Using Constructs of the Transtheoretical Model to Predict Classes of Change in Regular Physical Activity: A Multi-Ethnic Longitudinal Cohort Study

Explaining variation in meeting recommended levels of physical activity across time is important for the design of effective public health interventions. To model longitudinal change in constructs of the Transtheoretical Model and test their hypothesized relations with change in meeting the Healthy People 2010 guidelines for regular participation in moderate or vigorous physical activity, a cohort (N = 497) from a random, multi-ethnic sample of 700 adults living in Hawaii was assessed at 6-month intervals three or more times for 2 years. Latent class growth modeling was used to classify people according to their initial levels and trajectories of change in the transtheoretical variables and separately according to whether they met the physical activity guideline each time. Relations of the variables and their change with classes of meeting the guideline were then tested using multinomial logistic regression. Despite declines or no change in mean scores for all transtheoretical variables except self-efficacy, participants who maintained or attained the physical activity guideline were more likely to retain higher scores across the 2 years of observation. The usefulness of transtheoretical constructs for predicting maintenance of, or increases in, public health levels of physical activity was generally supported. These longitudinal results support earlier cross-sectional findings which indicate that, contrary to theory, people appear to use both experiential and behavioral processes while they attempt to increase or maintain their physical activity.     

Physical Activity and Stages of Change: A Longitudinal Test in Types 1 and 2 Diabetes Samples

The transtheoretical model's (TTM's) ability to predict physical activity stage transitions that incorporates all social-cognitive constructs from the original model has not been conducted among adults with diabetes. The purpose of this study was to test the capacity of the TTM for predicting physical activity stage transitions among adults (≥18 years of age) with type 1 (N = 517) or type 2 (N = 1,157) diabetes over 6 months. Participants were identified by a random-digit dialing telephone protocol through the Alberta Diabetes Registry. Assessments of TTM's stage of physical activity behavior change, self-efficacy, pros and cons, cognitive Processes of Change, and behavioral Processes of Change at baseline (time 1) and 6 months (time 2) were assessed by questionnaire. Over this time period, participants were categorized as having regressed (moved back at least one stage), remained (no stage change), or progressed (moved forward at least one stage). Baseline TTM constructs were analyzed for their ability to predict transition over 6 months. Moderate support for the TTM constructs in predicting physical activity stage transitions was found. Self-efficacy, pros, and behavioral Processes of Change hold relatively strong predictive power for stage progression over 6 months, with very few differences found between the types 1 and 2 diabetes groups. The capacity of the model in predicting stage transition is partially supported. When promoting physical activity among adults with diabetes, targeting self-efficacy, pros, and cognitive Processes of Change may favorably support stage transition in the pre-action stages, while strategies to enhance the behavioral Processes of Change may be appropriate for the Action and Maintenance stages.     

Are Constructs of the Transtheoretical Model for Physical Activity Measured Equivalently Between Sexes,Age Groups,and Ethnicities?

Background/Purpose  Identifying mediators of physical activity change requires measurement instruments that are reliable, valid, and generalizable to multiple populations. Despite continued application of the transtheoretical model (TTM) to the study of physical activity, the structural components of the TTM measurement instruments have been understudied in diverse populations. Methods  A multiethnic sample (N = 700, M _age = 47, 63% women, 38% Caucasian) of participants living in Hawaii completed TTM measures. The factor validity and measurement equivalence/invariance (ME/I) of decisional balance, barrier self-efficacy, temptations, and processes of change instruments were explored between men, women, age groups, and ethnicities. Results/Conclusions  Measurement models of barrier self-efficacy and revised models of temptations and processes of change demonstrated sufficient evidence for ME/I among all subgroups. A revised model of decisional balance demonstrated sufficient evidence for ME/I between genders and among ethnicities, but not among age groups. Future research should examine the stability of these constructs across time.     

Surgical Complications in Older Adults Predict Decline in Self-Perceived Cognitive Function in the Ensuing Year: A Cohort Study

BackgroundSurgical complications are common among older adults and are potential indicators of poorer long-term outcomes. The authors examined the effects of in-hospital complications on changes in older adults’ self-perceived cognitive function in the year after surgery.MethodThe authors conducted a prospective longitudinal study with 2,155 older adults (age ≥ 65) undergoing surgery, investigating the association between self-reported, in-hospital complications after surgery and Patient-Reported Outcomes Measurement Information System Applied Cognition-Abilities survey (4 items, cognitive function) at 30 days and 1 year after surgery. Surveys were scored on a continuous scale of 0–100, with higher scores representing better self-perceived cognitive functioning. Patient characteristics including demographics, type of complications, surgery type, pain, and activities of daily living were also collected.ResultsHaving one in-hospital complication was associated with a decrease of 1.79 points (95% confidence interval (CI): ?2.78, ?0.80), indicating lower self-perceived cognitive functioning at 1 year after surgery; having two or more in-hospital complications was associated with 2.82 point (95% CI: ?4.50, ?1.15) decrease at 1 year after surgery. Models specific to complication type indicated that respiratory [?3.04, (95% CI: ?5.50, ?0.57)], neural [?2.11, (95% CI: ?3.97, ?0.25)], and general complications [?2.39, (95% CI: ?3.51, ?1.28)] were associated with statistically significant decreases in cognitive function.DiscussionOlder surgical patients who suffer in-hospital complications show greater decline in self-perceived cognitive function during the ensuing year. Geriatric specialists may be able to intervene in the immediate perioperative period to reduce complications and possibly mitigate cognitive decline among older adults.     

Validity of Processes of Change in Physical Activity Among College Students in the TIGER Study

Objective  

To test the factorial validity and measurement equivalence/invariance of scales used to measure processes of change derived from the Transtheoretical Model (TTM) applied to physical activity.     

Quantitative Modeling of External Ventricular Drain Output to Predict Shunt Dependency in Aneurysmal Subarachnoid Hemorrhage: Cohort Study

Neurocritical Care - Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical...     

A Comprehensive Model to Predict Atrial Fibrillation in Cryptogenic Stroke: The Decryptoring Score

ObjetiveCryptogenic stroke (CS) represents up to 30% of ischemic strokes (IS). Since atrial fibrillation (AF) can be detected in up to 30% of CS, there is a clinical need for estimating the probability of underlying AF in CS to guide the optimal secondary prevention strategy. The aim of the study was to develop the first comprehensive predictive score including clinical conditions, biomarkers, and left atrial strain (LAS), to predict AF detection in this setting.MethodsSixty-three consecutive patients with IS or transient ischemic attack with ABCD2 scale ≥ 4 of unknown etiology were prospectively recruited. Clinical, laboratory, and echocardiographic variables were collected. All patients underwent 15 days wearable Holter-ECG monitoring. Main objective was the Decryptoring score creation to predict AF in CS. Score variables were selected by a univariate analysis and, thereafter, score points were derived according to a multivariant analysis.ResultsAF was detected in 15 patients (24%). Age > 75 (9 points), hypertension (1 point), Troponin T > 40 ng/L (8.5 points), NTproBNP > 200 pg/ml (0.5 points), LAS reservoir < 25.3% (24.5 points) and LAS conduct < 10.4% (0.5 points) were included in the score. The rate of AF detection was 0% among patients with a score of < 10 and 80% among patients with a score > 35. The comparison of the predictive validity between the proposed score and AF-ESUS score resulted in an AUC of 0.94 for Decryptoring score and of 0.65 for the AF-ESUS score(p < 0.001).ConclusionThis novel score offers an accurate AF prediction in patients with CS; however these results will require validation in an independent cohort using this model before they may be translated into clinical practice     

Association between Heart Failure and Clinical Prognosis in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study

Background and PurposeIschemic stroke is a common cause of death worldwide. In clinical practice it is observed that many individuals who have experienced an ischemic stroke also suffer from simultaneous comorbidities such as heart failure, which could be directly associated with a worse clinical prognosis. Therefore, this study analyzed outcomes in terms of the severity of the event, inhospital mortality, duration of hospital stay, and inhospital recurrence of the episode, in order to determine the implications resulting from the presentation of both pathologies.MethodsThis was a retrospective-cohort, hospital-based study.ResultsThe study included 110 subjects with heart failure (exposed) and 109 subjects without heart failure (nonexposed). The incidence of inhospital mortality was 27.27% in exposed patients and 9.17% in nonexposed patients (p<0.001), and the presence of heart failure increased the risk of death by 92% (p=0.027). According to scores on the National Institutes of Health Stroke Scale, the median severity was worse in exposed than nonexposed patients (16.1 vs. 9.2, p =0.001). The median hospital stay was 9 days in subjects with heart failure and 7 days in nonexposed patients (p=0.011). The rate of inhospital stroke did not differ significantly between exposed and nonexposed patients (1.82% vs. 0.92%, p=0.566).ConclusionsIndividuals with heart failure who suffer from an acute ischemic stroke show worse clinical outcomes in terms of mortality, event severity, and duration of hospital stay.     

Analyzing Theoretical Mechanisms of Physical Activity Behavior Change in Breast Cancer Survivors: Results from the Activity Promotion (ACTION) Trial

Background We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors. Purpose To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks. Methods Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group. Results Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = −0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks. Conclusions Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.     

Initial Heroin Use Patterns Predict 5-Year Relapse: Results from a Longitudinal Cohort Study in Shanghai,China

People start to use heroin in different patterns. This study identified three initial heroin use patterns in a heroin use cohort: No-factor initial pattern (with no factors of initial heroin use), Single-factor initial pattern (with 1 of 3 factors of initial heroin use), and Multiple-factor initial pattern (with 2 or 3 factors of initial heroin use). The cumulative heroin relapse rate was 53.3%, 62.4%, and 72.7% respectively for No-factor, Single-factor, and Multiple-factor initial patterns during the 5-year follow-up. The adjusted hazard ratio (AHR) was 1.401 (95% CI: 1.091–1.799, p?=?0.008) in Single-factor initial pattern and 2.381 (95% CI: 1.546–3.668, p <?0.001) in Multiple-factor initial pattern compared to No-factor initial pattern. This study added new evidence to the impact of initial heroin use on long-term relapse risk, which suggested that initial heroin use patterns should not be neglected.

     

Individual Factors and the Context of Physical Activity in Exercise Dependence: A Prospective Study of ‘Ultra-Marathoners’

Although there is a growing body of literature examining determinants and correlates of exercise dependence, there has been a lack systematic measures of individual factors combined with the context of physical activity characteristics. The aim of this prospective study was therefore to examine the relative influence of individual factors and environmental context of physical activity on exercise dependence. This study examined a group of 95 ‘ultra-marathoners’ of a 100 km race. Each participant completed a questionnaire that assessed individual factors (e.g., sex, age, BMI, marital status, etc.), context of the physical activity (e.g., environmental and social context of practice), and the effect on the body as a result of physical activity (e.g., body control and modification). For participants in this study, the strongest predictors of exercise dependence were individual factors (age and BMI), and exercising in the city in an unstructured space. It is concluded that an ecological model of physical activity could be applied to exercise dependence, and that exercise dependence could provide interesting insights into the promotion of physical activity as a health-related behaviour.