Multidimensional structure of a questionnaire to assess barriers to and motivators of physical activity in recipients of solid organ transplantation

Purpose: To explore the underlying dimensions of the Barriers and Motivators Questionnaire that is used to assess barriers to and motivators of physical activity experienced by recipients of solid organ transplantation and thereby improve the application in research and clinical settings.

Method: A cross-sectional study was performed in recipients of solid organ transplantation (n?=?591; median (IQR) age?=?59 (49; 66); 56% male). The multidimensional structure of the questionnaire was analyzed by exploratory principal component analysis. Cronbach’s α was calculated to determine internal consistency of the entire questionnaire and individual components.

Results: The barriers scale had a Cronbach’s α of 0.86 and was subdivided into four components; α of the corresponding subscales varied between 0.80 and 0.66. The motivator scale had an α of 0.91 and was subdivided into four components with an α between 0.88 to 0.70. Nine of the original barrier items and two motivator items were not included in the component structure.

Conclusion: A four-dimensional structure for both the barriers and motivators scale of the questionnaire is supported. The use of the indicated subscales increases the usability in research and clinical settings compared to the overall scores and provide opportunities to identify modifiable constructs to be targeted in interventions.

• Implications for rehabilitation

• Organ transplant recipients are less active than the general population despite established health benefits of physical activity.

• A multidimensional structure is shown in the Barriers and Motivators Questionnaire, the use of the identified subscales increases applicability in research and clinical settings.

• The use of the questionnaire with its component structure in the clinical practice of a rehabilitation physician could result in a faster assessment of problem areas in daily practice and result in a higher degree of clarity as opposed to the use of the individual items of the questionnaire.

     

Understanding factors that influence participation in physical activity among people with a neuromusculoskeletal condition: a review of qualitative studies

Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions. Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised. Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling “normal”, motivation and optimism, redefining self and escapism from everyday boundaries. Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions.

• Implications for Rehabilitation

• Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity.

• It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity.

• Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered.

• Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual’s barriers to physical activity.

• A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.

     

An exploratory qualitative study of the meaning and value of a running/walking program for women after a diagnosis of breast cancer

Purpose: To generate insights into the personal meaning and value of a running/walking program for women after a diagnosis of breast cancer.

Methods: After completing a 12-week running/walking program with a 5-km training goal, eight women were interviewed and seven participated in a focus group. The interviews and focus group were audio-recorded and transcribed verbatim. Data were thematically analyzed.

Results: Data portrayed the personal benefits and value of the clinic. Four themes were identified: (1) receiving practical information and addressing targeted concerns, (2) pushing personal limits, (3) enabling a committed mindset, and (4) seeing benefits and challenges of running/walking with a group.

Conclusions: Findings provide initial understanding of how women experience a running/walking program after a diagnosis of breast cancer and what they find to be important about their experiences. The range of positive benefits experienced by women suggests a running/walking program can help fill a gap in care for women diagnosed with breast cancer, and thus be part of cancer rehabilitation. However, because some women felt isolated at times, future research should seek to examine how running/walking programs can be modified and tailored so that all women find it socially beneficial.

• Implications for Rehabilitation

• The diagnosis and treatment of breast cancer can result in side effects and increase the risk of long-term disability.

• Physical activity can help women manage the side effects and lessen the risk of long-term disability.

• In a relatively small sample, this study shows that participation in a running/walking program can be an important part of breast cancer recovery.

     

Women's experience of physical activity following breast cancer treatment

Physical activity is of great benefit to women treated for breast cancer and can even be vital. The aim of this qualitative study was to describe how women treated for breast cancer experience physical activity after surgery. Twelve women, strategically selected according to hospital, age and length of time since surgery, took part in a semi-structured interview. A qualitative method with a phenomenographic approach was used.
The result indicates that the incentive to remain or return to a normal physical condition is an important motive for physical activity after breast cancer surgery. The experience of physical activity was, from the women's perspective, expressed in (i) compliance to instructions and need for support, (ii) struggle to get back to normal and fear of negative side-effects, (iii) a wish to stay normal and not allow limitations and (iv) getting control of the situation with new strategies. In conclusion, instructions and motivation are important in starting up and/or continuing physical activity after breast cancer treatment. While in considering the vital benefits of physical activity for breast cancer patients healthcare professionals, and in particular physiotherapists, must be aware of the need for information and the patients' motive for exercise and physical activity to be able to guide and encourage them individually.
The professionals must also understand the need for empowerment for these women to take control over their lives and to allow the limitations that eventually occur.     

Relationship between physical activity,disability, and physical fitness profile in sedentary Latina breast cancer survivors

Objective: To report baseline data from a physical activity (PA) intervention for Latina breast cancer survivors, and assess the relationship between PA, fitness, and disability. Methods: Eighty-nine Latina breast cancer survivors from San Juan, PR and Houston, TX (age: 55.4 ± 9.9 years; BMI: 29.87 ± 5.62 kg/m²; ≥ 3 months post-treatment) participated in this study. At baseline participants completed fitness testing (six-minute walk test [6MWT], 30-second sit-stand; grip strength, lower and upper extremity and low back strength, shoulder range of motion, balance testing), and assessment of physical activity (PA) and disability. PA was assessed using the International Physical Activity Questionnaire (IPAQ). A subsample (n = 27) received an accelerometer to compare objective versus self-reported PA. Results: Participants exhibited low PA (M = 76.5 MET·minutes/week; SD = 183.4), poor fitness (6MWT M = 436.4 meters, SD = 99.1; 30s sit-stand, M = 11.6 stands, SD = 3.1), and no detectable disability. In an adjusted model lower extremity fitness was associated with PA, with a one repetition increase in sit-to-stand associated with 49 additional minutes of self-reported PA plus walking per week. The correlation between IPAQ moderate-vigorous PA and accelerometer was 0.38 (p = 0.047). Conclusion: Latina breast cancer survivors have low physical activity and fitness levels that increase their risk of disability, cardiometabolic comorbidities, and potential cancer recurrence.     

Aerobic physical activity and salivary cortisol levels among women with a history of breast cancer

BackgroundPhysical activity (PA) helps reduce cancer-related symptoms and improves overall functioning for women with and without a history of breast cancer (BC). Few researchers have examined the associations between PA and physiological stress measures. The aim of this study was to determine whether aerobic PA was associated with diurnal and reactive cortisol patterns, and whether these associations differed for women with and without a history of BC.MethodsParticipants were 25 women with a history of BC and 23 women without a history of BC who self-reported aerobic PA frequency. To assess diurnal cortisol patterns, participants provided five saliva samples collected on two consecutive days at the following times: upon awakening, 30 min after waking, 12 PM, 4 PM, and 9 PM. To measure reactive cortisol patterns, participants provided seven saliva samples collected before, during, and after doing the Trier Social Stress Test.ResultsCortisol patterns differed statistically based on women’s cancer history, whereby women without a history of BC had significantly higher overall cortisol reactivity to an acute stressor, and a marginally significant (p = .05) cancer experience by aerobic PA interaction was observed when analyzing diurnal cortisol data.ConclusionsFindings suggest that PA may not have the same effect on women with and without a history of BC.     

The difference is more than floating: factors affecting breast cancer survivors’ decisions to join and maintain participation in dragon boat teams and support groups

Purpose: Peer support can be helpful in rehabilitation from breast cancer, but participation in peer support groups is low. Groups that provide support opportunities in physical activity contexts are an attractive alternative for some survivors. This study examined survivors’ reasons for joining and maintaining participation on a dragon boat team, along with perceptions of barriers and attractions to traditional peer support groups.

Materials and methods: Seventeen breast cancer survivors were interviewed on five occasions over their first two seasons of a newly formed dragon boating team to explore their perceptions of peer support groups and dragon boating. Data were inductively analyzed using thematic analysis.

Results: Categories surrounding physical, psychological, social and community features were identified with several themes emerging within each. Advantages of dragon boating included opportunities to get a combination of physical, psychosocial and community benefits; health improvement and behavior change; and obtaining social support without the focus being on cancer. Peer support groups were identified as having advantages for forming relationships and avoiding barriers associated with physical activity.

Conclusions: While neither type of program meets all needs, practical considerations are identified for incorporating advantages of both programs to improve participation.

• Implications for rehabilitation

• Further understanding of perceptions, and attractions and challenges to taking part in group programs will inform development of accessible programs that target multiple rehabilitation needs.

• Physical activity can provide a positive, alternative focus that takes the emphasis off of cancer, which is more accessible to some survivors.

• Physical activity also provides opportunities to build relationships around a common, positive goal, which can be a foundation for providing support for coping with cancer.

     

肺癌幸存者体力活动的研究进展

本文对肺癌幸存者体力活动相关研究进行综述。研究表明,肺癌患者体力活动可降低肺癌风险、改善心肺和疲劳状况、提高生存率、改善生活质量及改善睡眠等。其影响因素主要包括:疾病相关、生活习惯、医务人员引导及其他相关因素。临床常采用6分钟步行距离、国际体力活动问卷、生活质量核心问卷、肺癌治疗功能评价表等相关的测量工具评估肺癌患者体力活动。为肺癌幸存期的患者制定运动安全策略,选择理想的运动方案,关注肺癌患者运动障碍因素及需求,是完善肺癌幸存者体力活动最佳活动处方,可为制定有效的体力活动计划提供一定的参考和借鉴。     

Use of a tool to determine perceived barriers to children's healthy eating and physical activity and relationships to health behaviors

This pilot investigation assesses whether barriers to children's healthy eating and physical activity reported by parents on a newly developed brief pediatric obesity screening and counseling tool are related to healthy eating and physical activity behaviors. The sample included parents of 115 Medicaid-enrolled children in a general pediatric clinic. Of 10 barriers, 7 were statistically associated with parent-reported behaviors with odds ratios (ORs) ranging from 0.6 to 9.4. Relationships remained significant when child characteristics were controlled in the analysis. Although additional testing is needed, the tool provides clinicians with an approach to identify barriers and behaviors for targeted counseling.     

Determinants of adherence to exercise in women treated for breast cancer

We describe adherence to a three group randomised controlled trial that involved aerobic exercise therapy (N=34) and exercise-placebo intervention (N=36) or usual care (N=38) in women treated for breast cancer. We also investigated relationships between routes of trial recruitment, socio-economic characteristics, health behaviours, cancer treatment regimen(s) and subsequent adherence to the interventions. Women who had completed breast cancer treatment 12-36 months previously were randomised to one of the groups. The intervention groups attended an exercise facility three times per week for eight weeks. A total of 77% of the aerobic exercise therapy and 88.9% of the exercise-placebo groups attended at least 70% of prescribed sessions. The percentage of women achieving 30min of aerobic exercise per session steadily increased during the intervention but many women were not able to achieve this goal. Routes of trial recruitment, socio-economic characteristics, health behaviours and cancer treatment regimen(s) were not related to intervention. Exercise therapy participants were able to comply with the progressive nature of the aerobic exercise intervention, although some women were not able to achieve 30min of aerobic exercise per session by intervention completion. Research is still required to tease out all the potential determinants of exercise in this population.     

Lifestyle physical activity of older rural women

The purpose of this study was to describe and examine the lifestyle physical activity behaviors (household, leisure, occupational) of older rural women. Background characteristics included demographics, environment, social support, and health. Intrapersonal characteristics included motivation and self-efficacy. The majority of the women's energy expenditure was in the household dimension. Social support was positively associated with household activities. A higher level of leisure physical activity was associated with living within the two small cities and reporting lower levels of health and lower motivation. This research highlights the importance of household physical activity and the contribution of social support for household physical activity, both of which may be important in developing interventions to promote physical activity in older rural women.     

Gender comparisons of perceived benefits of and barriers to physical activity in middle school youth

Perceived benefits of and barriers to physical activity (PA) reported by 206 middle school boys and girls in a survey were compared. Only “take care of myself, stay in shape, and be healthier” emerged as a greater benefit for girls than boys. Among students not on a sports team, boys reported fewer barriers than girls. Among those selecting an active pursuit, boys perceived more barriers than girls. When controlling for sports team participation and perceived benefits and barriers, boys reported more minutes of vigorous PA than girls. As boys and girls reported relatively similar benefits of and barriers to PA, nurse counseling with both groups can focus on the same information. Effort is particularly needed to increase PA among girls. © 2008 Wiley Periodicals, Inc. Res Nurs Health 32:163–176, 2009     

Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities

Law M, Petrenchik T, King G, Hurley P. Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities.

Objective

To comprehensively describe parent perceptions of environmental barriers to recreational, community, and school participation for children with physical disabilities.

Design

Secondary analysis of cross-sectional data gathered in the first wave of a longitudinal study of the child, family, and environmental factors affecting the recreational and leisure participation of school-age children with physical disabilities.

Setting

General community.

Participants

Parent-child pairs (N=427). Child participants included 229 boys and 198 girls with physical disabilities in 3 age cohorts (6–8, 9–11, 12–14y).

Interventions

Not applicable.

Main Outcome Measure

Craig Hospital Inventory of Environmental Factors.

Results

Barriers to participation were encountered in school and work environments (1.54±1.88), physical and built environments (1.36±1.35), within institutional and government policies (1.24±1.71), services and assistance (1.02±1.2), and attitudes and social support (.87±1.17). Age, socioeconomic status, level of physical functioning, and behavioral difficulties were related to the impact of barriers reported in certain areas. No significant differences by the sex of the children or rural versus urban community were found.

Conclusions

Parents report environmental barriers in several areas, providing valuable information about the environmental factors that support or hinder participation while showing the complexity of these issues. Future research is required to further identify potential avenues for intervention.     

Interventions to promote physical activity among African American women

The lack of routine physical activity among African American women places them at risk for negative health outcomes associated with inactivity. The number of studies focused on African American women has increased dramatically in the past decade. This review examined the intervention research literature testing strategies to increase activity among African American women. Eighteen studies with 1,623 subjects were retrieved. Diverse interventions, settings, and measures were reported. Common methodologic weaknesses included lack of randomization of subjects, single-group design, instruments without documented validity and reliability, significant attrition, and questionable timing of outcome variable measurement. Strategies to design and deliver culturally appropriate interventions are reviewed. Suggestions for future research, such as examining intragroup differences and communal resources, are provided.     

Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper

Background

Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity.

Aim

This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people.

Conclusion

A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.