A prediction model of aerobic exercise in older adults living in a continuing-care retirement community

Outcome Expectations and Older Adults with Knee Osteoarthritis: Their Exercise Outcome Expectations in Relation to Perceived Health, Self-Efficacy, and Fear of Falling

Outcome expectations are a determinant of exercise engagement and adherence. However, the factors that influence outcome expectations for exercise remain poorly understood for people with knee osteoarthritis. In this paper, a cross-sectional study was conducted by recruiting 211 older adults from three clinics in Southern Taiwan. This study explored older adults with knee osteoarthritis exercise outcome expectations and perceived health, self- efficacy, and fear of falling. The older adults completed the Outcome Expectations for Exercise Scale (OEES), the pain and physical function subscales of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Perceived Health Status Scale, the Self-Efficacy for Exercise scale (SEE- C), the Activities-Specific Balance Confidence Scale (ABC), the Geriatric Depression Scale (GDS). Multiple logistic regression models were used to determine associations between outcome expectations for exercise and physical and psychosocial outcomes in the knee OA population. Among the participants of the cross-sectional study, the mean age was 72.04 (SD = 5.53) years, and 71.6% were female. Higher outcome expectations for exercise were associated with higher physical function (OR = 0.98; 95% CI [0.96−1.99]; p = 0.007), better perceived health (OR = 1.30; 95% CI [1.12−1.51]; p < 0.001), greater self-efficacy (OR =1.03; 95% CI [1.01−1.04]; p = 0.006), and less fear of falling (OR = 3.33; 95% CI [1.21−9.19]; p = 0.020). Thus, the results indicated that outcome expectations for exercise among the participants were significantly associated with physical function, perceived health, self-efficacy, and fear of falling. These findings suggest the importance of personal factors in the design of interventions to promote exercise behavior changes among elderly patients with Knee Osteoarthritis.

An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors

BACKGROUND

Previous studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects.

PURPOSE

To examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors.

METHODS

Ecological momentary assessment (EMA) surveys were delivered up to eight 5- to 7-day periods over 6 months. Participants (n = 100) rated their affective and physiological states before and after each exercise session (predictors) and recorded their self-efficacy and outcome expectancy each morning (mediators). Exercise (outcome) was based on self-reported EMA surveys and accelerometer measures. A 1-1-1 multilevel mediation model was used to disaggregate the within-subject (WS) and between-subject (BS) effects.

RESULTS

At the WS level, a more positive affective state after exercise was associated with higher self-efficacy and positive outcome expectation the next day, which in turn was associated with higher subsequent exercise levels (ps < .05). At the BS level, participants who typically had more positive affective and experienced less intense physiological sensation after exercise had higher average self-efficacy, which was associated with higher average exercise levels (ps < .05).

CONCLUSIONS

In endometrial cancer survivors, affective experience after exercise, daily self-efficacy and positive outcome expectation help explain the day-to-day differences in exercise levels within-person. Findings from this study highlight potentials for behavioral interventions that target affective experience after exercise and daily behavioral cognitions to promote physical activity in cancer survivors' everyday lives.

A survey of social cognitive determinants of physical activity among Iranian women using path analysis method

Introduction

This cross-sectional study was carried out on 400 women selected from urban health centers in Isfahan through stratified sampling. The study was designed to evaluate the social cognitive theoretical model in explaining the determinants of physical activity among women using path analysis method.

Methods

In a hypothetical framework, the relationship between self-efficacy, outcome expectation, social support and self-regulation and physical activity were assessed using path analysis and indices of fitness. Furthermore, the predictive power of the model was evaluated.

Results

The social cognitive theoretical model had a good predictive power for physical activity. Confirmatory factor analysis revealed the suitability of the theoretical model; this model is able to cover 80% of the physical activity variance. Evaluation of the social cognitive theoretical model using path analysis showed that self-regulation was the strongest determinant of physical activity. Social support and outcome expectation had very weak effects on physical activity; nonetheless, their effect was enhanced by the presence of self-regulation. Self-efficacy had a weak effect on physical activity, however, as an intermediate variable, it reinforced the impact of social support and outcome expectation on physical activity.

Conclusions

The use of the present hypothetical model is suggested as an appropriate framework in research related to physical activity among women as well as to strengthening self-regulation skills in designing and implementing programs promoting physical activities.

Developing Culturally Relevant Design Guidelines for Encouraging Physical Activity: a Social Cognitive Theory Perspective

The prevalence of physical inactivity and non-communicable diseases is on the rise worldwide. This calls for a systematic approach in addressing the problem, which is almost becoming a global epidemic. Research has shown that theory-driven interventions are more likely to be effective than uninformed interventions. However, research on the determinants of physical activity and the moderating effect of culture is scarce. To bridge this gap, we conducted a large-scale comparative study of the determinants of physical activity among 633 participants from individualist and collectivist cultures. Using the Social Cognitive Theory, a widely applied behavioral theory in health interventions, we modeled the determinants of physical activity for each culture and mapped them to implementable strategies in the application domain. Our structural equation model shows that, in the individualist culture, Self-Efficacy (βT = 0.55, p < 0.001) and Self-Regulation (βT = 0.33, p < 0.001) are the strongest determinants of Physical Activity. However, in the collectivist culture, Social Support (βT = 0.42, p < 0.001) and Outcome Expectation (βT = 0.11, p < 0.01) are the strongest determinants of Physical Activity. We discussed these findings, mapped the respective behavioral determinants to the corresponding persuasive strategies in the health domain and provided a set of general design guidelines for tailoring the strategies to the respective cultures.

The Role of Caregivers in Physical Activity for Older Adults With Alzheimer's Disease

This study examined the determinants of physical activity (PA) for older adults with Alzheimer's disease (AD) to learn more about how to promote PA in this population. Caregivers of older adults with AD (N = 99) provided information related to care recipient's PA, as well as addressed sociodemographics and perceptions about their care recipient's PA. Gender of care recipient was a significant predictor of PA (β = .80, P < .05); men with AD participated in more PA than women with AD. Also, caregiver's outcome expectation for care recipient's PA also predicted more PA (β = .82, P < .05). Caregiver's perceived benefits of PA (outcome expectation) for their care recipient partially mediated the relationship between self-efficacy for care recipient's PA and the reported levels of PA for the care recipient. This study demonstrated the importance of caregiver perceptions about care recipient's PA.

Social cognitive determinants of exercise behavior in the context of behavior modeling: a mixed method approach

Research has shown that persuasive technologies aimed at behavior change will be more effective if behavioral determinants are targeted. However, research on the determinants of bodyweight exercise performance in the context of behavior modeling in fitness apps is scarce. To bridge this gap, we conducted an empirical study among 659 participants resident in North America using social cognitive theory as a framework to uncover the determinants of the performance of bodyweight exercise behavior. To contextualize our study, we modeled, in a hypothetical context, two popular bodyweight exercise behaviors - push ups and squats - featured in most fitness apps on the market using a virtual coach (aka behavior model). Our social cognitive model shows that users' perceived self-efficacy (βT = 0.23, p < 0.001) and perceived social support (βT = 0.23, p < 0.001) are the strongest determinants of bodyweight exercise behavior, followed by outcome expectation (βT = 0.11, p < 0.05). However, users' perceived self-regulation (βT = -0.07, p = n.s.) turns out to be a non-determinant of bodyweight exercise behavior. Comparatively, our model shows that perceived self-efficacy has a stronger direct effect on exercise behavior for men (β = 0.31, p < 0.001) than for women (β = 0.10, p = n.s.). In contrast, perceived social support has a stronger direct effect on exercise behavior for women (β = 0.15, p < 0.05) than for men (β = -0.01, p = n.s.). Based on these findings and qualitative analysis of participants' comments, we provide a set of guidelines for the design of persuasive technologies for promoting regular exercise behavior.

Depressive symptoms, perceived stress, self-efficacy, and outcome expectations: Predict fitness among adolescents with obesity

The objective of the present study was to test if outcome expectancy mediated the relationship between fitness and self-efficacy, perceived stress, and depressive symptoms.Adolescents with obesity (n = 228) completed measures of perceived stress and depressive symptoms at baseline, self-efficacy and outcome expectancy at baseline and 3 months, and fitness at baseline and 6 months. Structural equation modeling was used to analyze the data. Results showed that self-efficacy was positively associated with fitness via outcome expectancies. For females, fewer depressive symptoms were linked to fitness via self-efficacy and outcome expectancies. Exercise interventions that enhance exercise self-efficacy, outcome expectancy, and reduce depressive symptoms may increase fitness.

Outcome Expectations and Osteoarthritis: Association of Perceived Benefits of Exercise With Self-Efficacy and Depression

OBJECTIVE

Outcome expectancy is recognized as a determinant of exercise engagement and adherence. However, little is known about which factors influence outcome expectations for exercise among people with knee osteoarthritis (OA). This is the first study to examine the association of outcome expectations for exercise with demographic, physical, and psychosocial outcomes in individuals with knee OA.

METHODS

We performed a cross-sectional analysis of the baseline data from a randomized trial of tai chi versus physical therapy in participants with symptomatic knee OA. Knee pain was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome expectations for exercise, self-efficacy, depression, anxiety, stress, and social support were measured using standard instruments. Logistic regression models were utilized to determine associations with outcome expectations.

RESULTS

There were 262 participants, with a mean age of 59.8 years and a mean body mass index of 32.1 kg/m2 ; 69.1% of the participants were female, 51.5% were white, the mean disease duration was 8.6 years, and the mean WOMAC knee pain and function scores were 260.8 and 906.8, respectively. Higher outcome expectations for exercise were associated with greater self-efficacy (odds ratio [OR] 1.25 [95% confidence interval (95% CI) 1.11-1.41]; P = 0.0004), as well as with fewer depressive symptoms (OR 0.84 for each 5-point increase [95% CI 0.73-0.97]; P = 0.01). Outcome expectancy was not significantly associated with sex, race, education, pain, function, radiographic severity, social support, anxiety, or stress.

CONCLUSION

Our results suggest significant associations between outcome expectations for exercise and self-efficacy and depression. Future studies should examine how these relationships longitudinally affect long-term clinical outcomes of exercise-based treatment for knee OA.

Work-site wellness programmes in Sweden: a cross-sectional study of physical activity, self-efficacy, and health

In Sweden, a work-site wellness programme implies reimbursing some of the expenses for health-promoting activities. Although work-site wellness programmes are readily available in Sweden, a large number of employees elect not to participate.

OBJECTIVES

The aim of this study was to investigate the association of physical activity, self-reported general health assessment and self-efficacy with participation in a work-site wellness programme.

STUDY DESIGN

A cross-sectional study design was used.

METHODS

An online questionnaire was distributed to employees of a manufacturing company with 2500 employees in southwest Sweden.

RESULTS

Those who took advantage of the work-site wellness programme assessed their general health as better and had higher assessment of physical activity. The study showed that being enlisted also implies a higher level of physical activity and general health; however, the effect sizes of these correlations were small. Self-efficacy, i.e. perceived behavioural control, was not associated with participation in the work-site wellness programme. However, self-efficacy was correlated with both general health assessment and physical activity. A regression analysis to determine explanatory contributions to the general health assessment score showed no significant contribution from participation in a work-site wellness programme, but was instead explained by perceived behavioural control and physical activity.

CONCLUSIONS

Given the small effect size of the difference in physical activity between participators and non-participators in the work-site wellness programme, it is probable that only a small proportion of participators changed their health-promoting activities as a result of the work-site wellness programme.

Older people's perceived causes of and strategies for dealing with social isolation

OBJECTIVE

To explicate lay theories relating to social isolation and to identify instances of positive deviance to inform future efforts to encourage older people to participate in protective behaviors.

METHOD

Twelve focus groups and 20 individual interviews were conducted with Australians aged 40 years and older. Data were collected in metropolitan and regional areas. The age threshold was based on the need to generate formative research to inform interventions to encourage people to engage in preventive behaviors prior to reaching older age when they become more susceptible to social isolation.

RESULTS

Two primary lay theories were identified in the data. These are related to the recognized importance of social connection and the belief that forming new social connections becomes more difficult with age due to a range of individual and external factors. Examples of positive deviance that were identified included viewing overcoming social isolation as an incremental process, being prepared to be the instigator of social interaction, and adopting an external focus.

CONCLUSION

The findings suggest that the provision of a broad range of group activities may need to be combined with a focused approach to targeting and approaching those most at risk to reduce the burden of social isolation at a population level.

How do couples influence each other's physical activity behaviours in retirement? An exploratory qualitative study

BACKGROUND

Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other's physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other's physical activity behaviour in retirement.

METHODS

A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis.

RESULTS

Three themes emerged: spousal attitude towards physical activity, spouses' physical activity behaviour and spousal support. While spouses' attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise.

CONCLUSIONS

Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport.

Social-cognitive theory predictors of exercise behavior in endometrial cancer survivors

OBJECTIVE

This study evaluated whether social-cognitive theory (SCT) variables, as measured by questionnaire and ecological momentary assessment (EMA), predicted exercise in endometrial cancer survivors.

METHOD

One hundred posttreatment endometrial cancer survivors received a 6-month home-based exercise intervention. EMAs were conducted by using hand-held computers for 10- to 12-day periods every 2 months. Participants rated morning self-efficacy and positive and negative outcome expectations by using the computer, recorded exercise information in real time and at night, and wore accelerometers. At the midpoint of each assessment period, participants completed SCT questionnaires. Using linear mixed-effects models, the authors tested whether morning SCT variables predicted minutes of exercise that day (Question 1) and whether exercise minutes at time point Tj could be predicted by questionnaire measures of SCT variables from time point Tj-1 (Question 2).

RESULTS

Morning self-efficacy significantly predicted that day's exercise minutes (p < .0001). Morning positive outcome expectations were also associated with exercise minutes (p = .0003), but the relationship was attenuated when self-efficacy was included in the model (p = .4032). Morning negative outcome expectations were not associated with exercise minutes. Of the questionnaire measures of SCT variables, only exercise self-efficacy predicted exercise at the next time point (p = .003).

CONCLUSIONS

The consistency of the relationship between self-efficacy and exercise minutes over short (same day) and longer (Tj to Tj-1) time periods provides support for a causal relationship. The strength of the relationship between morning self-efficacy and exercise minutes suggest that real-time interventions that target daily variation in self-efficacy may benefit endometrial cancer survivors' exercise adherence.

A theoretical model of efficacy beliefs, functional status and quality of life for older people during rehabilitation: testing causal relationships

AIMS

Structural equation modelling tested hypothesized causal relationships between age, gender, pain, depression, self-efficacy, outcome expectations, functional status and quality of life in older Australians post-orthopaedics surgery across three stages of their rehabilitation.

BACKGROUND

Self-efficacy is important in forming personal beliefs about capabilities to perform functional activities, which is believed to maintain individual's quality of life. Research examining how efficacy beliefs influence functional status in older people following orthopaedic events is limited.

DESIGN

A descriptive, longitudinal method was used for this study.

METHODS

A convenience sample of 101 older people with orthopaedic surgery to lower extremities was recruited from private rehabilitation units in Brisbane, Australia. Data were collected from September 2008-November 2009. Standardized questionnaires were used to measure efficacy beliefs, functional status, and quality of life.

RESULTS

Structural equation modelling revealed that depression, efficacy beliefs, age, and gender significantly influenced quality of life, as self-efficacy and gender have a direct relationship on functional status. Across three stages in the model, outcome expectation at stage 2 was the most significant predictor of functional recovery after discharge. Older men with higher quality of life at admission was positively related to self-efficacy and negatively associated with depression at stage 2: quality of life influenced outcome expectations and pain positively at stage 3.

CONCLUSION

Rehabilitation programmes play a significant role in assisting older people in resuming functional activities and quality of life following orthopaedic surgery. Enhancing self-efficacy may facilitate older people's participation and adherence to rehabilitation programmes during hospitalization and following discharge.

Validity of the Multidimensional Outcome Expectations for Exercise Scale in Continuing-Care Retirement Communities

Objective:

The current study examined the psychometric properties and validity of the Multidimensional Outcome Expectations for Exercise Scale (MOEES) in a sample of older adults with physical and functional comorbidities.

Methods:

Confirmatory factor analysis was used to examine the hypothesized 3-factor model in 108 older adults (M age 85 yr) residing in continuing-care retirement communities.

Results:

Analyses supported the 3-factor structure of the MOEES reflecting physical, social, and self-evaluative outcome expectations, with a 12-item model providing the best fit. Theorized bivariate associations between outcome expectations and physical activity, self-efficacy, and functional performance were all supported.

Conclusions:

The 12-item version of the MOEES appears to be a reliable and valid measure of outcome expectations for exercise in this sample of older adults with physical and functional comorbidities. Further examination of the factor structure and the longitudinal properties of this measure in older adults is warranted.

Influences on neighborhood walking in older adults

The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.

Projections of hospitalised fall-related injury in NSW, Australia: impacts on the hospital and aged care sectors

Projections of the number, rate and cost of fall-related hospitalised injuries for individuals aged 65 years and older in New South Wales (NSW), Australia were estimated to 2051 for two scenarios: (1) demographic change only using 2008 admission rates; and (2) modelled change using negative binominal regression taking into account current trends in admission rates. Based on demographic change alone, the number and cost of fall injury hospitalisations among older people is expected to increase almost three-fold by 2051. Transfers to permanent residential aged care will also increase 3.2 fold. However, if the fall-related hospitalisation rate sustains its current trend, these increases are projected to be more than ten-fold by 2051. Even with demographic change alone, there will be a significant impact on the resources required to care for older people suffering a fall injury hospitalisation over the next forty years in NSW. The impact on the hospital and aged care sectors will be considerable unless significant improvements occur in the prevention and treatment of fall-related injury in older people.

Evaluation of the NSW Management Policy to Reduce Fall Injury Among Older People, 2003-2007: implications for policy development

AIM

To retrospectively evaluate the NSW Management Policy to Reduce Fall Injury Among Older People, 2003-2007.

METHODS

The process evaluation was conducted by interviewing stakeholders regarding the implementation of the Policy. A document review was also undertaken to identify activities and initiatives undertaken during the implementation process.

RESULTS

Key achievements in the implementation of the Policy and significant early events, decisions and contextual factors which acted as barriers to the implementation were identified. Results included the: identification of the need for the prioritisation of evidence-based interventions; application of consistent best practice guidelines for implementing falls prevention strategies in the community; and development of an evaluation and monitoring framework concurrent with the development of policy.

CONCLUSION

Subsequent policy initiatives must be strategically focused and coordinated if future activities are to have a significant impact on the increasing burden of fall-related injury.

Promoting self-efficacy and outcome expectations to enable adherence to resistance training after cardiac rehabilitation

BACKGROUND AND OBJECTIVE

Resistance training offers clinical and functional benefits to cardiac patients, yet exercise adherence after cardiac rehabilitation (CR) is problematic. This study examined effects of an intervention targeting self-efficacy, outcome expectations, and adherence to upper-body resistance exercise after CR.

PARTICIPANTS AND METHODS

Cardiac patients (N = 40) were randomly allocated to receive either standard exercise recommendations (wait-list control) or an intervention involving a theory-based instructional manual and Thera-Band resistive bands for upper-body resistance exercise. Self-efficacy and outcome expectations were assessed at baseline and 4 weeks later. Participation in resistance exercise was measured at 4 weeks postbaseline and at 3-month follow-up.

RESULTS AND CONCLUSIONS

The intervention group reported higher levels of self-efficacy, outcome expectations, and resistance exercise volume compared with the control group at the 4-week follow-up. Adherence differences were sustained at 3-month follow-up, with some support that self-efficacy for adhering to resistance training mediated the effects of the intervention on follow-up exercise training frequency. Findings support the use of a theory-based motivational manual and Thera-Band resistive bands to increase self-efficacy and outcome expectations for, and adherence to, resistance training after CR.

In fitness and health? A prospective study of changes in marital status and fitness in men and women

The authors examined the prospective associations between marital status transitions and changes in fitness in men and women. Between 1987 and 2005, a total of 8,871 adults (6,900 men) aged 45.6 (standard deviation, 9.1) years were examined at the Cooper Clinic, Dallas, Texas; the median follow-up was ∼3 years. Marital transition categories (from single to married, married to divorced, divorced to remarried) were derived from self-reported marital status at baseline and follow-up. Fitness (maximal oxygen consumption) was assessed by a maximal treadmill test. Analyses were adjusted for baseline levels and changes in body mass index, physical activity, smoking, alcohol consumption, and major chronic diseases. Compared with the corresponding "control" groups (remaining single, married, or divorced), transitioning from being single to married was associated with a reduction in fitness in women (P = 0.03); divorce was associated with an increase in fitness in men (P = 0.04); and remarriage was associated with a reduction in fitness in men (P = 0.05). The authors conclude that the transitions to being married (from single to married or from divorced to remarried) are associated with a modest reduction, while divorce is associated with a modest increase in fitness levels in men. Study results suggest that these patterns may be different in women, but further research is required to confirm this.

Gender differences in physical activity and its determinants in rural adults in Korea

AIM

This study aimed to examine gender differences in physical activity and its determinants among rural adults in Korea.

BACKGROUND

Only limited studies exist that examined gender differences in physical activity in Korean adults. Major determinants for physical activity such as self-efficacy, benefits and barriers have been studied, but little is known about their gender differences. Nurses promoting and teaching adults to increase physical activity need data for evidence-based practice.

DESIGN

A cross-sectional descriptive design was used.

METHOD

Participants were 481 adults living in a rural area of Korea. The physical activity status, exercise self-efficacy, benefits, barriers and sociodemographics were compared between men and women. Descriptive statistics, t-test and binary logistic regression were used for data analysis.

RESULTS

The physical activity status, perceived self-efficacy and benefits of physical activity in women were significantly lower than those of men. For men, only self-efficacy was statistically significant in explaining recommended physical activity as well as physical activity participation. However, for women, benefits and barriers as well as self-efficacy significantly explained their participation of physical activity, but not the recommended physical activity. Unlike men, women's physical activity was significantly associated with sociodemographic factors.

CONCLUSION

Gender differences found in this study should be the basis for evidence-based nursing practice. Tailored nursing interventions based on gender would improve physical activity of rural adults in Korea and beyond.

RELEVANCE TO CLINICAL PRACTICE

Nurses providing care for rural adults should know the gender differences in the determinants of physical activity and provide gender-specific interventions to improve their physical activity.

Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation

OBJECTIVE

To determine the effectiveness of a pedometer-based telephone intervention on the physical activity levels of cardiac patients who did not attend a CRP.

METHODS

A randomised controlled trial was conducted with 215 patients referred to a CRP but who could not or chose not to attend. The 6-week intervention included self-monitoring of physical activity using a pedometer and step calendar; and behavioural counselling and goal setting sessions. Data were collected at baseline, 6 weeks and 6 months.

RESULTS

Study groups did not differ significantly at baseline. After 6 weeks, improvements in total physical activity time (p=0.027), total physical activity sessions (p=0.003), walking time (p=0.013) and walking sessions (p=0.002) in the intervention group were significantly greater than the control group after adjusting for baseline differences, and remained significant at 6 months.

CONCLUSION

The findings that the pedometer-based telephone intervention was successful in increasing physical activity levels in cardiac patients who did not attend a CRP could result in major health benefits for this group of people.

PRACTICAL IMPLICATIONS

The pedometer-based telephone intervention could be offered as an effective and accessible option for patients not attending a CRP to increase and maintain their physical activity levels after hospitalisation.

Effect of a motivational group intervention upon exercise self efficacy and outcome expectations for exercise in Schizophrenia Spectrum Disorders (SSDs)

BACKGROUND

Persons with SSDs contend with multiple barriers to exercise. Interventions are needed to enhance attitudes theoretically linked to exercise behavior.

OBJECTIVE

Examine effect of Walk, Address Sensations, Learn About Exercise, Cue Exercise for SSDs (WALC-S) intervention upon exercise self efficacy (SEE) and outcome expectations (OEES) in 97 outpatients with SSDs.

DESIGN

Experimental, pre test posttest. Randomization to experimental (WALC-S) or time-and-attention control (TAC) after baseline SEE and OEES measures. Measures repeated after WALC-S or TAC.

RESULTS

N = 97, 46% female, 43% African American, average age 46.9 years (SD = 2.0). Mean SEE scores were significantly higher in WALC-S participants after intervention (F ((1,95)) = 5.92, p = 0.0168), however, mean OEES scores were significantly higher in control participants after intervention (F ((1,95)) = 5.76, p = 0.0183.

CONCLUSION

This is the first study to examine SEE and OEES in SSDs. Interventions to enhance exercise attitudes are a critical first step toward the ultimate goal of increasing exercise participation.

Physical Activity in Middle-aged and Young-old Adults

This study tests the associations of self-efficacy, outcome expectancies, perceived barriers, self-regulatory behaviors and social support with physical activity. Data from 116 married community-dwelling middle-aged and young-old couples ( M = 58.86 years, SD = 7.16, range = 50 to 75) were collected via mail-in survey. The model indicated that self-efficacy was directly and indirectly related to physical activity through outcome expectancies, perceived barriers and self-regulatory behaviors. The results clarify the associations among the social cognitive constructs and physical activity, and suggest that interventions targeting multiple social cognitive constructs could increase the activity levels of middle-aged and young-old adults.

Do the determinants of physical activity change by physical activity level?

AIM

The paper reports on a study to describe the determinants of physical activity according to physical activity level among rural women in Korea.

BACKGROUND

The benefits of physical activity for promoting health and preventing illness are well known, and gender and regional disparities in physical activity have been reported. Although the number of women who perform physical activity has increased, many still do not meet the recommended levels to gain health benefits.

METHOD

A cross-sectional descriptive study was conducted using a structured questionnaire. A convenience sample of 245 women living in a rural area of Korea was recruited during 2004. Self-efficacy, benefits, barriers and sociodemographics were examined in relation to three levels of physical activity: inactive, insufficiently active and active. Descriptive statistics and multinomial logistic regression were used for data analysis.

RESULT

Perceived self-efficacy, benefits and barriers were statistically significant determinants only when the insufficiently active group was compared with the inactive group. Sociodemographic factors related to work and family roles statistically significantly explained the physical activity levels of rural women.

CONCLUSION

Nursing interventions to increase self-efficacy and benefits, or decrease perceived barriers could be effective for initiating physical activity for inactive women, whereas the same may not apply for insufficiently active women. Insufficiently active women may have false confidence that their physical activity will help them gain health benefits. Reducing the burdens of work and family roles of rural women might improve their physical activity levels.

A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions

The prevention of falls is currently high on the health policy agenda in the United Kingdom, which has led to the establishment of many falls-prevention services. If these are to be effective, however, the acceptability of services to older people needs to be considered. This paper reports a systematic review of studies of older people's perceptions of these interventions. The papers for review were identified by searching electronic databases, checking reference lists, and contacting experts. Two authors independently screened the studies and extracted data on the factors relating to participation in, or adherence to, falls-prevention strategies. Twenty-four studies were identified, of which 12 were qualitative. Only one study specifically examined interventions that promote participation in falls-prevention programmes; the others explored older people's attitudes and views. The factors that facilitated participation included social support, low intensity exercise, greater education, involvement in decision-making, and a perception of the programmes as relevant and life-enhancing. Barriers to participation included fatalism, denial and under-estimation of the risk of falling, poor self-efficacy, no previous history of exercise, fear of falling, poor health and functional ability, low health expectations and the stigma associated with programmes that targeted older people.

A telephone-only motivational intervention to increase physical activity in rural adults: a randomized controlled trial

BACKGROUND

Both urban and rural adults are likely to be inactive, but rural adults have less access to exercise classes or facilities to increase physical activity.

OBJECTIVES

To evaluate whether a telephone-only motivational interviewing (MI) intervention would increase daily physical activity of rural adults.

METHODS

This randomized controlled trial enrolled 86 physically inactive adults living in rural communities (mean age = 58 years, range = 30-81 years) who stated that they were ready to increase physical activity during the next 6 months. Participants were assigned randomly to MI intervention (n = 43) or control (n = 43) groups. The MI group participants received a pedometer and monthly MI telephone calls over 6 months from a counselor. Control group participants received an equal number of telephone calls without MI content. Physical activity was measured by self-report using the Community Healthy Activities Model Program For Seniors Physical Activity Questionnaire for Older Adults. Data were collected by mailed surveys and analyzed using analysis of variance.

RESULTS

Seventy-two participants completed the study (35 in the intervention group and 37 in the control group). The telephone-only MI intervention increased self-efficacy for exercise (p = .019) but did not increase levels of physical activity (p = .572) compared with controls.

DISCUSSION

The intervention increased self-efficacy for exercise but did not increase physical activity, possibly due to seasonal effects, the control condition, or the length of the MI intervention. Even so, future studies are warranted because telephone-only MI has potential as a practical, relatively inexpensive method to provide health counseling to rural adults in a broad geographic area. This study produced an effect size on physical activity that will be useful to guide future studies.

Housing and care for older people: life in an English purpose-built retirement village

Retirement communities are a relatively new long-term accommodation and care option in the United Kingdom. Policy makers and providers endorse the proposition that they are suited for the accommodation of both ‘fit’ and ‘frail’ older people, although comparatively little is known about what it is actually like to live in such communities, about whether they cater adequately for older people with a wide spectrum of needs and abilities, or if they provide acceptable solutions to older people's housing or care needs. This paper addresses these questions by reporting the findings of an independently funded three-year study of a new retirement village, Berryhill, in the north Midlands of England. The paper examines the background to this and similar developments, details how the study was carried out, and then examines what it was like to live at Berryhill. It focuses on the housing and care aspects, and explores the residents' motivations for moving to the village; their views about the accommodation; and their use of and satisfaction with the social and leisure amenities. The health and care needs of residents and the formal and informal supports are also featured. The conclusion discusses whether the village can truly be a ‘home for life’ in the face of increasing frailty, and whether or not these new models of accommodation and care can indeed cater for both ‘fit’ and ‘frail’ older people.

Detrimental effects of falling on health and well-being in later life: the mediating roles of perceived control and optimism

Falling is common among older adults, often resulting in decreased functional ability and quality of life. To understand processes underlying the fall/health and well-being relationship, it is important to identify psychosocial mediators. The current study examined the impact of falling on subsequent physical health, negative emotions and physical activity among 231 young-old (<85) and old-old (85+) community-dwelling adults, and the mediating effects of global perceived control (PC) and optimism. Regression results indicated that falling predicted poorer physical health, greater negative emotions and less physical activity among old-old but not young-old adults. Falling negatively predicted PC and optimism, which mediated the effects of falling on health and well-being among the old-old group. Findings have implications for enhancing recovery from falling via bolstering PC and optimism.

Participation in health-promoting behaviour: influences on community-dwelling older Chinese people

AIM

This paper reports a study to determine the factors affecting community-dwelling older Chinese people's health-promoting behaviour in the domains of physical activity, healthy dietary practices and stress management, and to identify any barriers to these behaviours.

BACKGROUND

Previous studies have identified factors affecting different types of health-promoting behaviours, including perceived self-efficacy, perceived benefits and five individual characteristics (age, sex, marital status, education and perceived health) of older non-Chinese people. However, few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people's health-promoting behaviour.

METHOD

Individual face-to-face interviews were completed in 2002-2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 (years mean 76). Participants had no apparent communication and cognition impairments. A structured interview schedule was used to collect the data.

RESULTS

Multiple regression analysis showed that perceived self-efficacy, perceived benefits and sex together explained 38.4% of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong. Fatigue during and after physical activity, enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour.

CONCLUSION

When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers, community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour. Future studies should include more critical factors based on theories, empirical evidence and knowledge of culture with samples that are random and from more diverse community settings.

Outcome expectations and physical activity participation in two samples of older women

Outcome expectations have received little study in physical activity (PA) research. This study examined whether initial outcome expectations and their achievement at 6 months (i.e. outcome realizations) predicted subsequent PA participation (7-12 months) in 118 older women. Initial outcome expectations were not associated with PA participation. Outcome realizations at 6 months, however, predicted subsequent PA participation (p < .05). Women with high expectations but low attainment had the lowest subsequent participation rates. Women with high attainment, regardless of expectations, had the highest rates. Findings replicate and extend an earlier study and argue for a more dynamic conceptualization of outcome expectations.

Predictors of physical activity in older adults with borderline hypertension

BACKGROUND

Physical activity (PA) is effective in controlling blood pressure (BP) and is important in the treatment and prevention of hypertension in the elderly. Reasons for engaging in regular PA are complex and are influenced by personal, interpersonal, and environmental factors.

OBJECTIVE

To test a predictive model of PA in older adults with borderline hypertension.

METHODS

Data were collected from a multiethnic nonprobability sample of 267 men and women 60-75 years of age. The predictor variables were gender, ethnicity, income, previous exercise experience, self-efficacy for PA, perceived health status, awareness of BP, barriers to PA, intrinsic motivation for health, motivation for PA, interpersonal influence, and environmental influence.

RESULTS

The hypothesized model was tested and modified using path analysis. The final model explained 44% of the variance in PA. The variables that directly predicted PA were gender, income, previous exercise experience, self-efficacy for PA, and motivation for PA. Variables that indirectly predicted PA were perceived health status, barriers to PA, self-efficacy for PA, intrinsic motivation for health, and environmental influence.

CONCLUSIONS

The significant associations between the cognitive appraisal and motivation concepts extend previous research and add to the understanding of the complex factors that influence regular PA. The PA model can be a foundation for further research and practice.

Effect of problem-based learning on stages of change for exercise behaviour in patients with coronary artery disease

BACKGROUND AND PURPOSE

Physical activity plays an important part in preventing coronary artery disease and is targeted in most rehabilitation and education programmes. The aim of the present study was to evaluate stages of change for exercise behaviour in patients with a recent event of coronary artery disease.

METHOD

A randomized two-group, pre--post-test design was used. Fifty-seven subjects were included in the problem-based learning intervention group and 61 subjects were included in the traditional rehabilitation control group. Data were analysed by intention-to-treat. A single-item five-category scale, based on the 'Stages of Change' model was used to measure the level of exercise behaviour. The statistical analysis used two non-parametric approaches for ordered categorical data.

RESULTS

There was a significant systematic change over time towards the extreme scale categories in both groups. This suggested that individuals who were inactive before the intervention regressed, whereas individuals with some interest in physical activity remained static or improved. No significant differences between groups were found.

CONCLUSION

Problem-based learning did not significantly influence patients' progression through exercise behaviour stages. Rehabilitation teams should be observant of inactive participants and their greater risk of regression.

Social-cognitive determinants of physical activity: The influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study

A social-cognitive model of physical activity was tested, using structural equation analysis of data from 999 adults (21% African American; 66% female; 38% inactive) recruited from 14 southwestern Virginia churches participating in the baseline phase of a health promotion study. Within the model, age, race, social support, self-efficacy, and self-regulation contributed to participants' physical activity levels, but outcome expectations did not. Of the social-cognitive variables, self-regulation exerted the strongest effect on physical activity. Independent of self-regulation, self-efficacy had little effect. Social support influenced physical activity as a direct precursor to self-efficacy and self-regulation. The model provided a good fit to the data and explained 46% of the variance in physical activity among the diverse group of adults.

Reliability and validity of the self-efficacy for exercise and outcome expectations for exercise scales with minority older adults

Older African Americans and Latinos tend to exercise less than older Whites and are more likely to have chronic diseases that could benefit from exercise. Measurement of self-efficacy of exercise and exercise outcome expectations in this older population is required if exercise is to be monitored carefully and enhanced in this population. The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise Scale (SEE) and Outcome Expectations for Exercise Scale (OEE) in a sample of African American and Latino older adults. A total of 166 individuals, 32 males (19%) and 134 females (81%) with an average age of 72.8 +/- 8.4 years participated in the study. The SEE and OEE scales were completed using face-to-face interviews. There was evidence of internal consistency for both scales with alphas of .89 and .90 for the SEE scale and .72 and .88 for the OEE scale. There was some evidence of validity for both scales based on confirmatory factor analysis and hypothesis testing, because factor loadings were greater than .50 in all but two items in the OEE, and there were significant relationships between self-efficacy and outcome expectations and exercise behavior at all testing time-points. The measurement models showed a fair fit of the data to the models. The study provided some evidence for the reliability and validity of the SEE and OEE when used with minority older adults, and it provides some guidelines for future scale revisions and use.

Motivational interviewing to promote physical activity for people with chronic heart failure

AIM

This paper reports a study comparing, over a 5-month period, two different methods of increasing physical activity: a traditional exercise programme and one based on motivational interviewing.

BACKGROUND

Chronic heart failure is associated with poor quality of life that can be improved by increased physical activity. Patients who are directed to engage in physical activity have a record of low compliance.

METHOD

Sixty older aged heart failure patients were randomly assigned to standard care, motivational interviewing or both treatments. The primary outcome was physical activity (kcal/kg/day), with the 6-minute walk test as a secondary outcome.

FINDINGS

At entry, no significant differences were observed between the three groups. Following treatment, the 'motivational interviewing' and 'both treatments' groups reported an increase in their level and type of activities, whereas the 'standard care' group did not. All groups significantly increased their 6-minute walk distance.

CONCLUSIONS

Motivational interviewing, which incorporates established behaviour change principles and a flexible approach to promotion of activity, increases reported physical activity in older patients with heart failure over a short period. In terms of level and type of activity, this approach gives a better outcome than standard care, and nurses should explore alternative strategies to promote health in this population.

Gender Differences in Physical Activity and Walking Among Older Adults

Older women are generally more sedentary and less active than older men, but little is known about the specific factors underlying the differences between the genders in physical activity (PA). The purpose of this study was to compare men and women regarding their household leisure time PA, walking activity, and personal and environmental factors related to physical activity. Self-administered questionnaires were completed by 276 older adults recruited from senior centers. Findings revealed that women were less active overall but more involved in household activities. The women's personal and environmental factors represented poor conditions for PA, and as a result they engaged in lower levels of PA than men.

A review of the outcome expectancy construct in physical activity research

BACKGROUND

Outcome expectancy is a central construct in social cognitive models of health behavior widely used as frameworks for physical activity research.

PURPOSE

This article provides a review of the outcome expectancy construct and its application to research on physical activity.

METHODS

Theoretical articles describing definitions and placement of outcome expectancy within social cognitive models, as well as empirical research on outcome expectancy and physical activity, were reviewed.

RESULTS

Self-efficacy theory, the transtheoretical model, the theory of planned behavior, and protection motivation theory differ in their labeling and conceptualization of outcome expectancy but unanimously include expected outcomes of behavior. Preliminary empirical investigation of the role of outcome expectancy in understanding physical activity has yielded mixed results. Positive outcome expectancy appears to be more predictive of physical activity in older adults than in young to middle-aged adults, and personal barriers appear to be the most predictive subtype of negative outcome expectancy. In addition, a small number of studies indicate relations between outcome expectancy and other theoretical variables, including behavioral intention, stage of change, and self-efficacy.

CONCLUSIONS

Further research on the role of outcome expectancy is necessary to design effective physical activity interventions. New directions in outcome expectancy research could involve (a) expanding the conceptualization of outcome expectancy to include expected outcomes of sedentary behavior and affective responses to physical activity, (b) further examination of potential moderators of the relation between outcome expectancy and physical activity (such as outcome value and outcome proximity), (c) distinguishing between the role of outcome expectancy in behavior onset versus behavior maintenance, (d) examining outcome expectancy as a mechanism of change in environmental intervention approaches, and (e) further analysis of interrelations between outcome expectancy and other social cognitive variables.

Evidence Review on Older People's Views and Experiences of Falls Prevention Strategies

BACKGROUND

A systematic review was undertaken of qualitative and quantitative studies and reviews that focus on older people's views and experiences of falls prevention. The review was undertaken to provide an additional dimension to the clinical effectiveness evidence provided by a Cochrane review on falls prevention (Gillespie et al. 2003) to inform the development of a national guideline on falls prevention in older people. As guideline recommendations or policies relating to preventive strategies have the potential to increase health care costs, it is important that all sources of evidence are reviewed by guideline development groups so that an understanding is achieved of the acceptability and sustainability of interventions in relation to different groups and settings.

METHOD

Accordingly, this review examined the literature on the views, preferences, and experiences of older people in relation to falls prevention strategies. Twenty-four studies meeting the inclusion criteria were critically reviewed and were then summarized into evidence tables. The key facilitators and barriers to participation in falls prevention programs were derived from the commonly occurring and consistent themes arising from the reviewed studies. The implications of these findings for the clinical effectiveness review conclusions were then taken into account.

FINDINGS

Several important findings emerged. These included preferences for falls prevention strategies not involving behaviour change among some groups, the need to promote the social value of falls prevention programs, and the importance of identifying and addressing factors associated with activity avoidance.

CONCLUSIONS AND IMPLICATIONS

In terms of the impact of these findings on the Cochrane review, the most important implication is that although trials of multifactorial falls prevention packages have reported beneficial results, in clinical practice it is important to consult with individual potential participants and find out what characteristics they are willing to modify, and what changes they are prepared to make to reduce their risk of falling. Otherwise, there is the risk that expensive programs are not properly targeted or fail to achieve maximum participation rates. Further work on the most robust and pragmatic methods of synthesizing disparate studies on patients' views and preferences to inform evidence-based guideline recommendations is needed.

Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants

The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participant's adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.

Older women and exercise: explanatory concepts

BACKGROUND

Older women remain predominantly sedentary despite potential health benefits and reduced risks of cardiovascular disease associated with regular exercise. Primary care interventions to increase exercise need to focus on constructs amenable to intervention that predict exercise behavior.

PURPOSE

The study tested an explanatory model of older women's exercise behavior using concepts from social cognitive theory, the transtheoretical model, and the theory of planned behavior (self-efficacy, outcome expectancy, perceived exercise barriers, processes of change, perceived health, and age).

METHODS

Data were collected by interviews with 203 older community-dwelling women physically capable of some exercise. Ordinary least squares regression results were used to determine the direct and indirect effects in a path model.

FINDINGS

All concepts and 13 hypothesized paths were retained in the trimmed model. The constructs accounted for 46% of the variance in exercise behavior. Outcome expectancy had the largest total effect. Processes of change had the largest direct effect on exercise behavior. Exercise self-efficacy and perceived exercise barriers accounted for similar amounts of variance in exercise behavior, whereas age and health had only modest effects.

CONCLUSION

Important constructs for future exercise model testing and intervention research should include outcome expectancy, processes of change, exercise self-efficacy, and perceived barriers to exercise. Primary care interventions designed to increase older women's exercise should focus on these same constructs.

Association of physical activity and visual attention in older adults

OBJECTIVES

This study was conducted to examine possible associations between physical activity and visual attention in community-dwelling older adults.

METHODS

Older adults (age 65-95) completed the Useful Field of View (UFOV (R)) test of visual attention, and they also reported current physical activity levels using the Exercise Participation Questionnaire (EPQ) and the Physical Activity Scale for the Elderly (PASE).

RESULTS

UFOV (R) performance was significantly correlated with both measures of physical activity, but some of these effects overlapped with the effects of age. The 21 participants (15%) who reported regular participation on the EPQ were found to have significantly better UFOV (R) scores than the more inactive participants both before and after controlling for age, gender, and visual acuity.

DISCUSSION

The preservation of visual attention skills across the life span may be more highly correlated with regular participation in exercise training activities than it is with more general occupational and leisure-related physical activity.

Model testing for reliability and validity of the Outcome Expectations for Exercise Scale

BACKGROUND

Development of a reliable and valid measure of outcome expectations for exercise appropriate for older adults will help establish the relationship between outcome expectations and exercise. Once established, this measure can be used to facilitate the development of interventions to strengthen outcome expectations and improve adherence to regular exercise in older adults.

OBJECTIVES

Building on initial psychometrics of the Outcome Expectation for Exercise (OEE) Scale, the purpose of the current study was to use structural equation modeling to provide additional support for the reliability and validity of this measure.

METHODS

The OEE scale is a 9-item measure specifically focusing on the perceived consequences of exercise for older adults. The OEE scale was given to 191 residents in a continuing care retirement community. The mean age of the participants was 85 +/- 6.1 and the majority were female (76%), White (99%), and unmarried (76%). Using structural equation modeling, reliability was based on R2 values, and validity was based on a confirmatory factor analysis and path coefficients.

RESULTS

There was continued evidence for reliability of the OEE based on R2 values ranging from .42 to .77, and validity with path coefficients ranging from .69 to .87, and evidence of model fit (X2 of 69, df = 27, p < .05, NFI = .98, RMSEA = .07).

CONCLUSION

The evidence of reliability and validity of this measure has important implications for clinical work and research. The OEE scale can be used to identify older adults who have low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and thereby improve exercise behavior.