Factors influencing the exercise behaviour of patients

The sports physician faces major practical problems in stimulating the activity of sedentary patients, and also ensuring their subsequent adherence to a prescribed exercise regimen. Both individual and society bear some responsibility for poor exercise compliance. Patients are most likely to persist with programmes which are well-adapted to their physical, physiological, psychological and socioeconomic characteristics. The quality of leadership is also an important variable. Open-ended and structured questionnaires suggest that motivations to exercise include the improvement of health, the development of fitness, the control of bodyweight as well as an improvement in personal appearance, socialising, and simply a wish to 'feel better'. The main perceived reason why people 'drop out' of formal exercise classes is through lack of time, although often the individuals making this complaint appear to have substantial free time. Personality characteristics of the adherent depend on the type of programme that is offered and the degree of social support that is provided; extraversion, a high self-esteem and self-motivation are common findings. Modelling of exercise behaviour has drawn upon the concepts of Skinner, Becker and most recently Fishbein. Beliefs and their evaluation seem more influential than subjective norms, although exercise behaviour is also heavily influenced by past experience of physical activity. Programmes should be designed to maximise external reinforcement of the exercise habit until the early discomforts of training are overcome, and the patient discovers the internal rewards of a more active lifestyle.     

Factors associated with physical activity in Canadian adults with diabetes

INTRODUCTION: The purpose of this study was to identify key demographic and health factors associated with physical activity (PA) participation in adults with type 1 or type 2 diabetes. METHODS: Participants were adults > or = 18 yr of age living in the province of Alberta, Canada who were previously diagnosed with type 1 (N = 697) or type 2 (N = 1614) diabetes. Individuals were recruited from the Canadian Diabetes Association (Alberta) registry and through a random digit-dialing protocol. Multiple and logistic regression models were employed to identify demographic and health factors related to PA levels, of which many to date have not been examined in this population. Analyses were conducted separately for type 1 and type 2 groups. RESULTS: Of those with type 1 and type 2 diabetes, 63.7 and 71.9%, respectively, were not achieving recommended PA levels. For those with type 1, higher PA levels were associated with a younger age, being single, higher income, lower level of perceived disability, and not smoking. For the type 2 group, a younger age, male gender, higher education, higher income, lower body mass index, and lower level of perceived disability were associated with higher PA levels. CONCLUSIONS: Many of our results for both diabetes types are consistent with findings from other limited research in this domain. Contrary to previous research, however, a significant negative relationship was reported between body mass index and PA for the type 2 group. In addition, perceived disability was negatively associated with PA, which, to date, has not been reported in the literature with type 2 individuals. Research and practice related to physical activity promotion for this population should take into account specific demographic and health factors associated with PA.     

Factors associated with physical activity among young adults with a disability

The purpose of this study was to examine: (1) total physical activity and (2) the relative importance of functioning and disability, environmental and personal factors for total physical activity among young adults with a disability. The International Classification of Functioning, Disability and Health developed by the World Health Organization was used as a structural framework for a cross‐sectional survey, based on a questionnaire. The population studied was 327 young adults (age 18–30) with a disability who were members of interest organizations for persons with disabilities. Using an adapted version of the self‐administered short form of International Physical Activity Questionnaire (IPAQ), the sample reported some differences in physical activity related to the type and the onset of disability. Linear regression analyses revealed that personal factors demonstrated more power in explaining the variance in physical activity than both the environmental factors and factors related to functioning and disability. As for the able‐bodied, intrinsic motivation and identity as an active person were the factors most strongly associated with physical activity behavior. This should have important consequences for how professionals try to motivate people with disabilities for physical activity, and how they plan and implement rehabilitation.     

Chronic physical exercise reduces anxiety-like behavior in rats

While many individuals with anxiety disorders receive drug therapy, many do not respond or adversely respond to drugs. An alternative treatment, exercise, has been shown to relieve negative feelings and induce positive shifts in mood. The purpose of this study was to establish an animal model to specifically test the effects of chronic physical exercise on anxiety-related behaviors. Thirty-two male Sprague Dawley rats were divided into two groups: runners (R) and nonrunners (NR). Runners ran on a treadmill for 45 minutes a day, five days a week, for ten weeks at a moderate intensity. Nonrunners remained in their cages in the treadmill room during the running period and were handled for an equal amount of time. After ten weeks of training, two behavioral tests were administered including the elevated plus maze and open field tests. Results comparing R and NR showed higher responses by R in percent open arm time and center square time during the elevated plus maze test, as well as in number of entries into the center, number of rears, and lower fecal boli count during the open field test, p < 0.05. In addition, there were no differences in total activity levels between groups as indicated by similar closed arm entries in the elevated plus maze test and total lines crossed in the open field test. These results indicate that treadmill training reduces anxiety-like behaviors in two animal tests of anxiety, without a significant change in total activity levels. These data are in support of treadmill training as a model to test the anxiolytic effects of exercise.     

Factors affecting levels of physical activity in adults

A large proportion of adults in Western cultures are physically inactive, despite several decades of warnings about the potentially negative health consequences of a sedentary lifestyle. Efforts to promote physical activity have focused on identifying its determinants and designing interventions that might effectively promote regular physical activity. The multitude of factors that induce adults to initiate and maintain programmes of physical activity have been divided into those that are invariable (age, gender, race, ethnicity) and those that are presumed to be modifiable (behavioural and personality characteristics, environmental circumstances and community settings). The lack of consistency in the design, analysis and reporting of interventions in the lives of inactive or sedentary individuals has produced equivocal results. However, several social and environmental factors have systematically emerged as determinants of physical activity in adults. In ethnic minorities, the removal of barriers such as unaffordable facilities and unavailable childcare, high crime rates, fear for personal safety and culturally inappropriate activities are of primary importance. Social support from family, peers, communities and healthcare providers has resulted in modest improvements across cultures, ages and genders in selected settings, but the definition of specific interventions and their outcomes deserve additional attention. Longitudinal studies indicate that components of physical fitness are relatively transitory, with low to modest correlations between physical activity and measures of physical fitness in childhood and adolescence and in adulthood. Attempts to explain the activity behaviour of adults by applying various theories in programmes of intervention have also produced mixed results. Successful interventions tailor programmes to individual needs, account for personal levels of fitness, allow for personal control of the activity and its outcomes, and provide for social support by family, peers and communities. The initiation and maintenance of regular physical activity in adults depends on a multitude of biological and sociocultural variables that demand attention across the lifespan.     

Factors associated with exercise adherence among older adults. An individual perspective

This paper reviews the literature concerning factors at the individual level associated with regular exercise among older adults. Twenty-seven cross-sectional and 14 prospective/longitudinal studies met the inclusion criteria of a mean participant age of 65 years or older. The findings are summarised by demographics, exercise experience, exercise knowledge, physiological factors, psychological factors, activity preferences and perceived social influences. In general, education and exercise history correlate positively with regular exercise, while perceived physical frailty and poor health may provide the greatest barrier to exercise adoption and adherence in the elderly. Social-cognitive theories identify several constructs that correlate with the regular exercise behaviour of older adults, such as exercise attitude, perceived behavioural control/self-efficacy, perceived social support and perceived benefits/barriers to continued activity. As well, stage modelling may provide additional information about the readiness for regular exercise behaviour among older adults. However, relatively few studies among older adults exist compared with middle-aged and younger adults. Further, the majority of current research consists of cross-sectional designs or short prospective exercise trials among motivated volunteers that may lack external validity. Future research utilising longitudinal and prospective designs with representative samples of older adults will provide a better understanding of significant causal associations between individual factors and regular exercise behaviour.     

Health-related and sociodemographic correlates of meeting the muscle strengthening exercise recommendations in middle-aged and older adults with and without disabilities

Sport Sciences for Health - To identify sociodemographic and health correlates of meeting the muscle strengthening (MS) exercise recommendations in middle-aged and older adults by disability...     

Factors influencing the variations of ejection fraction during exercise in chronic aortic regurgitation

The influence of left ventricular volume variations and regurgitant fraction variations upon left ventricular ejection fraction during exercise was examined using equilibrium radionuclide angiography in patients suffering from aortic regurgitation. Ejection fraction (EF), regurgitant fraction (RF), end diastolic volume (EDV) and end systolic volume (ESV) variations from rest to peak exercise were determined in 44 patients suffering from chronic aortic regurgitation (AR) and in 8 healthy volunteers (C). In C, EF increased (+0.10 +/- 0.03, P less than 0.01) and ESV decreased significantly (-23% +/- 12%, P less than 0.01), RF and EDV did not vary significantly. In AR patients, EF, EDV and ESV did not vary significantly because of important scattering of individual values. Changes in EF and ESV were inversely correlated (r = -0.79, P less than 0.01) and RF decreased significantly (-0.12 +/- 0.10, P less than 0.01). Volumes and EF changes during exercise occurred in three different ways. In a 1st subgroup of 7 patients, EF increased (+0.09 +/- 0.03, P less than 0.05) in conjunction with a reduction of ESV (-24% +/- 12%, P less than 0.05) without a significant change in EDV. In a 2nd group of 22 patients, EF decreased (-0.04 +/- 0.07, P less than 0.01) in association with an increase in ESV (+17% +/- 16%, P less than 0.01) and no change in EDV. In a 2nd group of 22 patients, EF decreased (-0.04 +/- 0.07, P less than 0.01) in association with an increase in ESV (+17% +/- 16%, P less than 0.01) and no change in EDV. In a 3rd subgroup of 15 patients, EF decreased (-0.02 +/- 0.06, P less than 0.01) despite a reduction in ESV (-7% +/- 6%, P less than 0.01) because of a dramatic EDV decrease (-10% +/- 6%, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors influencing the variations of ejection fraction during exercise in chronic aortic regurgitation

The influence of left ventricular volume variations and regurgitant fraction variations upon left ventricular ejection fraction, during exercise was examined using equilibrium radionuclide angiography in patients suffering from aortic regurgitation. Ejection fraction (EF), regurgitant fraction (RF), end diastolic volume (EDV) and end systolic volume (ESV) variations from rest to peak exercise were determined in 44 patients suffering from chronic aortic regurgitation (AR) and in 8 healthy volunteers (C). In C, EF increased (+0.10±0.03, P<0.01) and ESV decreased significantly (-23%±12%, P<0.01) RF and EDV did not vary significantly. In AR patients, EF, EDV and ESV did not vary significantly because of important scattering of individual values. Changes in EF and ESV were inversely correlated (r=-0.79, P<0.01) and RF decreased significantly (-0.12±0.10, P<0.01). Volumes and EF changes during exercise occurred in three different ways. In a 1st subgroup of 7 patients, EF increased (+0.09±0.03, P<0.05) in conjunction with a reduction of ESV (-24%±12%, P<0.05) without a significant change in EDV. In a 2nd group of 22 patients. EF decreased (-0.04±0.07, P<0.01) in association with an increase in ESV (+17%±16%, P<0.01) and no change in EDV. In a 3rd subgroup of 15 patients, EF decreased (-0.02±0.06, P<0.01) despite a reduction in ESV (-7%±6%, P<0.01) because of a dramatic EDV decrease (-10%±6%, P<0.05). In this subgroup, changes in EF were inversely correlated with changes in ESV (r=-0.55, P<0.01) and positively related to EDV variations (r=0.42, P=0.02). EDV related to EDV variations (r=0.42, P=0.02). EDV changes were weakly, but significantly, correlated to RF decrease (r=0.39, P<0.05). We conclude that changes in left ventricular ejection fraction during exercise in patients with chronic aortic regurgitation are significantly related in some patients to changes in ventricular loading conditions as well as contractile state. Therefore, a correct interpretation of EF changes during exercise requires the simultaneous determination of changes in LV volumes.Abbreviations EDV end diastolic volume - EF ejection fraction - ESV end systolic volume - LV left ventricle - RV right ventricle     

下体负压联合体育锻炼对运动耐力及体能的影响

目的：研究制定适合疗养期间高性能战斗机飞行员进行专项下体负压和体能训练方案。方法：24名健康男性随机分为3组。体育锻炼组连续2周进行力量锻炼;下体负压锻炼组利用倾斜床进行下体负压锻炼。联合锻炼组每天以上述两种不同的锻炼方式进行复合锻炼。锻炼前后进行运动耐力及体能测试。结果：体育锻炼联合下体负压锻炼组锻炼10d后PWC170／kg、最大耗氧量显著提高,肌肉爆发力及静肌力指标较锻炼前显著提高（P〈0．05）;单纯体育锻炼组平板卧推、负重蹲起、30m冲刺跑、15m蛙跳成绩较锻炼前显著提高（P〈0．05）,单纯下体负压组仅平板卧推及15m蛙跳成绩较锻炼前显著提高（P〈0．05）。结论：体育锻炼联合下体负压锻炼10d后可明显提高受试者运动耐力及下肢、腰腹肌肉爆发力及静肌力。     

Physical activity patterns of African-American women with physical disabilities

There is a dearth of research on the exercise and activity patterns of persons with disabilities, particularly minority women with disabilities. This lack of information makes it difficult for public health officials to set policy guidelines for this segment of the population. PURPOSE: The purpose of this study was to survey the exercise and activity patterns of African-American women with severe physical disabilities (N = 50). METHODS: The Physical Activity and Disability Survey (PADS) was created for subjects who have a severe limitation in movement and function (e.g., limited ability to stand or walk, needs an assistive aid to ambulate, needs assistance with activities of daily living). Reliability data were obtained on the PADS for interrater, test-retest, and internal consistency on the two subscales (Exercise and Activity). The Exercise subscale had an interrater reliability of 0.83 and test/retest reliability of 0.85. The Activity subscale had an interrater reliability of 0.68 and test/retest reliability of 0.66. Cronbach's alpha for internal consistency was 0.78 for the Exercise subscale and 0.68 for the Activity subscale. RESULTS: Results showed very low levels of exercise and general activity patterns in African-American women with physical disabilities. Only 8.2% of the sample participated in leisure-time physical activity, and only 10% engaged in aerobic exercise three or more days per week for at least 15 min. Unstructured physical activity (e.g., work-related activity, housework, gardening, shopping) was nearly absent. CONCLUSION: Our data suggest that the extremely low levels of self-reported physical activity in African-American women with severe physical disabilities expose them to a higher risk of secondary health conditions.     

Association of sedentary and physical activity time with maximal fat oxidation during exercise in sedentary adults

The present work examines the relationships of objectively measured sedentary time and physical activity (PA) with maximal fat oxidation during exercise (MFO) and the intensity of exercise that elicits MFO (Fat_max), in young and middle-aged men and women. A total of 121 young sedentary adults (81 women, age 22.1 ± 2.1 years, body mass index 25.2 ± 4.9 kg/m²) and 70 middle-aged sedentary adults (36 women, age 53.4 ± 4.9 years, body mass index 26.8 ± 3.8 kg/m²) participated in this cross-sectional study. PA was objectively assessed using a wrist-worn accelerometer for 7 consecutive days. Wrist accelerations were classified into sedentary time and PA of different intensity (light, moderate, vigorous, moderate-vigorous), taking into account age-specific cut-offs. MFO and Fat_max were determined for all subjects by indirect calorimetry, using a walking graded exercise test. No association was found between any of the sedentary time-related variables and MFO (all P ≥ .05). However, several sedentary time-related variables were related to FAT_max in young men and women (all P ≤ .04). A positive relationship was also detected between PA and MFO in young and middle-aged women (P ≤ .05), although this became non-significant after adjustment for cardiorespiratory fitness (P > .05). The present results suggest that, depending on the characteristics of the study cohort, sedentary time, and PA time may be related to MFO and FAT_max during exercise. Future longitudinal and intervention studies are warranted to better understand the role of sedentary time and PA in metabolic flexibility during exercise.     

Factors influencing the restoration of fluid and electrolyte balance after exercise in the heat.

Maintenance of fluid balance is a major concern for all athletes competing in events held in hot climates. This paper reviews recent work relating to optimisation of fluid replacement after sweat loss induced by exercising in the heat. Data are taken from studies undertaken in our laboratory. Issues investigated were drink composition, volume consumed, effects of consuming food with a drink, effects of alcohol in rehydration effectiveness, voluntary intake of fluid, and considerations for women related to the menstrual cycle. The results are presented as a series of summaries of experiments, followed by a discussion of the implications. The focus of this review is urine output after ingestion of a drink; fluid excreted in urine counteracts rehydration. Also included are data on the restoration of plasma volume losses. Ingestion of large volumes of plain water will inhibit thirst and will also promote a diuretic response. If effective rehydration is to be maintained for some hours after fluid ingestion, drinks should contain moderately high levels of sodium (perhaps as much as 50-60 mmol/l) and possibly also some potassium to replace losses in the sweat. To surmount ongoing obligatory urine losses, the volume consumed should be greater than the volume of sweat lost. Palatability of drinks is important in stimulating intake and ensuring adequate volume replacement. Where opportunities allow, the electrolytes required may be ingested as solid food consumed with a drink. There are no special concerns for women related to changes in hormone levels associated with the menstrual cycle. Ingestion of carbohydrate-electrolyte drinks in the post-exercise period restores exercise capacity more effectively than plain water. The effects on performance of an uncorrected fluid deficit should persuade all athletes to attempt to remain fully hydrated at all times, and the aim should be to start each bout of exercise in a fluid replete state. This will only be achieved if a volume of fluid in excess of the sweat loss is ingested together with sufficient electrolytes.     

Factors explaining the physical activity of young adults: the importance of early socialization

As a part of the large project Cardiovascular Risk in Young Finns, the purpose of the present study was to examine how adult physical activity is influenced by early physical activity and current social and health-related factors. A total of 2411 children and adolescents aged 9, 12, 15 and 18 years were randomly selected from five university towns and their rural surroundings in 1980. They were followed up for 12 years by means of questionnaires. In 1992 they were 21, 24, 27 and 30 years old. The results showed that early physical activity and current social and health-related behaviours were significantly related to the level of adult physical activity. Multivariable analyses indicated that early physical activity, in particular, was the best predictor of adult physical activity in all groups, with the exception of the 21-year-old women. The social and health-related factors such as occupation, employment status and smoking also predicted physical activity in some age-gender groups.     

Factors related to adherence to an exercise program for healthy adults

Healthy men (N = 33) and women (N = 73) participated in a 6-month exercise program three mornings per week, and their attendance scores (percent of total classes attended) were related to a variety of physiological, anthropometric, psychological, and demographic variables which were studied. These subjects were also grouped by adherence patterns; 18% attended less than 10% of the classes (early dropouts = EDO), 40% attended between 10 and 50% of the classes (nonadherers = NAd), and 42% attended more than 50% (adherers = Ad). Correlation coefficients between all of the variables and attendance were low. However, certain patterns did emerge. Those who continued the program more than 10% of the sessions tended to be the more physically fit women and less physically fit men. The EDO men and women were more likely to 1) have less stability in the community (less time at present address or occupation), 2) be single, and 3) have no children. Self-motivation scores (SMI) for EDO men were significantly lower, but the correlation between SMI and attendance for all subjects was only r = 0.052. "Blue-collar" men had a greater-than-expected dropout rate; however, educational level did not affect adherence. Health care behavior (including smoking) and previous exercise patterns did not affect attendance. Eleven variables that were related to adherence were selected for further study. The predictive values and sensitivities for these variables ranged from 47-85% and 15-62%, respectively. Using criteria of multiple positive scores did not improve the ability to predict attendance behavior. It was concluded that for healthy volunteers, participant characteristics are not good predictors of compliance to an exercise regimen.     

Factors influencing isometric exercise training‐induced reductions in resting blood pressure

Hypertension is a major health concern, and current recommendations for blood pressure management (lifestyle modifications and pharmacological intervention) have not been universally successful. For two decades, isometric exercise training (IET) has become established as effective at reducing in resting BP (RBP) in a short period (4–10 weeks). The most common IET modes have comprised isometric handgrip (IHG) or isometric bilateral leg (IBL) training and 4 × 2‐min contractions at ～20–50% maximal voluntary contraction with 1–5‐min rest between. Although this type of exercise training could have important implications, for hypertensive patients and in preventing hypertension development, little is known about the mechanisms responsible for IET‐induced RBP reductions. This uncertainty derives from a lack of understanding concerning the most effective IET programs for specific populations. Possible influential factors and mechanisms include age, sex, pre‐existing disease and medication, and IET‐induced adaptations in the exercising muscle and nervous system, which are discussed in this review. Designing effective IET programs may involve manipulation of exercise intensity, frequency, duration and mode, as well as consideration of yet discovered mechanisms for RBP reductions. We call for additional research designed to understand more about the mechanisms involved in IET‐induced RBP reductions for maximum effectiveness.     

Minimal effects of age and prolonged physical and mental exercise on healthy adults’ gait

BackgroundGait adaptability in old age can be examined by responses to various perturbations. Fatigability due to mental or muscle exercises can perturb internal cognitive and muscle resources, necessitating adaptations in gait.Research questionWhat are the effects of age and mental and muscle fatigability on stride outcomes and gait variability?MethodsTwelve older (66–75yrs) and twelve young (20–25 yrs) adults walked at 1.2 m/s before and after two fatigue conditions in two separate sessions. Fatigue conditions were induced by repetitive sit-to-stand task (RSTS) and by 30-min of mental tasks and randomized between days (about a week apart). We calculated the average and coefficient of variation of stride length, width, single support, swing time and cadence, and the detrended fluctuations analysis (DFA) based on 120 strides time intervals. We also calculated multi-scale sample entropy (MSE) and the maximal Lyapunov exponent (λmax) of mediolateral (ML) and anteroposterior (AP) of the Center of Pressure (CoP) trajectories.ResultsIn both age groups, RSTS modestly affected stride length, single support time, cadence, and CV of stride length (p ≤ 0.05), while the mental task did not affect gait. After fatigability, λmax - ML increased (p ≤ 0.05), independent of fatigue condition. All observed effects were small (η²: 0.001 to 0.02).SignificanceMuscle and mental fatigability had minimal effects on gait in young and healthy older adults possibly because treadmill walking makes gait uniform. It is still possible that age-dependent muscle activation underlies the uniform gait on the treadmill. Age- and fatigability effects might be more overt during real life compared with treadmill walking, creating a more effective model for examining gait and age adaptability to fatigability perturbations.     

Factors affecting pain relief in response to physical exercise interventions among healthcare workers

The aim of this study is to identify factors associated with musculo‐skeletal pain reduction during workplace‐based or home‐based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0‐10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group‐based coaching sessions on motivation for regular physical exercise, or (ii) home‐based physical exercise (HOME) performed alone during leisure‐time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi‐adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure‐time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home‐based exercise in reducing musculo‐skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo‐skeletal pain.