Adherence to physical and mental activity interventions: coping plans as a mediator and prior adherence as a moderator

Objective. Adherence to behavioural intervention programmes is a necessary condition for beneficial outcomes to be achieved. This study tested whether social cognitive variables and coping plans predict adherence. Design and methods. Adherence was examined in a randomized controlled trial with healthy older women (age range: 70–93 years), who were randomized to a physical (N= 86) or a mental (N= 85) activity intervention. Intentions, self‐efficacies, coping plans, and objectively measured adherence levels were assessed. A moderated mediation analysis evaluated the power of coping plans to translate intention into behaviour, depending on levels of prior adherence. Results. Adherence to the physical activity programme (65%) was significantly lower than adherence to the mental activity programme (84%, p < .001). Intentions (β= .22) weakly predicted adherence in the initiation period of the physical activity programme (6 weeks); pre‐action self‐efficacy predicted adherence in the initiation period of the mental activity programme (β= .35). In both groups, coping plans predicted mid‐period adherence (10 weeks) and long‐term adherence (20 weeks), moderated by prior adherence (all ps < .01). Coping plans mediated the relationship between intentions and behaviour only in the exercise condition. Conclusions. Instructing older individuals to generate coping plans facilitated their adherence to physical and mental activity programmes. This effect was larger for participants with lower levels of prior adherence – and may have prevented them from dropping out of the programme.     

A theoretical investigation of the development of physical activity habits in retirement

Objectives. This study examined the impact of retirement on physical activity (PA) patterns. More specifically, the process of initiating and maintaining behaviour changes in PA were explored using a self‐determination theory perspective. Design. Semi‐structured interviews were conducted to explore the formation of lifestyle habits post‐retirement, and the role of PA within these. Interviews were analysed using thematic analysis and an informal comparison made between physically active and inactive retired adults. Methods. A total of 11 participants (7 female, 4 male; 6 physically active, 5 physically inactive) were recruited from churches and a local newspaper advertisement in South West England. On average, participants (M age=62.91 years; SD =2.3) had been retired 2 years and 8 months (SD =20.03). Results. Three main themes emerged from the interviews specific to retired adults; social factors, lifelong tendencies, and sense of purpose. All retired adults searched for purpose in their lives, and for physically active adults having an exercise schedule contributed to this on a daily basis. PA also represented a source of personal challenge, whereas physically inactive retirees sought meaning and challenge from non‐exercise domains. All participants were acutely aware of their mortality, but active participants felt that PA would increase their chances of enjoying a healthy retirement, rather than accepting a decline in physical function. Conclusions. The results highlighted how global aspirations for life after retirement can influence one's post‐retirement lifestyle. The implications for future research and potential health promotion approaches are discussed.     

Translating good intentions into physical activity: older adults with low prospective memory ability profit from planning

Prospective memory (PM) is the ability to remember to perform an intended action in the future and is necessary for regular physical activity (PA). For older adults with declining PM, planning strategies may help them to act upon their intentions. This study investigates PM as a moderator in a mediation process: intention predicting PA via planning. A mediated moderation was estimated with longitudinal data of older adults (M = 70 years). Intentions (T1) predicted PA (T3) via action and coping planning (T2). PM was included as moderator on the planning-PA association. Both planning strategies were significant partial mediators (action planning: b = 0.17, 95 % CI [0.10, 0.29]; coping planning: b = 0.08, 95 % CI [0.02, 0.18]). For individuals with lower PM, the indirect effect via coping planning was stronger than with higher PM (b = 0.06, 95 % CI [0.01, 0.16]). Action planning is important for PA in old age regardless of PM performance, whereas older adults with lower PM benefitted most from coping planning. Intervention studies for older adults should consider training PM and promote planning skills.     

Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample

Objectives. To investigate the utility of the protection motivation theory (PMT) for explaining physical activity (PA) in an adult population with type 1 diabetes (T1D) and type 2 diabetes (T2D). Design. Cross‐sectional and 6‐month longitudinal analysis using PMT. Methods. Two thousand three hundred and eleven individuals with T1D (N =697) and T2D (N =1,614) completed self‐report PMT constructs of vulnerability, severity, response efficacy, self‐efficacy, and intention, and PA behaviour at baseline and 6‐month follow‐up. Multi‐group structural equation modelling was conducted to: (1) test the fit of the PMT structure; (2) determine the similarities and differences in the PMT structure between the two types of diabetes; and (3) examine the explained variance and compare the strength of association of the PMT constructs in predicting PA intention and behaviour. Results. The findings provide evidence for the utility of the PMT in both diabetes samples (χ²/df =1.27?4.08, RMSEA=.02–.05). Self‐efficacy was a stronger predictor of intention (β=0.64–0.68) than response efficacy (β=0.14–0.16) in individuals with T1D or T2D. Severity was significantly related to intention (β=0.06) in T2D individuals only, whereas vulnerability was not significantly related to intention or PA behaviour. Self‐efficacy (β's=0.20–0.28) and intention (β's=0.12–0.30) were significantly associated with PA behaviour. Conclusions. Promotion of PA behaviour should primarily target self‐efficacy to form intentions and to change behaviour. In addition, for individuals with T2D, severity information should be incorporated into PA intervention materials in this population.     

Enhancing intentions to attend cervical cancer screening with a stage‐matched intervention

Objective. The study evaluated the effects of a pros enhancing intervention on intention to uptake cervical cancer screening. It was hypothesized that the pros enhancement session (compared to an education session) would affect intentions of preintentional women, whereas it was expected to have negligible effects among women in intentional and actional stages of the health action process approach (HAPA). Thus, we tested the HAPA using stage‐matched and stage‐mismatched interventions. Further, a change in decisional balance was assumed to mediate the relationship between the group assignment and intention, with age acting as the moderator. Design and methods. Respondents (1,436 women, aged 18–60) were randomly assigned to either the intervention or control condition and filled out questionnaires before and directly after the manipulation (in one web‐based session). Results. Direct effects of the group assignment were observed only among preintentional women. Across the stages, however, change in decisional balance mediated the effects of the group assignment on the intention to uptake screening. Further, among participants in the preintentional stage, this mediation became significant only for women aged 35 or older. Conclusions. Although direct effects are in line with stage assumptions of the HAPA, meditational analysis among pre‐ and post‐intentional women indicated that similar processes accounted for post‐manipulation intention. Future research testing stage models should account for the mediating processes, which explain the effects of the intervention.     

CBT for late‐life insomnia and the accuracy of sleep and wake perceptions: Results from a randomized‐controlled trial

Subjective and objective estimates of sleep are often discordant among individuals with insomnia who typically under‐report sleep time and over‐report wake time at night. This study examined the impact and durability of cognitive‐behavioural therapy for insomnia on improving the accuracy of sleep and wake perceptions in older adults, and tested whether changes in sleep quality were related to changes in the accuracy of sleep/wake perceptions. One‐hundred and fifty‐nine older veterans (97% male, mean age 72.2 years) who met diagnostic criteria for insomnia disorder were randomized to: (1) cognitive‐behavioural therapy for insomnia (n = 106); or (2) attention control (n = 53). Assessments were conducted at baseline, post‐treatment, 6‐months and 12‐months follow‐up. Sleep measures included objective (via wrist actigraphy) and subjective (via self‐report diary) total sleep time and total wake time, along with Pittsburgh Sleep Quality Index score. Discrepancy was computed as the difference between objective and subjective estimates of wake and sleep. Minutes of discrepancy were compared between groups across time, as were the relationships between Pittsburgh Sleep Quality Index scores and subsequent changes in discrepancy. Compared with controls, participants randomized to cognitive‐behavioural therapy for insomnia became more accurate (i.e. minutes discrepancy was reduced) in their perceptions of sleep/wake at post‐treatment, 6‐months and 12‐months follow‐up (p < .05). Improved Pittsburgh Sleep Quality Index scores at each study assessment preceded and predicted reduced discrepancy at the next study assessment (p < .05). Cognitive‐behavioural therapy for insomnia reduces sleep/wake discrepancy among older adults with insomnia. The reductions may be driven by improvements in sleep quality. Improving sleep quality appears to be a viable path to improving sleep perception and may contribute to the underlying effectiveness of cognitive‐behavioural therapy for insomnia.     

Discontinuity patterns in stages of the precaution adoption process model: Meat consumption during a livestock epidemic

Objectives. Patterns of changes in social‐cognitive variables were investigated in order to test selected stages of the precaution adoption process model (PAPM). It was hypothesized that non‐linear trends (discontinuity patterns) in perceived vulnerability, positive and negative outcome expectancies, procrastination, and self‐efficacy might be observed across the stages. Design. Cross‐sectional data from 808 respondents were employed. Method. Questionnaire data were collected in an on‐line study on meat consumption during a livestock epidemic in Germany. Polynomial trends and analyses of variance with post‐hoc ‐contrasts were used to examine the patterns of change. Results. Discontinuity patterns were found for perceived vulnerability, negative outcome expectancies, and procrastination. The data provided partial support for discontinuity patterns in self‐efficacy. Continuity patterns were found for positive outcome expectancies. Conclusions. Results provide support for a stage model rather than a pseudo‐stage model.     

Determinants of condom use among a random sample of single heterosexual adults

Objectives. The aim of this study was to identify the determinants of single heterosexuals' use of condoms during each sexual intercourse. Design. Cohort of individuals followed over a period of 2 years. Methods. Respondents were 574 single heterosexual individuals who answered questions during a telephone interview. Results. Attitude, perceived behavioural control, self‐efficacy and moral norm explained 65% of the variance in intentions to use condoms (p <.0001). The determinants of condom use at 1 year follow‐up (27% explained variance) were perceived behavioural control, past behaviour, and the interaction between intention and intention stability. At 2 years follow‐up, the significant determinants were past behaviour and intention by intention stability. In the present study, intentions to use condoms which remained stable across time were strong predictors of condom use (at 1 year: β=.42, p <.0001; at 2 years: β=.39, p <.003), while unstable intentions were not (at 1 year: β=.02, ns; at 2 years: β=.19, ns). Conclusion. Intention stability is a major determinant of the accuracy of intention for the prediction of subsequent behaviour.     

'Feeling' risk and seeing solutions: predicting vaccination intention against hepatitis B infection among men who have sex with men

This study assessed cognitive and affective predictors of intention to obtain vaccination against the hepatitis B virus (HBV) among men who have sex with men (MSM), based on leading social cognitive models of health behavior. The key predictors of vaccination intention were perceived risk of contracting HBV, expectancies regarding the outcome of vaccination, and the interaction between risk perception and outcome expectancies. Negative affect increased risk perceptions, which, in turn, positively affected vaccination intention. It is concluded that MSM should feel they are at risk for HBV, and see solutions to this risk.     

Gender power imbalance and differential psychosocial correlates of intended condom use among male and female adolescents from Venda,South Africa

Objectives. In South Africa, a gender power imbalance exists which may prevent women from negotiating safe sexual encounters. In this study we tested which constructs from Protection Motivation Theory (PMT) and the Theory of Planned Behavior (TPB) under these circumstances were most related to condom use intention. We hypothesized that in a situation of gender power imbalance self‐efficacy would be a more salient correlate of intended condom use for females, while for males attitude to condoms and subjective norm would be more important. Design. This study employed a cross‐sectional questionnaire design. Method. Male participants (N = 94) and female participants (N = 101) from Venda, South Africa completed standard, multi‐item, reliable measures of TPB constructs (condom‐related attitude, subjective norm, perceived behavioural control, intention) and PMT constructs (vulnerability, severity, fear, response‐efficacy, self‐efficacy) and reported their past condom use behaviour. Results. Regression analysis indicated that among males attitude to condoms and subjective norm were significantly related to intended condom use. Among females attitude and self‐efficacy were significantly related to intended condom use. Conclusion. The findings indicate that in a situation of gender power imbalance psychosocial correlates of intended condom use differ for males and females. Gender‐specific analysis of determinants of condom use may be more appropriate in a situation of gender power imbalance.     

The Road to Exercise Is Filled With Good Intentions: Why Don't My Proximal Exercise Intentions Match My Actions?

Difficulty in following through with proximal exercise intentions (PIs) may be associated with experiencing frequent, limiting perceived reasons (factors causing indecision) and low self‐regulatory efficacy (SRE) to cope. Differences in reason frequency, limitation, and SRE between adults whose PI frequency matched their exercise frequency and adults whose PI frequency was higher than their actual frequency (mismatched) were examined. Participants (N = 163) completed Web‐based measures of reason frequency, limitation, coping strategies and related SRE, intention, and exercise for the prior 4 weeks. A multivariate analysis of variance comparing matched (n = 89) with mismatched (n = 74) groups was significant. Matched participants reported significantly lower reason limitation and higher SRE, suggesting that they may have the SRE to buffer negative effects of limiting reasons.     

Sustaining self‐regulatory efficacy and psychological outcome expectations for postnatal exercise: Effects of a group‐mediated cognitive behavioural intervention

Objective . The objective of the current investigation was to examine if the effects of a group‐mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a standard exercise care condition on postnatal mothers' self‐regulatory efficacy (SRE), outcome expectations (OEs) and self‐directed physical activity (PA). Design . The design of the study consisted of two intervention conditions; group‐mediated cognitive behavioural counselling plus exercise (GMCB) and standard exercise (SE). Each condition consisted of two phases; a 4‐week supervised, centre‐based intensive exercise training phase followed by a 4‐week home‐based phase. Methods . Participants were 57 postnatal women randomly assigned to conditions (SE: N = 31; GMCB: N = 26). Measures of SRE and OEs were assessed prior to and following the centre‐based aspect of the intervention. Physical activity was measured following the intensive exercise training phase as well as the home‐based phase. Results . GMCB participants' SRE and OEs were sustained during the intervention whereas those of SE participants declined. GMCB participants also reported significantly greater time spent engaging in self‐directed PA at the conclusion of the intensive and home‐based phases. Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home‐based PA as confirmed by a significant sobel test. Conclusions . These findings suggest that a theory‐based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs, and in promoting greater self‐directed PA. SRE partially mediated the relationship between intervention condition and post home‐based PA supporting the targeting of that variable for change as part of the intervention.     

Physical inactivity and cognitive impairment in Korean older adults: gender differences in potential covariates

Background: Physical inactivity is one major lifestyle risk factor of mild cognitive impairment with ageing.

Aim: To investigate whether or not potential covariates modulate the association between physical activity (PA) and cognitive impairment in older adults.

Subjects and methods: Data from 10?245 Korean older adults (5817 women) were used.

Results: High PA older adults were younger and longer educated and had lower comorbidity and depression than low PA older adults. Compared with low PA men, moderate PA men only had a significantly lower odds-ratio (OR) and 95% confidence interval (95% CI) (OR?=?0.795, 95% CI?=?0.654?～?0.965, p?=?0.021) for having cognitive impairment, even after adjusting for measured covariates, which was no longer significant when additionally adjusted for comorbidity (OR?=?0.862, 95% CI?=?0.707?～?1.051, p?=?0.143). Compared with low PA women, moderate and high PA women had significantly lower risks of cognitive impairment (OR?=?0.830, 95% CI?=?0.712?～?0.969, p?=?0.018 and OR?=?0.784, 95% CI?=?0.651?～?0.943, p?=?0.010, respectively), even after adjusting for the measured covariates including comorbidity, which was no longer significant when additionally adjusted for depression (OR?=?0.897, 95% CI?=?0.776?～?1.049, p?=?0.173 and OR?=?0.919, 95% CI?=?0.761?～?1.111, p?=?0.385, respectively).

Conclusion: These findings suggest that gender differences in the covariates modulate the relationship between physical activity and cognitive decline in older Korean adults.     

The relationship between self‐efficacy and resting blood pressure in spousal Alzheimer's caregivers

Objective. To examine whether high levels of self‐efficacy for problem‐focused coping were significantly related to several resting BP measures in spousal Alzheimer's disease caregivers. Design. Cross‐sectional. Methods. Participants included 100 older caregivers (mean age = 73.8 ± 8.14 years) providing in home care for a spouse with Alzheimer's disease. All participants completed a 13‐item short form of the Coping Self‐Efficacy Scale and underwent an in‐home assessment where a visiting nurse took the average of three serial BP readings. Multiple regression was used to examine the relationship between self‐efficacy and mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) after controlling for age, gender, smoking history, body mass index, the care recipient's clinical dementia rating, diabetes, alcohol use, and the use of antihypertensive medications. Results. Overall, high levels of self‐efficacy for problem‐focused coping were associated with lower MAP, SBP, and PP. Self‐efficacy for problem‐focused coping was marginally associated with resting DBP, but not significant. In addition, we conducted secondary analyses of the other two self‐efficacy scales to explore the relationship between each dimension and MAP. We found that there were no significant relationships found between MAP and self‐efficacy for stopping unpleasant thoughts/emotions or self‐efficacy for getting social support. Conclusions. The present study adds to the current body of literature by illustrating the possibility that higher self‐efficacy can have physiological advantages, perhaps by buffering chronic stress's impact on resting BP. Another contribution of the current study is its attempt to understand the role of each individual component of self‐efficacy. These findings invite future research to investigate whether caregivers might experience cardiovascular benefits from interventions aimed at enhancing self‐efficacy.     

Sleep condition and cognitive decline in Japanese community‐dwelling older people: Data from a 4‐year longitudinal study

This study examined whether sleep duration and excessive daytime sleepiness (EDS) are related to cognitive decline among community‐dwelling older adults with intact cognition at baseline, using 4‐year longitudinal data. A total of 3,151 community‐dwelling older individuals aged ≥65 years were studied. They were assessed for cognitive function, including memory, attention, executive function and processing speed. Cognitive impairment was defined based on a score >1.5 standard deviations below the age‐ and education‐specific mean. Cognitive decline was defined in one or more cognitive tests at follow‐up. Self‐reported sleep duration (short, ≤6.0 hr; medium, 6.1–8.9 hr; long, ≥9.0 hr) and EDS at first‐wave examination were assessed and logistic regression analyses were used to examine the associations of sleep duration and EDS with cognitive status at second‐wave examination. The incidence of cognitive decline differed significantly among the sleep‐duration groups (short, 15.9%; medium, 11.9%; long, 20.1%; p = 0.001). The prevalence of having EDS was 13.1%, which was associated with a higher rate of cognitive decline than having no EDS (18.9% vs. 12.5%, p = 0.004). Long sleep duration compared with medium sleep duration (OR, 1.50; 95% CI, 1.05–2.13) and EDS (1.43; 1.01–2.03) independently impacted the incidence of cognitive decline. The results were similar after multiple imputations (long, 1.68, 1.12–2.52; EDS, 1.55, 1.05–2.29). In conclusion, our study revealed that both long sleep duration and EDS were independent risk factors associated with cognitive decline after 4 years among older adults.     

Subjective–objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment

Discrepancy between subjective and objective measures of sleep is associated with insomnia and increasing age. Cognitive behavioural therapy for insomnia improves sleep quality and decreases subjective–objective sleep discrepancy. This study describes differences between older adults with insomnia and controls in sleep discrepancy, and tests the hypothesis that reduced sleep discrepancy following cognitive behavioural therapy for insomnia correlates with the magnitude of symptom improvement reported by older adults with insomnia. Participants were 63 adults >60 years of age with insomnia, and 51 controls. At baseline, participants completed sleep diaries for 7 days while wearing wrist actigraphs. After receiving cognitive behavioural therapy for insomnia, insomnia patients repeated this sleep assessment. Sleep discrepancy variables were calculated by subtracting actigraphic sleep onset latency and wake after sleep onset from respective self‐reported estimates, pre‐ and post‐treatment. Mean level and night‐to‐night variability in sleep discrepancy were investigated. Baseline sleep discrepancies were compared between groups. Pre–post‐treatment changes in Insomnia Severity Index score and sleep discrepancy variables were investigated within older adults with insomnia. Sleep discrepancy was significantly greater and more variable across nights in older adults with insomnia than controls, P ≤ 0.001 for all. Treatment with cognitive behavioural therapy for insomnia was associated with significant reduction in the Insomnia Severity Index score that correlated with changes in mean level and night‐to‐night variability in wake after sleep onset discrepancy, P < 0.001 for all. Study of sleep discrepancy patterns may guide more targeted treatments for late‐life insomnia.     

The interplay of subjective social status and essentialist beliefs about cognitive aging on cortisol reactivity to challenge in older adults

Older adults are more likely than younger adults to experience stress when confronted with cognitive challenges. However, little is known about individual differences that might explain why some older adults exhibit stronger stress responses than others. We examined the interplay of two social‐cognitive factors to explain older adults' cortisol reactivity: (1) subjective social status, and (2) essentialist beliefs about cognitive aging. We hypothesized that, depending on whether older adults believe that aging‐related cognitive decline is inevitable versus modifiable, low subjective social status should lead to stronger or weaker cortisol reactivity. Using longitudinal data, we assessed the impact of cognitive challenges on stress reactivity in a sample of older adults (N = 389; 61–86 years). As predicted, regression analyses confirmed that 44 min after cognitively challenging tasks, older adults exhibited a significantly different cortisol reactivity depending on their subjective social status and their essentialist beliefs about cognitive aging. Specifically, older adults with low subjective social status and high essentialist beliefs showed a significantly elevated cortisol reactivity. We discuss the role of essentialist beliefs about cognitive aging to predict when and why high versus low subjective social status leads to stress responses in older adults.     

Physical Exercise in Chinese Older Adults: A Transtheoretical Model1

Physical exercise has a positive impact on physical and mental health among older adults. This study identifies significant correlates of exercise behavior among Hong Kong Chinese older adults under the transtheoretical model. The data came from a survey of a representative community sample of 425 elderly respondents in Hong Kong. Using multiple regression models, the authors found that perceived benefits of exercise and self‐efficacy for exercise were related significantly to exercise behavior, and their effects on exercise were mediated completely through the stages of changes in exercise. Although perceived barriers to exercise are significantly and negatively associated with exercise behavior, this relationship disappeared in multiple regression analysis after controlling demographic and several health‐related variables. Findings suggest that perceived benefits and self‐efficacy on exercise should be strengthened to motivate older adults to engage in a more active lifestyle.     

Determinants of HIV Risk and Protective Needle‐Sharing Behaviors Among Drug Injectors

Few studies have tested a broad range of theory‐based determinants of injection‐related risk and protective behaviors. The current study hypothesize relationships among attitudinal beliefs, normative influences, perceived self‐efficacy, intentions, and performing these behaviors consistent with the theory of planned behavior and related models. The conceptual model was tested in a cross‐sectional sample of 895 drug injectors recruited from street settings in the southwestern United States and who completed a face‐to‐face interview. Structural equation modeling results showed intention and self‐efficacy most consistently predicted needle sharing and bleaching considering all other model variables. Discussion focuses on the value of using these theoretical concepts to examine needle sharing and other behaviors among injection drug users and their relevance for developing HIV‐reduction interventions.