A Narrative Literature Review on the Role of Exercise Training in Managing Type 1 and Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia associated with impaired carbohydrate, lipid, and protein metabolism, with concomitant absence of insulin secretion or reduced sensitivity to its metabolic effects. Patients with diabetes mellitus have a 30% more risk of developing heart failure and cardiovascular disease compared to healthy people. Heart and cardiovascular problems are the first cause of death worldwide and the main complications which lead to high healthcare costs. Such complications can be delayed or avoided by taking prescribed medications in conjunction with a healthy lifestyle (i.e., diet and physical activity). The American College of Sports Medicine and the American Diabetes Association recommend that diabetic people reduce total sedentary time by incorporating physical activity into their weekly routine. This narrative literature review aims to summarize and present the main guidelines, pre-exercise cardiovascular screening recommendations, and considerations for patients with diabetes and comorbidities who are planning to participate in physical activity programs.

The intention-behaviour gap in physical activity: a systematic review and meta-analysis of the action control framework

OBJECTIVE

Intention is the proximal antecedent of physical activity in many popular psychological models. Despite the utility of these models, the discrepancy between intention and actual behaviour, known as the intention-behaviour gap, is a central topic of current basic and applied research. The purpose of this meta-analysis was to quantify intention-behaviour profiles and the intention-behaviour gap.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Literature search was conducted in June 2022 and updated in February 2023 in five databases.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Eligible studies included a measure of physical activity, an assessment of physical activity intention and the employment of the intention-behaviour relationship into profile quadrants. Only papers published in the English language and in peer-reviewed journals were considered. Screening was assisted by the artificial intelligence tool ASReview.

RESULTS

Twenty-five independent samples were selected from 22 articles including a total of N=29 600. Random-effects meta-analysis revealed that 26.0% of all participants were non-intenders not exceeding their intentions, 4.2% were non-intenders who exceeded their intentions, 33.0% were unsuccessful intenders and 38.7% were successful intenders. Based on the proportion of unsuccessful intenders to all intenders, the overall intention-behaviour gap was 47.6%.

CONCLUSION

The findings underscore that intention is a necessary, yet insufficient antecedent of physical activity for many. Successful translation of a positive intention into behaviour is nearly at chance. Incorporating mechanisms to overcome the intention-behaviour gap are recommended for clinical practice.

Exercise training reduces circulating cytokines in male patients with coronary artery disease and type 2 diabetes: A pilot study

Low-grade inflammation is central to coronary artery disease (CAD) and type 2 diabetes (T2D) and is reduced by exercise training. The objective of this study was to compare the anti-inflammatory potential of moderate-to-vigorous intensity continuous training (MICT) and high-intensity interval training (HIIT) in patients with CAD with or without T2D. The design and setting of this study is based on a secondary analysis of registered randomized clinical trial NCT02765568. Male patients with CAD were randomly assigned to either MICT or HIIT, with subgroups divided according to T2D status (non-T2D-HIIT n = 14 and non-T2D-MICT n = 13; T2D-HIIT n = 6 and T2D-MICT n = 5). The intervention was a 12-week cardiovascular rehabilitation program consisting of either MICT or HIIT (twice weekly sessions) and circulating cytokines measured pre- and post-training as inflammatory markers. The co-occurrence of CAD and T2D was associated with increased plasma IL-8 (p = 0.0331). There was an interaction between T2D and the effect of the training interventions on plasma FGF21 (p = 0.0368) and IL-6 (p = 0.0385), which were further reduced in the T2D groups. An interaction between T2D, training modalities, and the effect of time (p = 0.0415) was detected for SPARC, with HIIT increasing circulating concentrations in the control group, while lowering them in the T2D group, and the inverse occurring with MICT. The interventions also reduced plasma FGF21 (p = 0.0030), IL-6 (p = 0.0101), IL-8 (p = 0.0087), IL-10 (p < 0.0001), and IL-18 (p = 0.0009) irrespective of training modality or T2D status. HIIT and MICT resulted in similar reductions in circulating cytokines known to be increased in the context of low-grade inflammation in CAD patients, an effect more pronounced in patients with T2D for FGF21 and IL-6.

Physical activity for health

Physical activity plays a substantial role in maintaining people's good health and mental wellbeing, but that is not all: not only it positively affects the individuals' mental and physical health, but a lack of physical exercise exerts a negative impact also on the overall economy of a nation. In addition, physical inactivity not only increases the risk of non-communicable diseases (NCD), but also contributes significantly to the increased morbidity and mortality in patients suffering from these diseases. On the contrary, physical activity reduces the risk of NCDs - such as cardiovascular diseases, type 2 diabetes, and cancer - in a dose-dependent manner; regular exercise is also associated with many health benefits and delayed mortality. However, understanding the role of physical activity in modern society and creating an awareness in the general population is one of the most important tasks of health and recreation promoters. Correspondingly, there is a dire need to enhance our knowledge, perception, and awareness of physical activity and its impacts on an individual's health, ultimately contributing to developing a healthy society. The current review will focus on the health benefits of the two most widely studied modifiable lifestyle risk factors, physical activity and diet, focusing particularly on the Mediterranean diet.

Pilot Feasibility Assessment of a Tailored Physical Activity Prescription in Overweight and Obese People in a Public Hospital

We aimed to evaluate the feasibility of a tailored physical activity (PA) prescription in overweight and obese people in a tertiary hospital in Lima, Peru. A feasibility pre-post-pilot study was conducted using mixed methods. Participants received a tailored prescription scheme for PA that lasted twelve weeks. It included two prescription sessions, three follow-up phone calls, and three evaluations. Primary feasibility outcomes were recruitment, visits, and phone call adherence. Primary intervention outcomes were self-reported PA levels and the 6 min walk test. Out of 228 people invited to participate, 30 were enrolled and received the first session of prescription, 11 went to the second session, and 21 went to the final evaluation; phone call participation decreased progressively during follow-up. There were no differences in the 6th week and the 12th week compared to the baseline for all the measures, except in the 6 min walk test. The participants considered the intervention was well designed, but they suggested complementing it with dietary instructions. The prescription of PA in overweight and obese people is feasible for promoting PA, but its implementation requires refinements to anticipate possible barriers to changing behavior.

Moderate Intensity Aerobic Exercise Potential Favorable Effect Against COVID-19: The Role of Renin-Angiotensin System and Immunomodulatory Effects

The coronavirus disease (COVID-19) pandemic is caused by a novel coronavirus (CoV) named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As the angiotensin converting enzyme 2 (ACE2) is the cellular receptor of SARS-CoV-2, it has a strong interaction with the renin angiotensin system (RAS). Experimental studies have shown that the higher levels of ACE2 or increasing ACE2/ACE1 ratio improve COVID-19 outcomes through lowering inflammation and death. Aerobic moderate intensity physical exercise fights off infections by two mechanisms, the inhibition of ACE/Ang II/AT1-R pathway and the stimulation of ACE2/Ang-(1-7)/MasR axis. Exercise can also activate the anti-inflammatory response so that it can be a potential therapeutic strategy against COVID-19. Here, we summarize and focus the relation among COVID-19, RAS, and immune system and describe the potential effect of aerobic moderate intensity physical exercise against CoV as a useful complementary tool for providing immune protection against SARS-CoV-2 virus infection, which is a novel intervention that requires further investigation.

What Is Moderate to Vigorous Exercise Intensity?

A variety of health benefits associated with physical activity depends upon the frequency, intensity, duration, and type of exercise. Intensity of exercise is the most elusive of these elements and yet has important implications for the health benefits and particularly cardiovascular outcomes elicited by regular physical activity. Authorities recommend that we obtain 150min of moderate to vigorous intensity physical activity (MVPA) each week. The current descriptions of moderate to vigorous intensity are not sufficient, and we wish to enhance understanding of MVPA by recognition of important boundaries that define these intensities. There are two key thresholds identified in incremental tests: ventilatory and lactate thresholds 1 and 2, which reflect boundaries related to individualized disturbance to homeostasis that are appropriate for prescribing exercise. VT2 and LT2 correspond with critical power/speed and respiratory compensation point. Moderate intensity physical activity approaches VT1 and LT1 and vigorous intensity physical activity is between the two thresholds (1 and 2). The common practice of prescribing exercise at a fixed metabolic rate (# of METs) or percentage of maximal heart rate or of maximal oxygen uptake (V̇O₂max) does not acknowledge the individual variability of these metabolic boundaries. As training adaptations occur, these boundaries will change in absolute and relative terms. Reassessment is necessary to maintain regular exercise in the moderate to vigorous intensity domains. Future research should consider using these metabolic boundaries for exercise prescription, so we will gain a better understanding of the specific physical activity induced health benefits.

A Comparison of Motives by Gender and Age Categories for Training at Norwegian Fitness Centres

Examining participatory motives clarifies what engages and keeps individuals participating in exercise. The popularity of training at fitness centres has greatly increased over the last two decades, but individual determinants for motivation remain uncertain. This study compared motives between gender and age categories in training and performing physical activity at Norwegian fitness centres. To compare motives, a survey utilising a standardised questionnaire (MPAM-R) was conducted at six different Norwegian fitness centres. It was hypothesised that the intrinsic motive socialisation and extrinsic motive fitness would be more important among the older age categories for both genders, while the extrinsic motive appearance and intrinsic motive enjoyment would be more important among younger age groups. A total response of 183 men and 150 women, aged 14-80 years, was divided into seven categories based on their age and included in the statistical analysis. The main findings after conducting a two-way analysis of variance (ANOVA) with repeated measures, were that the most important motive for training at fitness centres was increasing fitness, followed by enjoyment, competence, vitality and appearance. The social motive was rated the lowest. Women rated fitness and enjoyment higher compared to men, and men rated the motive for appearance higher than women, but this decreased with age in both genders. With increasing age, the importance of enjoyment and competence decreased in men, while women seemed to place increased importance on vitality with age. The importance of the social motive decreased first as age increased, but then increased again in the age group 41-50 years and older. It was concluded that the motives for participating in exercise at fitness centres was dependent on individual characteristics and that motives about training at fitness centres differed by gender and changed with age.

Maternal and Cord Blood Metabolite Associations with Gestational Weight Gain and Pregnancy Health Outcomes

Pre-pregnancy obesity and excessive gestational weight gain (GWG) are risk factors for future maternal and childhood obesity. Maternal obesity is potentially communicated to the fetus in part by the metabolome, altering the child's metabolic program in early development. Fasting maternal blood samples from 37 singleton pregnancies at 25-28 weeks of gestation were obtained from mothers with pre-pregnancy body mass indexes (BMIs) between 18 and 40 kg/m². Various health measures including GWG, diet, and physical activity were also assessed. At term (37-42 weeks), a venous umbilical cord sample was obtained. Serum metabolomic profiles were measured using nuclear magnetic resonance spectroscopy as well as a gut and metabolic hormone panel. Maternal and cord serum metabolites were tested for associations with pre-pregnancy BMI, GWG, health outcomes, and gut and metabolic hormones. While cord blood metabolites showed no significant correlation to maternal obesity status or other measured health outcomes, maternal serum metabolites showed distinct profiles for lean, overweight, and obese women. Additionally, four serum metabolites, namely, glutamate, lysine, pyruvate, and valine, allowed prediction of excessive GWG when pre-pregnancy BMI was controlled. Metabolic biomarkers predictive of GWG are reported and, if validated, could aid in the guidance of prenatal weight management plans as the majority of pregnancy weight gain occurs in the third trimester.

(How) Does Affect Influence the Formation of Habits in Exercise?

Objectives: Habitually instigated exercise is thought to increase health behavior maintenance. Previous research has explored several aspects of habit formation. However, there is a lack of longitudinal research investigating affective determinants, especially post-exercise affective states. Therefore, the present study aimed to investigate (a) if behavior frequency will enhance automaticity, (b) if positive affect will enhance automaticity, and (c) if positive affect will moderate the relationship between behavior frequency and automaticity. Methods: 226 participants (64% females, mean age 24 years) who attended weekly sports and gym classes at two universities were followed for 13 weeks. Class attendance was documented on a weekly basis (behavior frequency) during the semester. Before, during and immediately after each class, participants filled in the Feeling Scale (affective valence). Furthermore, at the beginning of each class, they answered a question about their automaticity in arriving at the decision to attend the class (instigation habit). We used a two-level modeling approach to predict subsequent automaticity by the different constructs at the previous attendance. Results: The cumulative frequency of prior class attendance did not significantly enhance the automaticity of the decision to re-attend the class. There were significant effects of valence on automaticity on the between-subject level, i.e., a one-point higher mean valence score was associated with a 0.62 point increase in automaticity (p = 0.001). No moderation effects of affect on the association between behavior frequency and automaticity were observed. Conclusion: Behavior repetition, albeit not significant, and positive affective states at the end of an exercise class may be beneficial in building exercise instigation habits. Practitioners and researchers alike may thus want to emphasize the importance of behavior repetition and affective response for health behavior maintenance.

Well-Being, Physical Fitness, and Health Profile of 2,203 Danish Girls Aged 10-12 in Relation to Leisure-time Sports Club Activity-With Special Emphasis on the Five Most Popular Sports

Madsen, M, Larsen, MN, Cyril, R, Møller, TK, Madsen, EE, Ørntoft, C, Lind, RR, Ryom, K, Christiansen, SR, Wikman, J, Elbe, AM, and Krustrup, P. Well-being, physical fitness, and health profile of 2,203 Danish girls aged 10-12 in relation to leisure-time sports club activity-with special emphasis on the five most popular sports. J Strength Cond Res XX(X): 000-000, 2020-This study investigated the relationship between leisure-time sports club activities and well-being as well as physical health parameters in 10-12-year-old Danish girls. Two thousand two hundred three girls took part in the study, which included questionnaires on participation in leisure-time sports clubs, well-being, Yo-Yo intermittent recovery level 1 children's test, long jump, balance tests, body composition, blood pressure (BP), and resting heart rate (RHR). Data were analyzed according to whether the girls participated in leisure-time sport and according to the 5 most frequently reported sports. Girls enrolled in leisure-time sports had higher physical well-being (49.3 ± 8.6 vs. 45.2 ± 8.3), psychological well-being (50.4 ± 9.0 vs. 49.4 ± 9.8), experienced more peer and social support (50.2 ± 10.0 vs. 48.9 ± 10.7), and perceived a more positive school environment (52.5 ± 8.0 vs. 50.5 ± 9.3), as well as showing higher Yo-Yo (+39%), long jump (+10%), and balance performance (+15%) than girls not involved in sport clubs. The girls active in sports clubs had higher relative muscle mass (+5%), lower fat percentage (-11%), body mass index (-5%), RHR (-3.4 b·min), and diastolic BP (-1.4 mm Hg) compared with girls not involved in sport (p < 0.05). Girls who played soccer showed higher aerobic fitness compared with inactive girls (+67%), dancers (+39%), swimmers (+38%), and gymnasts (+16%). Gymnasts had a lower fat percentage than inactive girls (-19%), team handballers (-10%), swimmers (-12%), and soccer players (-4%). Girls participating in club-based leisure-time sports showed higher well-being and better fitness and health profiles than girls not involved in any sports club activities. Girls involved in soccer had better aerobic fitness and gymnasts a lower fat percentage.

Regular Aerobic Exercise-Alleviated Dysregulation of CAMKIIα Carbonylation to Mitigate Parkinsonism via Homeostasis of Apoptosis With Autophagy

This study investigated carbonylation of proteins with oxidative modification profiling in the striatum of aging and Parkinson disease (PD) rats, as well as the long-term effects of regular aerobic exercise on the carbonylation process and the damaging effects of PD vs habitual sedentary behavior. Regular aerobic exercise improved the PD rats' rotational behavior, increased tyrosine hydroxylase expression in both the striatum and substantia nigra pars compacta, and decreased α-synuclein expression significantly. Interestingly, apoptotic nuclei and autophagosomes were increased in the aerobic exercise PD rat striatum. Carbonylated protein Ca2+/calmodulin-dependent protein kinase alpha (CAMKIIα) was present in the middle-aged and aged groups but only in the sedentary, not the exercise, PD rat striatum. Notably, CAMKIIα was characterized by a 4-hydroxynonenal adduct. Regular aerobic exercise upregulated CAMKIIα expression level, activated the CAMK signaling pathway, and promoted the expression of autophagy markers Beclin1 and microtubule-associated proteins 1 A/1B light chain 3II. Aberrant carbonylation of CAMKII initiated age-related changes and might be useful as a potential biomarker of PD. Regular aerobic exercise alleviated protein carbonylation modification of CAMKIIα and regulated the CAMK signaling pathway, thereby affecting and regulating the homeostasis of apoptosis and autophagy in the striatum to alleviate the neurodegenerative process of PD lesions.

Health Benefits of Physical Activity: A Strengths-Based Approach

Our special series on Cardiac Rehabilitation outlined the importance of routine physical activity and/or exercise participation in the primary and secondary prevention of cardiovascular disease and many other chronic medical conditions. The evidence is overwhelming, demonstrating that nearly everyone can benefit from becoming more physically active. This messaging has been widely disseminated at regional, national, and international levels. Often, this messaging highlights a physical inactivity crisis and the health perils of not engaging in sufficient amounts of physical activity. This deficits-based messaging often includes generic threshold-based recommendations stating that health benefits can only be accrued with specific volumes or intensities of physical activity. In this Editorial, we argue that the current generic and deficits-based messaging misses a great opportunity to focus on the positive and to facilitate hope and real change at the individual, community, and population levels. We advocate a strengths-based approach to health and wellness promotion that focuses on the innate strengths of individuals, families, and communities to enable self-empowerment and self-determination related to health and wellness. By taking a strengths-based approach, we can build hope, promoting the positive aspects of routine physical activity and exercise participation and providing a greater opportunity to enhance health and wellbeing for everyone.

Exploring the Association Between Physical Activity, Sedentary Behavior, and High-Sensitivity C-Reactive Protein Among Stroke Survivors

Stroke results in low physical activity, high sedentary behavior (SB), and elevated C-reactive protein (CRP), which are associated with stroke recurrence. This study examined the association between physical activity, SB, and CRP in stroke. CRP data from 185 stroke survivors (M_age = 65 years) from the National Health and Nutritional Examination Survey 2009-2010 were analyzed using weighted regression analysis. There was an interaction between physical activity and SB on CRP (estimated-β = -0.079, 95% confidence interval [-0.14, -0.02], p = .011). SB was associated with CRP among those who did not engage in physical activity (estimated-β = 0.068, 95% confidence interval [0.02, 0.11], p = .005), but not among those who did (estimated-β = 0.0003, 95% confidence interval [-0.03, 0.03], p = .988). Physical activity and SB are important modifiable risk factors to lower the risk of recurrent stroke. These findings provide insight into the inflammatory consequences of SB after stroke, particularly among those who also do not engage in physical activity.

Increasing Physical Activity Through Principles of Habit Formation in New Gym Members: a Randomized Controlled Trial

BACKGROUND

The promotion of physical activity (PA) is paramount to public health, yet interventions in the social cognitive tradition have yielded negligible improvements. The limited progression may be due to an overreliance on intention as the proximal determinant of behavior and a lack of consideration of implicit/automatic processes. The purpose of this study was to examine the impact of a habit formation intervention on PA over 8 weeks in a two-arm parallel design, randomized controlled trial.

METHODS

Participants (n = 94) were new gym members with the intention to engage in PA but below international PA guidelines at baseline, who were randomized into a control or habit experimental group. The experimental group attended a workshop (at baseline) and received a follow-up booster phone call at week 4. The primary outcome of the study was minutes of moderate-vigorous intensity PA (MVPA) at week 8. The secondary outcome was a manipulation check to determine if the experimental group effectively incorporated habit-building constructs (cues and practice consistency).

RESULTS

The experimental group showed a significant increase in MVPA after 8 weeks in both accelerometry (d = 0.39, p = .04) and self-report (d = 0.53, p = .01) compared with the control group. The experimental group also showed an increase in use of cues (d = 0.56, p < .001) and practice consistency (d = 0.40, p = .01) at week 8.

CONCLUSION

The results contribute to the initial validity of increasing PA through a focus on preparation cues and practice consistency. Future research should replicate these findings and extend the duration of assessment to evaluate whether PA changes are sustained. Registered Trial Number NCT02785107.

Health benefits of physical activity: a systematic review of current systematic reviews

PURPOSE OF REVIEW

The health benefits of physical activity and exercise are clear; virtually everyone can benefit from becoming more physically active. Most international guidelines recommend a goal of 150 min/week of moderate-to-vigorous intensity physical activity. Many agencies have translated these recommendations to indicate that this volume of activity is the minimum required for health benefits. However, recent evidence has challenged this threshold-centered messaging as it may not be evidence-based and may create an unnecessary barrier to those who might benefit greatly from simply becoming more active. This systematic review evaluates recent systematic reviews that have examined the relationship between physical activity and health status.

RECENT FINDINGS

Systematic reviews and/or meta-analyses (based largely on epidemiological studies consisting of large cohorts) have demonstrated a dose-response relationship between physical activity and premature mortality and the primary and secondary prevention of several chronic medical conditions. The relationships between physical activity and health outcomes are generally curvilinear such that marked health benefits are observed with relatively minor volumes of physical activity.

SUMMARY

These findings challenge current threshold-based messaging related to physical activity and health. They emphasize that clinically relevant health benefits can be accrued by simply becoming more physically active. VIDEO ABSTRACT: http://links.lww.com/HCO/A42.

Positive affektive Reaktionen in Sport und Bewegung durch allgemeine Kompetenzen und spezifische Verhaltenskompetenzen von Trainerinnen und Trainern

Zusammenfassung. Affektive Reaktionen bei Sporttreibenden stellen wichtige Determinanten dar, die Aufrechterhaltung von Sport und Bewegung zu fördern und perspektivisch Dropouts bei Trainierenden zu vermeiden. Die Trainerinnen und Trainer eines Sport- oder Bewegungsprogramms haben dabei einen maßgeblichen Einfluss auf die positiven affektiven Reaktionen (PAR) von Trainierenden. Ein entscheidender Aspekt dabei ist, mit welchen Kompetenzen Trainerinnen und Trainer PAR während des Trainings induzieren. Das Ziel dieser Studie ist es, die allgemeinen Kompetenzen und die spezifischen Verhaltenskompetenzen der Trainerinnen und Trainer zu identifizieren, welche mit den wahrgenommenen PAR der Trainierenden in körperlicher Bewegung und Freizeitsport verbunden sind. Um diese Kompetenzen festzustellen, wurden mit 30 Trainerinnen und Trainern aus dem Freizeit- und Breitensport teilstandardisierte Leitfadeninterviews durchgeführt. Es wurden drei allgemeine Kompetenzen für Trainerinnen und Trainer identifiziert. Dabei handelt es sich um die sozial-emotionale Kompetenz, die Kontextsensibilität und die Fachkompetenz. Aus diesen allgemeinen Kompetenzen lassen sich drei spezifische Verhaltenskompetenzen für Trainerinnen und Trainer ableiten: die Motivationskompetenz, die Adaptationskompetenz und die Organisationskompetenz. Diese Kompetenzen wurden in einem Modell zusammengefasst, welches die zentralen Wirkzusammenhänge der Verhaltenskompetenzen hinsichtlich PAR aufzeigt.

Mediating Mechanisms in a Physical Activity Intervention: A Test of Habit Formation

BACKGROUND

A recent randomized controlled trial found that an intervention focused on developing an exercise habit increased weekly minutes of moderate to vigorous physical activity (MVPA) over 8 wk compared to a control group. The purpose of the current study was to test if changes in habit, as well as other behavioral strategy constructs from the Multi-Process Action Control Test, mediated between group condition and MVPA (self-report and accelerometry).

METHODS

Inactive new gym members (N = 94) were randomized into control or experimental (habit-building) groups.

RESULTS

No construct entirely explained mediation condition (experimental and control) and changes in MVPA measured by accelerometry. Self-report MVPA found affective judgments, behavioral regulation, and preparatory habit to be mediated between group (experimental/control conditions) and changes in behavior (β = 0.36, 95% confidence interval [.05-.78]).

CONCLUSIONS

Self-reported and objectively measured behavior models demonstrated complete and partial mediation, respectively. New gym members could benefit from successful behavioral enactment by developing constructs to support habit formation.

Physical activity: Health impact, prevalence, correlates and interventions

OBJECTIVE

To provide a broad overview of the state of physical activity (PA) research in the form of (1) definitions of PA, (2) health benefits, (3) prevalence, (4) correlates and (5) interventions.

DESIGN

A high-level overview of published reviews of the literature.

RESULTS

Regular PA is an effective primary and secondary preventative strategy against at least 25 chronic medical conditions with risk reduction typically in the 20-30% range. While approximately 75% of adults meet recommended PA guidelines, the prevalence is slightly lower for women compared to men, and considerably lower for youth, older adults and those in higher income countries. Motivation, self-efficacy and self-regulation remain consistent correlates of PA. Interventions show PA changes in the small effect size range for adults and youth but the heterogeneity is considerable across studies. Only a few (aggregate of behavioural regulation strategies, supervision, high frequency of contact) reliable moderators of intervention success were identified across study quality, sample characteristics, theory/behaviour change techniques and delivery modes/settings.

CONCLUSION

PA research should continue to examine the mechanisms causing health outcomes, the dose that can lead to clinically relevant changes in health status, the scope and validity of PA surveillance and innovative behaviour change techniques, while improving the reach and duration of PA interventions.

The role of habit in different phases of exercise

OBJECTIVES

The primary purpose of this study was to investigate how habit strength in a preparatory and performance phase predicts exercise while accounting for intention. The secondary purpose was to determine the strength of potential habit antecedents (affective judgement, perceived behavioural control, consistency, and cues) in both exercise phases.

DESIGN

This was a prospective study with measures collected at baseline and week 6.

METHODS

Participants (n = 181) were a sample of adults (18-65) recruited across nine gyms and recreation centres who completed baseline and follow-up questionnaires after 6 weeks.

RESULTS

Intention (β = .28, p = .00) and habit preparation (β = .20, p = .03), predicted exercise, and change of exercise with coefficients of β = .25, (p = .00) and β = .18, (p = .04), respectively, across 6 weeks but not habit performance (p>.05).

CONCLUSIONS

This study highlighted the distinction between the two phases of exercise and the importance of preparatory habit in predicting behaviour. Focusing on a consistent preparatory routine could be helpful in establishing an exercise habit. Statement of contribution What is already known on this subject? A recent meta-analysis found habit to correlate r = .43 with behaviour (Gardner, de Bruijn, & Lally, ). Verplanken and Melkevik () propose that habit in exercise should be measured in separate components. Phillips and Gardner () interpreted this as habitual instigation (thought) to exercise and execution. What does this study add? Extended pervious work and identified two distinct behavioural phases (preparation and performance) for exercise. Habit model revealed that temporal consistency was the strongest predictor in both phases of exercise. Intention and habit of preparatory behaviour predicted exercise fluctuations in gym members.

Physical activity levels and associated socio-demographic factors in Bangladeshi adults: a cross-sectional study

Background

Low level of physical activity (PA) has become an important public health problem even in low-income countries. The objectives of this study were to measure PA levels, determine the prevalence of low PA and identify socio-demographic factors associated with it in Bangladeshi adults.

Methods

Data from 792 (urban, 395; rural, 397) Bangladeshi adults (25–64 years) were included in this population-based cross-sectional study conducted in 2011. Global Physical Activity Questionnaire version 2 (GPAQ-2) was used to measure PA. The metabolic equivalent task (MET) in minutes per week was calculated to determine total PA. Participants were categorized into low, moderate and high PA groups. Logistic regression was used to assess socio-demographic factors associated with low level of PA.

Results

Median MET-minute of total PA per week was almost double in the rural area (1720) than the urban area (960). The overall prevalence of low PA was 50.3% (95% CI: 46.8–53.8), urban 59.5% (54.7–64.3) and rural 41.9% (37.0–46.8). Women in general were more inactive (women 63.1% [58.3–67.9], men 39.3% [34.6–44.0]). The main contributions to total PA were from work (urban 40.0%, rural 77.0%) and active commute (57.0%, 21.0%). Leisure-time PA represented a very small proportion (<3.0%). Multiple logistic regressions found a significant association of urban residence (OR = 2.2; 95% CI: 1.5–3.2), women (2.1; 1.4–3.9), oldest age group 55–64 years (15.6; 7.5–32.2) compared to youngest age group 25–34 years, graduation or further education (8.6; 4.1–17.7), and higher socio-economic class (2.4; 1.4–4.2) compared to poor with insufficient PA.

Conclusions

This study identifies low PA in a rural and urban population in Bangladesh and that further large-scale population studies are warranted.

Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription

BACKGROUND

Physical activity (PA) is a key intervention for chronic disease, yet few physicians provide exercise prescription (EP). EP is an important component in larger strategies of reducing non-communicable disease (NCD). Our objective was to assess Family Medicine Residents (FMR) knowledge, competence, and perspectives of EP to help inform future curriculum development.

METHODS

A 49-item cross-sectional survey was administered to 396 University of British Columbia FMR. Residents' EP knowledge, competence, attitudes/beliefs, current practices, personal physical activity levels, and perspectives of training were assessed using, primarily, a 7-point Likert scale.

RESULTS

The response rate was 80.6% (319/396). After eliminating 25 that failed to meet the inclusion criteria, 294 were included in the final analysis. The majority 95.6% of FMR reported EP as important in their future practice, despite having low knowledge of the Canadian PA Guidelines (mean score 1.77/4), low self-reported competence prescribing exercise as prevention (mean score 13.35/21), and rating themselves "somewhat incompetent" prescribing exercise to patients with chronic disease (mean score 11.26/21). FMR believe PA is integral to their patients' health (98.0%), sedentary behaviour is harmful (97.9%), and feel a responsibility to discuss PA with patients (99.7%). Few FMR (14.9%) perceived their training in EP as adequate and 91.0% desire more.

CONCLUSIONS

FMR report EP is important, yet do not perceive they are sufficiently prepared to provide EP. In future curricular development, medical educators should consider residents' low knowledge, competence, perceived program support, and their expressed desire for more training in exercise prescription.

Understanding the Reasons behind Anticipated Regret for Missing Regular Physical Activity

Anticipated affective reactions to missing physical activity (PA), often labeled anticipated regret, has reliable evidence as a predictor of PA intention and behavior independent of other standard social cognitive constructs. Despite this evidence, the sources of regret are understudied and may come from many different reasons. The purpose of this study was to theme the reasons for why people responded to anticipated regret over missing regular PA for 2 weeks. Participants were a random sample of 120 university students who were primed on the public health definition of PA, completed measures of regret, and were asked to list their reasons for regret. Ninety-five percent of participants expressed that they would regret not being active and gave a total of 357 reasons. The dominant theme (n = 247; 69%) was a missed opportunity to obtain the benefits of PA, followed by shame/guilt for not being able to follow-through with one's goals or self-categorized role (n = 99; 28%) with a final theme of perceived pressure from others (n = 11; 3%). From a practical perspective, the diversity of these reasons suggest that more clarity on the source of regret should be present in assessment, while building from both attitude and identity theories may help understand how regret motivates PA in future intervention.

Exercise during Short-Term and Long-Term Continuous Exposure to Hypoxia Exacerbates Sleep-Related Periodic Breathing

STUDY OBJECTIVES

Exposure to hypoxia elevates chemosensitivity, which can lead to periodic breathing. Exercise impacts gas exchange, altering chemosensitivity; however, interactions between sleep, exercise and chronic hypoxic exposure have not been examined. This study investigated whether exercise exacerbates sleep-related periodic breathing in hypoxia.

METHODS

Two experimental phases. Short-Term Phase: a laboratory controlled, group-design study in which 16 active, healthy men (age: 25 ± 3 y, height: 1.79 ± 0.06 m, mass: 74 ± 8 kg) were confined to a normobaric hypoxic environment (FIO2 = 0.139 ± 0.003, 4,000 m) for 10 days, after random assignment to a sedentary (control, CON) or cycle-exercise group (EX). Long-Term Phase: conducted at the Concordia Antarctic Research Station (3,800 m equivalent at the Equator) where 14 men (age: 36 ± 9 y, height: 1.77 ± 0.09 m, mass: 75 ± 10 kg) lived for 12-14 months, continuously confined. Participants were stratified post hoc based on self-reported physical activity levels. We quantified apnea-hypopnea index (AHI) and physical activity variables.

RESULTS

Short-Term Phase: mean AHI scores were significantly elevated in the EX group compared to CON (Night1 = CON: 39 ± 51, EX: 91 ± 59; Night10 = CON: 32 ± 32, EX: 92 ± 48; P = 0.046). Long-Term Phase: AHI was correlated to mean exercise time (R(2) = 0.4857; P = 0.008) and the coefficient of variation in night oxyhemoglobin saturation (SpO2; R(2) = 0.3062; P = 0.049).

CONCLUSIONS

Data indicate that exercise (physical activity) per se affects night SpO2 concentrations and AHI after a minimum of two bouts of moderate-intensity hypoxic exercise, while habitual physical activity in hypobaric hypoxic confinement affects breathing during sleep, up to 13+ months' duration.

Reflections on Physical Activity and Health: What Should We Recommend?

The health benefits of regular physical activity are irrefutable; virtually everyone can benefit from being active. The evidence is overwhelming with risk reductions of at least 20%-30% for more than 25 chronic medical conditions and premature mortality. Even higher risk reductions (ie, ≥ 50%) are observed when objective measures of physical fitness are taken. International physical activity guidelines generally recommend 150 minutes per week of moderate- to vigorous-intensity physical activity. A critical review of the literature indicates that half of this volume of physical activity might lead to marked health benefits. There is compelling evidence to support health promotion strategies that emphasize that health benefits can be accrued at a lower volume and/or intensity of physical activity. Public health policies are needed that reduce the barriers to physical activity participation such that everyone can reap the benefits of physical activity. It is also important to highlight that sedentary time (particularly sitting time) carries independent health risks. The simple message of "move more and sit less" likely is more understandable by contemporary society and is formed on the basis of a strong body of evidence. For practitioners who work directly with clients, it is recommended that an individualized prescription (dosage) that takes into consideration the unique characteristics and needs of the client is provided. Physical activity or exercise promotion should not be done in isolation; it should be part of an integrated approach to enhance healthy lifestyle behaviours.

Using short vignettes to disentangle perceived capability from motivation: a test using walking and resistance training behaviors

Self-efficacy is arguably the strongest correlate of physical activity, yet some researchers suggest this is because the construct confounds ability with motivation. We examine a more circumscribed construct, called perceived capability (PC), meant to measure ability but not motivation and propose that the construct will not be related to unskilled physical activities but may be linked to skilled behaviors. The purpose of this paper was to examine whether a PC construct can be stripped of motivation using a vignette approach in both walking and resistance training behaviors. Participants were a random sample of 248 university students, who were then randomly assigned to either answer resistance training or walking behavior questions. Both groups completed a PC measure and reasons for their answer before and after reading a vignette that clarified the phrasing of capability to a literal use of the term. PC was significantly (p < .01) higher post- compared to pre-vignette and the differences were greater (p < .01) for walking than for resistance training. PC had significantly (p < .01) smaller correlations with intention and self-reported behavior post-disambiguation, which resulted in a null relationship with walking but a small correlation with resistance training behavior. When PC was combined with intention to predict behavior, however, there was no significant (p > .05) difference in the amount of variance explained pre- to post-vignette. Thought listing showed that participants did not report capability barriers to walking and over half of the sample construed capability as motivation/other priorities pre-vignette. The findings support use of a vignette approach for researchers who wish to disentangle the assessment of PC from motivation while creating no overall loss in explained variance of physical activity.

Knowledge and awareness of Canadian Physical Activity and Sedentary Behaviour Guidelines: a synthesis of existing evidence

The aim of this review was to consolidate and synthesize existing evidence regarding current knowledge and awareness of the Canadian Physical Activity (PA) and Sedentary Behaviour (SB) Guidelines. MEDLINE, Embase, and PsycINFO were searched for peer-reviewed publications pertaining to the guidelines. Content experts, key organizations (i.e., ParticipACTION and the Canadian Fitness and Lifestyle Research Institute), journal Web sites, and service organizations (i.e., the Canadian Society for Exercise Physiology (CSEP) and the Public Health Agency of Canada) were consulted for additional evidence. Scientific publications (n = 6) and research from ParticipACTION and the Canadian Fitness and Lifestyle Research Institute reported that awareness of the guidelines is low, especially with respect to the SB guidelines. Less than 10% of survey respondents from the Canadian population were aware of the PA guidelines, and less than 5% were aware of the SB guidelines. Information on the guidelines was available on 51% of public health unit and CSEP partner Web sites. Online metrics (e.g., downloads, site accessions) from CSEP, the Public Health Agency of Canada, and journal Web sites showed that online accession of the guidelines was high (e.g., all “highly accessed” on journal Web sites). This review showed that awareness of the Canadian PA and SB Guidelines is low among the general population but higher among the scientific and stakeholder communities. Governmental, nongovernmental, and stakeholder organizations should collaborate in creating sustained, long-term, and well-resourced communication plans to reach the Canadian population to raise awareness of PA and SB guidelines and should implement programs to facilitate their uptake.

Predictors of Adherence in a Community-Based Tai Chi Program

Cette étude a examiné les facteurs qui influent l'adhésion dans un programme de de tai-chi à 16 semaines parmi les adultes multi-ethniques d'âge moyen et plus âgés qui vivent dans un environnement faible socio-économique à Toronto. L'analyse a été basée sur des données recueillies auprès de trois cohortes du programme de tai-chi qui ont eu lieu à partir d'août 2009 à mars 2012. La variable principale de résultat, l'adhésion, a été mesurée par le nombre total de sessions suivies par chacun des participants. L'échantillon total était de 210 participants, avec un âge moyen de 68,1 ± 8,6. Basé sur le modèle de régression, l'adhésion a été associée de façon significative à l'âge plus avancé, au stress plus perçu, à l'enseignement supérieur, et aux scores mentales et physiques plus élevés de composants sur le Questionnaire Abrégée 36. Inversement, une faible observance était significativement associée à une activité physique hebdomadaire de base plus élevée. Nos résultats suggèrent que nous devrions cibler les personnes les moins instruites, à la santé mentale et physique médiocre, pour optimiser l'adhésion aux futurs programmes de tai-chi communautaires.

Prediction of attendance at fitness center: a comparison between the theory of planned behavior, the social cognitive theory, and the physical activity maintenance theory

In the processes of physical activity (PA) maintenance specific predictors are effective, which differ from other stages of PA development. Recently, Physical Activity Maintenance Theory (PAMT) was specifically developed for prediction of PA maintenance. The aim of the present study was to evaluate the predictability of the future behavior by the PAMT and compare it with the Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT). Participation rate in a fitness center was observed for 101 college students (53 female) aged between 19 and 32 years (M = 23.6; SD = 2.9) over 20 weeks using a magnetic card. In order to predict the pattern of participation TPB, SCT and PAMT were used. A latent class zero-inflated Poisson growth curve analysis identified two participation patterns: regular attenders and intermittent exercisers. SCT showed the highest predictive power followed by PAMT and TPB. Impeding aspects as life stress and barriers were the strongest predictors suggesting that overcoming barriers might be an important aspect for working out on a regular basis. Self-efficacy, perceived behavioral control, and social support could also significantly differentiate between the participation patterns.

Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis

BACKGROUND

The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear.

PURPOSE

To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent of physical activity.

DATA SOURCES

English-language studies in MEDLINE, PubMed, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and Google Scholar databases were searched through August 2014 with hand-searching of in-text citations and no publication date limitations.

STUDY SELECTION

Studies assessing sedentary behavior in adults, adjusted for physical activity and correlated to at least 1 outcome.

DATA EXTRACTION

Two independent reviewers performed data abstraction and quality assessment, and a third reviewer resolved inconsistencies.

DATA SYNTHESIS

Forty-seven articles met our eligibility criteria. Meta-analyses were performed on outcomes for cardiovascular disease and diabetes (14 studies), cancer (14 studies), and all-cause mortality (13 studies). Prospective cohort designs were used in all but 3 studies; sedentary times were quantified using self-report in all but 1 study. Significant hazard ratio (HR) associations were found with all-cause mortality (HR, 1.240 [95% CI, 1.090 to 1.410]), cardiovascular disease mortality (HR, 1.179 [CI, 1.106 to 1.257]), cardiovascular disease incidence (HR, 1.143 [CI, 1.002 to 1.729]), cancer mortality (HR, 1.173 [CI, 1.108 to 1.242]), cancer incidence (HR, 1.130 [CI, 1.053 to 1.213]), and type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to 2.222]). Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.

LIMITATION

There was marked heterogeneity in research designs and the assessment of sedentary time and physical activity.

CONCLUSION

Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.

PRIMARY FUNDING SOURCE

None.

The impact of parenthood on Canadians' objectively measured physical activity: an examination of cross-sectional population-based data

BACKGROUND

Parenthood has been associated with declines in leisure-time exercise and moderate-to-vigorous physical activity (MVPA), but less is known about its impact on sedentary time and light-intensity activity. Although the health benefits of MVPA are well established, a growing body of research has been showing that even after controlling for MVPA levels, a detrimental dose-response association exists between sedentary time and adverse health outcomes and a beneficial dose-response association exists for light-intensity activity.

METHODS

This study examined the impact of parenthood, the number of children in the home, and the age of the youngest child on objectively measured physical activity (i.e., accelerometer derived daily minutes of sedentary, light, and MVPA) among a nationally representative cross-sectional sample of 2234 men and women who participated in the 2009-2011 Canadian Health Measures Survey.

RESULTS

After controlling for sociodemographic variables, ANCOVAs indicated that parents engaged in more light activity but less MVPA than non-parents and women whose youngest child was aged 12-15 years were more sedentary than women without children. Among both men and women, having a child <6 years of age in the home was associated with the greatest amount of light activity and lowest MVPA.

CONCLUSIONS

Modest differences emerged between the physical activity level of parents and non-parents for both genders and across intensity levels. In general, parenthood was associated with less MVPA and more light-intensity activity, and more differences emerged among women compared to men. More research is needed before conclusions can be drawn regarding the health consequences of these differences.

Self-presentation in exercise: changes over a 12-week cardiovascular programme for overweight and obese sedentary females

Self-presentational concerns, shown to influence exercise-related cognitions and behaviours, are evaluated frequently in the absence of exercise or following a single bout of physical activity. The purpose of the present study was to examine longitudinally, the extent to which participating in a structured 12-week cardiovascular exercise intervention elicited changes in self-presentational efficacy expectancy (SPEE) and social physique anxiety (SPA). Participants were 80 sedentary women with overweight or obesity (mean body mass index 29.02 kg/m(2), SD=4.71) between the ages of 19 and 45 wanting to begin an exercise programme (mean age 33.4 years, SD=7.6). The Self-Presentational Efficacy Scale (SPES) and the Social Physique Anxiety Scale (SPAS) were completed by each participant prior to commencing the study, and at the 6- and 12-week time points. For those who completed the programme, repeated measures ANOVAs indicated significant increases in SPEE between baseline and week 6 (P<0.001, η(2)=0.37), and week 6 to 12 (P<0.05, η(2)=0.10), while SPA decreased significantly between baseline and week 6 (P<0.01, η(2)=0.16). Bivariate correlation analyses revealed that length of participation in the study was positively related to SPEE and negatively related to SPA. Implications of focusing on these variables within a physical activity intervention are discussed with respect to exercise behaviour, programme development and adherence.

Exploring the covariates of sport participation for health: an analysis of males and females in England

Increasing sport participation has been identified as a key vehicle for achieving World Health Organisation guidelines for health-enhancing physical activity (HEPA). A policy challenge is to promote this changed behaviour. Making use of the Active People Survey, a zero-inflated ordered probit model is used to identify the covariates of sport participation for males and females with respect to the related decisions to either participate in sport or not, and to participate at either lower or higher than desired intensity. To inform current policy emphases, the Active Places Survey is also used to examine the causal impact of facility provision on these behaviours. Results indicate that females are more likely to adopt less intensive activity even with time available. Families could place most constraints on females, but also reduce the intensity of male participation. Education has a greater association with higher intensity female activity. The largest effects are identified for sport club membership and facility satisfaction. Both of these affect male intensity of activity most. The main policy challenges facing sport in contributing to HEPA are shown to involve retaining male intensity of participation when ageing and encouraging greater female intensity of participation, with more appropriate matching of facilities.

Physical activity and its relation to cancer risk: updating the evidence

Scientific evidence for the primary prevention of cancer caused by physical activity of regular moderate-intensity or greater is rapidly accumulating in this field. About 300 epidemiologic studies on the association between physical activity and cancer risk have been conducted worldwide. The objectives of this paper were three-fold: (i) to describe briefly the components of physical activity and its quantification; (ii) to summarize the most important conclusions available from comprehensive reports, and reviews of the epidemiologic individual and intervention studies on a role physical activity in cancer prevention; (iii) to present proposed biological mechanisms accounting for effects of activity on cancer risk. The evidence of causal linked physical activity and cancer risk is found to be strong for colon cancer - convincing; weaker for postmenopausal breast and endometrium cancers - probable; and limited suggestive for premenopausal breast, lung, prostate, ovary, gastric and pancreatic cancers. The average risk reductions were reported to be 20-30%. The protective effects of physical activity on cancer risk are hypothesized to be through multiple interrelated pathways: decrease in adiposity, decrease in sexual and metabolic hormones, changes in biomarkers and insulin resistance, improvement of immune function, and reduction of inflammation. As there are several gaps in the literature for associations between activity and cancer risk, additional studies are needed. Future research should include studies dealing with limitations in precise estimates of physical activity and of a lack of consensus on what defines sedentary behavior of individuals and those linked with the proposed biomarkers to cancer risk and controlled exercise intervention trials.

The effect of exercise on carbohydrate preference in female rats

Exercise has a myriad of health benefits, including positive effects against heart disease, diabetes, and dementia. Cognitive performance improves following chronic exercise, both in animal models and humans. Studies have examined the effect of exercise on feeding, demonstrating a preference towards increased food consumption. Further, sex differences exist such that females tend to prefer carbohydrates over other macronutrients following exercise. However, no clear effect of exercise on macronutrient or carbohydrate selection has been described in animal or human studies. This research project sought to determine the effect of voluntary exercise on carbohydrate selection in female rats. Preference for a complex (starch) versus a simple (dextrose) carbohydrate was assessed using a discriminative preference to context paradigm in non-exercising and voluntarily exercising female rats. In addition, fasting blood glucose and performance in the Morris water task was examined in order to verify the effects of exercise on performance in this task. Female rats given access to running wheels preferred a context previously associated with starch, whereas females with no running wheel access preferred a context previously associated with dextrose. No changes in blood glucose were observed. However, cognitive differences in the Morris water task were observed such that voluntary exercise allowed rats to find a new location of a hidden platform following 4 days of training to an old platform location. These results suggest that voluntary exercise may decrease preservative behaviors in a spatial navigation task through the facilitation of plasticity mechanisms. This study is the first of its kind to demonstrate the influence of exercise on taste preference for complex and simple carbohydrates with this context conditioning paradigm.

Is high-intensity exercise better than moderate-intensity exercise for weight loss?

This viewpoint debates the state-of-the-art research focusing on the optimal intensity of the exercise programs for inducing a sustained weight or fat-mass loss in overweight/obese people. In our demanding society, the most attractive messages in the popular press are those promising the best results in a short time. This might explain the emphasis given by media to those scientific articles that report the efficacy on weight loss of exercise programs by their shorter duration and higher intensity. However, in the literature on overweight or obese people, there is little conclusive evidence for more favorable effects with high-intensity training than with continuous moderate-intensity exercise on body weight or fat mass loss. Since both exercise protocols have been demonstrated as useful to reduce body weight, the decision on the intensity of exercise prescription should be individualized and based on outcomes different from fat or weight loss. In this regard, there are pro and contra arguments for the prescription of high-intensity aerobic exercise in obese people. Among the pro arguments, is the demonstration that, in several studies, high-intensity training appears to induce superior improvements in aerobic fitness. Among the contra arguments to prescribe high-intensity exercise is the demonstration that prescribing a higher-intensity exercise decreases adherence and results in the completion of less exercise. Thus, a successful exercise program should be proposed at a moderate intensity and a low perceived effort because obese subjects who have low self-efficacy, poor mood status, and are not familiar with high-intensity workouts could easily drop out.

Evidence-based risk recommendations for best practices in the training of qualified exercise professionals working with clinical populations

This systematic review examines critically "best practices" in the training of qualified exercise professionals. Particular attention is given to the core competencies and educational requirements needed for working with clinical populations. Relevant information was obtained by a systematic search of 6 electronic databases, cross-referencing, and through the authors' knowledge of the area. The level and grade of the available evidence was established. A total of 52 articles relating to best practices and (or) core competencies in clinical exercise physiology met our eligibility criteria. Overall, current literature supports the need for qualified exercise professionals to possess advanced certification and education in the exercise sciences, particularly when dealing with "at-risk" populations. Current literature also substantiates the safety and effectiveness of exercise physiologist supervised stress testing and training in clinical populations.

Evidence-based risk assessment and recommendations for physical activity clearance: cancer

Physical activity is becoming increasingly acknowledged as an integral component of in the multidisciplinary management of cancer patients. Intensive inquiry in this area is likely to increase further over the next decade; however, cancer-specific, evidence-based risk assessment and recommendations for physical activity are not available. A systematic literature review was performed of all studies conducting an exercise training intervention and (or) any form of objective exercise test among adults diagnosed with cancer. Studies were assessed according to evaluation criteria developed by a panel of experts. A total of 118 studies involving 5529 patients were deemed eligible. Overall, the results suggest that exercise training and maximal and submaximal exercise testing are relatively safe procedures with a total nonlife-threatening adverse event rate of <2%. There was only 1 exercise training-related death. However, the quality of exercise testing methodology and data reporting is less than optimal. Thus, whether the low incidence of events reflects the true safety of exercise training and exercise testing in cancer patients or less than optimal methodology and (or) data reporting remains to be determined. Evidence-based absolute and relative contraindications to physical activity and exercise training and testing are provided as well as probing decision-trees to optimize the adoption and safety of physical activity in persons diagnosed with cancer.

Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease

The 2 most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Growing evidence supports the benefits of exercise for all patients with these diseases. Due to the etiology of COPD and the pathophysiology of asthma, there may be some additional risks of exercise for these patients, and hence accurate risk assessment and clearance is needed before patients start exercising. The purpose of this review was to evaluate the available literature regarding the risks of exercise for patients with respiratory disease and provide evidence-based recommendations to guide the screening process. A systematic review of 4 databases was performed. The literature was searched to identify adverse events specific to exercise. For COPD, 102 randomized controlled trials that involved an exercise intervention were included (n = 6938). No study directly assessed the risk of exercise, and only 15 commented on exercise-related adverse events. For asthma, 30 studies of mixed methodologies were included (n = 1278). One study directly assessed the risk of exercise, and 15 commented on exercise-related adverse events. No exercise-related fatalities were reported. The majority of adverse events in COPD patients were musculoskeletal or cardiovascular in nature. In asthma patients, exercise-induced bronchoconstriction and (or) asthma symptoms were the primary adverse events. There is no direct evidence regarding the risk of exercise for patients with COPD or asthma. However, based on the available literature, it would appear that with adequate screening and optimal medical therapy, the risk of exercise for these respiratory patients is low.

Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain

We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%-11% (0.06%-2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions.

Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 2011

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally known preparticipation screening tools developed on the basis of expert opinion. The primary purposes of this consensus document were to seek evidence-based support for the PAR-Q and PARmed-X forms, to identify whether further revisions of these instruments are warranted, to determine how people responding positively to questions on the PAR-Q can be safely cleared without medical referral, and to develop exercise clearance procedures appropriate for various clinical conditions across the human lifespan. Seven systematic reviews were conducted, examining physical-activity-related risks and effective risk-stratification procedures for various prevalent chronic conditions. An additional systematic review assessed the risks associated with exercise testing and training of the general population. Two gap areas were identified and evaluated systematically: the role of the qualified exercise professional and the requisite core competencies required by those working with various chronic conditions; and the risks associated with physical activity during pregnancy. The risks associated with being physically inactive are markedly higher than transient risks during and following an acute bout of exercise in both asymptomatic and symptomatic populations across the lifespan. Further refinements of the PAR-Q and the PARmed-X (including online versions of the forms) are required to address the unique limitations imposed by various chronic health conditions, and to allow the inclusion of individuals across their entire lifespan. A probing decision-tree process is proposed to assist in risk stratification and to reduce barriers to physical activity. Qualified exercise professionals will play an essential role in this revised physical activity clearance process.

Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions

Physical activity has established mental and physical health benefits, but related adverse events have not received attention. The purpose of this paper was to review the documented adverse events occurring from physical activity participation among individuals with psychological or cognitive conditions. Literature was identified through electronic database (e.g., MEDLINE, psychINFO) searching. Studies were eligible if they described a published paper examining the effect of changes on physical activity behaviour, included a diagnosed population with a cognitive or psychological disorder, and reported on the presence or absence of adverse events. Quality of included studies was assessed, and the analyses examined the overall evidence by available subcategories. Forty trials passed the eligibility criteria; these were grouped (not mutually exclusively) by dementia (n = 5), depression (n = 10), anxiety disorders (n = 12), eating disorders (n = 4), psychotic disorders (n = 4), and intellectual disability (n = 15). All studies displayed a possible risk of bias, ranging from moderate to high. The results showed a relatively low prevalence of adverse events. Populations with dementia, psychological disorders, or intellectual disability do not report considerable or consequential adverse events from physical activity independent of associated comorbidities. The one exception to these findings may be Down syndrome populations with atlantoaxial instability; in these cases, additional caution may be required during screening for physical activity. This review, however, highlights the relative paucity of the reported presence or absence of adverse events, and finds that many studies are at high risk of bias toward reporting naturally occurring adverse events.

The health benefits and challenges of exercise training in persons living with schizophrenia: a pilot study

BACKGROUND

In addition to the hallmark cognitive and functional impairments mounting evidence indicates that schizophrenia is also associated with an increased risk for the development of secondary complications, in particular cardio-metabolic disease. This is thought to be the result of various factors including physical inactivity and the metabolic side effects of psychotropic medications. Therefore, non-pharmacological approaches to improving brain health, physical health, and overall well-being have been promoted increasingly.

METHODS

We report on the health-related physical fitness (body composition, blood pressure, heart rate, and aerobic fitness) and lipid profile of persons living with schizophrenia and effective means to address the challenges of exercise training in this population.

RESULTS

There was a markedly increased risk for cardio-metabolic disease in 13 persons living with schizophrenia (Age = 31 ± 7 years) including low aerobic fitness (76% ± 34% of predicted), reduced HDL (60% of cohort), elevated resting heart rate (80% of cohort), hypertension (40% of cohort), overweight and obesity (69% of cohort), and abdominal obesity (54% of cohort). Individualized exercise prescription (3 times/week) was well tolerated, with no incidence of adverse exercise-related events. The exercise adherence rate was 81% ± 21% (Range 48%-100%), and 69% of the participants were able to complete the entire exercise training program. Exercise training resulted in clinically important changes in physical activity, aerobic fitness, exercise tolerance, blood pressure, and body composition.

CONCLUSION

Persons living with schizophrenia appear to be at an increased risk for cardio-metabolic disease. An individualized exercise program has shown early promise for the treatment of schizophrenia and the various cognitive, functional, and physiological impairments that ultimately affect health and well-being.

Action control of exercise behavior: evaluation of social cognition, cross-behavioral regulation, and automaticity

Intention is considered the proximal determinant of behavior in many popular theories applied to understanding physical activity, yet intention-behavior discordance is high. Thus, an understanding of constructs that facilitate or inhibit the successful translation of intentions into behavior is both timely and important. The action control approach of dividing the intention-behavior relationship into quadrants of successful/unsuccessful intenders has shown utility in the past by demonstrating the magnitude of intention-behavior discordance and allowing for an outcome variable to test predictors. The purpose of this article was to evaluate automaticity and cross-behavioral regulation as predictors of exercise action control, in conjunction with other more standard social cognitive predictors of perceived behavioral control and affective and instrumental attitudes. Participants were a random sample of 263 college students who completed predictor measures at time one, followed by exercise behavior two weeks later. Participants were classified into three intention-behavior profiles: (1) nonintenders (14.1%; n = 31), (2) unsuccessful intenders (35.5%; n = 78), and (3) successful intenders (48.6%; n = 107). Affective attitude, perceived behavioral control, automaticity, and cross-behavioral regulation were predictors of action control. The results demonstrate that automaticity and cross-behavioral regulation, constructs not typically used in intention-based theories, predict intention-behavior discordance.