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Baillot A, Asselin M, Bernard P, Lapointe J, Bond DS, Romain AJ, Garneau PY, Biertho L, Tchernof A, Blackburn P, Langlois MF, Brunet J. Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I). Obes Surg 2024; 34:1639-1652. [PMID: 38483742 DOI: 10.1007/s11695-024-07161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA. METHODS This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention. RESULTS Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention. CONCLUSION Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.
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Affiliation(s)
- Aurélie Baillot
- École Interdisciplinaire de Santé, Université du Québec en Outaouais, 283 Boul. Alexandre-Taché, Gatineau, Québec, J8X 3X7, Canada.
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- Centre de Recherche en Médecine Psychosociale, Centre Intégré de Santé et Services, Sociaux de L'Outaouais, Gatineau, Québec, Canada.
| | | | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Josyanne Lapointe
- Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Dale S Bond
- Department of Surgery, Hartford Hospital/HealthCare, Hartford, CT, USA
| | - Ahmed Jérôme Romain
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Y Garneau
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec et Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - André Tchernof
- Institut Universitaire de Cardiologie et de Pneumologie de Québec et École de Nutrition, Université Laval, Québec, Québec, Canada
| | - Patricia Blackburn
- Division of Kinesiology, Department of Health Sciences, Université du Québec À Chicoutimi, Chicoutimi, Québec, Canada
| | - Marie-France Langlois
- CHUS Research Center and Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jennifer Brunet
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Riddell H, Lamont W, Lombard M, Paduano S, Maltagliati S, Gucciardi DF, Ntoumanis N. Autonomous motivation promotes goal attainment through the conscious investment of effort, but mental contrasting with implementation intentions makes goal striving easier. THE JOURNAL OF SOCIAL PSYCHOLOGY 2024; 164:230-243. [PMID: 36587628 DOI: 10.1080/00224545.2022.2163610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2023]
Abstract
People with autonomous motives (e.g., personal importance) may use automated strategies to effortlessly sustain goal-directed behavior and overcome obstacles. We investigated whether conscious effort, ease of goal striving, physiological effort, and the number of obstacles encountered mediate relations between motives and goal attainment for a competitive cycling goal. Additionally, half the participants (n = 57) were trained in Mental Contrasting with Implementation Intentions (MCII) - a technique that facilitates development of goal-directed behavior - with remaining participants (n = 54) treated as controls. Conscious investment of effort mediated relations between autonomous motives and goal attainment. Subjective ease of goal striving and physiological effort did not. This result indicates that successful goal striving is not perceived as effortless for autonomously motivated individuals working on competitive goals. Conversely, MCII predicted a reduction in obstacles, which in turn was associated with easier goal striving but not goal attainment. Although MCII did not support goal attainment in the current study, its ability to minimize the influence of obstacles may still be useful for other types of goals or for sustaining long-term goal pursuit.
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Affiliation(s)
| | | | | | | | | | | | - Nikos Ntoumanis
- Curtin University
- University of Southern Denmark
- Halmstad University
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Pritchard MW, Lewis SR, Robinson A, Gibson SV, Chuter A, Copeland RJ, Lawson E, Smith AF. Effectiveness of the perioperative encounter in promoting regular exercise and physical activity: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101806. [PMID: 36816345 PMCID: PMC9929685 DOI: 10.1016/j.eclinm.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Low levels of physical activity (PA) are associated with poorer health outcomes. The perioperative encounter (extending from initial contact in primary care to beyond discharge from hospital) is potentially a good time to intervene, but data regarding the effectiveness of interventions are scarce. To address this, we systematically reviewed existing literature to evaluate the effectiveness of interventions applied perioperatively to facilitate PA in the medium to long-term (at least six months after the intervention). METHODS In this systematic review and meta-analysis, we searched Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, CINAHL, Embase, PsycInfo, and SPORTDiscus from database inception to October 22nd 2020, with an updated search done on August 4th 2022. We searched clinical trials registers, and conducted forward- and backward-citation searches. We included randomised controlled trials and quasi-randomised trials comparing PA interventions with usual care, or another PA intervention, in adults who were scheduled for, or had recently undergone, surgery. We included trials which reported our primary outcomes: amount of PA or whether participants were engaged in PA at least six months after the intervention. A random effects meta-analysis was used to pool data across studies as risk ratios (RR), or standardised mean differences (SMDs), which we interpreted using Cohen. We used the Cochrane risk of bias tool and used GRADE to assess the certainty of the evidence. This study is registered with PROSPERO, CRD42019139008. FINDINGS We found 57 trials including 8548 adults and compared 71 interventions facilitating PA. Most interventions were started postoperatively and included multiple components. Compared with usual care, interventions may slightly increase the number of minutes of PA per day or week (SMD 0.17, 95% CI 0.09-0.26; 14 studies, 2172 participants; I2 = 0%), and people's engagement in PA at the study's end (RR 1.19, 95% CI 0.96-1.47; 9 studies, 882 participants; I2 = 25%); this was moderate-certainty evidence. Some studies compared two different types of interventions but it was often not feasible to combine data in analysis. The effect estimates generally indicated little difference between intervention designs and we judged all the evidence for these comparisons to be very low certainty. Thirty-six studies (63%) had low risk of selection bias for sequence generation, 27 studies (47%) had low risk of bias for allocation concealment, and 56 studies (98%) had a high risk of performance bias. For detection bias for PA outcomes, we judged 30 studies (53%) that used subjective measurement tools to have a high risk of detection bias. INTERPRETATION Interventions delivered in the perioperative setting, aimed at enhancing PA in the medium to long-term, may have overall benefit. However, because of imprecision in some of the findings, we could not rule out the possibility of no change in PA. FUNDING National Institute for Health Research Health Services and Delivery Research programme (NIHR127879).
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Affiliation(s)
- Michael W. Pritchard
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | - Sharon R. Lewis
- Bone and Joint Health, School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Amy Robinson
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | | | | | - Robert J. Copeland
- The Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Euan Lawson
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Andrew F. Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
- Corresponding author. Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK.
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Baillot A, St-Pierre M, Lapointe J, Bernard P, Bond D, Romain AJ, Garneau PY, Biertho L, Tchernof A, Blackburn P, Langlois MF, Brunet J. Acceptability and feasibility of the TELEhealth BARIatric behavioural intervention to increase physical ACTIVity (TELE-BariACTIV): A single-case experimental study protocol (Preprint). JMIR Res Protoc 2022; 11:e39633. [PMID: 36173668 PMCID: PMC9562082 DOI: 10.2196/39633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Regular physical activity (PA) is recommended to optimize weight and health outcomes in patients who have undergone metabolic and bariatric surgery (MBS). However, >70% of patients have low PA levels before MBS that persist after MBS. Although behavioral interventions delivered face-to-face have shown promise for increasing PA among patients who have undergone MBS, many may experience barriers, preventing enrollment into and adherence to such interventions. Delivering PA behavior change interventions via telehealth to patients who have undergone MBS may be an effective strategy to increase accessibility and reach, as well as adherence. Objective This paper reports the protocol for a study that aims to assess the feasibility and acceptability of the protocol or methods and the Telehealth Bariatric Behavioral Intervention (TELE-BariACTIV). The intervention is designed to increase moderate-to-vigorous intensity PA (MVPA) in patients awaiting bariatric surgery and is guided by a multitheory approach and a patient perspective. Another objective is to estimate the effect of the TELE-BariACTIV intervention on presurgical MVPA to determine the appropriate sample size for a multicenter trial. Methods This study is a multicenter trial using a repeated (ABAB’A) single-case experimental design. The A phases are observational phases without intervention (A1=pre-MBS phase; A2=length personalized according to the MBS date; A3=7 months post-MBS phase). The B phases are interventional phases with PA counseling (B1=6 weekly pre-MBS sessions; B2=3 monthly sessions starting 3 months after MBS). The target sample size is set to 12. Participants are inactive adults awaiting sleeve gastrectomy who have access to a computer with internet and an interface with a camera. The participants are randomly allocated to a 1- or 2-week baseline period (A1). Protocol and intervention feasibility and acceptability (primary outcomes) will be assessed by recording missing data, refusal, recruitment, retention, attendance, and attrition rates, as well as via web-based acceptability questionnaires and semistructured interviews. Data collected via accelerometry (7-14 days) on 8 occasions and via questionnaires on 10 occasions will be analyzed to estimate the effect of the intervention on MVPA. Generalization measures assessing the quality of life, anxiety and depressive symptoms, and theory-based constructs (ie, motivational regulations for PA, self-efficacy to overcome barriers to PA, basic psychological needs satisfaction and frustration, PA enjoyment, and social support for PA; secondary outcomes for a future large-scale trial) will be completed via web-based questionnaires on 6-10 occasions. The institutional review board provided ethics approval for the study in June 2021. Results Recruitment began in September 2021, and all the participants were enrolled (n=12). Data collection is expected to end in fall 2023, depending on the MBS date of the recruited participants. Conclusions The TELE-BariACTIV intervention has the potential for implementation across multiple settings owing to its collaborative construction that can be offered remotely. International Registered Report Identifier (IRRID) DERR1-10.2196/39633
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Affiliation(s)
- Aurélie Baillot
- Nursing Department, Université du Québec en Outaouais, Gatineau, QC, Canada
- Institut du savoir de l'hôpital Montfort-recherche, Ottawa, ON, Canada
- Centre de Recherche en Médecine Psychosociale, Centre Intégré de Santé et Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Maxime St-Pierre
- Basic Science Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Josyanne Lapointe
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Dale Bond
- Department of Surgery, Hartford Hospital/HealthCare, Hartford, CT, United States
| | - Ahmed Jérôme Romain
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pierre Y Garneau
- Department of Surgery, Université de Montréal, Montréal, QC, Canada
| | - Laurent Biertho
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - André Tchernof
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Patricia Blackburn
- Division of Kinesiology, Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Marie-France Langlois
- CHUS Research Center and Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jennifer Brunet
- Institut du savoir de l'hôpital Montfort-recherche, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Zabatiero J, Smith A, Gucciardi DF, Hamdorf Am JM, Taylor SF, Hill K. Patterns of Change in Device-Based Physical Activity and Sedentary Time Following Bariatric Surgery: a Longitudinal Observational Study. Obes Surg 2021; 31:3015-3025. [PMID: 33712935 DOI: 10.1007/s11695-021-05337-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is to investigate changes in physical activity (PA) and sedentary time (ST) over 12 months following bariatric surgery. METHODS Pre-surgery and at 3, 6, 9, and 12 months post-surgery, wearable devices were used to measure PA at different intensities, grouped according to energy expenditure and daily step count, and ST. Measures were also collected of weight and self-efficacy for exercise. Pre- and 12 months post-surgery, measures were collected of body composition and cardiovascular fitness. RESULTS Thirty adults scheduled for bariatric surgery were recruited (20 females, 44.1 [range, 22.0 to 65.0] years, body mass index 39.6 [range, 30.9 to 50.9] kg/m2). When compared to pre-surgery measures, over the 12 months post-surgery, there were no changes in the percentage of waking hours (mean [95% CI]) spent in ST (- 2% [- 6 to 3]), light intensity PA (1% [- 3 to 5]), and moderate-to-vigorous intensity PA (1% [- 1 to 3]). At all time points, participants spent most (> 70%) of their waking hours accumulating ST, with little time spent in light intensity PA (~ 21%) and almost no time in moderate-to-vigorous intensity PA (~ 5%). Step count and cardiovascular fitness were also unchanged. There were significant changes in weight, self-efficacy for exercise, and body composition. CONCLUSIONS Although bariatric surgery resulted in substantial weight loss and improved self-efficacy for exercise, it was insufficient to effect change in PA, ST or cardiovascular fitness. Complementing surgical intervention with behavioral interventions may optimize change in PA and ST.
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Affiliation(s)
- Juliana Zabatiero
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, 6845, Australia.
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, 6845, Australia
| | - Daniel F Gucciardi
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, 6845, Australia
| | - Jeffrey M Hamdorf Am
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Western Surgical Health, Nedlands, WA, Australia
| | - Susan F Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Western Surgical Health, Nedlands, WA, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, 6845, Australia.,Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, WA, Australia
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Jiménez-Loaisa A, González-Cutre D, Beltrán-Carrillo VJ, Alcaraz-Ibáñez M. Changes in Bariatric Patients' Physical Activity Levels and Health-Related Quality of Life Following a Postoperative Motivational Physical Activity Intervention. Obes Surg 2020; 30:2302-2312. [PMID: 32172362 DOI: 10.1007/s11695-020-04489-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Self-determination theory (SDT) has been widely used as a useful motivational framework for improving long-term adherence to physical activity (PA) and health-related quality of life (HRQoL). The aim of this study was to examine the effects of a 6-month motivational PA intervention (MPAI) on bariatric patients' PA levels and HRQoL from pre-surgery to the end of the MPAI (7 months post-surgery). Additionally, a re-test was performed 13 months post-surgery. METHODS A total of 40 participants undergoing sleeve gastrectomy were assigned to a 6-month MPAI or to a control group. The MPAI was based on techniques and messages from SDT. At baseline and post-intervention measures, both groups wore accelerometers for one week and completed the SF-36 questionnaire. RESULTS A total of 32 participants (78.1% female) completed all measures and were included in the final analyses. PA levels did not significantly differ between groups as a consequence of the intervention. Clinically significant differences (d ≥ 0.5) favoring the MPAI group were found for SF-36 domains of bodily pain (at pre-surgery, increasing at 7 and 13 months post-surgery), general health and vitality (7 months post-surgery), and physical functioning and physical component score (both 7 and 13 months post-surgery). Social functioning also showed clinically significant differences favoring the MPAI group at pre-surgery, increasing at 7 months post-surgery. These differences disappeared at 13 months post-surgery. CONCLUSIONS SDT-based PA interventions could enhance several dimensions of bariatric patients' HRQoL after surgery. Further research is needed to understand what motivational processes are key aspects to promote PA participation in these patients.
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Affiliation(s)
- Alejandro Jiménez-Loaisa
- Department of Sport Sciences, Sport Research Centre, Miguel Hernández University of Elche, Avenida de la Universidad s/n, 03202, Elche, Alicante, Spain
| | - David González-Cutre
- Department of Sport Sciences, Sport Research Centre, Miguel Hernández University of Elche, Avenida de la Universidad s/n, 03202, Elche, Alicante, Spain.
| | - Vicente J Beltrán-Carrillo
- Department of Sport Sciences, Sport Research Centre, Miguel Hernández University of Elche, Avenida de la Universidad s/n, 03202, Elche, Alicante, Spain
| | - Manuel Alcaraz-Ibáñez
- Department of Education, Faculty of Education Sciences, University of Almería, Carretera Sacramento s/n, 04120, La Cañada de San Urbano, Almería, Spain.,Contexts in School Learning in Physical Education and Health Habits, Health Research Centre, University of Almería, Almería, Spain
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7
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Beltrán-Carrillo VJ, Jiménez-Loaisa A, Jennings G, González-Cutre D, Navarro-Espejo N, Cervelló E. Exploring the socio-ecological factors behind the (in)active lifestyles of Spanish post-bariatric surgery patients. Int J Qual Stud Health Well-being 2020; 14:1626180. [PMID: 31187702 PMCID: PMC6566659 DOI: 10.1080/17482631.2019.1626180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose: Physical activity (PA) is considered essential for the treatment of morbid obesity and the optimization of bariatric surgery outcomes. The objective of this article was to identify the facilitators and barriers that bariatric patients perceived to do PA one year after finishing a PA programme for the promotion of a long-term active lifestyle. This objective was addressed from a socio-ecological and qualitative perspective. Methods: Nine patients (eight women and one man), aged between 31 and 59 years, participated in semi-structured interviews directly following the PA programme and one year after it. A content analysis was carried out to analyze the qualitative data. Results: Weight loss, improvement of physical fitness, perceived competence, and enjoyment were the main facilitators of PA. Complexes related to skin folds, osteoarthritis, perceived unfavourable weather conditions, lack of social support and economic resources, long workdays, lack of specific PA programmes, and other passive leisure preferences were the main barriers to participate in PA. Conclusions: Results highlight the important interplay between personal, social environmental, and physical environmental factors to explain (in)active behaviours of bariatric patients. The findings of this article could be useful for future research and interventions aimed at promoting PA in bariatric patients.
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Affiliation(s)
| | - Alejandro Jiménez-Loaisa
- a Department of Sport Sciences, Sport Research Centre , Miguel Hernández University , Elche , Spain
| | - George Jennings
- b Cardiff School of Sport and Health Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - David González-Cutre
- a Department of Sport Sciences, Sport Research Centre , Miguel Hernández University , Elche , Spain
| | | | - Eduardo Cervelló
- a Department of Sport Sciences, Sport Research Centre , Miguel Hernández University , Elche , Spain
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