions can target self-efficacy and received social support to test the efficacy of these mechanisms in increasing individuals' ability to ensure they consume adequate amounts of fruits and vegetables.

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

OBJECTIVES

Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs).

DESIGN

Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs.

MAIN OUTCOME MEASURES

Intensity and frequency of PA.

RESULTS

A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).

Associations between individual and environmental factors and habitual physical activity among older Chinese adults: A social-ecological perspective

PURPOSE

To examine, within a social-ecological framework, associations between multifaceted individual and environmental factors and habitual physical activity (HPA) among older Chinese adults.

METHODS

Through a mix of qualitative and quantitative methods, a survey instrument assessing various factors underlying 3 social-ecological dimensions of intrapersonal, interpersonal, and community and environmental resources was developed. Using a cross-sectional design, older adults (n = 1580, aged 67 ± 7 years) recruited from 10 communities in Shandong province completed the social-ecological survey of HPA. Data were analyzed using Partial Least Squares Path Modeling.

RESULTS

Factors related to intrapersonal (medical knowledge, motivation, physical function, sport skills, socioeconomic status, and education), interpersonal (social support, social activity, and social norms), and community and physical environmental resources (safety, capacity, availability of and access to physical activity facilities) were found to be significantly associated with older adults' participation in HPA.

CONCLUSION

The findings provide an initial validation of a social-ecological approach to the study of HPA in China, suggesting that strategies aimed at promoting physical activity in older adults should address multiple levels of factors that may contribute to the likelihood of older Chinese adults being physically active.

Physical activity, self-efficacy, and quality of life in older Czech adults

Despite efforts to expand global physical activity (PA) surveillance data to include both low- and high-income countries worldwide, our understanding of the relationship between PA and quality of life (QOL) in older adults from culturally diverse backgrounds is limited. We tested McAuley's social-cognitive model of the PA-QOL relationship in the cultural context of the Czech Republic, a post-communist central European country. A total of 546 older Czech adults (mean age 68 years) completed a battery of questionnaires assessing indicators of PA, self-efficacy, health status, and global QOL. A structural equation model was used to test the relationship between PA and QOL. The model hypothesized an indirect relationship between PA and QOL: PA predicted self-efficacy, which in turn predicted global QOL through mental and physical health status. The analyses indicated an acceptable fit of the proposed model, albeit with different emphases than those of studies from Western countries. Above all, we observed a stronger effect of PA on self-efficacy and a weaker mediating effect of health status on the PA-QOL relationship. Our findings supported the validity of McAuley's PA-QOL social-cognitive model for a non-Western cultural context. However, it seems that self-efficacy and health status may influence the PA-QOL relationship in this population in a manner different from that proposed in McAuley's model.

Positive Exercise Experience Facilitates Behavior Change via Self-Efficacy

PURPOSE

Motivational processes can be set in motion when positive consequences of physical exercise are experienced. However, relationships between positive exercise experience and determinants of the motivational and the volitional phases of exercise change have attracted only sparse attention in research.

METHOD

This research examines direct and indirect associations between positive experience and motivational as well as volitional self-efficacy, intention, action planning, and exercise in two distinct longitudinal samples. The first one originates from an online observational study in the general population with three measurement points in time (N = 350) and the second one from a clinical intervention study in a rehabilitation context with four measurement points (N = 275).

RESULTS

Structural equation modeling revealed the following: Positive experience is directly related with motivational self-efficacy as well as intentions in both samples. In the online sample only, positive experience is associated with volitional self-efficacy. In each sample, experience is indirectly associated with action planning via motivational self-efficacy and intentions. Moreover, action planning, in turn, predicts changes in physical exercise levels.

CONCLUSIONS

Findings suggest a more prominent role of positive experience in the motivational than in the volitional phase of physical exercise change. Thus, this research contributes to the understanding of how positive experience is involved in the behavior change process.

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

When people intend and plan to perform higher levels of physical activity, they do not start on impulse without preparing. Thus, preparation is a behavioral construct positioned between planning and target behavior. This may be reflected by the acquisition of sports equipment as well as monitoring devices such as pedometers. The research questions are who takes such preparatory action, whether picking up a complimentary pedometer can be predicted by self-efficacy and outcome expectancies, and whether this kind of preparatory action facilitates subsequent physical activity. A longitudinal physical activity survey was conducted with 143 university students who were offered a complimentary pedometer. Collecting this free gift served as indicator of preparatory behavior. Outcome expectancies and self-efficacy beliefs were specified as predictors of this behavior. Two weeks later, physical activity differences between the groups were determined. Collecting the pedometer was associated with higher levels of physical activity at follow-up. Outcome expectancies failed to predict the pedometer collection, but self-efficacy did. An interaction between these two factors indicated that self-efficacy compensated for low outcome expectancies. Pedometer acquisition signifies a preparatory action that is facilitated by self-efficacy. Positioned between planning and target behavior, they constitute a proximal self-regulatory step towards health behavior change.

Positive experience, self-efficacy, and action control predict physical activity changes: a moderated mediation analysis

OBJECTIVES

Experiencing positive consequences of one's physical activity is supposed to facilitate further activity. This motivational outcome might be generated by an increase in perceived self-efficacy. In addition to such a mediator effect, we examine whether this applies generally or only under conditions of volitional control. For this purpose, perceived action control was considered as a putative moderator.

DESIGN AND METHOD

N = 193 students participated in a study with three measurement points in time. At baseline, positive experience with previous physical activity was measured as a predictor of physical activity. Two weeks later, self-efficacy and action control variables were assessed as putative mediator and moderator, respectively. After another 2 weeks, physical activity was measured as the outcome. A moderated mediation model was specified with baseline physical activity and sex as covariates.

RESULTS

Self-efficacy was found to mediate between initial positive experience and later physical activity, and this mediation was moderated by action control.

CONCLUSIONS

Participants' perceptions of positive experience were associated with their subsequent self-efficacy fostering physical activity. However, persons with low levels of action control did not translate positive experience into physical activity via self-efficacy.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Numerous studies have shown that exercise-specific self-efficacy predicts subsequent physical activity. Prior positive experience with physical activity is suggested to be associated with exercise-specific self-efficacy. Furthermore, action control was found to be beneficial for the maintenance of physical activity. What does this study add? This study unveils the mechanisms between these social-cognitive determinants: our longitudinal results suggest that the mediation of positive experience and subsequent physical activity via self-efficacy is moderated by action control. Persons with low levels of action control did not translate positive experience into physical activity via self-efficacy.

‘I do not need a flu shot because I lead a healthy lifestyle’: Compensatory health beliefs make vaccination less likely

Compensatory health beliefs, a self-defence strategy, were examined in a theory-guided intervention promoting influenza vaccination at the workplace. In total, 851 employees were randomised to one group aimed at enhancing intention formation (standard group) or to another one assisting self-regulation (intervention group). Assessments took place after the intervention and 5 months later, investigating whether the intervention would interfere with compensatory health beliefs. The intervention generated an indirect effect via planning on vaccination. Compensatory health beliefs mediated between intention and behaviour. An interaction between intervention group and compensatory health beliefs on behaviour transpired. At low compensatory health belief levels, the intervention group resulted in more vaccinations than the standard group.