Theory of planned behavior to promote physical activity of adults with physical disabilities: Meta-analytic structural equation modeling

BackgroundAdults with physical disabilities experience lower physical activity (PA) engagement. The theory of planned behavior (TPB) has been one of dominant theories in understanding and promoting PA. There is no previous meta-analysis examining the use of the TPB on PA of adults with physical disabilities.ObjectiveThe purposes of this review were 1) to conduct meta-analysis to examine predictive effects of TPB on PA behavior of adults with physical disabilities and 2) to investigate a possible moderator among components of TPB.MethodsOne-stage meta-analytic structural equation modeling was used to conduct meta-analysis. Type of physical disability was examined as a moderator.ResultsIntention had moderate effect on PA (β = 0.37, p < .001), attitude had a moderate effect on intention (β = 0.30, p < .001), SN had a non-significant effect on intention (β = 0.03, p = .75), and PBC had a moderate effect on intention (β = 0.43, p < .001) and a non-significant direct effect on PA (β = 0.09, p = .18). The studies conducted with only participants with SCI lowered the predictive effect (β = ?0.12, p = .02) of PBC on PA.ConclusionsPredictive effects of component of TPB were slightly different from those of individuals without disabilities. Type of physical disability can be a critical factor determining the impact of perceived control on PA behavior. Attitude and PBC can be targets for promoting PA of adults with physical disabilities.     

Psychosocial predictors of eating habits among adults in their mid-30s: The Oslo Youth Study follow-up 1991–1999

Background  

The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.     

Psychosocial predictors of physical activity and health-related quality of life among adults with physical disabilities: an integrative framework

BackgroundPeople with disabilities report lower physical activity (PA) and health-related quality of life (HRQOL) levels than people without disabilities. Therefore, it is important to identify factors that motivate individuals with disabilities to be physically active and thus increase their HRQOL.ObjectivesThe purpose of the study was to prospectively explore the effects of past theory of planned behavior (TPB) constructs on future (6-month) HRQOL (physical and mental health) through past stages of change (SOC) and future (6-month) PA among adults with physical disabilities. Two models were tested whereby the SOC and PA served as the mediators between the TPB constructs, physical health (PH-Model), and mental health (MH-Model). It was hypothesized that both models would fit the sample data.MethodsParticipants were 141 adults with physical disabilities (mean age = 46.04, females = 70.9%). The online survey was completed at two different time periods. First, the TPB constructs and SOC were assessed using self-report standardized questionnaires. Six months later, participants completed standardized self-report scales about their PA and HRQOL levels. Using LISREL 8, two path analyses were conducted to examine the two study models (PH-Model and MH-Model).ResultsBased on the two path analyses, attitude had the highest effect on SOC followed by perceived behavioral control within both well-fit models. The PH-Model explained more variance in PA (26%) and physical health (55%) than the MH-Model.ConclusionsHealth promoters should reinforce both positive intentions and behavioral experiences to increase PA and HRQOL among adults with physical disabilities.     

Levels and patterns of physical activity and sedentary behavior in adults with and without visual impairment

BackgroundLimited data are available on objectively measured physical activity (PA) and sedentary behavior (SB) among adults with and without visual impairment (VI).ObjectiveTo compare PA and SB levels and patterns in adults with and without VI and to examine how these differ based on sex and day of the week.MethodsThirty-two participants with VI and 32 participants without VI participated in this cross-sectional study. PA and SB were assessed using GT3X ActiGraph accelerometers during waking hours for 7 days, and variables were examined in terms of disability group, sex, and day of the week. Nonparametric Mann–Whitney U test and Wilcoxon signed-rank test were used, and significance was set at p < 0.05.ResultsPA did not differ in terms of sex or day of the week in participants with VI. The PA of participants without VI was significantly higher for men than it was for women and was significantly higher during weekdays than on weekend days. Total sedentary time and the duration of SB breaks were significantly longer for female participants with VI than for those without VI. The number of sedentary bouts lasting ≥10 min during weekend days was significantly higher for participants with VI than for those without VI.ConclusionsMost adults with and without VI did not meet the recommended levels of daily PA and spend a large portion of the day being sedentary. Interventions to enhance PA and reduce sedentary time in adults with and without VI are required.     

Physical Activity is Associated With Fewer Subjective Cognitive Complaints in 47 Low- and Middle-Income Countries

ObjectivesTo determine the association between physical activity (PA) and subjective cognitive complaints (SCCs), and the influential factors in this association.DesignCross-sectional study.Setting and ParticipantsCommunity-based data of the World Health Survey, which included 248,504 individuals from 47 low- and middle-income countries (LMICs), were analyzed [mean age = 38.6 (standard deviation 16.1) years; 50.7% female].MethodsPA was assessed with the International Physical Activity Questionnaire. Participants were grouped into those who meet (high PA) the 150 minutes of moderate-to-vigorous intensity PA per week recommendation, and those who do not (low PA). Two questions on subjective memory and learning complaints in the past 30 days were used (scales ranged from 1 to 5, with higher scores representing more severe SCC). Multivariable ordinal logistic regression and mediation analyses were performed.ResultsOverall, after adjusting for sociodemographic and a wide range of behavioral, psychological, and physical factors, low PA was associated with a higher risk for having more severe subjective memory complaints [odds ratio (OR) = 1.10, 95% confidence interval (CI) = 1.04-1.23] and learning complaints (OR = 1.18, 95% CI = 1.12-1.26). Significant associations were only observed among the middle-aged (45-64 years; learning complaints OR = 1.19, 95% CI = 1.06-1.33) and older populations (≥65 years; memory complaints OR = 1.31, 95% CI = 1.15-1.49, and learning complaints OR = 1.41, 95% CI = 1.24-1.60). Chronic physical conditions, sleep problems, depression, and anxiety explained between 7.7% and 29.4% of the PA-SCC association among those aged ≥45 years.Conclusions and ImplicationsLow PA was associated with increased odds for more severe SCCs in middle-aged and older adults in LMICs. Given the particularly rapid increase in dementia in LMICs, more longitudinal research is warranted from this setting to understand the utility of PA promotion in the prevention of cognitive impairment.     

US adults with visual impairments meeting 24-h movement guidelines: Updated national prevalence estimates

BackgroundDespite known benefits of engaging in recommended amounts of physical activity (PA), sleep, and sedentary behavior (SB), little is known about how adults with visual impairments (VIs) meet these guidelines in isolation or simultaneously.ObjectiveThis study estimated (a) the prevalence of US adults with VIs who are partially or fully meeting the 24-h movement guidelines, and (b) the differential contribution of work-related, leisure, and transportation to total time accrued for PA.MethodsA cross-sectional sample of adults with VIs (n = 466) was drawn from the National Health and Nutritional Examination Survey (NHANES) 2015–2018 combined datasets. Guideline adherence was measured using self-report items for average time spent physically active, sitting and sleeping. Weighted prevalence estimates were produced for meeting guidelines separately and in combination. The average percent of PA minutes accrued across work-related, leisure and transportation were compared among those meeting PA guidelines.ResultsAn estimated 29.6% (SE = 3.6) of US adults with VIs met all three guidelines. An estimated 59.3% (SE = 3.5) adults with VIs met PA guidelines alone or in combination with SB and sleep. Within this group, the majority of weekly PA minutes (average 63.9%) was accrued at work.ConclusionsAn estimated two thirds of adults with VIs are not engaged in healthful 24-h movement behaviors. Targeted interventions for adults with VIs are warranted that may require a comprehensive approach to PA, SB, and sleep. Work emerged as an important location for adults with VIs to accrue PA, inviting future research to explore associations between employment and 24-h movements within this population.     

Understanding physical activity behavior of Chinese female college students with/without vulnerable conditions: a theory of planned behavior perspective

Guided by the theory of planned behavior (TPB), this study examined the relationships between three constructs of TPB (attitude, subjective norm, perceived behavioral control [PBC]) and physical activity intention and behavior among Chinese female college students, and evaluated whether the relationships differed between healthy and vulnerable individuals within this population. Participants included 436 female college students (301 healthy and 135 vulnerable; Mean age = 19.24 years; SD = 0.97 years) recruited from five universities in China, and the data collection was completed in Fall 2015. Path analysis supported the direct and indirect relations of TPB constructs to physical activity intention and behavior among female college students, and the path model was invariant across the two groups. The vulnerable group reported significantly lower attitude, subjective norm, intention, and physical activity behavior than the healthy group but not for PBC. These findings suggest fostering positive attitudes and intention toward physical activity are important among Chinese female college students, regardless of their health status.     

Predicting physical activity in university students with disabilities: The role of social ecological barriers in the theory of planned behaviour

BackgroundEven though university students with disabilities are less active than their peers without disabilities, there is scarce knowledge on the predictors of physical activity (PA) in this population.ObjectivesTo predict PA in Spanish university students with disabilities using the Theory of Planned Behaviour (TPB) and to examine the role of social ecological barriers within this theoretical framework.MethodsParticipants (N = 1079; Mean age = 40.12) for this cross-sectional study were recruited through the disability care services of 55 Spanish universities. The TPB constructs were assessed using a questionnaire. The Spanish short form of the International Physical Activity Questionnaire was used to measure PA and the reduced Spanish version of the Barriers to Physical Activity for People with Mobility Impairments was used to measure social ecological barriers.ResultsTwo different models were computed through path analysis. Model 1 included the traditional TPB constructs and model 2 added a social ecological barriers variable. In both models, attitudes (β = 0.152; β = 0.152), subjective norms (β = 0.114; β = 0.115) and self-efficacy (β = 0.657; β = 0.659) each predicted PA intentions. PA intentions (β = 0.118; β = 0.122), self-efficacy (β = 0.225; β = 0.207) and controllability (β = 0.098; β = 0.075) predicted PA. In model 2, social ecological barriers predicted PA (β = 0.099). Regression analyses revealed intrapersonal barriers as a significant predictor of self-efficacy (β = ?0.441). Controllability was predicted by intrapersonal barriers (β = ?0.265), community barriers (β = ?0.100) and organizational barriers (β = ?0.095).ConclusionsFuture PA behaviour change interventions should target intentions, self-efficacy and controllability, since they directly predicted PA. These interventions would benefit from considering social ecological barriers to PA.     

Physical activity and symptoms of anxiety and depression in adults with and without visual impairments: The HUNT Study

PurposeTo examine the association of leisure-time physical activity (PA) and symptoms of anxiety and depression among adults with and without self-reported visual impairment.MethodsA population-based cohort study including 34,393 participants 20–67 years of age from the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995–1997) who also participated in the follow-up (HUNT3, 2006–2008). Of the participants, 3719 (10.8%) had self-reported visual impairment (SRVI). Unadjusted and fully adjusted generalized linear models were used to calculate relative risks (RR) and corresponding 95% confidence intervals (CIs) of PA with anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS) separately for visual impairment and gender.ResultsAt follow-up, a two-folded higher prevalence of HADS-defined anxiety and depression (a score ≥ 8) was found among adults with SRVI than among adults with self-reported no visual impairment (SRNI). In adults with SRVI and SRNI, fewer depression symptoms at follow-up were significantly associated with high baseline PA scores compared with low PA scores, after adjusting for possible confounders (p < 0.05). In adults with SRNI, high baseline PA was related to fewer anxiety symptoms at follow-up compared with their less physically active counterparts, but the associations turned non-significant after adjusting for possible confounders (p > 0.05). PA was not significantly related to anxiety symptoms among adults with SRVI (p > 0.05).ConclusionsRegular PA was associated with fewer depression symptoms in adults with SRVI and SRNI, with less clear associations found for anxiety symptoms.     

Physical activity counseling promotes physical and psychological resilience in older veterans with posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD.MethodsOlder (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months.ResultsPrimary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 min/week to 161 min/week among participants in the intervention arm (p = 0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p < 0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p < 0.05).ConclusionsGiven the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.     

Testing the feasibility and acceptability of an Acceptance and Commitment Therapy intervention to increase physical activity among individuals with depression: A protocol paper

BackgroundEngaging in regular physical activity (PA) is particularly important among individuals with depression, who are at heightened risk for a host of negative health outcomes. However, people with depression are 50% less likely to meet national guidelines for PA and face unique barriers to PA adherence, including lower distress tolerance and motivation for exercise. Acceptance and Commitment Therapy (ACT) may offer promise for increasing PA among adults with depressive symptoms due to its effects on distress tolerance and motivation. Therefore, we developed ACTivity, an ACT-based intervention designed to promote PA among low-active adults with elevated depressive symptoms. Prior to testing the efficacy of ACTivity in an RCT, an important first step is to conduct a preliminary trial to establish feasibility of study procedures for the ACTivity and comparison intervention programs, as well as to establish the credibility/acceptability of the intervention. The purpose of this paper is to describe the ACTivity intervention and the design of this feasibility trial.Method/designWe will conduct a feasibility RCT with two parallel groups and a 1:1 allocation ratio comparing ACTivity to a comparison intervention (relaxation training + PA promotion) among 60 low-active adults with elevated depressive symptoms. All study procedures will be conducted remotely.DiscussionResults of this feasibility study will inform a subsequent RCT designed to test the efficacy of ACTivity. If shown to be efficacious, ACTivity will provide a treatment that can be widely disseminated to increase PA among adults with depressive symptoms and thereby decrease their risk for chronic disease.     

The impact of stroke on psychological and physical function outcomes in people with long-term physical disability

BackgroundAn increased number of people who have a long-term physical disability (LTPD) are aging. Similar to older adults without previous disability, individuals with LTPD may experience age-related comorbidities secondary to aging. A leading cause of disability in the United States among older adults is stroke. Limited evidence supports that individuals with LTPD are at higher risk of a stroke compared to those without disability. Stroke may negatively impact physical, cognitive, and/or psychosocial function. For those who have lived longer with LTPD, the impact of stroke may differ.ObjectiveTo determine the impact of stroke on health outcomes in people with LTPD.MethodsThirty-three individuals with both LTPD and self-reported stroke were identified in a national purposive sample of adults reporting physical disability associated with LTPD (Group A). Group A was compared to an age matched sample of 33 individuals with the same conditions but no stroke (Group B). Group A participants were also compared to national norms based on age cohort from a national sample of 182 stroke survivors (Group C).ResultsAge range of all participants = 65–74 years. Combine sample among three groups = 248. Group A did not differ from Group B. However, Group A reported significantly higher pain interference (p < .001), fatigue (p = .003), and decreased physical function (p < .001) than Group C.ConclusionsThe study informs how the impact of acquiring another condition after living with a LTPD differs among a general stroke population and those who are living with LTPD.     

Understanding physical activity intentions among French Canadians with type 2 diabetes: an extension of Ajzen's theory of planned behaviour

Background  

Regular physical activity is considered a cornerstone for managing type 2 diabetes. However, in Canada, most individuals with type 2 diabetes do not meet national physical activity recommendations. When designing a theory-based intervention, one should first determine the key determinants of physical activity for this population. Unfortunately, there is a lack of information on this aspect among adults with type 2 diabetes. The purpose of this cross-sectional study is to fill this gap using an extended version of Ajzen's Theory of Planned Behavior (TPB) as reference.     

Prevalence of physical activity in European adults — Compliance with the World Health Organization's physical activity guidelines

BackgroundAdults are recommended to engage in at least 150 min/week of moderate-to-vigorous physical activity (PA).PurposeThis study aimed to examine the level of compliance with PA recommendations among European adults.MethodsUsing data from European Social Survey round 6, PA self-report data was collected from 52,936 European adults from 29 countries in 2012. Meeting PA guidelines was assessed using World Health Organization criteria.Results61.47% (60.77% male, 62.05% female) of European adults reported to be engaged in moderate to vigorous PA at least 30 min on 5 or more days per week. The likelihood of achieving the PA recommended levels was higher among respondents older than 18–24. For those aged 45–64 years the likelihood increased 65% (OR = 1.65, 95% CI: 1.51–1.82, p < 0.001) and 112% (OR = 2.12, 95% CI: 1.94–2.32, p < 0.001) for males and females, respectively. Those who were high school graduates were more likely to report achieving the recommended PA levels than those with less than high school education (males: OR = 1.19, 95% CI: 1.12–1.27, p < 0.001; females: OR = 1.13, 95% CI: 1.06–1.20, p < 0.001).ConclusionAlthough about 60% of European adults reported achieving the recommended levels of PA, there is much room for improvement among European adults, particularly among relatively inactive subgroups.     

Calibration and validation of the Physical Activity Barrier Scale for persons who are blind or visually impaired

BackgroundIt is critical to employ accurate measures when assessing physical activity (PA) barriers in any subpopulation, yet existing measures are not appropriate for persons with blindness or visual impairment (PBVI) due to a lack of validity or reliability evidence.ObjectiveTo develop and calibrate a PA barrier scale for PBVI.MethodsAn expert panel (n = 3) and 18 PBVI were recruited to establish content validity for a PA barriers subscale; 160 PBVI (96 females) completed the scale along with the Physical Activity Scale for Individuals with Physical Disabilities for calibration. To establish construct-related validity evidence, Confirmative factor analysis (CFA) and Rasch analysis were applied. To investigate internal consistency and reliability, Cronbach's alpha and the reliability coefficient (R) were employed, respectively.ResultsFollowing CFA and Rasch analyses, five items were eliminated due to misfits; reliability coefficients were unchanged upon deletion of these items. The barriers perceived by PBVI to have the most negative impact on PA included “lack of self-discipline” (logit = 1.40) and “lack of motivation” (logit = 1.27). “Too many stairs in the exercise facility” (logit = −1.49) was perceived to have the least impact.ConclusionsThe newly-developed scale was found to be a valid and reliable tool for evaluating PA barriers in PBVI. To enhance promotion of health-producing levels of PA in PBVI, practitioners should consider applying this new tool as a precursor to programs aimed at improving PA participation in this group.     

Obesity misclassification and the metabolic syndrome in adults with functional mobility impairments: Nutrition Examination Survey 2003–2006

ObjectivesThe purpose of this study was to estimate the degree of obesity misclassification between body mass index (BMI) and body fat percentage in adults with functional mobility impairment, and to determine cardiometabolic risk profiles.MethodsData from the combined 2003–2006 National Health and Nutrition Examination Survey (NHANES) were incorporated. The representative sample included 852 individuals, aged 20–85 years, reporting at least one major physical limitation related to mobility or lower body function, and 4724 individuals reporting no impairments. Body mass index, percent body fat (%BF) as determined by dual energy X-ray absorptiometry (DXA), objectively measured sedentary behavior and activity, and markers of cardiometabolic risk were compared between adults with and without functional mobility impairments. Among functional mobility impaired individuals, sensitivity, specificity, and receiver operating characteristic curves were used to evaluate the performance of BMI as a continuous variable, as well as various BMI thresholds to detect obesity defined by sex-specific %BF cutoffs.ResultsAdults with functional mobility impairments were older, had larger waist circumferences (WC), had greater prevalence of obesity according to BMI and %BF, were more sedentary, had less physical activity, and had higher overall cardiometabolic risk. The standard BMI cutoff for obesity had excellent specificity in both men (100%) and women (98.4%) with functional mobility impairment, but sensitivity was poor (< 55%). Whereas approximately 36% and 43% of impaired men and women fell into the obese BMI category, over 80% of men and women were obese according to %BF. Individuals with high %BF who were misclassified as not obese, according to BMI, had a significantly higher prevalence of the metabolic syndrome (17.6%) compared to subjects with normal BMI and low %BF (2.1%).ConclusionsObesity misclassification and cardiometabolic risk are prevalent among individuals with functional mobility impairments, and thus diagnostic screening for obesity should be modified to account for %BF and/or waist circumference. Behavioral interventions to decrease sedentary behavior, increase activity, and reduce abdominal obesity are warranted.     

24-h movement behaviors among autistic adults: Differences by sex,age, and level of independence

BackgroundAutistic adults have low levels of physical activity [PA], high levels of sedentary behavior [SB], and insufficient sleep. Not known is the extent to which engagement in these movement behaviors vary by sex, age, and level of independence in activities of daily living (ADLs).ObjectiveTo characterize movement behaviors in a national sample of autistic adults by sex, age, and level of independence in ADLs.MethodsA national sample of autistic adults and caregivers of autistic adults self-reported PA, SB and sleep behaviors as well as demographic variables using an electronic survey. Levels of engagement in movement behaviors were described, and compared by sex, age (young-adult versus middle-age), and level of independence in ADLs.ResultsData were collected on 361 autistic adults (60.3% male, n = 217, m^age = 30.82 years, SD = 10.24). Overall, 44% did not meet the PA guideline; PA guideline adherence was lowest among males and those who were dependent on others in ADLs. Overall, the SB guideline was not met by 43% of the sample at weekdays and 48% at weekends. SB guideline adherence was lowest among adults who were middle-aged, and those who were fully independent in ADLs. Overall, 35.2% did not meet the total sleep time (TST) guideline. Middle-aged autistic adults had the lowest adherence to the TST guideline.ConclusionsThese finding should prompt researchers to consider these demographic differences, and tailor research and programmatic efforts to account for the unique movement behavior profiles of different segments of this heterogenous population.     

Predicting Participation in Group Parenting Education in an Australian Sample: The Role of Attitudes, Norms, and Control Factors

We examined the theory of planned behavior (TPB) in predicting intentions to participate in group parenting education. One hundred and seventy-six parents (138 mothers and 38 fathers) with a child under 12 years completed TPB items assessing attitude, subjective norms, perceived behavioral control (PBC), and two additional social influence variables (self-identity and group norm). Regression analyses supported the TPB predictors of participation intentions with self-identity and group norm also significantly predicting intentions. Editors’ Strategic Implications: These findings provide preliminary support for the TPB, in conjunction with additional sources of social influence, as a predictive model for participation in parent education and other prevention programs.