Fostering positive experiences of group-based exercise classes after breast cancer: what do women have to say?

Purpose: The adverse side effects of current treatments for breast cancer highlight the need for rehabilitative programmes. Group-based exercise programmes have been found to be effective in reducing symptoms and treatment side effects and improving physical and psychological health in cancer survivors. To assist programme administrators and instructors in the ongoing design and delivery of optimal group-based exercise programmes, we conducted a longitudinal qualitative study to explore breast cancer survivors’ perceptions of the instructor and the climate the instructor created within the context of a group-based exercise programme, and how this contributes to women’s motivational experiences. Method: Seven women participating in an eight-week group-based exercise programme were interviewed at the start and end of the programme. Data were analysed using thematic analysis. Results: The instructor’s attributes (energy, enthusiasm, approachability, knowledge, experience) and her focus on promoting self-improvement, personal progress, skill development and task mastery contributed to participants’ positive experiences, which served to enhance their motivation to remain involved in the programme. Conclusions: Instructors play an essential role in creating a supportive climate and fostering positive experiences in group-based exercise programmes for breast cancer survivors. Hiring caring and knowledgeable instructors who are able to create a supportive climate may enhance breast cancer survivors’ experiences in group-based exercise programmes and promote sustained participation.

• Implications for Rehabilitation

• Promoting self-improvement, personal progress, skill development and task mastery can enhance breast cancer survivors’ adherence to group-based exercise programmes, which can help mitigate the effects of cancer and its treatment.

• In addition to training leaders to run safe and effective programmes, hiring instructors who have high energy, and who are enthusiastic, approachable, knowledgeable and experienced can promote breast cancer survivors’ adherence to group-based exercise programmes.

• Training in breast cancer management is required to allow instructors to understand the complexities of this disease and develop tailored exercise programmes.

• Future research needs to identify training techniques that can effectively promote exercise instructors’ competence in working with breast cancer survivors.

     

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.

     

Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences

Purpose: This systematic review was conducted to provide rich and deep evidence of the perceived determinants and consequences of physical activity and exercise based on qualitative research in multiple sclerosis (MS). Method: Electronic databases and article reference lists were searched to identify qualitative studies of physical activity and exercise in MS. Studies were included if they were written in English and examined consequences/determinants of physical activity in persons with MS. Content analysis of perceived determinants and consequences of physical activity and exercise was undertaken using an inductive analysis guided by the Physical Activity for people with Disabilities framework and Social Cognitive Theory, respectively. Results: Nineteen articles were reviewed. The most commonly identified perceived barriers of physical activity and exercise were related to the environmental (i.e. minimal or no disabled facilities, and minimal or conflicting advice from healthcare professionals) and related to personal barriers (i.e. fatigue, and fear and apprehension). The most commonly identified perceived facilitators of physical activity were related to the environment (i.e. the type of exercise modality and peer support) and related to personal facilitators (i.e. appropriate exercise and feelings of accomplishment). The most commonly identified perceived beneficial consequences of physical activity and exercise were maintaining physical functions, increased social participation and feelings of self-management and control. The most commonly identified perceived adverse consequences were increased fatigue and feelings of frustration and lost control. Conclusions: Results will inform future research on the perceived determinants and consequences of physical activity and exercise in those with MS and can be adopted for developing professional education and interventions for physical activity and exercise in MS.

• Implications for Rehabilitation

• Physical activity and exercise behaviour in people with multiple sclerosis (MS) is subject to a number of modifiable determinants.

• Healthcare professionals working to promote physical activity and exercise in those with MS should choose to endorse the positive benefits of participation.

• Future physical activity interventions for those with MS may be improved by incorporating behavioural management strategies.

     

Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes

Abstract

Purpose: Exercise-after-stroke programmes are increasingly being provided to encourage more physical exercise among stroke survivors, but little is known about what motivates people with stroke to participate in them. This research aimed to identify factors that motivate long-term stroke survivors to exercise, and the implications for programme design. Methods: In two separate studies, focus groups and individual interviews were used to investigate the views of long-term stroke survivors on exercise and participating in exercise programmes. Their data were analysed thematically, and the findings of the studies were synthesised. Results: Eleven stroke survivors and two partners took part in two focus groups; six other stroke survivors (one with a partner) were interviewed individually. Factors reported to influence motivation were the psychological benefits of exercise, a desire to move away from a medicalised approach to exercise, beliefs about stroke recovery, and on-going support to sustain commitment. A number of potential implications of these themes for exercise programme design were identified. Conclusions: A range of personal beliefs and attitudes and external factors may affect the motivation to exercise, and these vary between individuals. Addressing these factors in the design of exercise programmes for long-term stroke survivors may enhance their appeal and so encourage greater engagement in exercise.

• Implications for Rehabilitation

• Exercise programmes may be more attractive to long-term stroke survivors if the psychological well-being benefits of participation are emphasised in their promotion.

• Some participants will be more attracted by programmes that are de-medicalised, for example, by being located away from clinical settings, and led by or involving suitably-trained non-clinicians.

• Programmes offered in different formats may attract stroke survivors with different beliefs about the value of exercise in stroke recovery.

• Programmes should provide explicit support strategies for on-going engagement in exercise.

     

The functional exercise capacity and its correlates in obese treatment-seeking people with binge eating disorder: an exploratory study

Abstract

Purpose: The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity. Methods: Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented. Results: The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1?±?75.8?m versus 682.7?±?98.4, p?<?0.05) compared to non-obese controls. No significant differences were found between obese participants with and without BED. Participants with BED reported significantly (p?<?0.05) more musculoskeletal pain and fatigue after the walk test than obese and non-obese controls. A forward stepwise regression analysis demonstrated that sports participation and perceived physical strength explained 41.7% of the variance on the 6MWT in obese participants with BED. Conclusion: Physical activity participation, physical self-perception and perceived physical discomfort during walking should be considered when developing rehabilitation programs for obese people with BED.

• Implications for Rehabilitation

• Rehabilitation programmes in people with binge eating disorder should incorporate a functional exercise capacity assessment.

• Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers.

• Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.

     

From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke

Abstract

Purpose: Physical activity (PA) improves fitness, functioning, health and wellbeing after stroke. However, many survivors are inactive. This study explored survivors’, carers’ and physiotherapists’ beliefs about PA to identify how these support or hinder PA participation. Methods: Semi-structured in-depth interviews with community dwelling stroke survivors (n?=?38); two focus groups involving six carers each; two focus groups, respectively, involving seven and eight stroke rehabilitation physiotherapists from clinical and community settings. Data were audio-recorded and transcribed. Analysis was structured using the Framework Approach to identify themes and a dynamic, conceptual model. Findings: Desired outcomes and control over outcome achievement were key concepts. For survivors and carers, PA supported participation in valued activities, providing continuity with pre-stroke sense of self. Carers adopted motivating strategies for PA to support recovery and participation in shared activities. In contrast, physiotherapists prioritised physical and functional outcomes and viewed survivors’ control of outcomes as limited which was reflected by the support they provided. Conclusions: Individualised interventions that account for social and environmental influences on behaviour appear vital to enabling survivors to participate in meaningful physical activities. Such interventions should facilitate development of shared perspectives among physiotherapists, carers and survivors of PA and related outcomes and provide tailored strategies to facilitate PA participation.

• Implications for Rehabilitation

• Physical activity after stroke rehabilitation is important for fitness, health, functioning and well-being.

• Reasons for survivors participating or not in physical activity after stroke are complex and varied.

• Physiotherapists and carers influence survivors’ participation in physical activity but their views about how to do this do not always match, or do they always complement the views of survivors.

• Integrated approaches to supporting physical activity that account for survivors’ preferences and recognise the carers’ role should be developed and applied by physiotherapists and other health professionals.

     

The effect of ice skating on psychological well-being and sleep quality of children with visual or hearing impairment

Abstract

Purpose: Physical exercise and sports have a key role in preventing physical and psychiatric problems in children. However, children with a disability often experience difficulty participating in physical activity due to a lack of suitable opportunities. Participation in an accessible sport is particularly important for these children, but studies examining which sports are beneficial for which disability groups are rare. In this study, we assessed the effects of ice skating on the psychological well-being, self-concept, and sleep quality of children with hearing or visual impairment. Method: Forty students (20 visually impaired and 20 hearing impaired) aged 8–16 were included in a regular ice skating programme for three months. We examined the sleep quality, self-concept, and behavioural and emotional states of the children before and after participating in the programme. Results: There was a significant improvement in self-concept, behavioural and emotional problems, and sleep quality (p?<?0.05 for each) of the children with hearing impairment. Although the sleep quality (p?=?0.019) and emotional problem scores (p?=?0.000) of the visually impaired children improved; self-concept, peer relations and hyperactivity scores of these children worsened (p?<?0.05 for each). Conclusion: Ice skating is one of the popular sport alternatives that gives children the opportunity to exercise and have fun together. The results of this study revealed that regular ice skating programmes may have positive effects on the psychological well-being of children with hearing impairment. Despite some positive effects, caution must be use when including visually impaired children in ice skating programmes. Generalization of the study's outcomes is limited as the study group were residential students enrolled in special education institutions for children who are blind or deaf.

• Implications for Rehabilitation

• Ice skating is a community-based sport and a popular leisure activity that can also have benefits for people with disabilities.

• Ice skating and children with hearing impairment:

• Self-concept, behavioural and emotional problems, and sleep quality of the children with hearing impairment significantly improved after ice skating.

• Ice skating programmes may be considered as a rehabilitation alternative for children with hearing impairment.

• Ice skating and children with visual impairment:

• Caution must be use when including children with visual impairment in ice skating programmes because of possible negative psychological outcomes.

• Balance exercises before starting the practices on ice should be considered for preventing some possible negative outcomes in children with visual impairment.

     

Promoting physical activity in rheumatoid arthritis: a narrative review of behaviour change theories

Abstract

Purpose: Despite physical activity having significant health benefits for people with rheumatoid arthritis (RA), current levels of physical activity in this population are suboptimal. Changing behaviour is challenging and interventions aimed at increasing physical activity in this context have had varying levels of success. This review provides an overview of common behaviour change theories used in interventions to promote physical activity and their application for promoting physical activity in people with RA. Method: A scoping, narrative review was conducted of English language literature, using the search terms “physical activity/exercise” and keywords, which are associated with behaviour change interventions. The theoretical basis of such interventions in people with RA was assessed using the “theory coding scheme”. Results: Six theories which have been used in physical activity research are discussed. Further, four studies which aimed to increase physical activity levels in people with RA are explored in detail. Conclusions: To date, behaviour change interventions conducted in RA populations to increase physical activity levels have not had a strong theoretical underpinning. It is proposed that an intervention utilising the theory of planned behaviour is developed with the aim of increasing physical activity in people with RA.

• Implications for Rehabilitation

• Interventions to promote physical activity in the rheumatoid arthritis (RA) population have failed to change participants' behaviour.

• A small number of studies have used behaviour change theories in the development and delivery of interventions.

• The theory of planned behaviour is recommended as the theoretical basis for an intervention to promote physical activity in the RA population.

     

Knowledge mobilization regarding activity and exercise after spinal cord injury: a Canadian undergraduate curriculum scan

Purpose: The purpose of this study was to conduct a curriculum scan of Canadian undergraduate university programs to determine the relative emphasis placed on the activity and exercise after spinal cord injury (SCI), in the context of physical disability studies. Method: Eighty-three Canadian Universities were evaluated for courses discussing: (i) general information about SCI, (ii) physical activity and exercise after SCI, (iii) general information about other physical disabilities and (iv) physical activity and exercise for such disabilities. Online course calendars (2009) were scanned, and their accuracy was verified by instructors or administrative assistants. Results: The curriculum scan revealed 113 courses that discuss physical disability. Seventy-four of these courses cover information regarding SCI, 47 of which include content relating to activity and exercise. In comparison, 104 courses discuss other physical disabilities, 76 of which cover material related to activity and exercise. Further, the 47 courses that cover activity and exercise after SCI are only offered in 22 Canadian Universities, and only 31 are mandatory for a degree. Conclusions: A substantial number of future healthcare professionals lack exposure to material regarding activity and exercise after SCI during their undergraduate education. This curricular oversight likely contributes to ineffective exercise strategies and the relative inactivity of the SCI population.

Implications for Rehabilitation

• Individuals with spinal cord injury are relatively inactive due to the many physical, psychological and social barriers they face regarding activity and exercise participation.

• Effective knowledge mobilization regarding activity and exercise after SCI to future healthcare providers is an essential step in promoting participation.

• This undergraduate curriculum scan showed that students lack exposure to issues regarding the activity and exercise after SCI in Canadian Universities.

• The lack of effective knowledge mobilization in this area likely contributes to the low levels of activity and exercise participation in the SCI population.

     

Association between mental health and physical activity in patients with chronic heart failure

Abstract

Purpose: Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. Methods: We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (≥68 points) group (n?=?148) and poor-MH (<68 points) group (n?=?95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. Results: PA correlated positively with MH in all patients (steps: r?=?0.46, p?<?0.001; EE: r?=?0.43, p?<?0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1?±?280.7 versus 7174.1?±?221.5 steps, p?<?0.001; 133.9?±?10.8 versus 215.9?±?8.4?kcal, p?<?0.001). Cut-off values of 5590.8 steps and 141.1?kcal were determined as PA target values associated with improved MH. Conclusions: Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.

• Implications for Rehabilitation

• Poor mental health may negatively affect physical exercise in CHF outpatients.

• In particular step counts and energy expenditure are lower in those with poor mental health.

• It may be that focused exercise training may impact positively both on mental health and physical well being.

     

Individualized vs. group exercise in improving quality of life and physical activity in patients with cardiac disease and low exercise capacity: results from the DOPPELHERZ trial

Purpose: Important goals of cardiac rehabilitation maintenance programs (CMP) are to increase leisure time physical activity (LTPA) and improve health-related quality of life (HRQoL). Elderly patients with cardiac disease and low exercise capacity are simultaneously the most severely affected and have the most to gain from exercise-based rehabilitation. Individualized combined exercise (ICE) may be an effective modality to achieve these goals. We compared six months of ICE to CMP in their effects on LTPA and HRQoL.

Methods: Sixty patients (70?±?9 years, 39% female) with cardiac disease and low exercise capacity (<6 MET) were randomly allocated to six months of once-weekly ICE or CMP. The patients in ICE performed moderate endurance and resistance exercise on machines, based on intensities from individual peak exercise testing. Patients in CMP performed weekly sessions of calisthenics, flexibility, coordination and relaxation activities. LTPA and HRQoL were assessed with accelerometry and questionnaires at baseline and six months.

Results: Sixty patients completed the trial. ICE increased vigorous PA (ICE: Δ?+?12 MET-min/d, CMP: Δ –5 MET-min/d, p?=?.02) and steps per day (ICE:?+1586 steps/d, CMP: –838 steps/d, p?p?Conclusions: ICE resulted in significant improvements in physical activity levels and health related quality of life in moderate to high-risk patients compared to CMP.

• Implications for rehabilitation

• Relatively low volumes and intensities of exercise may lead to substantial improvements in both physical activity levels and health-related quality of life

• Exercise modes in cardiac rehabilitation maintenance programs should not be limited to calisthenics and large group-based exercise

• Supplemental resistance exercise may improve health-related quality of life and increase physical activity levels in patients with low exercise capacity

• Moderate to high-risk elderly patients also benefit from individualized endurance-resistance exercise

     

Are patients 1 year post-stroke active enough to improve their physical health?

Purpose: This study aimed to quantify physical activity one year post-stroke ? by means of a multifaceted approach combining absolute, relative, and self-reported measures of physical activity (PA) ? and to investigate their mutual associations. The determinants of PA were explored. Method: Daily PA was measured in 16 mildly disabled stroke patients (median RMA-GF score of 12 (IQR?=?10–12.5)) using a heart rate monitor, a pedometer, the Baecke Physical Activity Questionnaire and the Physical Activity Scale for individuals with physical disabilities. Potential determinants were age, gender, functional mobility, peak exercise capacity, mood, participation and hours of daylight. Results: On average, stroke participants had a good baseline level of activity (44?±?39?min/day spent moderate active, 6428?±?4117 steps/day), but only three (19%) performed more than 10,000 steps/day, required for health benefits. Functional mobility, cardiorespiratory fitness, mood and participation were related to the total daily steps, but not to the time spent in moderate intense activities. Discrepancies between absolute (frequency and duration) and relative (intensity) measures of PA exist regarding the achieved quantity and its potential determinants. Conclusions: It is not only important to be active, but to be active enough to improve health. Health recommendation for stroke survivors to perform moderate intense PA needs to be translated into a pedometer-based step goal.

Implications for Rehabilitation

• On average, stroke survivors had a good baseline level of physical activity (PA), but only some reached a level which could improve their physical health.

• Health recommendations for stroke survivors on amount of moderate intense PA should be translated into a pedometer-based step goal.

     

The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis – a mixed methods study

Purpose: Understanding motivational factors related to physical activity (PA) maintenance is essential in promoting long-term exercise benefits. This study explored the impact of self-efficacy (SE) on post-intervention PA maintenance in patients with hip osteoarthritis. Method: An SE-theory based mixed-methods sub-study of a trial investigating the effects of 4 months supervised exercise in patients with hip osteoarthritis. Questionnaire data (n?=?52; baseline and 12 months) on PA and SE (Arthritis Self-Efficacy Scale, ASES, score-range 10–100) were analysed (Mann–Whitney test) for differences in characteristics of maintainers and non-maintainers. Semi-structured individual interviews (n?=?15; at 12-months follow-up) were analysed using directed content analysis. Results: Compared to non-maintainers (n?=?9; 17%) maintainers (n?=?31; 60%) had improved (p?Conclusion: SE contributes to understanding of post-intervention PA maintenance in patients with hip osteoarthritis. However, disease-related factors and clinical trial participation appears significant too.

• Implications for Rehabilitation

• Patients’ perceived self-efficacy for physical activity contributes to the understanding of post-intervention physical activity maintenance in patients with hip osteoarthritis.

• Practitioners may benefit from incorporating the self-efficacy theory in the planning and execution of exercise interventions to promote post-intervention physical activity maintenance and long term health benefits.

• Post-intervention physical activity maintenance may be increased by focussing on the patients’ exercise self-efficacy through verbal persuasion and support, disease-specific information and information on normal physiological responses to exercise combined with an individualised training progression to support experiences of success and achievement of desired outcomes.

     

Benefits and barriers to physical activity for individuals with disabilities: a social-relational model of disability perspective

Abstract

Purpose: To provide a qualitative overview of selected research on physical activity (PA) engagement by people with physical disabilities from a social relational model perspective. Method: Selected articles that exemplify some of the paradoxes, nuances, contrasting perspectives and complexities of the knowledge base in this area are discussed within a disability studies framework. Results: PA is arguably more important for people with disabilities relative to people without disabilities although they are quite inactive. Individuals who are physically activity enjoy a range of benefits spanning physiological, emotional, cognitive and social categories. Unfortunately many people cannot enjoy the benefits of PA because of the many medical, psychological, social and environmental barriers they face making PA quite difficult. Conclusions: Rehabilitation professionals can provide a better standard of care to clients if they are aware of the benefits and barriers of PA.

• Implications for Rehabilitation

• Rehabilitation professionals should understand behavior change strategies and their application to people with disabilities in order to help their clients initiate and maintain physical activity (PA).

• Rehabilitation professionals should be aware of how they might convey low PA expectations to their clients and simultaneously understand the unique challenges faced by their clients in attempting to incorporate PA into their lives on a regular basis.

• Rehabilitation professionals should be familiar with local disability friendly exercise facilities and adapted sport programs in order to steer their clients towards such opportunities.

     

A qualitative exploration of the impact of a 12-week group exercise class for those moderately affected with multiple sclerosis

Purpose: The evidence base to support therapeutic exercise for people with multiple sclerosis (MS) is improving; however few studies have considered the patients’ perspective. This study aimed to explore the experiences and views of people moderately affected with MS following participation in a 12-week exercise programme. Method: Twenty people with MS participated in a group exercise class. Subsequently, four men and ten women took part in one of two focus groups. Semi-structured questions were used to elicit participants’ views on the exercise class, outcomes from exercise and the exercise class and any perceived facilitators or barriers to exercise. Data were analysed using a general inductive method. Results: Benefits to participating in exercise for those with MS included social support and symptom improvement. Psychosocial factors, symptoms and lack of service emerged as exercise barriers. Three inter-related themes emerged; (1) The exercise class developed as a bridge to allow participants to realise, (2) the benefits of the class, helping them to overcome and (3) barriers to exercise. Conclusion: Taking part in an exercise class was a positive experience for people with MS. Healthcare professionals should work with exercise professionals to provide feasible exercise opportunities to help those with MS benefit from therapeutic exercise.

Implications for Rehabilitation

• People moderately affected with multiple sclerosis (MS) feel group exercise offers symptom improvement and social benefits.

• MS-related symptoms and a lack of service options may prevent those with MS exercising.

• Physiotherapists should work alongside exercise professionals to establish exercise services for those with MS.

     

The intention to exercise and the execution of exercise among persons with multiple sclerosis – a qualitative metasynthesis

Purpose: This review was designed as a qualitative metasynthesis aiming to identify factors influencing the intention to exercise and the execution of exercise among persons with multiple sclerosis (PwMS). Method: Based on principles laid out by Sandelowski and Barroso, this qualitative metasynthesis started with a systematic literature search for studies of PwMS’s experiences relating to exercise in the following databases: CINAHL, Rehabilitation and Sports Medicine Source, PubMed, Web of Science and Psychology & Behavioral Science. The metasynthesis procedure also included critical appraisal using the Consolidated Criteria for Reporting Qualitative Research checklist, and integrating synthesis of the articles’ findings. Results: The metasynthesis included nine articles. Factors identified as influencing intention to exercise and the execution of exercise included social support, professional support and outcome expectations. Strong relationships between these three themes were detected for the intention to exercise, the execution of exercise or both among PwMS. Conclusions: The present metasynthesis offers a comprehensive understanding of factors influencing the intention to exercise and the execution of exercise among PwMS. Our findings reveal that health professionals influence the part of the process where PwMS enter the exercise setting, as well as the PwMS’s intention to exercise.

• Implications for Rehabilitation

• Social support, professional support and outcome expectations are potential facilitators and barriers for the intention to exercise and the execution of exercise among PwMS.

• Health professionals specializing in MS rehabilitation can influence the intention and the execution of physical exercise among PwMS when there exists a personal and supportive patient–professional relationship.

• Outcome expectations may impact the motivational and volitional phases of physical exercise.

     

Exercise therapy improves both mental and physical health in patients with major depression

Abstract

Purpose: to present clinical guidelines for exercise therapy in depressed patients derived from recent meta-analyses. Method: four meta-analyses on effects of physical exercise on mental and physical in depression were analysed. Results: For mild to moderate depression the effect of exercise may be comparable to antidepressant medication and psychotherapy; for severe depression exercise seems to be a valuable complementary therapy to the traditional treatments. Depression is associated with a high incidence of co-morbid somatic illnesses, especially cardiovascular diseases, type 2 diabetes and metabolic syndrome. Exercise is extremely powerful in preventing and treating these diseases. Physical exercise is an outstanding opportunity for the treatment of patients who have a mix of mental and physical health problems. Exercise therapy also improves body image, patient s coping strategies with stress, quality of life and independence in activities of daily living in older adults. Conclusions: Physical therapists should be aware, that several characteristics of major depression (e.g. loss of interest, motivation and energy, generalised fatigue, a low self-worth and self-confidence, fear to move, and psychosomatic complaints) and physical health problems interfere with participation in exercise. Therefore, motivational strategies should be incorporated in exercise interventions to enhance the patients' motivation and adherence in exercise programs.

• Implications for Rehabilitation

• For mild to moderate depression, the effect of exercise may be comparable with antidepressant medication and psychotherapy; for severe depression, exercise seems to be a valuable complementary therapy to the traditional treatments.

• Exercise therapy also improves physical health, body image, patient’s coping strategies with stress, quality of life, and independence in activities of daily living in older adults.

• Motivational strategies should be incorporated in exercise interventions to enhance the patients’ motivation.

     

The relationship between physical activity and health status in patients with chronic obstructive pulmonary disease following pulmonary rehabilitation

Aim: To investigate the relationship between physical activity (PA) and measures of health-related quality of life (HRQoL) and hospital admissions in people with chronic obstructive pulmonary disease (COPD) following pulmonary rehabilitation (PR). Method: CINAHL, Medline, PubMed, AMED, PsycINFO and Cochrane Library (database inception to July 2014) were searched. Relevant outcomes included relationships between PA and HRQoL, lung function (forced expiratory volume in one?second, FEV₁) and/or hospital admission. Six quantitative and 11 qualitative studies were included and Harden’s method of data synthesis in a mixed-methods systematic review was applied. Results: Six months following PR, increase activity levels was associated with improvement of 62m in 6MWD, 2.31 and 15.55 points increase in SGRQ and CRDQ total scores, respectively, 1.3% FEV₁ and reduced dyspnoea. No study reported on hospital admission. Reported relationships were facilitated by healthcare professionals, social supporters, motivation and encouragement, reduced fear and seeing benefits and hindered by changing physical health, environment, lack of motivation, fear and social isolation. Conclusion: The associations between increased levels of PA and quality of life, respiratory function and dyspnoea are largely based on 6MWD and PA questionnaires. Objective measurement of free living activity in exercise maintenance phase is required along with participants’ views.

• Implications for rehabilitation

• Pulmonary rehabilitation (PR) is a non-therapeutic intervention in which a team of multidisciplinary health care professionals use individually tailored supervised exercise training, self-management education, psychological and social support to optimize the physical and social performance and autonomy of patients with chronic respiratory impairment. Initial benefits from PR decline after program completion.

• Clinical guidelines advocate increase exercise and activity in sustaining initial benefits of PR. Following PR, increased levels of physical activity in people with COPD undertaking exercise maintenance programmes are positively related with improvements in exercise capacity, quality of life and dyspnoea.

• Barriers to activity participation in exercise maintenance programmes, which need to be overcome, are fear, lack of motivation, environmental factors, such as social isolation and changes in physical health. Rehabilitation professionals and social supporters can make rehabilitation more long-lasting and facilitate people with COPD to participate in activity by motivating and encouraging them, reducing their fears and reinforcing the benefits of activity participation.