Muscle gains and emotional strains: conflicting experiences of change among overweight women participating in an exercise intervention program

A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women

Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.

Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature

BACKGROUND

Physical activity (PA) has many benefits in preventing diseases and maintaining physical and mental health. Women, in particular, can benefit from regular PA. However, women's PA did not increase over the past decade globally, and the situations faced by women are often gender-specific. Healthy young adult women's PA does not receive as much attention as older women and adolescent girls, yet, they face the same situation of low level of PA. This review aims to explore and synthesise the self-identified barriers and facilitators to young adult women's participation in PA from qualitative research studies and offer suggestions for future studies and programs designed for this population.

METHODS

A systematic search was conducted in Pubmed, Web of Science, Scopus, Medline, and SPORTDiscus for studies published between January 2000 to February 2022 to identify qualitative studies on the barriers and facilitators of young adult women's PA between ages 18 to 40. The search yielded 694 studies initially, of which 23 were included. The research quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Data were extracted and thematically analysed based on the tenets of the social-ecological model (SEM).

RESULTS

Identified barriers and facilitators were grouped into different levels of the SEM, with the most frequently cited factors being time, body image and societal beauty standards, family duty and social support, religious and cultural norms, organisation and community facilities and environment, safety issues and physical environment. Descriptive data were thematically analysed and synthesised in line with the five levels: body image, health and beauty; multiple roles, support, and PA; religious identity, cultural identity, and PA; safety issues and women's fears.

CONCLUSIONS

This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women's PA. It highlighted that the factors young adult women face are diverse at different levels yet holistic and intertwined. Future studies on young adult women's PA should address the social-cultural influence and would benefit from applying multilevel strategies employing the SEM model. It is critical to create an open and inclusive environment and offer more opportunities for women.

TRIAL REGISTRATION

PROSPERO CRD42021290519.

How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies

Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.

Effectiveness of Abdominal and Gluteus Medius Training in Lumbo-Pelvic Stability and Adductor Strength in Female Soccer Players. A Randomized Controlled Study

BACKGROUND

Abdominal and lumbo-pelvic stability alterations may be the origin of lower limb injuries, such as adductor pathology in soccer players. Imbalance can be caused by both intrinsic and extrinsic factors.

METHODS

In this randomized controlled trial over 8 weeks, 25 female footballers were randomly allocated to an experimental group (isometric abdominal training and gluteus medius-specific training) or a control group (isometric abdominal training). Evaluations were performed at baseline, at the end of the intervention and after a 4-week follow-up period. The exercise protocol in common for both groups included three exercises: Plank, Lateral plank and Bird dog. Specific exercises for the gluteus medius were: Pelvic drop and Stabilization of the gluteus medius in knee valgus. Outcome measures were lumbar-pelvic stability and adductor strength.

RESULTS

After the intervention, there was an increase in lumbo-pelvic stability in both groups, being greater in the control group than in the experimental group (mean differences [MD]: 4.84 vs. MD: 9.58; p < 0.01) with differences in the analysis of repeated measures (p < 0.001), but not in group interaction (p = 0.26). Changes were found in adductor strength in the experimental group (MD: -2.48; p < 0.001 in the left adductor; MD: -1.48; p < 0.01 in right adductor) and control group (MD: -1.68; p < 0.001 in the left adductor; MD: -2.05; p < 0.001 in the right adductor) after the intervention, with differences in the analysis of repeated measures in left (p < 0.001) and right (p < 0.001) adductor strength.

CONCLUSIONS

An abdominal and gluteal training protocol shows no advantage over a protocol of abdominal training alone for lumbo-pelvic stability and adductor strength, while improvements in both variables are maintained at four weeks follow-up.

"The Weight Is Even Worse Than the Cancer": Exploring Weight Preoccupation in Women Treated for Breast Cancer

Cancer-related changes in body weight are problematic given that excess weight is associated with an increased risk of cancer reoccurrence and mortality. The purpose of this qualitative study was to explore the experiences of weight-concerned women treated for early-stage breast cancer. A purposeful sample of women were selected based on criteria for high weight and body image concerns ( n = 11; M_age = 65.31 ± 10.96 years). Each participant engaged in a one-on-one semi-structured interview. Five themes were identified: weight concerns contributed to psychological distress, prevalent history of weight cycling and ongoing quest to manage weight, shifting psychological impact of cancer versus weight, perceptions of failure around goal-oriented weight management behaviors, and internalized and explicit social pressures for weight loss in the context of risk reduction. In light of the fundamental challenges of weight management, and the present findings, improving weight-related distress should be a clinical priority to improve the well-being of women in survivorship.

Men's reactions to receiving objective feedback on their weight, BMI and other health risk indicators

BACKGROUND

Receiving information about one's weight, Body Mass Index (BMI) and other indicators of health risk may prompt behaviour change. This study investigated men's reactions to receiving information on indicators of health risk prior to taking part in a men-only weight management programme, Football Fans in Training (FFIT). It also investigated the extent to which the information was reported as influencing lifestyle change and having adverse consequences.

METHODS

We undertook a qualitative, semi-structured, telephone interview study with 28 men who took part in FFIT. We sought to interview approximately equal numbers of men who had and had not lost 5% or more of their pre-programme body weight by the end of the 12-week programme. Data were analysed thematically utilising principles of framework analysis.

RESULTS

Some men were apprehensive about receiving information which confirmed their overweight/obese status, particularly those less familiar with having similar information fed back to them. The professional football setting and the people present (including other men on the programme whom they perceived to be 'like them' and the fieldwork staff) were important factors in making the men feel comfortable in an otherwise potentially threatening situation. Men who achieved greater weight loss were more likely to report being motivated by this pre-programme feedback and to perceive themselves as responsible for their current weight and health status. However, for others the information only reaffirmed what they suspected about their relatively poor health status and was insufficient to prompt behaviour change.

CONCLUSION

Undertaking measurements and receiving information on health risk indicators, such as weight or BMI, within the context of behaviour change programmes can enhance motivation for behaviour change when communicated in an empathic and non-stigmatising way, and therefore should be considered as an integral part of interventions. However, providing feedback on health risk may be insufficient to prompt behaviour change in some people and may be detrimental to those with poor body image and/or lacking personal agency to adopt lifestyle changes. It is therefore imperative that adequate support and opportunities are made available when information on weight and disease risk are fed back within research or other settings.

'It's like a personal motivator that you carried around wi' you': utilising self-determination theory to understand men's experiences of using pedometers to increase physical activity in a weight management programme

Background

Self-monitoring using pedometers is an effective behaviour change technique to support increased physical activity (PA). However, the ways in which pedometers operate as motivational tools in adoption and maintenance of PA is not well understood. This paper investigates men’s experiences of pedometers as motivational tools both during and after their participation in a 12-week group-based, weight management programme for overweight/obese men, Football Fans in Training (FFIT).

Methods

Semi-structured telephone interviews were conducted with 28 men, purposively sampled to include men who did and did not achieve 5% weight loss during the programme. Data were analysed thematically utilising the framework approach, using Self-Determination Theory (SDT) - namely concepts of behavioural regulation and the basic needs of relatedness, competence and autonomy - as an analytical lens.

Results

During the programme, FFIT’s context and fellow participants supported relatedness and encouraged use of the pedometer. The pedometer was seen to provide tangible proof of progress, thus increasing competence for change, whilst the ability to monitor one’s own progress and take remedial action supported autonomy; these men portrayed the pedometer as an ‘ally’. However, a minority found the pedometer ‘dispiriting’ or controlling when it evidenced their inability to meet their PA targets.

After the programme, some men no longer used the device as they had fully internalised their motivations for increased PA. In contrast, others continued to use pedometers or progressed to other self-monitoring technologies because it was enjoyable and facilitated maintenance of their increased PA. However, the minority of men who experienced the pedometer as controlling no longer used it. They were less successful in achieving 5% weight loss and appeared reliant on external factors, including support from coach and group members, to maintain motivation.

Conclusion

These findings show how self-monitoring using pedometers and associated goal setting supported the development of autonomous motivation for PA, during and after participation in a group-based programme. They also suggest that programmes could focus on early identification of participants who remain motivated by extrinsic factors or express negative experiences of self-monitoring tools, to offer greater support to identify the benefits of PA based on a person’s own values.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0505-z) contains supplementary material, which is available to authorized users.

Physical activity adoption to adherence, lapse, and dropout: a self-determination theory perspective

Grounded in Self-Determination Theory, we aimed to explore and identify key motivational processes involved in the transition from a physically inactive to an active lifestyle, and the processes involved in lapse and dropout behavior within a walking program. We implemented a qualitative, longitudinal case study method, using semistructured interviews and theoretical thematic analyses. Fifteen women were interviewed over 10 months and three profiles were generated: (a) nonadherence, (b) lapse/readoption of physical activity, and (c) adherence. Internalization of walking behavior was key to adherence. Satisfaction of the needs for competence and relatedness were central for participation during exercise at the adoption stages, and autonomy was particularly pertinent in facilitating adherence. Those who lapsed and restarted physical activity experienced feelings of autonomy at the point of readoption. Sources of support were driving forces in the adoption and adherence phases.

Situational motivation and perceived intensity: their interaction in predicting changes in positive affect from physical activity

There is evidence that affective experiences surrounding physical activity can contribute to the proper self-regulation of an active lifestyle. Motivation toward physical activity, as portrayed by self-determination theory, has been linked to positive affect, as has the intensity of physical activity, especially of a preferred nature. The purpose of this experimental study was to examine the interaction between situational motivation and intensity [i.e., ratings of perceived exertion (RPE)] in predicting changes in positive affect following an acute bout of preferred physical activity, namely, running. Fourty-one female runners engaged in a 30-minute self-paced treadmill run in a laboratory context. Situational motivation for running, pre- and post-running positive affect, and RPE were assessed via validated self-report questionnaires. Hierarchical regression analyses revealed a significant interaction effect between RPE and introjection (P < .05) but not between RPE and identified regulation or intrinsic motivation. At low levels of introjection, the influence of RPE on the change in positive affect was considerable, with higher RPE ratings being associated with greater increases in positive affect. The implications of the findings in light of SDT principles as well as the potential contingencies between the regulations and RPE in predicting positive affect among women are discussed.

A synthesis of qualitative research on overweight and obese people's views and experiences of weight management

The effectiveness of existing weight management programmes may be improved by understanding overweight and obese people's perceptions of the reasons for successful and unsuccessful weight management. Many qualitative studies have investigated overweight and obese adults' experiences with weight management. This paper presents findings of a meta-ethnography that synthesized 17 qualitative studies of overweight and obese adults' weight management experiences, principally in the context of behavioural weight management programmes. Twelve themes were derived describing factors that overweight and obese people identify as relevant to weight management: health concerns, expectations towards weight management, attributions for weight gain, psychological barriers, psychological facilitators, self-perception and body image, stigmatization, socio-cultural factors, environmental barriers, environmental facilitators, experiences with weight management programmes and positive outcomes of programme participation. Interventions that address all of the modifiable factors identified in this review are likely to appear credible to participants and will engage with the intra- and extra-individual factors that they perceive as affecting their weight management efforts.

Using positive deviance for determining successful weight-control practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.

Uncovering the lived experience of well-being

The words well-being, health, and wellness are commonly used in an interchangeable manner by health care professionals and the lay public. We undertook a hermeneutic phenomenological study of well-being and discovered a soulful strength and a rhythmic flow to this lived experience. There is a letting go that is experienced as a tension and rhythmic interchange, as in breathing. Harmony and balance lie at its foundation. Well-being requires a personal drive to exist. It is not experienced through purposeful means; rather, it is experienced in a self-forgetful way, in the free space where life unfolds and where people come to see their worlds in different ways. The results of this research suggest the experience of well-being holds a significant place within nursing practice for clients and for nurses.