Predicting Objectively Measured Exercise Participation from Motivation and Basic Needs Satisfaction: Does a Mediational Model Exist?

This study (a) explored whether relationships exist between objectively assessed exercise participation and both controlled extrinsic motivation and amotivation, and (b) investigated the possible mediation of the relationships between satisfaction of the basic needs and objectively assessed exercise participation. Participants (n = 162) were members of a worksite wellness program. Before beginning the program, participants completed a 33‐item survey measuring the constructs of self‐determination theory. Objectively assessed exercise participation was measured via attendance. Path analysis revealed that the net effect of external regulation on attendance was positive. Of the basic needs, only autonomy was a significant predictor of attendance, with no mediation of this relationship. Appealing to participants' external regulation and need for autonomy may enhance exercise participation.     

The impact of patient education on knowledge,attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease

ObjectivePatient education (PE) delivered during exercise-based cardiac rehabilitation (CR) aims to promote health behaviour change, including attendance at CR exercise sessions, by imparting knowledge about coronary artery disease (CAD) and improving CR-related attitudes. This study evaluated the impact of PE on aspects of patient motivation (i.e., CAD-related knowledge, attitudes towards CR) and exercise session attendance.MethodsAdults with CAD referred to a 12-week CR program were recruited. CAD knowledge, perceived necessity/suitability of CR, exercise concerns, and barriers to CR were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review.ResultsAmong 90 patients (60 ± 10 years; 88% men), CAD knowledge and perceived necessity of CR improved pre- to post-PE; gains persisted at 12-weeks. Stronger pre-CR intentions to attend exercise sessions predicted greater attendance. Greater knowledge gains did not predict improvements in CR attitudes or exercise attendance.ConclusionWhereas PE may be useful for improving knowledge and attitudes regarding CAD self-management, more formative research is needed to determine whether PE can promote CR attendance.Practice implicationsCardiac PE programs may be more successful in promoting exercise attendance if they target patients’ behavioural intentions to attend and attitudes toward CR, rather than focussing exclusively on imparting knowledge.     

Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: An attribution theory perspective

The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A5-week follow-up self-report of exercise wasthen completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived successwere the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.     

Social cognitive determinants of hospital-based exercise in cancer patients following high-dose chemotherapy and bone marrow transplantation

Preliminary evidence indicates that physical exercise may be an effective strategy for the rehabilitation of cancer patients following bone marrow transplantation (BMT), but the determinants of such exercise are not known. In this study, we used a prospective design to evaluate the theory of planned behavior (Ajzen, 1991) as a social cognitive framework for understanding exercise motivation and behavior in 37 BMT patients. On admittance to the hospital, participants completed a baseline questionnaire that assessed the theory of planned behavior and then monitored the frequency and duration of self-initiated cycle ergometer exercise during their hospitalization. Hierarchical regression analyses demonstrated that intention and perceived behavioral control explained 36% of the variance in exercise behavior when the analyses were restricted to nonthrombocytopenic patients (n = 28). Moreover, attitude and perceived behavioral control explained 68% of the variance in exercise intentions. We concluded that the theory of planned behavior provided an excellent understanding of exercise intentions in this population and context and that its ability to predict exercise behavior could be improved substantially by taking into account significant medical complications. Kerry S. Courneya’s research program is supported by the National Cancer Institute of Canada (NCIC) with funds from the Canadian Cancer Society (CCS) and the CCS/NCIC Sociobehavioral Cancer Research Network.     

Examining the role of social support and group cohesion in exercise compliance

The present study sought to examine the role of social support and group cohesion in the compliance behavior of females required to exercise for health-related reasons. Compliance behavior was assessed as attendance and dropout behavior. Participants (N = 49) drawn from a clinical exercise group completed questionnaires to assess cohesion and social support. Discriminant function analyses were able to discriminate between high and low attenders as well as between dropouts and graduates. Participants reporting high scores on the support provision of reliable alliance and the cohesion factor of ATG-Task, along with low scores on the social support provision of guidance, were more likely to attend a higher proportion of classes. For dropouts, participants with higher scores on the support provision of reliable alliance were less likely to drop out. As a secondary objective, it was found that cohesion and social support variables both contributed to the successful prediction of attendance.     

Participants,Usage, and Use Patterns of a Web-Based Intervention for the Prevention of Depression Within a Randomized Controlled Trial

Background

Although Web-based interventions have been shown to be effective, they are not widely implemented in regular care. Nonadherence (ie, participants not following the intervention protocol) is an issue. By studying the way Web-based interventions are used and whether there are differences between adherers (ie, participants that started all 9 lessons) and nonadherers, more insight can be gained into the process of adherence.

Objective

The aims of this study were to (1) describe the characteristics of participants and investigate their relationship with adherence, (2) investigate the utilization of the different features of the intervention and possible differences between adherers and nonadherers, and (3) identify what use patterns emerge and whether there are differences between adherers and nonadherers.

Methods

Data were used from 206 participants that used the Web-based intervention Living to the full, a Web-based intervention for the prevention of depression employing both a fully automated and human-supported format. Demographic and baseline characteristics of participants were collected by using an online survey. Log data were collected within the Web-based intervention itself. Both quantitative and qualitative analyses were performed.

Results

In all, 118 participants fully adhered to the intervention (ie, started all 9 lessons). Participants with an ethnicity other than Dutch were more often adherers (χ² ₁=5.5, P=.02), and nonadherers used the Internet more hours per day on average (F_1,203=3.918, P=.049). A logistic regression showed that being female (OR 2.02, 95% CI 1.01-4.04; P=.046) and having a higher need for cognition (OR 1.02; 95% CI 1.00-1.05; P=.02) increased the odds of adhering to the intervention. Overall, participants logged in an average of 4 times per lesson, but adherers logged in significantly more times per lesson than nonadherers (F_1,204=20.710; P<.001). For use patterns, we saw that early nonadherers seemed to use fewer sessions and spend less time than late nonadherers and adherers, and fewer sessions to complete the lesson than adherers. Furthermore, late nonadherers seemed to have a shorter total duration of sessions than adherers.

Conclusions

By using log data combined with baseline characteristics of participants, we extracted valuable lessons for redesign of this intervention and the design of Web-based interventions in general. First, although characteristics of respondents can significantly predict adherence, their predictive value is small. Second, it is important to design Web-based interventions to foster adherence and usage of all features in an intervention.

Trial Registration

Dutch Trial Register Number: NTR3007; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3007 (Archived by WebCite at http://www.webcitation.org/6ILhI3rd8).     

Social cognitive and physical health determinants of exercise adherence for HIV-1 seropositive, early symptomatic men and women

This study examined social cognitive and physical health factors that might explain variations in exercise adherence in a 3-month supervised exercise intervention for a group of mildly symptomatic, HIV-1 seropositive men and women. The social cognitive predictor variables were outcome expectations and self-efficacy. The physical health predictor variables included CD4 cell counts, self-report inventories of physical symptoms, and physicians’ examinations. Self-report inventories of physical symptoms were associated with physicians’ examinations and combined into a composite measure of physical health. Criterion variables included exercise adherence rates, VO_{2 max} change, and status as a “remainer” versus “drop-out.” The composite measure of physical health emerged as a significant predictor of adherence rate and gave perfect prediction of remainers and a moderate prediction of dropouts. No significant associations were observed between the social cognitive predictors and adherence. Results suggest that for this population physical health status is a better predictor of exercise adherence than either perceived self-efficacy or outcome expectancy.     

Treatment motives as predictors of acquisition and transfer of relaxation methods to everyday life

This article presents results from four studies of the significance of type and number of initial treatment motives for acquisition and transfer to everyday life of progressive relaxation (PR) and autogenic training (AT). On the basis of theories of treatment motivation and compliance, we hypothesize that motives for participation are determinants of learning and transfer. Results are reported from (1) two studies with 113 participants in introductory courses on AT and 94 participants in introductory courses on PR and (2) two replication studies with 94 (AT) and 101 participants (PR). Participants indicated their motives for participation. Short-term indicators of treatment success include number of dropouts and subjective evaluations of relaxation exercises; long-term outcomes include transfer of relaxation exercises to everyday life and evaluations of exercise evaluations at follow-up 3 to 6 months after the end of course. Results suggest that for both AT and PR, dropout and subjective relaxation exercise evaluations can be predicted from participation motives. Long-term outcomes can be predicted only for AT. However, for both PR and AT it is shown that for up to four motives, the number of initial course motives is correlated with short-term and long-term predictors of course outcome. We conclude that motivation for participation is highly relevant to client-course matching and adaptive indication of relaxation therapies. Results lead to a threshold hypothesis about the relationship between the number of participation motives and short-term as well as long-term learning and transfer outcome.     

Effects of participation in the Executive Leadership in Academic Medicine (ELAM) program on women faculty's perceived leadership capabilities.

PURPOSE: This study measured the impact of participation by women academics in the Executive Leadership in Academic Medicine (ELAM) program as part of a robust evaluation agenda. METHOD: The design is a classic pre/post, within-group, self-report study. The survey elicits self-perception about leadership in ten constructs: knowledge of leadership, management, and organizational theory; environmental scanning; financial management; communication; networking and coalition building; conflict management; general leadership; assessment of strengths and weaknesses; acceptance of leadership demands; and career advancement sophistication. The post surveys inquire additionally about perceived program usefulness. Data were collected from 79 participants (1997-98, 1998-99, and 2000-01 classes). Response rates were nearly 100% (pre) and 69% to 76% (post). RESULTS: Statistically significant increases (p <.01) in perceived leadership capabilities were identified across all ten leadership constructs. Gains were large in knowledge of leadership and organizational theory, environmental scanning, financial management, and general leadership. Gains in career building knowledge were large to moderate. More modest were gains in communication, networking, and conflict management. There were significant correlations between each leadership construct and perceived usefulness of the program. CONCLUSIONS: Significant improvements were reported on all leadership constructs, even when participants viewed themselves as already skilled. While it cannot be concluded that participation in ELAM directly and solely caused all improvements, it seems unlikely that midcareer women faculty would improve on all ten constructs in 11 months after program completion by natural maturation alone. Future research will investigate whether the changes are due to ELAM or other factors, and assess whether participants show more rapid advancement into leadership than comparable women not participating in ELAM.     

Adherence to exercise interventions in the treatment of hypercholesterolemia

The goals of this study were to determine the rate of adherence to exercise treatment of hypercholesterolemia and to identify personality and demographic factors associated with adherence. Of the 31 subjects entering the 26-week program, 12 attended 80% or more of the scheduled sessions. Adherence was positively associated with the perceived seriousness of hypercholesterolemia, the expectation of benefit from treatment, and depressed feelings of helplessness and hopelessness. Negative associations were identified between adherence and the perception of health status being under the control of chance or of powerful others. Older subjects were more likely to be adherers at 8 and 16 weeks but not at 26 weeks.     

An Exploratory Investigation of the Relationship between Proxy Efficacy, Self-efficacy and Exercise Attendance

The purpose of the study was to examine the relationship between perceptions of self-efficacy, proxy efficacy, and exercise class attendance of participants involved in a 10-week structured group fitness program. At week 3, 127 females completed measures of self-efficacy and proxy efficacy and their class attendance was monitored for the subsequent four weeks. Self-efficacy was assessed through measures of exercise, scheduling, and barrier self-efficacy. Proxy efficacy was assessed through a measure of fitness instructor efficacy defined as participants' confidence in their fitness instructors' communication, teaching, and motivating capabilities. Results revealed positive correlations between self-efficacy variables and proxy efficacy. Hierarchical multiple regression analyses indicated that among those who were classified as exercise initiates (n = 33), self-efficacy and proxy efficacy accounted for 34 percent of the variance in exercise class attendance with the latter variable explaining a unique 12 percent. Consistent with theorizing, these preliminary findings indicate that for instructor-led, group physical activities such as aerobics classes, proxy efficacy perceptions are related to self-efficacy and may also be an important predictor of exercise behavior.     

Overcoming barriers to exercise among parents: a social cognitive theory perspective

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n = 226) and fathers (n = 70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and 1 year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise.     

Cognitive mediators of the social influence-exercise adherence relationship: A test of the theory of planned behavior

The purpose of this study was to examine cognitive constructs from the theory of planned behavior (i.e., attitude, perceived behavioral control, and intention) as potential mediators of the relationship between selected social influence constructs (i.e., subjective norm, social support, and cohesion) and adherence to structured exercise classes. Sixty-two participants completed self-administered questionnaires during the fourth week (social influence constructs) and eighth week (cognitive constructs) of a 12-week exercise program. Exercise adherence was monitored during weeks 9 through 12 using perceived intensity and attendance. Pearson correlations indicated that social support correlated with perceived behavioral control, whereas cohesion correlated with attitude. Path analysis supported two distinct paths from social influence to exercise adherence: (a) social support perceived behavioral control intention excersise adherence, and (b) cohesion attitude intention exercise adherence. Discussion focuses on the theoretical importance of these findings, conceptual and measurement issues regarding subjective norm, and suggestions for future research.     

Physical exercise and improvement of liver oxidative metabolism in the elderly

Drug metabolizing capacity is generally reduced in the elderly, and physical exercise has been reported to increase drug oxidative metabolism. The purpose of this investigation was to study the effects of engagement in a program of regular physical exercise on the clearance and metabolite excretion of antipyrine, a marker of oxidative metabolism, in elderly subjects. The saliva clearance of antipyrine and the production clearances of antipyrine metabolites were studied in 37 elderly women (mean age 66 years). Subjects attended 60-min sessions three times a week for 12 weeks. Each session consisted of both aerobic (training of cardiorespiratory capacity) and nonaerobic (training of muscular strength/endurance and flexibility/coordination) exercises performed at 50–75% of maximum oxygen uptake. Antipyrine was administered orally and pharmacokinetic parameters were obtained from saliva and urine samples. After 3 months of participation in the exercise program, salivary antipyrine clearance was significantly increased by 17% mean (SEM) 0.42 (0.02) vs 0.36 (0.02) ml/min/kg; P < 0.05) and the half-life of antipyrine was significantly reduced by 18% (17.9 (1.1) vs 22.3 (1.3) h; P < 0.05). No significant change with exercise was observed in the renal clearance of antipyrine or in the norantipyrine formation clearance, but significant increases were found for hydroxymethylantipyrine [42 (5) vs 32 (4) μl/kg/min; P < 0.05; +31%] and 4-hydroxyantipyrine [243 (18) vs 194 (17) μl/kg/min; P < 0.05; +25%] formation clearances. These findings indicate that regular exercise leads to increased disposition of antipyrine in the elderly and that the main metabolic pathways of the compound are changed differentially. Accepted: 25 June 1999     

Employee and organizational factors associated with participation in an incentive-based worksite smoking cessation program

This study investigated employee and worksite characteristics prospectively predictive of participation among 474 smokers in nine different worksites taking part in a year-long incentive-based smoking cessation program. Several different ways of defining participation (e.g., joining versus level of attendance, first 6 months versus entire program) were studied. A consistent pattern of results was observed across two of the participation indices, joining the program and participating in one or more monthly follow-up meetings. Both worksite (number of employees, previous health promotion history, degree of support from management) and employee (gender, motivation, previous quit attempts) variables were predictive of participation. Logistic regression analyses revealed that each set of variables, worksite and employee characteristics, was significantly related to participation after controlling for the effects of the other set. We were less able to predict level of attendance among participants who joined the program. Implications of these findings for future studies of participation in health promotion programs are discussed.This work was supported by NCI Grant 1 PO1 CA 44648.     

Effect of regular exercise on homocysteine concentrations: the HERITAGE Family Study

We investigated whether regular aerobic exercise could affect plasma total homocysteine (tHcy), and whether there were sex-related or racial differences in tHcy changes. Data were available for 816 black and white men and women, aged 17–65 years, 711 of whom completed a 20 week aerobic exercise training program. The tHcy concentration was measured in frozen plasma samples by an HPLC method. In Blacks, tHcy did not change with exercise training [men −0.5 (SD 3.7) μmol/l, women 0.0 (2.2) μmol/l) but increased significantly in Whites (men +0.3 (1.7) μmol/l, women +0.2 (1.6) μmol/l). No sex-related differences were found in either racial group. Changes in tHcy correlated negatively with baseline homocysteine (r = −0.40, P < 0.0001). Homocysteine levels of the “High” (hyperhomocysteinemia) (≥15 μmol/l) group (n = 30) decreased significantly with regular aerobic exercise from 23.1 (12.1) to 19.6 (7.6) μmol/l. Homocysteine levels of the “Normal” group increased slightly from 8.2 ± 2.2 to 8.5 ± 2.4 μmol/l. Men exhibit racial differences for tHcy responses to exercise training. Regular aerobic exercise has favorable effects on individuals with hyperhomocysteinemia, but tHcy slightly increased in individuals within the normal range.     

Illness perceptions,mood and coping in predicting attendance at cardiac rehabilitation

Objective: The aim of this study was to identify psychological variables in poor/non‐attendance at cardiac rehabilitation (CR). We investigated whether attenders and poor/non‐attenders differed in relation to components of the self‐regulatory model and coping, and which of these variables were the best predictors of attendance behaviour. Design: A cross‐sectional, between groups design was employed. In contrast with two previous similar studies, participants completed self‐report measures shortly before the start date for the CR programme. Univariate and logistic regression analyses were conducted. Method: In all, 93 individuals who had been invited to attend CR completed the Illness Perceptions Questionnaire (IPQ), the Hospital Anxiety and Depression Scale (HADS) and the Coping Orientation to Problems Experienced (COPE). Subsequently, 32 participants failed to attend, or dropped out early from, the programme. Results: Attenders differed from poor/non‐attenders in that they perceived a greater number of symptoms and consequences of their illness, greater distress, less strong beliefs that their illness had been caused by a germ or virus, and used problem‐focused and emotion‐focused coping more frequently. The best predictors of poor/non‐attendance were lower perceptions of symptoms and controllability/curability of illness, and less frequent use of problem‐focused and more frequent use of maladaptive coping strategies. Conclusion: Attenders and poor/non‐attenders at CR were distinguished by illness representations, distress and usage of coping strategies. The variables found to be the best predictors of attendance could be used to screen those unlikely to attend and to develop interventions for enhancing attendance.     

The effect of health beliefs and feelings of self efficacy on self management behavior of children with a chronic disease

This study is among the first to examine the value of chronically ill children's health beliefs, self-efficacy beliefs, experiences of hospitalization, and participation in a health education program in predicting self-management behavior. Data were collected from a random sample of 214 children with asthma being served by any of four NYC hospitals. As measured, perceived self-efficacy, prior hospitalization and participation in a health education program had modest predictive value for self-management while measures of perceived severity of asthma attacks and beliefs in the benefits of self-management techniques in controlling the disease failed to predict subsequent use of self-management techniques. We conclude that (1) the Health Belief Model may not be useful in predicting the behavior of children because of their developmental status, or (2) the measures used in the present study did not adequately tap the health belief constructs.     

Predicting the intentions and behavior of exercise initiates using two forms of self-efficacy

The general objective of the study was to examine the influence of various aspects of self-efficacy on the exercise attendance of novice exercisers. This objective had three distinct features. First, self-efficacy was operationalized as both perceptions toovercome barriers and appraisals of ability toschedule regular exercise sessions. Second, a more unstructured, less regimented, form of exercise that required greater personal control was examined—the forms of activity chosen and self-regulated by novice participants. Third, individuals in the initiation stage of their exercise history were studied. Results indicated that both forms of efficacy (barrier and scheduling) significantly predicted behavioral intention (BI) throughout the exercise program (R ² changes=.13–.26,p's<.02). BI was found to be the best predictor of the first 2 months of attendance (R ² change=.12,p<.05), while scheduling efficacy and past behavior best predicted attendance during the last 2 months (R ² change=.16 and .24,p<.02 andp<.001, respectively). A model combining both social cognitive variables (efficacy beliefs) and behavioral variables (past attendance) captured more variation in predicting the last 2 months of attendance than a model involving only social-cognitive variables.