Motivational and evolutionary aspects of a physical exercise training program: a longitudinal study

The Effect of Wearable-Based Real-Time Feedback on Running Injuries and Running Performance: A Randomized Controlled Trial

BACKGROUND

Running technique and running speed are considered important risk factors for running injuries. Real-time feedback on running technique and running speed by wearables may help reduce injury risk.

PURPOSE

To investigate whether real-time feedback on spatiotemporal metrics and relative speed by commercially available pressure-sensitive insoles would reduce running injuries and improve running performance compared with no real-time feedback.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

A total of 220 recreational runners were randomly assigned into the intervention and control groups. Both groups received pressure-sensitive insoles, but only the intervention group received real-time feedback on spatiotemporal metrics and relative speed. The feedback aimed to reduce loading on the joint/segment estimated to exhibit the highest load. Injury rates were compared between the groups using Cox regressions. Secondary outcomes compared included injury severity, the proportion of runners with multiple injuries, changes in self-reported personal best times and motivation (Behavioral Regulation in Exercise Questionnaire-2), and interest in continuing wearable use after study completion.

RESULTS

A total of 160 participants (73%) were included in analyses of the primary outcome. Intention-to-treat analysis showed no significant difference in injury rate between the groups (Hazard ratio [HR], 1.11; P = .70). This was expected, as 53 of 160 (33%) participants ended up in the unassigned group because they used incorrect wearable settings, nullifying any interventional effects. As-treated analysis showed a significantly lower injury rate among participants receiving real-time feedback (HR, 0.53; P = .03). Similarly, the first-time injury severity was significantly lower (-0.43; P = .042). Per-protocol analysis showed no significant differences in injury rates, but the direction favored the intervention group (HR, 0.67; P = .30). There were no significant differences in the proportion of patients with multiple injuries (HR, 0.82; P = .40) or changes in running performance (3.07%; P = .26) and motivation. Also, ~60% of the participants who completed the study showed interest in continuing wearable use.

CONCLUSION

Real-time feedback on spatiotemporal metrics and relative speed provided by commercially available instrumented insoles may reduce the rate and severity of injuries in recreational runners. Feedback did not influence running performance and exercise motivation.

REGISTRATION

NL8472 (Dutch Trial Register).

Subjective Exercise Experience and Group Cohesion among Chinese Participating in Square Dance: A Moderated Mediation Model of Years of Participation and Gender

(1) Background: This study aimed to explore the relationship between years of participation, subjective exercise experience, and group cohesion among gender-specific square dance practitioners. (2) Methods: The Subjective Exercise Experience Questionnaire (SEEQ) and Group Environment Questionnaire (GEQ) were used to evaluate Subjective Exercise Experience (SEE) and group cohesion (GC). An analysis was conducted on 130 Chinese (63 males and 67 females) using multiple group analysis within a structural equation model. (3) Results: (a) The positive aspects of Subjective Exercise Experience (SEE) and Positive Well-Being (PWB), had a strongly positive effect on GC in both groups. The negative aspects of SEE, Psychological Fatigue (PF), and Psychological Distress (PD), had negative effects on GC. (b) Only for the male group was there an indirect effect of participation years on the association between SEE and GC in the model (a × b = 0.062, 95% CI [0.001, 0.181]; standard error (SE) = 0.062, p = 0.048). (c) The significant differences between paths coefficients were noticed in the association of years of participation with SEE (t = -2.043) and GC (t = -1.962). (4) Conclusion: Based on these results, gender differences in terms of the partial mediating role of adherence in the relationship of SEE and GC were presented for future research, fitness popularization, and society.

Motivation Levels and Goals for the Practice of Physical Exercise in Five Different Modalities: A Correspondence Analysis

The identification of the practitioner’s profile regarding their motivation level for physical exercise engagement could be a behavioral strategy to increase exercise adherence. The present study investigates the associations between motivation levels, modalities practiced, and goals concerning the practice of physical exercise among physical exercise practitioners. A total of 100 physical exercise practitioners, of which 67 were women, took part in this study. The participants were engaged in extreme fitness program, strength training, fight training, Pilates, and functional training. Motivation level (BREQ-3) and expectations regarding regular physical exercise (IMPRAF-54) were assessed. A multiple correspondence analysis demonstrates preferential relationships between descriptive and non-inferential variables. Strength training and fight training practitioners seek these modalities with the goals of “Health” and “Aesthetics,” demonstrating low autonomy in relation to the behavior for the practice of physical exercise. Extreme conditioning program and functional training practitioners have as goal “Pleasure,” demonstrating medium and high levels of autonomy for such practice and Pilates practitioners have the goal of “Stress Control.” To promote and encourage the regular practice of physical exercise, this strategy could be used to take actions that increase the public’s intention to start or continue in a physical exercise program.

The Association Between the Subjective Exercise Experience of Chinese Women Participating in Square Dance and Group Cohesion: The Mediating Effect of Income

Background: Chinese square dance has become well known worldwide in recent years, and most participants are women who dance with a group in their communities. In particular, middle-aged women may have physical and mental health problems, and participating in square dance may increase women's positive subjective well-being and decrease their negative emotions, which may improve their health over the long term. In addition, participating in square dance can promote group cohesion. Our study aimed to examine the relationship between the subjective exercise experience of participating in square dance and group cohesion and whether some variables (e.g., age, education, duration, income level, and work) play a role as mediators in the association with subjective exercise experience and group cohesion. Methods: In total, 1,468 Chinese women from 31 provinces and 82 cities participated in this study by completing an online questionnaire. The questionnaire consisted of a subjective exercise experience questionnaire and a group environment questionnaire. We analyzed the collected data and built a statistical model. Results: (a) Square dance satisfied women's physical and psychological needs partly; (b) positive well-being (PWB) was positively correlated with group cohesion, and fatigue was negatively correlated with group cohesion; and (c) the income level was a partial mediator of the relationship between group cohesion and subjective exercise experience. Conclusion: Chinese women have different motivations for participating in square dance. Because this activity can help meet women's physical and psychological needs, an increasing number of individuals worldwide participate in square dance. As women's subjective well-being increases, group cohesion increases, and vice versa. Moreover, the subjective exercise experience remains a significant predictor of group cohesion after including income level as a mediator, suggesting that the model indicates partial mediation.

Bee honey and exercise for improving physical performance, reducing fatigue, and promoting an active lifestyle during COVID-19

Active lifestyle has enormous health benefits. However, physical activity has globally decreased since the beginning of the current coronavirus disease 2019 (COVID-19) outbreak because of social distancing measures. Older adults and people with age-related diseases (e.g., diabetes, obesity, cancer, cardiovascular disorders, etc.) are widely affected by COVID-19 and its grave adverse effects because of their baseline poor immune function. Although they are in intense need for the therapeutic benefits of exercise, they may express a low capacity for exercising due to skeletal muscle dysfunction and low motivation. Honey is a natural energy-rich, low glycemic index food with a variety of biological activities. It is reported to correct muscle pathology in diseased conditions. Because skeletal muscle is the key structure involved in exercise, we explored the literature for the exercise-promoting potential of natural honey. Bee honey improves physical performance at moderate levels of activity, and it reduces the production of inflammatory cytokines and biomarkers of fatigue following strenuous exercise among athletes. Supplementing ischemic heart disease patients with honey combined with floral pollen improved patients' tolerance for physical loads and corrected metabolism. Therefore, the therapeutic use of honey may have implications for to increasing the capacity for exercise in aged and diseased individuals. Soundly designed studies are needed to evaluate such possibility.

Is Self-Determined Motivation a Useful Agent to Overcome Perceived Exercise Barriers in Patients With Type 2 Diabetes Mellitus?

Background: Devising a program to increase physical activity (PA)/exercise behavior in patients with type 2 diabetes mellitus (T2DM) can meet with limited effectiveness in real-world settings because of the variety of barriers to PA/exercise that individuals need to overcome. An alternative approach is to explore whether targeting motivation as a facilitator may be effective to increase PA/exercise. This study aimed to understand attitudes toward perceived barriers to PA/exercise by examining individual levels of motivation, grounded on self-determination theory, in patients with T2DM. Methods: This study used an integrated approach combining qualitative and quantitative analysis. Sixteen patients with T2DM were grouped (n = 8 for each group) into either a higher self-motivation (HSM) or lower self-motivation (LSM) group via the Relative Autonomy Index. Thematic and deductive analysis were used to identify attitudes based on ten preconceived barrier themes: apathy, dislike, no priority, lack of support, health problems, lack of knowledge, unfavorable environment, tiredness, lack of time, and financial constraints. Quantitative analysis was to assess statistical differences in the volume of PA/exercise across the two groups, and a mixed-methods analysis was employed to highlight unique cases. Results: Patients in the HSM group expressed positive attitudes toward barriers to PA/exercise, while patients in the LSM group expressed a greater degree of hindrance. Although regular PA/exercise is necessary for T2DM management, patients with LSM considered PA/exercise a lesser priority displaying negative attitudes such as apathy and dislike. Conversely, patients with HSM placed greater emphasis on the benefits of PA/exercise regardless of apathy and dislike. Lack of time and health problems were commonly reported in both groups. The volume of PA/exercise corresponded to motivation levels, but there were some unique cases which arose from active commuting habits and severe health problems. Conclusion: These findings provide insights on how attitudes to perceived barriers to PA/exercise differ by levels of motivation. One insight was that examining motivation should be an essential consideration when designing practical strategies to overcome PA/exercise barriers in patients with T2DM. Lack of time and health problems exist regardless of motivation levels. Future research requires a tailored approach to managing barriers to PA/exercise in patients with T2DM.

Measurement of Motivation States for Physical Activity and Sedentary Behavior: Development and Validation of the CRAVE Scale

Physical activity, and likely the motivation for it, varies throughout the day. The aim of this investigation was to create a short assessment (CRAVE: Cravings for Rest and Volitional Energy Expenditure) to measure motivation states (wants, desires, urges) for physical activity and sedentary behaviors. Five studies were conducted to develop and evaluate the construct validity and reliability of the scale, with 1,035 participants completing the scale a total of 1,697 times. In Study 1, 402 university students completed a questionnaire inquiring about the want or desire to perform behaviors "at the present moment (right now)." Items related to physical activity (e.g., "move my body") and sedentary behaviors (e.g., "do nothing active"). An exploratory structural equation model (ESEM) revealed that 10 items should be retained, loading onto two factors (5 each for Move and Rest). In Study 2, an independent sample (n = 444) confirmed these results and found that Move and Rest desires were associated with stage-of-change for exercise behavior. In Study 3, 127 community-residing participants completed the CRAVE at 6-month intervals over two years- two times each session. Across-session interclass correlations (ICC) for Move (ICC = 0.72-0.95) and Rest (ICC = 0.69-0.88) were higher than when they were measured across 24-months (Move: ICC = 0.53; Rest: ICC = 0.49), indicating wants/desires have state-like qualities. In Study 4, a maximal treadmill test was completed by 21 university students. The CRAVE was completed immediately pre and post. Move desires decreased 26% and Rest increased 74%. Changes in Move and Rest desires were moderately associated with changes in perceived physical fatigue and energy. In Study 5, 41 university students sat quietly during a 50-min lecture. They completed the CRAVE at 3 time points. Move increased 19.6% and Rest decreased 16.7%. Small correlations were detected between move and both perceived energy and tiredness, but not calmness or tension. In conclusion, the CRAVE scale has good psychometric properties. These data also support tenets of the WANT model of motivation states for movement and rest (Stults-Kolehmainen et al., 2020a). Future studies need to explore how desires to move/rest relate to dynamic changes in physical activity and sedentarism.

Basic psychological needs, exercise intention and sport commitment as predictors of recreational sport participants' exercise adherence

Objective: This study aims to predict exercise adherence by examining from the standpoints of the exercise intention, the self-determination theory and the sport commitment model. Design and Main Outcome Measures: Data were collected from 391 Korean sports centre members (teens: 5.4%, twenties: 15.1%, thirties: 25.1%, forties: 28.1% and ≥ fifties: 26.3%). Questionnaires assessed the exercise intention and sport commitment as well as autonomy, competence and relatedness. Exercise adherence was measured by electronic attendance system. Data were analysed using reliability testing, descriptive statistics, correlation analysis, logistic regression analysis and binary classifier system. Results: All variables except for cognitive commitment had significant predictive power for 3-month exercise adherence. In contrast, only basic psychological needs were found to have significant predictive power for 6-month exercise adherence. Further, autonomy (OR = 4.58) showing the strongest predictive power (classification accuracy = 86.4%). Conclusion: These findings imply that 'basic psychological needs' plays a more key role than 'exercise intention' in predicting exercise adherence. This study has implications that need to focus not only on enjoyment or competition but also on the autonomy, relatedness and competence pertaining to the basic psychological needs and to work to satisfy those needs and maintain motivation to continue regular exercise.

Effects of morning vs. evening combined strength and endurance training on physical performance, sleep and well-being

The aim of the present study was to examine how combined strength and endurance training in the morning and evening influences the adaptations in strength and endurance performance, perception of time management, psychological well-being and sleep. The combined training period lasted for 24 weeks and the participants were divided into the morning training (MG, n = 18), evening training (EG, n = 24) and control groups (CG, n = 10). Isometric leg press force (iLP), maximal oxygen consumption (VO₂max), sleep behavior, fatigue, time management, motivation, self-esteem and health-related quality of life (HRQoL) were assessed. Morning to evening difference in iLP was observed in both MG and EG at Pre and Post, with higher force values in the evening, but not for VO₂max. iLP force increased significantly in EG in the morning (p < 0.001) and evening (p = 0.010). VO₂max increased in MG and EG both in the morning (both p < 0.001) and in the evening (MG: p < 0.001; EG: p = 0.003). Participants of the present study slept 7-8 h per night and the self-reported sleep duration, get-up time and the average time to go to bed were similar between the groups and did not change from Pre to Post. From HRQoL dimensions, the score for bodily pain decreased in MG (p = 0.029) and significant between-group differences were observed for Pre-Post changes in MG and EG (p = 0.001) as well as between MG and CG (p < 0.001). In vitality, a significant between-group difference was observed for Pre to Post changes in MG and EG (p = 0.014). Perception of time management decreased in EG (p = 0.042) but stayed unchanged for MG and CG. For the intrinsic motivation to participate, significant between-group differences were observed for MG and EG (p = 0.033) and between MG and CG (p = 0.032) for Pre to Post changes. Self-esteem improved in MG (p = 0.029) and EG (p = 0.024). The present combined strength and endurance training program performed in the morning and in the evening led to similar improvements in strength and endurance performance. Training in the morning or in the evening did not disrupt the already good sleep behavior and it was able to further increase the self-esteem. Although training in the morning hours may leave more time for free time activities or social life (i.e. family and friends) compared to the evening training, it might be more challenging to stay motivated to participate in prolonged training programs in the morning hours.

Adherence, Adhesion, and Dropout Reasons of a Physical Activity Program in a High Social Vulnerability Context

BACKGROUND

One of the most important health determinants is social vulnerability, which can interfere in the practice of physical activity (PA). This study aimed at analyzing adherence to a PA program in a high social vulnerability context.

METHODS

A longitudinal study with a 6-month intervention period was conducted. The program offered monitored walks associated with behavioral change educational campaigns. Sociodemographic characteristics, occupation, PA level, noncommunicable chronic diseases, participants' frequency of participation in the program, and intervention dropout reasons were evaluated. Descriptive and survival analyses were accomplished.

RESULTS

Among the 106 participants, 88.0% were female and 21.7% were older adults. The most mentioned participation reasons were health improvement (23.0%), weight loss (19.0%), disease control (17.0%), and social living (12%). The mean frequency of participation in the program was 27.4%. Dropout rate was 52.7%. The main reported reasons for dropping out were work hours (27.8%), health problems (25.9%), personal reasons (22.2%), and lack of time (11.1%). Factors associated with remaining in the program were being older adults and presenting body mass index <25 kg/m².

CONCLUSIONS

Results showed that in a high social vulnerability context, adherence to PA programs is low, and adult-life-related commitments and high levels of obesity are factors associated with lower adherence.

Functional and Respiratory Capacity of Patients with Chronic Kidney Disease Undergoing Cycle Ergometer Training during Hemodialysis Sessions: A Randomized Clinical Trial

Purpose

Exercise is recommended for patients undergoing hemodialysis, to reduce the decrease in functional capacity secondary to the progression of chronic kidney disease. A cycle ergometer can be easily added to an exercise routine during hemodialysis sessions. The purpose of this article was to assess the results of a training protocol with the cycle ergometer during hemodialysis sessions on the respiratory function and functional capacity of patients with chronic kidney disease on hemodialysis.

Method

In this randomized clinical trial (NCT no. 02834026), 39 patients undergoing hemodialysis were randomly allocated into two groups: the treatment group (TG, n = 20), who underwent a cycle ergometer protocol training, and the control group (GC, n = 19), not trained. The TG attended 24 training sessions, three times a week, during the intradialytic period. Training intensity was aimed at keeping the heart rate between 50 and 70% of its maximum. All participants were evaluated before and after the eight consecutive weeks of follow-up and had biochemicals data, anthropometric, functional, and respiratory outcomes evaluated.

Results

A significant difference was observed between groups in forced vital capacity, forced expiratory volume in the first second, peak expiratory flow, maximal inspiratory and expiratory pressure, and Borg score and distance covered in the six-minute walk test. Improvement was also observed in biochemical and Kt/V test results for the TG.

Conclusion

The systematic training regimen with a cycle ergometer resulted in benefits in the respiratory function and functional capacity in patients with chronic kidney disease undergoing hemodialysis.

Can Interpersonal Behavior Influence the Persistence and Adherence to Physical Exercise Practice in Adults? A Systematic Review

Objective: Motivation seems to be a fundamental indicator of long-term physical exercise adherence. Self-Determination Theory (SDT) argues that social environment plays a central role in the satisfaction of basic psychological needs, which might directly affect the quality of one's motivation. Individuals who appear to be more self-determined tend to persist longer at certain behaviors. Therefore, this body of work intends to analyze the relationship between motivational variables and behavioral outcomes in the exercise context, having as theoretical background the Self-Determination Theory. Methods: This systematic review was conducted through an electronic search on Web of Science, PubMed, SPORTDiscus, and PsycINFO. Data such as instruments, main predictors and results were collected from studies published between 1985 and 2018. A total of 35 empirical studies were considered for a detailed analysis. Results: Results showed the relevance of autonomy support performed by exercise professionals, as well as the major contribution that these behaviors have toward the satisfaction of basic psychological needs, besides the inherent benefits of developing more autonomous regulations. According to the literature, few studies have analyzed interpersonal thwarting behavior and the way this relates to basic psychological needs' frustration. Nether less, there seems to be a negative relationship between less self-determined regulations and exercise practice. Conclusion: Despite the existence of numerous cross-sectional studies that demonstrate positive correlations between SDT and behavioral outcomes in the exercise context, longitudinal research that analyzes all six dimensions of interpersonal behaviors and their relationship with persistence and adherence to exercise proves to be crucial. However, according to this review, interventions based on SDT appear to be fundamental when it comes to promote the maintenance of a long-term exercise practice.

Physical activity levels and self-determined motivation among future healthcare professionals: Utility of the Behavioral Regulation in Exercise Questionnaire (BREQ-2)

Background: Healthcare professionals (HCPs) who are physically active are regarded as more likely to act as credible physical activity (PA) role models and promote healthy lifestyles. This study explores PA levels and underlying motivations, within and between HCP students, first testing the validity and reliability of the Behavioral Regulation in Exercise Questionnaire (BREQ-2). Methods: The International Physical Activity Questionnaire (IPAQ) and BREQ-2 were administered to 296 HCP university students (physiotherapy n = 47, medicine n = 105, nursing n = 121, radiography n = 23). Data were summarized using descriptive statistics. Mann Whitney and Kruskal Wallis tests compared scores between subgroups. Confirmatory factor analysis and internal consistency testing of the BREQ-2 was also undertaken. Results: Fifty-six percent (n = 166) of respondents were moderately active, 40% (n = 118) highly active and 4% (n = 12) inactive. Participants' responses indicated mainly self-determined motivation for exercise. Significantly different Relative Autonomy Index (RAI) (p ≤ 0.001), identified (p ≤ 0.001) and intrinsic (p ≤ 0.001) motivation subscale scores were noted between HCP groups and among low, moderate and high-level PA groups. Conclusions: This HCP cohort were found to be active and intrinsically motivated to exercise. The BREQ-2 was shown to be a valid and reliable tool with strong subscale internal consistency.

BDNF levels are increased in peripheral blood of middle-aged amateur runners with no changes on histone H4 acetylation levels

Our aim was to compare the basal levels of plasma brain-derived neurotrophic factor (BDNF) and global histone H4 acetylation in peripheral blood mononuclear cells (PBMCs) of healthy amateur runners (EXE group) with sedentary individuals (SED group) as well as to investigate the acute effect of a running race on these markers in the EXE group. Five days before the race, all participants were submitted to a basal blood collection. On the race day, two blood samples were collected in the EXE group before the running started and immediately at the end. In the basal period, a significant increase of plasma BDNF levels in the EXE individuals when compared to the SED group (p = 0.036) was demonstrated, while no difference in global histone H4 acetylation levels was observed. These parameters were unaltered in the EXE group after the race. The increased levels of BDNF might be linked to healthy middle-aged runners' phenotype.

The Role of Autonomous and Controlled Motivation in Exercise Intentions of Participants in a Mass Cycling Event

Purpose: This study used self-determination theory to examine the role of participants' autonomous and controlled motivation to exercise and to participate in a challenging mass cycling event and investigated whether the event enhanced intended and actual exercise behavior among the participants.

Method: Two hundred and twenty-eight subjects, having participated in the cycling event, completed a questionnaire shortly after the event and again 4 months later. The questionnaire measured self-reported cycling and exercise activity, training in preparation of the event, motivation to participate in the event, motivation to exercise, and future exercise intentions due to the event.

Results: Results showed that most participants were very active in cycling and other sports. The expected positive effect of autonomous motivation on exercise intentions and behavior could not be confirmed in our study. Multiple regression analyses revealed that the event had an enhancing effect on exercise intentions shortly after the event among participants that scored higher on controlled motivation to exercise (β = 0.15) and to participate (β = 0.15); also, participants were more satisfied with the event (β = 0.19) and had followed a preparation program before the event (β = 0.15). However, intentions and exercise behavior distinctively dropped 4 months after the event.

Conclusions: Events aiming to enhance their participants' exercise behavior need to attract less active participants and need to make additional efforts to prevent relapse in intentions and exercise behavior.

Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder

CONTEXT

Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs.

OBJECTIVE

To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively.

DATA SOURCES

We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology.

STUDY SELECTION

Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded.

DATA EXTRACTION

Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review.

DATA SYNTHESIS

We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting.

CONCLUSIONS

Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome.