What makes a good staging algorithm: examples from regular exercise

Self-determined motivation and physical activity in patients with rheumatoid arthritis: a cross-sectional study

OBJECTIVE

To identify factors associated with two self-reported measures of physical activity (PA) in patients with rheumatoid arthritis (RA).

METHOD

Hospital outpatients with RA from central Norway filled in questionnaires about symptoms, psychological factors, and PA. Outcomes were two alternative self-reported measures of PA: (i) fulfilling the aerobic PA recommendations of ≥ 150 min/week at moderate intensity or ≥ 75 min/week at vigorous intensity; or (ii) being in the PA maintenance stage of the Stages of Exercise Behaviour Change framework. Logistic regression was applied to identify factors associated with PA. Step 1 included the independent variables sex, age, and smoking habits. Step 2a added self-reported function, joint pain during the past 6 months, and fatigue to Step 1. Step 2b added Exercise Self-Efficacy and the Relative Autonomy Index (RAI), calculated from the Behavioural Regulation in Exercise Questionnaire-2, to Step 1. Step 3 included all the mentioned independent variables. Steps 1-3 were analysed for each PA measure.

RESULTS

In total, 227 patients participated. The RAI had a statistically significant positive association with being physically active according to both PA definitions. Joint pain had a significant negative association with meeting the aerobic PA recommendations but was not associated with being in the PA maintenance stage.

CONCLUSION

The degree of self-determined motivation was the most consistent variable associated with self-reported PA behaviour. Joint pain was associated with one of the two PA measures. Motivation and joint pain may be useful targets for intervention in clinical practice to improve PA engagement among patients with RA.

Deconstructing Fitbit to Specify the Effective Features in Promoting Physical Activity Among Inactive Adults: Pilot Randomized Controlled Trial

BACKGROUND

Wearable activity trackers have become key players in mobile health practice as they offer various behavior change techniques (BCTs) to help improve physical activity (PA). Typically, multiple BCTs are implemented simultaneously in a device, making it difficult to identify which BCTs specifically improve PA.

OBJECTIVE

We investigated the effects of BCTs implemented on a smartwatch, the Fitbit, to determine how each technique promoted PA.

METHODS

This study was a single-blind, pilot randomized controlled trial, in which 70 adults (n=44, 63% women; mean age 40.5, SD 12.56 years; closed user group) were allocated to 1 of 3 BCT conditions: self-monitoring (feedback on participants' own steps), goal setting (providing daily step goals), and social comparison (displaying daily steps achieved by peers). Each intervention lasted for 4 weeks (fully automated), during which participants wore a Fitbit and responded to day-to-day questionnaires regarding motivation. At pre- and postintervention time points (in-person sessions), levels and readiness for PA as well as different aspects of motivation were assessed.

RESULTS

Participants showed excellent adherence (mean valid-wear time of Fitbit=26.43/28 days, 94%), and no dropout was recorded. No significant changes were found in self-reported total PA (dz<0.28, P=.40 for the self-monitoring group, P=.58 for the goal setting group, and P=.19 for the social comparison group). Fitbit-assessed step count during the intervention period was slightly higher in the goal setting and social comparison groups than in the self-monitoring group, although the effects did not reach statistical significance (P=.052 and P=.06). However, more than half (27/46, 59%) of the participants in the precontemplation stage reported progress to a higher stage across the 3 conditions. Additionally, significant increases were detected for several aspects of motivation (ie, integrated and external regulation), and significant group differences were identified for the day-to-day changes in external regulation; that is, the self-monitoring group showed a significantly larger increase in the sense of pressure and tension (as part of external regulation) than the goal setting group (P=.04).

CONCLUSIONS

Fitbit-implemented BCTs promote readiness and motivation for PA, although their effects on PA levels are marginal. The BCT-specific effects were unclear, but preliminary evidence showed that self-monitoring alone may be perceived demanding. Combining self-monitoring with another BCT (or goal setting, at least) may be important for enhancing continuous engagement in PA.

TRIAL REGISTRATION

Open Science Framework; https://osf.io/87qnb/?view_only=f7b72d48bb5044eca4b8ce729f6b403b.

Revisiting the Transtheoretical Model for Physical Activity: A Large-Scale Cross-Sectional Study on Japanese-Speaking Adults

BACKGROUND

The Transtheoretical Model (TTM) has been the basis of health promotion programs, which are, for example, used to tailor behavioral interventions according to the stages of change. Empirical studies have shown that the TTM effectively describes the processes of behavioral adaptation to acquire healthier lifestyles; however, it has been argued that TTM-based interventions are not superior to non-TTM-based interventions for promoting physical activity (PA). Evidence has also highlighted some inconsistencies with theoretical assumptions, especially regarding how each process-of-change strategy emerges across the stages.

PURPOSE

Therefore, we investigated (a) how well the TTM describes the distributional characteristics of PA levels as well as other relevant variables (e.g., process of change, self-efficacy) across stages, and (b) how predictive the TTM variables are of PA levels within each stage.

METHODS

We analyzed data from 20,573 Japanese-speaking adults who completed online questionnaires on PA and TTM variables.

RESULTS

The results replicated previous findings that stage membership is associated with PA, the process of change, decisional balance, and self-efficacy, albeit with inconclusive evidence of temptations. Regression analyses revealed that some processes of change (self-reevaluation, reinforcement management, and self-liberation) were more predictive of PA in pre-active stages than in post-action stages; self-efficacy was predictive of PA only in the maintenance stage but not in the other stages.

CONCLUSIONS

Overall, the data support the theoretical assumptions of the TTM, but the stage specificity of the active processes may not always be consistent with the theory.

Transtheoretical Model for Exercise: Measure Redevelopment and Assessing the Role of Barriers in a Diverse Population

PURPOSE

To redevelop and improve Transtheoretical Model (TTM) exercise measures for Black and Hispanic/Latinx adults. The redeveloped scales will address barriers to exercise potentially relevant to populations of color in the United States (US).

DESIGN

Cross-sectional, split-half measure development.

SETTING

Online survey in the US.

SUBJECTS

450 Black and/or Hispanic/Latinx adults.

MEASURES

Demographics, exercise engagement (IPAQ-SF), stage of change (SOC), decisional balance (DCBL), self-efficacy (SE), and barriers to exercise.

ANALYSIS

Split-half exploratory (EFA) and confirmatory factor analyses (CFA) were executed to establish measurement structure and fit, followed by multivariate analyses to assess constructs by SOC.

RESULTS

EFA/CFA for DCBL revealed three factors (α = .85, .70, .75) which represented Pros of exercise, Cons of exercise related to time and safety, and Cons of exercise related to physical or emotional discomfort. Model fit was adequate (CFI = .89). For SE, two factors (α = .85, .77) resulted with good model fit (CFI = .91). These factors reflected self-efficacy to exercise when confronted with generally challenging situations, and self-efficacy to exercise when specifically experiencing affective difficulties, such as depression or anxiety. Lastly, a novel Barriers measure resulted in three factors (α = .82, .77, .76), representing barriers encountered due to family responsibilities, work obligations, and health challenges, with good model fit (CFI = .95). Shifts in the core TTM constructs by SOC largely mapped onto the theoretical trends expected under the TTM.

CONCLUSION

This study produced systematically developed TTM exercise measures for Black and Hispanic/Latinx adults in the US that address and incorporate important barriers to exercise. This research represents an important step forward in broadening the inclusion of diverse populations to TTM measure development processes and may lead to a better understanding of relevant factors impeding exercise engagement in the US.

Incorporating Physical Activity Assessments and Behavior Change Techniques Into Geriatrics

Ninety-one percent of adults 65 years and older do not perform the recommended levels of physical activity (PA), resulting in increased risk of disability, morbidity, and mortality. Despite knowing the benefits of PA and acknowledging the importance of assessing and addressing inadequate PA levels, 50%-75% of health care providers do not incorporate behavior change techniques into clinical practice. This clinical gap can be explained by a lack of knowledge or confidence in (1) assessing PA levels; (2) addressing inadequate PA levels; and (3) justifying the time needed to use these techniques in clinical practice. In this special communication, we address this gap by providing a 3-step theoretical-based clinical decision pathway that guides health care providers on how to identify older adults with inadequate PA levels, determine readiness to increase PA, and empower patents to develop an action plan that will increase their PA levels. We also provide a conceptual model that supports the use of techniques that assess and address inadequate PA by tying PA to the Age-Friendly Health System's 4Ms (ie, What Matters to the older adult, Mentation, Mobility, and Medications).

Use Patterns of Smartphone Apps and Wearable Devices Supporting Physical Activity and Exercise: Large-Scale Cross-Sectional Survey

Background

Physical inactivity is a global health issue, and mobile health (mHealth) apps are expected to play an important role in promoting physical activity. Empirical studies have demonstrated the efficacy and efficiency of app-based interventions, and an increasing number of apps with more functions and richer content have been released. Regardless of the success of mHealth apps, there are important evidence gaps in the literature; that is, it is largely unknown who uses what app functions and which functions are associated with physical activity.

Objective

This study aims to investigate the use patterns of apps and wearables supporting physical activity and exercise in a Japanese-speaking community sample.

Methods

We recruited 20,573 web-based panelists who completed questionnaires concerning demographics, regular physical activity levels, and use of apps and wearables supporting physical activity. Participants who indicated that they were using a physical activity app or wearable were presented with a list of app functions (eg, sensor information, goal setting, journaling, and reward), among which they selected any functions they used.

Results

Approximately one-quarter (n=4465) of the sample was identified as app users and showed similar demographic characteristics to samples documented in the literature; that is, compared with app nonusers, app users were younger (odds ratio [OR] 0.57, 95% CI 0.50-0.65), were more likely to be men (OR 0.83, 95% CI 0.77-0.90), had higher BMI scores (OR 1.02, 95% CI 1.01-1.03), had higher levels of education (university or above; OR 1.528, 95% CI 1.19-1.99), were more likely to have a child (OR 1.16, 95% CI 1.05-1.28) and job (OR 1.28, 95% CI 1.17-1.40), and had a higher household income (OR 1.40, 95% CI 1.21-1.62). Our results revealed unique associations between demographic variables and specific app functions. For example, sensor information, journaling, and GPS were more frequently used by men than women (ORs <0.84). Another important finding is that people used a median of 2 (IQR 1-4) different functions within an app, and the most common pattern was to use sensor information (ie, self-monitoring) and one other function such as goal setting or reminders.

Conclusions

Regardless of the current trend in app development toward multifunctionality, our findings highlight the importance of app simplicity. A set of two functions (more precisely, self-monitoring and one other function) might be the minimum that can be accepted by most users. In addition, the identified individual differences will help developers and stakeholders pave the way for the personalization of app functions.

Using a Motivational Paradigm to Develop an Exercise Program for Nurses with High Risk of Metabolic Syndrome

Nurses are frontline care providers whose health is vital to providing good quality of care to patients. The purpose of this study was to develop an exercise program for high-risk metabolic syndrome nurses based on the transtheoretical model. The transtheoretical model was used in this study due to its popular use in exercise behavior change and it can clearly identify the stage of exercise so as to plan an effective program to promote health. This was a quasi-experimental pilot study with a total of 40 participants who met the inclusion criteria. Exercise programs were developed for three groups distinguished by their commitment to exercising for health. Sixteen (40%) nurses moved one step forward, six (15%) nurses moved backward, and eighteen (45%) nurses maintained at the same stage over time (stable sedentary, 40%; stable active, 5%). Bowker’s test of symmetry, χ2 = 14.00 (p < 0.01), revealed that the population exercising increased significantly after the intervention. After the program, the perceived benefits from exercise in the decisional balance significantly increased to 1.53 (t = 2.223, p < 0.05), perceived exercise barriers significantly decreased to 3.10 (t = −3.075, p < 0.05), and self-efficacy significantly increased to 2.90 (t = 3.251, p < 0.01), respectively. Applying the transtheoretical model to health behavior enables significant change. The benefits of applying the transtheoretical model for promoting exercise include increasing perceived exercise benefits and self-efficacy, decreasing perceived exercise barriers, and increasing physical activity levels.

The Longitudinal Association Between Physical Activity and Physical Function in Older Women

Purpose

The age-related decline in physical function is ameliorated by physical activity; however, less is known about changes in physical function in active vs. inactive older women. The purpose of this study was to determine the longitudinal associations between physical activity and physical function in community-dwelling older women.

Methods

238 participants (age 79.0 ± 5.1) were dichotomized into two activity groups [inactive (IG); n = 144 or active (AG); n = 94] based on self-reported exercise at baseline. Repeated measures ANCOVA, controlling for age, measured differences in physical function between activity groups at baseline and 48-months using the Timed Up and Go, 30-s chair stand, and 30-second arm curl. Differences in Timed Up and Go classification [normal (≤ 8.23 s); preclinical limitations/limited physical function (&gt;8.23 s)] were analyzed using chi-square tests for activity group and for activity-age group (AG, &lt;80 years; AG, ≥ 80 years; IG, &lt;80 years; IG, ≥ 80 years).

Results

The repeated measures ANCOVA yielded a significant main effect for activity group for the Timed Up and Go (p = 0.006), 30-s chair stand (p = 0.002) and 30 s arm curl (p = 0.007) and a significant time main effect for the Timed Up and Go (p = 0.016). There were no significant group by time interactions. A larger proportion of the IG than the AG (58.2 vs. 86.5%, respectively) had Timed Up and Go scores &gt;8.23 s (p &lt; 0.001). At 48-months, individuals in the AG were more likely to have normal Timed Up and Go scores compared to those in the IG in both age groups [χ(3, N=236)2 = 42.56, p &lt; 0.001].

Conclusion

Older women who engaged in regular exercise at baseline had higher levels of objectively measured physical function and were less likely to have abnormal Timed Up and Go scores. These findings help illustrate the long-term benefit of exercise on physical function in older women.

Incremental levels of diagnostic information incentivize health-seeking in non-alcoholic fatty liver: a randomized clinical trial

Patients with chronic disorders like non-alcoholic fatty liver disease (NAFLD) face important challenges adhering to diagnostic and treatment tracks. As NAFLD increases, the need to incentivize health-seeking behaviors grows. No evidence-based interventions to address this gap exist. The aim of the study was to estimate the effect of providing increasing levels of diagnostic information on medical care-seeking in adults newly diagnosed with NAFLD. We randomly assigned adults with a sonographic diagnosis of NAFLD at a check-up unit in Mexico to one of five groups. All groups received medical consultation. A: no further interventions; B: received multimedia educational material (MEM); C: MEM + NAFLD-fibrosis-score (NFS); D: MEM + transient elastography (TE); E: MEM + NFS + TE. 1209 participants were randomized, follow-up rate 91%; 82% male, BMI 30.5 ± 4 kg/m². There were no differences in the proportion of patients undergoing further diagnostic evaluation of liver fibrosis (A 0.4%, E 0.4%, P-for-trend = 0.269). Groups who received more information sought specialized medical care more frequently: A 22%, E 30% (P-for-trend = 0.047). A trend to receive treatment was also observed at higher levels of information: A 26.7%, E 36.3% (P-for-trend = 0.134). Increasing the amount of diagnostic information seemed to increase patient's health-seeking. Tailoring the communication of information obtained for diagnosis could help to increase health-seeking in chronic disease patients.Trial registration: NCT01874249 (full date of first registration 11-06-2013).

Associations Between Smartphone Use for Physical Activity by South Korean College Students and Behavioral Change Constructs of the Transtheoretical Model

We examined associations between smartphone uses to assist physical activity (PA) and change constructs of the transtheoretical model (TTM) among Korean college students. Our participants were 242 college students who completed a cross-sectional survey of their smartphone use, PA, and TTM constructs. We applied Poisson regression models to test the associations between stages of change and smartphone PA use frequencies in four categories over the previous week: 1= watching PA instruction videos; 2 = tracking PA; 3 = searching and booking sites for PA; and 4 = finding and making appointments with PA partners. The associations between these smartphone uses and participants' self-efficacy, decisional balance, processes of change, and PA were tested via ordinary least squares regression models. Results were that participants in the precontemplation and maintenance stages were the least and most frequent users of the smartphones in all four categories, respectively. Category one usage was positively associated with participants' scores on pros (β = .22, p = .004), cognitive processes of change (β = .30, p < .001), and behavioral processes of change (β = .28, p < .001). Category two usage was positively associated with PA (β = .06, p = .048). While category three usage was not significantly associated with any TTM constructs except for stages of change, category four usage was positively associated with self-efficacy (β = .28, p < .001), pros (β = .30, p < .001), cognitive processes of change (β = .31, p < .001), behavioral processes of change (β = .06, p <. 001), and PA (β = .45, p < .001). These findings suggest that (a) active college students are likely to take advantage of smartphone to assist their PA, and (b) smartphones can help motivate college students toward regular PA.

WalkingPad protocol: a randomized clinical trial of behavioral and motivational intervention added to smartphone-enabled supervised home-based exercise in patients with peripheral arterial disease and intermittent claudication

Background

Physical exercise is a first-line treatment for peripheral arterial disease (PAD) and intermittent claudication (IC) reducing pain and increasing the distances walked. Home-based exercise therapy (HBET) has the advantage of reaching a higher number of patients and increasing adherence to physical exercise as it is performed in the patient’s residential area and does not have the time, cost, and access restrictions of supervised exercise therapy (SET) implemented in a clinical setting. Even so, rates of adherence to physical exercise are relatively low, and therefore, m-health tools are promising in increasing motivation to behavior change and adherence to physical exercise. A built-in virtual assistant is a patient-focused tool available in a mobile interface, providing a variety of functions including health education, motivation, and implementation of behavior change techniques.

Methods

This is a single-center, prospective, three-arm, single-blind, randomized, controlled, superior clinical trial with stratified and blocked random allocation. Three hundred participants with PAD and IC will be recruited from an Angiology and Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUPorto), Porto, Portugal. All patients will receive the same medical care recommended by  current guidelines. Participants in all three groups will receive a personalized prescription for an HBET program and a behavioral change and motivational intervention. Participants in experimental groups 1 and 2 will receive a smartphone with the WalkingPad app to monitor exercise sessions. Experimental group 2 WalkingPad app will have a built-in virtual assistant that will promote behavioral change and provide motivational support. Participants allocated to the active control group will not receive the m-health tool, but a practice diary to encourage monitoring. The  program will last for 6 months with three evaluation moments (baseline, 3, and 6 months). The primary outcome will be the change in distances walked (maximal and pain-free) from baseline to 3 and 6 months. Secondary outcomes will be changes in quality of life, patients’ perception of resistance, and walking speed.

Discussion

This study will allow measuring the effectiveness of an m-health tool in increasing motivation for behavior change and adherence to an HBET program in patients with PAD. The superiority of experimental group 2 in the primary and secondary outcomes will indicate that the virtual assistant is effective for motivating behavioral change and encouraging the practice and adherence to physical exercise. The use of m-health tools and virtual health assistants can potentially fill a gap in the access and quality of health services and information, reducing the burden on the health system and promoting self-management and self-care in chronic illness.

Trial registration

ClinicalTrials.govNCT04749732. Registered on 10 February 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06279-9.

What Predicts the Physical Activity Intention-Behavior Gap? A Systematic Review

BACKGROUND

Intention is theorized as the proximal determinant of behavior in many leading theories and yet intention-behavior discordance is prevalent.

PURPOSE

To theme and appraise the variables that have been evaluated as potential moderators of the intention-physical activity (I-PA) relationship using the capability-opportunity-motivation- behavior model as an organizational frame.

METHODS

Literature searches were concluded in August 2020 using seven common databases. Eligible studies were selected from English language peer-reviewed journals and had to report an empirical test of moderation of I-PA with a third variable. Findings were grouped by the moderator variable for the main analysis, and population sample, study design, type of PA, and study quality were explored in subanalyses.

RESULTS

The search yielded 1,197 hits, which was reduced to 129 independent studies (138 independent samples) of primarily moderate quality after screening for eligibility criteria. Moderators of the I-PA relationship were present among select variables within sociodemographic (employment status) and personality (conscientiousness) categories. Physical capability, and social and environmental opportunity did not show evidence of interacting with I-PA relations, while psychological capability had inconclusive findings. By contrast, key factors underlying reflective (intention stability, intention commitment, low goal conflict, affective attitude, anticipated regret, perceived behavioral control/self-efficacy) and automatic (identity) motivation were moderators of I-PA relations. Findings were generally invariant to study characteristics.

CONCLUSIONS

Traditional intention theories may need to better account for key I-PA moderators. Action control theories that include these moderators may identify individuals at risk for not realizing their PA intentions. Prospero # CRD42020142629.

A Tribute to the Mind, Methodology and Mentoring of Wayne Velicer

Wayne Velicer is remembered for a mind where mathematical concepts and calculations intrigued him, behavioral science beckoned him, and people fascinated him. Born in Green Bay, Wisconsin on March 4, 1944, he was raised on a farm, although early influences extended far beyond that beginning. His Mathematics BS and Psychology minor at Wisconsin State University in Oshkosh, and his PhD in Quantitative Psychology from Purdue led him to a fruitful and far-reaching career. He was honored several times as a high-impact author, was a renowned scholar in quantitative and health psychology, and had more than 300 scholarly publications and 54,000+ citations of his work, advancing the arenas of quantitative methodology and behavioral health. In his methodological work, Velicer sought out ways to measure, synthesize, categorize, and assess people and constructs across behaviors and time, largely through principal components analysis, time series, and cluster analysis. Further, he and several colleagues developed a method called Testing Theory-based Quantitative Predictions, successfully applied to predicting outcomes and effect sizes in smoking cessation, diet behavior, and sun protection, with the potential for wider applications. With $60,000,000 in external funding, Velicer also helped engage a large cadre of students and other colleagues to study methodological models for a myriad of health behaviors in a widely applied Transtheoretical Model of Change. Unwittingly, he has engendered indelible memories and gratitude to all who crossed his path. Although Wayne Velicer left this world on October 15, 2017 after battling an aggressive cancer, he is still very present among us.

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.

Correlates of Perceived Physical Activity Transitions during the COVID-19 Pandemic among Canadian Adults

BACKGROUND

The purpose of this study was to explore socio-ecological predictors of moderate to vigorous physical activity (MVPA) as a result of the COVD-19 pandemic restrictions.

METHOD

A representative sample of 1,055 English-speaking Canadians (18+ years) completed measures of MVPA during the COVID-19 restrictions and reflecting on MVPA prior to these restrictions, as well as demographics, COVID-19-related cognitions and behavior (i.e. perceived threat, social distancing), psychological factors (e.g. personality traits, habit, identity, strategic planning), social factors (e.g. dependent children, co-habitation), home environment affordances (exercise equipment, programming) and the neighborhood environment (e.g. access to outdoor recreation, neighborhood safety).

RESULTS

Participants perceived that they had decreased weekly MVPA (p < .01) and the availability of home equipment and strategic planning were critical predictors (p < .01). Profiles by MVPA guidelines, however, showed that 58 per cent of the sample had not changed and 6 per cent had increased MVPA. Identity was the critical predictor of the different MVPA profiles, followed by habit, extraversion, availability of home equipment, and the age of the participant (p < .01).

CONCLUSION

Pandemic restrictions have affected the MVPA of many Canadians, and variables across the socio-ecological spectrum explain who has been able to maintain MVPA during this unprecedented time.

Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility

PURPOSE

To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention.

METHODS

The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5-10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m2), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion.

RESULTS

Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05-1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01-1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3-13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04).

CONCLUSIONS

Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support.

TRIAL REGISTRATION

The LIFEstyle study was registered at the Dutch trial registry (NTR 1530; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530 ).

Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial

BACKGROUND

Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes.

OBJECTIVE

The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI.

METHODS

This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise.

RESULTS

Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes ( P ≥ .05).

CONCLUSIONS

A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude.

Congruence of stage-of-change for fruit, vegetables and take-out foods with consumption

Purpose

Young adults frequently engage in sub-optimal dietary behaviours, such as inadequate intakes of fruits and vegetables and excessive consumption of take-out meals. Theory-based interventions are suggested to promote dietary change. The transtheoretical model is an example that stages an individual’s readiness to change behaviours as precontemplation, contemplation, preparation, action and maintenance, and includes a series of processes that help people move between stages. The purpose of this study is to investigate whether self-reported usual dietary intakes of fruits and vegetables and take-out foods differ by reported stage-of-change.

Design/methodology/approach

Cross-sectional data from 250 overweight young adults, aged 18-35 years, who enrolled in a lifestyle intervention to prevent weight gain are analysed. Participant’s stage-of-change for increasing fruit and vegetable intakes and reducing take-out foods is determined using staging algorithms. This is compared with self-reported dietary intakes over the past month using a food frequency questionnaire. Differences in intakes and variety by stage-of-change are compared for fruits, vegetables and take-out foods.

Findings

Take-out foods differed between stages (p < 0.0001), with lower weekly intakes in action (309 g) and maintenance (316 g) compared with preparation (573 g). Daily fruit intakes and variety scores varied by stage-of-change (p < 0.0001), being highest for action and maintenance (261 g and 263 g, respectively, and variety scores of 1 and 2) compared with precontemplation, contemplation and preparation (all = 100 g and 0 for variety). Daily vegetable consumption and variety scores differed by stage (p = 0.009 and p = 0.025, respectively) being highest for action/maintenance (204 g and 2 for variety) versus precontemplation and preparation (<110 g daily and Variety 1).

Practical implications

The finding of no differences in intakes between precontemplation, contemplation or preparation stages implies that the adoption of the dietary behaviours is not a continuum but a move from pre-action to actioning the target intakes. This means that for planning health promotion and dietary counselling, assigning people to the three different pre-action stages may be unnecessary.

Originality/value

This study is the first to examine the congruence of self-reported readiness to change behaviour with dietary intakes of take-out foods as well as variety of fruit and vegetables in overweight young adults.

Momentary assessment of physical activity intention-behavior coupling in adults

Research attempting to elucidate physical activity (PA) intention-behavior relations has focused on differences in long-term behavior forecasting between people. However, regular PA requires a repeated performance on a daily or within-daily basis. An empirical case study application is presented using intensive longitudinal data from a study of PA in adults to (a) describe the extent to which short-term intention-behavior coupling occurs and (b) explore time-varying predictors of intention formation and short-term intention-behavior coupling. Adults (n = 116) participated in three 4-day waves of ecological momentary assessment (EMA). Each day, participants received EMA questionnaires assessing short-term PA intentions and wore accelerometers to assess whether they engaged in ≥10 min of moderate-to-vigorous physical activity (MVPA) in the 3-hour period after each EMA prompt. Concurrent affective states and contexts were also assessed through EMA. Participants reported having short-term intentions to engage in PA in 41% of EMA prompts. However, participants only engaged in ≥10 min of MVPA following 16% of the prompts that short-term PA intentions were reported indicating an intention-behavior gap of 84%. Odds of intentions followed by PA were greater on occasions when individuals reported higher levels of positive affect than was typical for them. This study is the first to take an EMA approach to describe short-term intention-behavior coupling in adults. Results suggest that adults have difficulty translating intentions into behavior at the momentary level, more so than over longer timescales, and that positive affect may be a key to successfully translating intentions into behavior.

Trajectories of Maintenance and Resilience in Healthful Eating and Exercise Behaviors in Older Adults

OBJECTIVE

Our objective was to describe behavioral change trajectories for healthful eating and exercise in a group of community-dwelling older adults. A secondary aim was to determine predictors of maintenance and resilience.

METHOD

Subjects were participants in the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) I study who had achieved postaction stage of change for at least one behavior by its end. They were recruited for SENIOR II, a 48-month study with annual assessments on demographic, anthropometric, cognitive, psychosocial, and behavioral variables.

RESULTS

Maintainers generally had higher levels of healthy behaviors and better cognitive function. Resilient older adults were similar to maintainers but were older and had greater functional limitations.

DISCUSSION

Findings suggest that both physical health and psychological capital provide important resources upon which to draw as older adults grow even older. The trajectory model can provide useful information for developing resilience interventions for older adults.

Healthy eating and active living after gestational diabetes mellitus (HEALD-GDM): Rationale, design, and proposed evaluation of a randomized controlled trial

BACKGROUND

Gestational diabetes mellitus (GDM) is a common complication in pregnancy and a significant risk factor for type 2 diabetes (T2D). Most women who have had GDM are not engaging in health behaviours known to reduce their risk for developing future T2D. The objective of this study is to evaluate the effectiveness of a lifestyle modification program targeting healthy eating and active living behaviours after a GDM pregnancy.

METHOD

This trial will randomize 100 women to either a lifestyle modification program or a control condition. Those allocated to the Healthy Eating and Active Living for Diabetes and Gestational Diabetes Mellitus (HEALD-GDM), program will receive a previously developed and tested 24-week program led by an Exercise Specialist at a local recreational facility. The original HEALD program will be tailored for women with GDM through the provision of complementary childcare at HEALD-GDM sessions and theory-guided peer-led telephone support. Our primary outcome is the 6-month change in objectively derived average daily moderate and vigorous physical activity.

DISCUSSION

Programs to increase physical activity in women with GDM should carefully consider and find ways to address known barriers specific to this population. We believe that our modified program may be successfully translated to women who have had GDM.

CLINICAL TRIALS REGISTRATION

NCT02483949.

Intervention Effects on Stage of Change Membership and Transitions among Adolescent Energy Balance Behaviors

The transition from childhood to adolescence is a crucial period for the development of healthy behaviors to be sustained later in life. With obesity a leading public health problem, the promotion of healthy behaviors has the potential to make a huge impact. The current study evaluated Stage of Change progression in a large (N = 4158) computer-delivered, Transtheoretical Model-tailored intervention focusing on physical activity and fruit and vegetable consumption (FV). Markov models were used to explore stage transitions and patterns of discrete change from sixth to ninth grade. Nested model comparisons examined the consistency of these patterns across time and intervention condition. Major findings supported models in which participants were free to transition forward and backward to any of the stages, but higher probabilities were observed for remaining in the same stage or for transitioning one or two stages forward. Participants in the intervention group had higher probabilities of transitioning toward Maintenance, with more change occurring relative to the comparison group during transitions from grades six to eight but not for grades eight to nine.

A Trial of Financial and Social Incentives to Increase Older Adults' Walking

INTRODUCTION

Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults' motivation to become active. This study tested the effects of financial incentives, donations to charity, and the combined effects of both interventions on older adults' uptake and retention of increased levels of walking.

STUDY DESIGN

RCT comparing three interventions to control. Data collection occurred from 2012 to 2013. Analyses were conducted in 2013-2016.

PARTICIPANTS

Ninety-four adults aged ≥65 years from Philadelphia-area retirement communities.

INTERVENTION

All participants received digital pedometers, walking goals of a 50% increase in daily steps, and weekly feedback on goal attainment. Participants were randomized to one of four groups: (1) Control: received weekly feedback only; (2) Financial Incentives: received payment of $20 each week walking goals were met; (3) Social Goals: received donation of $20 to a charity of choice each week walking goals were met; and (4) Combined: received $20 each week walking goals were met that could be received by participant, donated to a charity of choice, or divided between the participant and charity.

MAIN OUTCOME MEASURES

Mean proportion of days walking goals were met during the 16-week intervention and 4-week follow-up period.

RESULTS

After adjusting for baseline walking, the proportion of days step goals were met during the 16-week intervention period was higher in all intervention groups versus controls (relative risk, 3.71; 95% CI=1.37, 10.01). During the 4-week follow up period, the proportion of days step goals were met did not differ in intervention groups compared to control (relative risk, 2.91; 95% CI=0.62, 13.64).

CONCLUSIONS

Incentive schemes that use donations to a charity of choice, personal financial incentives, or a combination of the two can each increase older adults' initial uptake of increased levels of walking.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01643538.

Association of nutrition club membership with markers of health: a cross sectional study

Background

Nutrition clubs (NC) operate in community settings and provide members with nutrition education and meal replacements for weight management. NC are owned and operated by distributors of Herbalife products. There are over 6200 NC in the US, but there has been no independent assessment of the association of these NC with biomarkers of health.

Methods

We conducted a cross-sectional pilot study to compare the health status of 100 NC members to 100 community-matched controls (CC) in the greater Boston area. Each CC was matched to a NC member for community of residence (zip code), age category, gender, BMI category, race/ethnicity, education level (category), and readiness to make health changes. Measures obtained included cardio-metabolic risk factors, body composition, markers of nutritional status, reported health status, dietary intake, physical activity, sleep and depression.

Results

Participants were predominantly female (64%) and Hispanic (73%). NC members had significantly lower fasting insulin (P < 0.001) and lower HbA1c (P = 0.008), higher levels of 25 hydroxy-vitamin D (P = 0.001), and vitamin E:cholesterol ratio (P < 0.001), and lower prevalence of metabolic syndrome (P = 0.02) compared to CC. In addition, most of the NC members (99%) were satisfied with Herbalife NC membership for themselves and their families. A higher percentage of NC members (86%) compared to CC (32%) reported being in much better or somewhat better health compared to a year ago (P < 0.001); and they reported significantly better physical health (P = 0.03), and fewer sleep problems (P = 0.03).

Conclusion

Herbalife NC membership was positively associated with perceived health and measured cardiometabolic benefits. However, causality cannot be inferred from these findings.

Stage-based healthy lifestyles program for non-college young adults

Purpose

The purpose of this paper is to test the feasibility of implementing a healthy lifestyles intervention to maintain or achieve healthy weight for low-income young adults in vocational education.

Design/methodology/approach

Non-randomized, quasi-experimental feasibility test of a ten-week intervention with follow-up assessment designed using PRECEDE-PROCEED. A convenience sample included low-income young adults (n=165), 18-24 years recruited from two vocational training facilities. The intervention had weekly: online educational modules, targeting the non-dieting approach through healthful eating, and physical activity; and messages to promote fruit and vegetable intake, increased physical activity and stress management. Anthropometrics were measured, and an online survey on physical activity and eating behavior (e.g. self-regulation, self-instruction, emotional eating) was administered at baseline, post-, and follow-up.

Findings

At baseline, males were overweight and females were obese based on average BMI; no significant change in BMI, food intake, physical activity, or stress management were noted following the intervention. Eating behavior changed in treatment vs control group; food self-regulation was higher (p=0.025) for high use treatment group compared to the control group.

Practical implications

Lifestyle interventions are critical for low-income young adults who are overweight or obese by 18-24 years of age. Young adults who engage in such interventions can make food behavior changes that can have a mediating effect on healthy weight management. Models like PRECEDE-PROCEED are vital to success when working toward sustainable programs within communities.

Originality/value

Few healthy lifestyle programs have been reported for low-income, non-college young adults, specifically with a largely male population, and none with PRECEDE-PROCEED.

Staging Workers' Use of Hearing Protection Devices

The threat of noise-induced hearing loss is a serious concern for many workers. This study explores use of the transtheoretical model as a framework for defining stages of workers' acceptance of hearing protection devices. A secondary analysis was performed using a cross-section of data from a randomized, controlled clinical trial of an intervention to increase use of hearing protection. Use of hearing protection devices was well distributed across the theorized stages of change. Chi-square analysis and analysis of variance revealed significant differences between stages for the variables studied. Discrete stages of hearing protection device use can be identified, laying the foundation for further work investigating use of the transtheoretical model for promoting hearing protection device use. The model can provide a framework for tailoring interventions and evaluating their effects. With further development of the transtheoretical model, nurses may be able to easily identify workers' readiness to use hearing protection devices and tailor training toward that goal.

Counselling on Lifestyle Factors in Hypertension Care After Training on the Stages of Change Model

BACKGROUND

In assisting the nurse's counselling on lifestyle changes in hypertension care a behaviour model can be used.

AIM

To analyse the effects of nurses' training on the use of the stages of change model when counselling hypertensive patients to perform lifestyle changes.

METHODS

As part of a randomised, controlled trial, 19 nurses belonging to the intervention group took part in video-recorded consultation training with simulated patients. To evaluate the training, the nurses audio-recorded their consultations with two patients before and after the intervention. Analysis focused on the areas of non-pharmacological treatment and the nurses' attention to the patients' readiness for change.

RESULTS

Patient participation in the consultations increased after the training. The importance of non-pharmacological treatment was mentioned more frequently for all areas of lifestyle behaviour, exercise, smoking, alcohol consumption, food and stress, and the nurses acquired a more distinct structure for their consultations. The mean length of the recorded consultations increased from 18 min to 20.5 min. All the criteria for fulfillment of attention to patient's readiness to change were met in nine consultations before the training and in seven after it. After the training, attention was paid to support more frequently than before in the action and maintenance stages and a great deal of information was provided.

Predictors of Physical Activity Stage of Change among Adults with Physical Disabilities

Purpose.

To use the Transtheoretical Model (TTM) constructs to examine the most important physical activity stage of change predictors for mostly inactive adults with physical disabilities.

Methods.

A cross-sectional survey completed on the Internet. One hundred fifty-one individuals with physical disabilities (50% response rate) completed the survey questionnaires. Self-report standardized measures were used.

Results.

A direct discriminant function analysis revealed that the most important stage of change predictors were the behavioral (r2 = .88) and cognitive (r2 = .50) processes of change, followed by self-efficacy (r2 = .33) and decisional balance (r2 = .13). The most accurate stages in prediction were the contemplation (76.3%), preparation (58.3%), and precontemplation (40%) stages, whereas the least accurate stages were the action (0.0%) and maintenance (8.3%) stages.

Conclusion.

Health promoters and educators may use strategies from the TTM to develop theory-driven physical activity motivational programs for the posited populace. Considering the cross-sectional design, study replication is warranted.

The Relationship of Stage of Change for Smoking Cessation to Stage of Change for Fruit and Vegetable Consumption and Physical Activity in a Health Plan Population

Purpose.

The purpose of this study was to examine the relationship between stage of change for smoking cessation and stage of change for (1) fruit and vegetable consumption and (2) physical activity.

Design.

The data come from a cross-sectional telephone survey administered to a stratified random sample of health plan members (n = 9675).

Setting.

This study was conducted at a mixed-model health plan with approximately 1 million adult members.

Subjects.

Respondents were adults age 18 and older, who were randomly selected from five health plan product groups: commercial fully insured, commercial self-insured, two publicly subsidized plans, and Medicare supplemental insurance. Response rates ranged from 74.7% to 90.1% across these groups.

Measures.

The assessment included demographics and stage of change for smoking cessation, physical activity, and fruit and vegetable intake. Bivariate relationships among variables were analyzed with the use of contingency tables. Ordered logistic regression was used to examine the effects of stage of change for fruit and vegetable consumption and physical activity on stage of change for smoking while controlling for other factors.

Results.

Stage of change for smoking is more clearly related to stage of change for fruit and vegetable consumption (χ2 = 161.3, p < .001; Cramer's V = .11, p < .001) than to stage of change for physical activity (χ2 = 89.7, p < .001; Cramer's V = .08, p < .001). However, stage of change for fruit and vegetable consumption and physical activity are not strong predictors of stage of change for smoking.

Conclusions.

This study indicates that stage of change for both fruit and vegetable consumption and physical activity are independent constructs from stage of change for smoking cessation.

Stages of Change for Fruit and Vegetable Consumption in Deprived Neighborhoods

This article describes the association of external and psychosocial factors on the stages of change for fruit and vegetable consumption, among 2,781 inhabitants, aged 18 to 65 years, in deprived neighborhoods (response rate 60%). To identify correlates of forward stage transition, an ordinal logistic regression model, the Threshold of Change Model (TCM), was used to analyze the data. The results indicate that men, those from Dutch origin, those with (rather) low health locus of control, those displaying risk behaviors, and those without knowledge of dietary guidelines were less likely to move from one stage to another and therefore were more likely to be in a lower stage-of-change category. The results make it possible to distinguish target groups, which should receive more attention in future health promotion campaigns, and to identify factors to be addressed in those programs.

Intervening on Exercise and Nutrition in Older Adults

Presented are the basic design, methods, and baseline data analyses for the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR Project) an experimental study to investigate the relative effectiveness of a 12-month, stage of readiness to change-based multiple-behavior intervention (exercise and nutrition) compared to single-behavior interventions in a community-dwelling population of 1,277 older adults. Relationships between stage of readiness to change in the two target behaviors, as well as the relationship between stage of readiness and self-reported exercise levels and fruit and vegetable consumption, were examined using a combination of Pearson chi-squares, analyses of variance (ANOVA), and Spearman’s rank order correlations. Stage of change (SOC) for fruit and vegetable consumption was significantly associated with the dietary measure, and SOC for exercise was associated with both the three physical activity measures and servings of fruits and vegetables per day. Overall, individual older adult's readiness to change seems largely to be behavior-specific.

Validity of the Stages of Change in Steps instrument (SoC-Step) for achieving the physical activity goal of 10,000 steps per day

BACKGROUND

Physical activity (PA) offers numerous benefits to health and well-being, but most adults are not sufficiently physically active to afford such benefits. The 10,000 steps campaign has been a popular and effective approach to promote PA. The Transtheoretical Model posits that individuals have varying levels of readiness for health behavior change, known as Stages of Change (Precontemplation, Contemplation, Preparation, Action, and Maintenance). Few validated assessment instruments are available for determining Stages of Change in relation to the PA goal of 10,000 steps per day. The purpose of this study was to assess the criterion-related validity of the SoC-Step, a brief 10,000 steps per day Stages of Change instrument.

METHODS

Participants were 504 Australian adults (176 males, 328 females, mean age = 50.8 ± 13.0 years) from the baseline sample of the Walk 2.0 randomized controlled trial. Measures included 7-day accelerometry (Actigraph GT3X), height, weight, and self-reported intention, self-efficacy, and SoC-Step: Stages of Change relative to achieving 10,000 steps per day. Kruskal-Wallis H tests with pairwise comparisons were used to determine whether participants differed by stage, according to steps per day, general health, body mass index, intention, and self-efficacy to achieve 10,000 steps per day. Binary logistic regression was used to test the hypothesis that participants in Maintenance or Action stages would have greater likelihood of meeting the 10,000 steps goal, in comparison to participants in the other three stages.

RESULTS

Consistent with study hypotheses, participants in Precontemplation had significantly lower intention scores than those in Contemplation (p = 0.003) or Preparation (p < 0.001). Participants in Action or Maintenance stages were more likely to achieve ≥10,000 steps per day (OR = 3.11; 95 % CI = 1.66,5.83) compared to those in Precontemplation, Contemplation, or Preparation. Intention (p < 0.001) and self-efficacy (p < 0.001) to achieve 10,000 steps daily differed by stage, and participants in the Maintenance stage had higher general health status and lower body mass index than those in Precontemplation, Contemplation and Preparation stages (p < 0.05).

CONCLUSIONS

This brief SoC-Step instrument appears to have good criterion-related validity for determining Stages of Change related to the public health goal of 10,000 steps per day.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry reference: ACTRN12611000157976 World Health Organization Universal Trial Number: U111-1119-1755.

Study design, intervention, and baseline characteristics of a group randomized trial involving a faith-based healthy eating and physical activity intervention (Walk by Faith) to reduce weight and cancer risk among overweight and obese Appalachian adults

BACKGROUND

Increased prevalence of overweight and obesity among Appalachian residents may contribute to increased cancer rates in this region. This manuscript describes the design, components, and participant baseline characteristics of a faith-based study to decrease overweight and obesity among Appalachian residents.

METHODS

A group randomized study design was used to assign 13 churches to an intervention to reduce overweight and obesity (Walk by Faith) and 15 churches to a cancer screening intervention (Ribbons of Faith). Church members with a body mass index (BMI) ?25 were recruited from these churches in Appalachian counties in five states to participate in the study. A standard protocol was used to measure participant characteristics at baseline. The same protocol will be followed to obtain measurements after completion of the active intervention phase (12months) and the sustainability phase (24months). Primary outcome is change in BMI from baseline to 12months. Secondary outcomes include changes in blood pressure, waist-to-hip ratio, and fruit and vegetable consumption, as well as intervention sustainability.

RESULTS

Church members (n=664) from 28 churches enrolled in the study. At baseline 64.3% of the participants were obese (BMI?30), less than half (41.6%) reported regular exercise, and 85.5% reported consuming less than 5 servings of fruits and vegetables per day.

CONCLUSIONS

Church members recruited to participate in a faith-based study across the Appalachian region reported high rates of unhealthy behaviors. We have demonstrated the feasibility of developing and recruiting participants to a faith-based intervention aimed at improving diet and increasing exercise among underserved populations.

Changes of Motivational Variables in Patients with Multiple Sclerosis in an Exercise Intervention: Associations between Physical Performance and Motivational Determinants

Objectives. This study examines the effects of a standardized fitness training on motivational factors such as the intention to be physically active, self-efficacy, perceived barriers, counterstrategies, and exercise specific social support in patients with progressive Multiple Sclerosis (MS) and the relation of these factors to physical performance. Methods. Moderately disabled patients with secondary or primary progressive MS (Expanded Disability Status Scale of 4–6) were randomized to a training group or a waitlist control group. Patients completed on average 20 sessions of training tailored to their individual fitness at baseline over a course of 8–12 weeks. Motivational variables (stage of change according to the transtheoretical model (TTM), self-efficacy, perceived barriers, counterstrategies, and exercise specific social support) were assessed via questionnaires at baseline and follow-up. Results. Forty patients completed the trial. We found significant effects on stages of change (p = .016) and self-efficacy (p = .014) and a trend in counterstrategies (p = .08). Significant correlations between change of physical performance during the exercise training and change in the TTM, perceived barriers, and counterstrategies were detected. Conclusion. This study indicates that tailored individual endurance training could stabilize self-efficacy and increase exercise motivation in patients with progressive MS. Motivational variables were related to the physical performance.

Applying the transtheoretical model to promote functional fitness of community older adults participating in elastic band exercises

AIMS

The transtheoretical model was applied to promote behavioural change and test the effects of a group senior elastic band exercise programme on the functional fitness of community older adults in the contemplation and preparation stages of behavioural change.

BACKGROUND

Forming regular exercise habits is challenging for older adults. The transtheoretical model emphasizes using different strategies in various stages to facilitate behavioural changes.

DESIGN

Quasi-experimental design with pre-test and post-tests on two groups.

METHODS

Six senior activity centres were randomly assigned to either the experimental or control group. The data were collected during 2011. A total of 199 participants were recruited and 169 participants completed the study (experimental group n = 84, control group n = 85). The elastic band exercises were performed for 40 minutes, three times per week for 6 months. The functional fitness of the participants was evaluated at baseline and at the third and sixth month of the intervention. Statistical analyses included a two-way mixed design analysis of variance, one-way repeated measures analysis of variance and an analysis of covariance.

RESULTS

All of the functional fitness indicators had significant changes at post-tests from pre-test in the experimental group. The experimental group had better performances than the control group in all of the functional fitness indicators after three months and 6 months of the senior elastic band exercises.

CONCLUSION

The exercise programme provided older adults with appropriate strategies for maintaining functional fitness, which improved significantly after the participants exercising regularly for 6 months.

Validation of 5 stage-of-change measures for parental support of healthy eating and activity

OBJECTIVE

To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d of fruits and vegetables (FV), (2) limiting television (TV) to 2 h/d, (3) helping children achieve 1 h/d physical activity (PA), (4) limiting sugary drinks (SD) to 1 serving/wk, and (5) limiting fruit juice (FJ) to 4-6 oz/d.

DESIGN

Cross-sectional instrument development study. Construct validity was evaluated by examining whether parental self-efficacy, parental readiness ladder (ladder), and child's behavioral levels (eg, FV consumption) exhibited a theoretically consistent pattern across the SOC.

SETTING/PARTICIPANTS

Convenience sample (n = 283) of parents of children aged 4-10 years.

MEASURES

Survey assessed SOC, ladder, and child's behavioral level score for each topic (FV, TV, PA, SD, and FJ), and parental self-efficacy for measure except TV.

ANALYSIS

Analysis of variance with Tukey-Kramer post hoc tests examined whether variables differed by SOC.

RESULTS

Percentages of parents in the pre-action SOC were 34% (PA), 39% (FV), 42% (SD), 45% (TV), and 63% (FJ). Parental self-efficacy, ladder, and child's behavioral level differed significantly by SOC for each topic area (P < .001). Maintenance SOC was significantly higher than pre-action SOC.

CONCLUSIONS AND IMPLICATIONS

Measured variables exhibited a theoretically consistent pattern across SOC, suggesting construct validity and potential usefulness for obesity prevention efforts.

Validation of the TTM processes of change measure for physical activity in an adult French sample

BACKGROUND

Processes of change (POC) are constructs from the transtheoretical model that propose to examine how people engage in a behavior. However, there is no consensus about a leading model explaining POC and there is no validated French POC scale in physical activity

PURPOSE

This study aimed to compare the different existing models to validate a French POC scale.

METHOD

Three studies, with 748 subjects included, were carried out to translate the items and evaluate their clarity (study 1, n = 77), to assess the factorial validity (n = 200) and invariance/equivalence (study 2, n = 471), and to analyze the concurrent validity by stage × process analyses (study 3, n = 671).

RESULTS

Two models displayed adequate fit to the data; however, based on the Akaike information criterion, the fully correlated five-factor model appeared as the most appropriate to measure POC in physical activity. The invariance/equivalence was also confirmed across genders and student status. Four of the five existing factors discriminated pre-action and post-action stages.

CONCLUSION

These data support the validation of the POC questionnaire in physical activity among a French sample. More research is needed to explore the longitudinal properties of this scale.

The efficacy of a self-managed Acceptance and Commitment Therapy intervention DVD for physical activity initiation

OBJECTIVES

Initiating and maintaining physical activity presents the individual with challenges of inconvenience, discomfort, and counteractive energy. Addressing these challenges requires an intervention that elicits motivation to engage in this activity, minimizes the direct relationship between unwanted internal experiences and inaction, and is also in itself accessible and convenient. Accordingly, this study investigated the efficacy of a self-managed Acceptance and Commitment Therapy (ACT) intervention delivered via DVD and tailored for physical activity initiation.

DESIGN AND METHODS

Fifty-nine minimally active community participants were randomly allocated to receive a 12-week pedometer-based walking programme, or the same walking programme with the additional provision of the ACT DVD. The primary outcome was overall physical activity level (assessed at baseline and post-intervention), and the secondary outcome was pedometer-assessed step count (measured at 4-weekly intervals throughout the intervention period).

RESULTS

Participants who received the ACT DVD achieved a significantly greater increase in physical activity levels post-intervention, were more likely to achieve the goals specified in the programme, and reported a higher average step count than participants who received the walking programme in isolation.

CONCLUSIONS

The ACT intervention, delivered via DVD for the promotion of physical activity, proved a simple, efficient, and accessible method to encourage positive short-term increases in an important health-promoting behaviour. Statement of contribution What is already known? ACT interventions can increase physical activity levels through augmenting initiatory self-regulatory control. Face-to-face delivery presents challenges of accessibility and feasibility for community implementation. There is a need for effective interventions that maximize impact while minimizing inconvenience. What does this study add? Supplementing a walking programme with a self-managed ACT DVD produced significant increases in physical activity. The ACT DVD is a convenient, accessible, and potentially cost-effective approach to physical activity initiation. ACT lends itself to implementation as a self-managed electronically delivered intervention.

Prevention of HPV-related oral cancer: assessing dentists' readiness

OBJECTIVES

Epidemiological research indicates an association between the Human Papillomavirus (HPV) with a subset of oral cancers (OC). Dentists may play a role in primary prevention of HPV-related OC by discussing the HPV vaccine with patients. This study assessed dentists' readiness to discuss the HPV vaccine with female patients.

STUDY DESIGN

Cross-sectional web-based survey.

METHODS

A web-based survey based on the Transtheoretical Model was administered among Florida dentists (n = 210).

RESULTS

The majority of participants (97%) fell into the precontemplation and contemplation stages of readiness to discuss the HPV vaccine with patients. Perceived role and liability were determined to be predictive of dentists in contemplation stage as opposed to those in precontemplation (P < 0.05).

CONCLUSIONS

Findings suggest liability and perceived role as processes of change necessary to guide dentists to primary prevention of HPV-related OC despite high levels of knowledge. As public awareness of HPV-related OC increases, dentists may become more involved in primary prevention. Results of the current study may assist in developing intervention strategies for engaging dentists in discussing the HPV vaccine with patients.

Predictors of long-term change of a physical activity promotion programme in primary care

BACKGROUND

Further research is needed to improve the evidence regarding determinants of physical activity (PA) as a crucial step to plan higher effective intervention strategies. The goal of the present study is to identify socio-demographic and clinical characteristics of primary care (PHC) insufficiently active patients that are associated with longitudinal changes in the level of physical activity.

METHODS

Longitudinal analysis of baseline socio-demographic and clinical predictors of physical activity change in insufficiently active PHC patients who participated in a PA-promoting multi-centre randomized clinical trial conducted from October 2003 through March 2006. The primary outcome measure was the self-reported physical activity assessed with the 7-day Physical Activity Recall (PAR), at baseline, 6, 12 and 24 months. Baseline covariates included sex, age, social class, anthropometric measures and other cardiovascular risk factors or associated diseases (Diabetes, HTA, tobacco use, etc.), and stage of readiness to change PA. Generalized linear mixed models were used to estimate longitudinal association of studied variables on PA change over the three follow-up measurements.

RESULTS

A total of 3691 patients (85% of the 4317 recruited in the trial) with at least one follow-up measurement were included in the longitudinal analysis. At baseline, analysed patients (mean age: 50.6 years; 64.6% women) devoted 34.7 minutes and 2.36 metabolic equivalent hours per week (MET.h/week) to moderate and vigorous physical activity. Older age, male gender, higher social class, lower BMI, diagnosis of diabetes or hypertension, and measurement season were significant predictors of PA longitudinal change. The effect of baseline readiness to change on PA dose was modified by time, showing a positive gradient in favour of those with more readiness to change that increases significantly at 12 and 24 months (p-value interaction < .0001).

CONCLUSIONS

Identified baseline characteristics such as readiness to change and risk factors can guide physicians to prioritize time and intervention efforts for maximizing their impact on insufficiently active PHC patients.

Relationships between transtheoretical model stages of change, decisional balance, self-efficacy, and physical activity level among Nigerian market vendors

PURPOSE

This study explored decisional balance, self-efficacy, and physical activity (PA) level in relation to stages of change (SoC) for PA among Nigerian vendors. The study explored associations among decisional balance, self-efficacy, and PA level, and examined differences, by stage, in decisional balance, self-efficacy, and PA level.

DESIGN

Cross-sectional survey.

SETTING

Outdoor markets located in Eke Amobi, Nkwo, and Okpuno Egbu in Nnewi, southeastern Nigeria.

SUBJECTS

Participants were 499 market vendors (98 males and 401 females).

MEASURES

Self-efficacy, perceived barrier and benefit, PA level, and SoC for PA.

ANALYSIS

Spearman rank-order and partial correlations; analysis of variance by gender with Bonferroni post hoc adjustment.

RESULTS

Self-efficacy (r = 0.69; p = 0.000), perceived benefit (r = .12; p = .007), and perceived barrier (r = -.11; p = .017) for PA were related to the SoC. Adjusting for age, gender, and marital status, only self-efficacy (r = .48; p = .000) remained correlated with the SoC. In males, significant differences in perceived barrier (p = .003) and benefit (p = .003) lay between stages of contemplation and preparation and between stages of precontemplation and contemplation for self-efficacy (p = .006). In females, there were significance differences in self-efficacy across stages of precontemplation and contemplation (p = .000) and preparation and action (p = .007).

CONCLUSION

When designing PA interventions, age, gender, and marital status should be considered in explaining the relationships between outcome constructs of transtheoretical model (TTM) and SoC in vendors. It is also important to note that the stages at which outcome constructs of TTM change during PA interventions vary in males and females.

Surviving Childhood Cancer: Relationship between Exercise and Coping on Quality of Life

This research assesses Health-Related Quality of Life (HRQoL) in a Spanish sample of adolescent cancer survivors, and analyzes the relationship between HRQoL, coping styles and physical exercise. Forty-two survivors (12–19 years), who were ≥ 1 year of remission, completed standardized measures of HRQoL (CHIP-AE), coping strategies (ACS) and physical exercise (AECEF). Mean scores in all HRQoL domains were within normative values. Multiple regression analysis revealed that physical exercise and productive coping were related to higher HRQoL, whereas non-productive coping was related to lower HRQoL. This sample of survivors reported good levels of HRQoL, which are mediated by coping styles and physical exercise.