Physical Activity Behavior Change in Middle-aged and Older Women: The Role of Barriers and of Environmental Characteristics

The majority of North American women are insufficiently active. Using an ecological approach to examine physical activity behavior in a sample of middle-aged and older women, this study aimed to (1) describe barriers to physical activity behavior change as well as environmental characteristics present in their neighborhoods, (2) examine relationships between barriers and physical activity behavior change, and (3) investigate environmental characteristics that may contribute to physical activity behavior change. Participants were 149 women ranging in age between 39 and 68. At Time 1, self-reported physical activity was assessed. Six months later (Time 2), barriers and environmental characteristics were measured, and physical activity was re-assessed. The most prevalent barriers were daily activities and fatigue. Over time, inactive women reported higher levels of barriers (e.g. fatigue, lack of interest in physical activity) than women who remained active or increased their physical activity level. Certain environmental characteristics (e.g. enjoyable scenery, seeing others exercising in their neighborhood) are suggested as potential contributors to physical activity behavior change.     

Social Cognitive Predictors of Sun Protection Intention and Behavior

The authors investigated sunbathing behavior and intention prospectively using the Theory of Planned Behavior (TPB). Before summer, 85 young adults who intended to sunbathe completed a TPB questionnaire. After summer, 46 of them completed a second questionnaire about their summertime sunbathing behavior. The proposed model was successful in predicting both behavior and intention to use sun protection, with 45% of the variance of self-reported sunscreen use and 32% of the variance in intention explained by the TPB. Items designed to measure self-efficacy and perceived control loaded onto different factors and demonstrated discriminant validity. Self-efficacy predicted both intention and behavior (after controlling for all other TPB variables), but perceived behavioral control did not. The authors discuss the implications of the findings for potential interventions to improve sun protection behavior.     

Antecedent Exercise in the Treatment of Disruptive Behavior: A Meta-Analytic Review

A review and meta-analysis of 42 group and single-case studies evaluating antecedent exercise (AE) as a means of reducing disruptive behaviors was conducted. Of 16 group studies, 12 produced positive results and 4 produced negative results. The weighted mean effect size, expressed as Cohen's d, was .33 with a standard error of .08. Moderator analysis indicated that studies using direct behavioral observation, hyperactive subjects, or nonaerobic exercise obtained greater effects, and that studies of higher quality obtained weaker effects. Of 26 single-case studies, 22 produced positive results, 1 produced no effect, and 3 produced negative results. The weighted mean effect size, expressed as d, was 1.99 with a standard error of .411. Among the single-subject studies, moderator analyses were unable to detect statistically significant moderators of effect size. Information was reviewed suggesting that AE is socially acceptable, can be implemented with treatment integrity, and has a benign side effect profile. The extent to which AE is functionally based remains open to question due to a lack of understanding regarding mechanism of action. Ten hypothesized mechanisms of action are briefly discussed.     

Predictors of adherence to diabetes medications: the role of disease and medication beliefs

Despite the effectiveness of drug therapy in diabetes management high rates of poor adherence persist. The purpose of this study was to identify potentially modifiable patient disease and medication beliefs associated with poor medication adherence among people with diabetes. A cohort of patients with diabetes was recruited from an urban primary-care clinic in New York City. Patients were interviewed in English or Spanish about: disease beliefs, medication beliefs, regimen complexity, diabetes knowledge, depression, self-efficacy, and medication adherence (Morisky scale). Logistic regression was used to identify multivariate predictors of poor medication adherence (Morisky > 1). Patients (n = 151) had diabetes for an average of 13 years with a mean HgA1C of 7.6 (SD 1.7). One-in-four (28%) were poor adherers to their diabetes medicines. In multivariate analyses, predictors of poor medication adherence were: believing you have diabetes only when your sugar is high (OR = 7.4;2–27.2), saying there was no need to take medicine when the glucose was normal (OR = 3.5;0.9–13.7), worrying about side-effects of diabetes medicines (OR = 3.3;1.3–8.7), lack of self-confidence in controlling diabetes (OR = 2.8;1.1–7.1), and feeling medicines are hard to take (OR = 14.0;4.4–44.6). Disease and medication beliefs inconsistent with a chronic disease model of diabetes were significant predictors of poor medication adherence. These suboptimal beliefs are potentially modifiable and are logical targets for educational interventions to improve diabetes self-management.     

A Test of the Cognitive Social Learning Model of Type A Behavior

Abstract

Portions of the cognitive social learning model proposed by Price^1.2 as an explanation for the development and maintenance of Type A behavior were examined empirically. Specifically, the hypothesis that Type A behavior is fostered by various beliefs and fears and that these same beliefs and fears arise, in part, as the result of certain parental characteristics was investigated. A questionnaire assessing Type A behavior and the beliefs, fears, and parental characteristics proposed by Price was constructed and administered to a sample of males and females. The results indicated moderate associations between the variables examined for both males and females, with no significant gender differences in the pattern of relationships. The findings are congruent with relationships proposed by Price's model. Implications of the model are discussed in terms of additional research needed.     

基于社会信息加工模型的团体干预对孤独症谱系障碍儿童社交能力的影响

目的：以社会信息加工(SIP)情绪-认知整合模型为理论依据,设计适用于改善孤独症谱系障碍(ASD)儿童社交能力的团体干预项目,并对其效果进行即时和短期追踪评估。方法：49名4～10岁孤独症谱系障碍(ASD)儿童被随机分为干预组和对照组,两组同时接受常规康复训练,干预组在此基础上给予每周3次,每次1.5小时,共计18次的团体训练,采用《社交反应量表》评估。结果：训练结束后,干预组社交反应后测及追踪测得分均显著低于前测,后测与追踪测差异不显著,对照组三次测量差异均不显著。干预组的社交能力得到提升,各项指标追踪效果能够有效保持,在社交沟通和ASD行为方式上,追踪阶段还有进步。结论：基于SIP情绪-认知整合模型的团体干预项目能够有效改善ASD儿童的社交能力。     

Exploring discontinuity in prediction of smoking cessation within the precontemplation stage of change

Background: A stage model of health behaviour change assumes homogeneity within the stages, in terms of how predictors relate to stage progression. It is not known whether this assumption is valid for the Transtheoretical Model (TTM) stages of change. Purpose: To test the homogeneity of the precontemplation stage of the TTM for smoking cessation. We hypothesized that if there was any discontinuity in prediction, it would be most likely to occur around a question which made a distinction between those who were “happy to smoke for the rest of their life” and those who “should quit, but are not currently thinking about it.” Method: Repeated measures design with telephone surveys conducted two weeks apart. Participants were 370 randomly selected precontemplators aged 18–40 years. Results: Evidence of discontinuity in prediction was found within the precontemplation stage, but across a different split point than expected. More predictive power of a multivariate model was found among smokers who stated they were not interested in quitting, with this at least in part due to “wanting to smoke,” than was found when the model was run on the overall sample. Conclusion: The study supported a possible discontinuity in prediction within the precontemplation stage, suggesting that the stage may not be uniform. Further research is required to confirm whether there is a discontinuity and, if so, to determine its precise location and identify the predictors for which there is a difference. This work was supported by a postgraduate scholarship (Award Reference No. PP 02M 0899) from the National Heart Foundation of Australia to the first author and from an unrestricted educational research grant from Glaxo-SmithKline through the Australian Smoking Cessation Consortium. The authors would also like to acknowledge Fiona Newton for her thoughtful comments on an earlier draft.     

Action Control of Exercise Behavior: Evaluation of Social Cognition,Cross-Behavioral Regulation,and Automaticity

Intention is considered the proximal determinant of behavior in many popular theories applied to understanding physical activity, yet intention–behavior discordance is high. Thus, an understanding of constructs that facilitate or inhibit the successful translation of intentions into behavior is both timely and important. The action control approach of dividing the intention–behavior relationship into quadrants of successful/unsuccessful intenders has shown utility in the past by demonstrating the magnitude of intention–behavior discordance and allowing for an outcome variable to test predictors. The purpose of this article was to evaluate automaticity and cross-behavioral regulation as predictors of exercise action control, in conjunction with other more standard social cognitive predictors of perceived behavioral control and affective and instrumental attitudes. Participants were a random sample of 263 college students who completed predictor measures at time one, followed by exercise behavior two weeks later. Participants were classified into three intention–behavior profiles: (1) nonintenders (14.1%; n = 31), (2) unsuccessful intenders (35.5%; n = 78), and (3) successful intenders (48.6%; n = 107). Affective attitude, perceived behavioral control, automaticity, and cross-behavioral regulation were predictors of action control. The results demonstrate that automaticity and cross-behavioral regulation, constructs not typically used in intention-based theories, predict intention–behavior discordance.     

Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: Part 2 of a Phase II Preclinical Exploratory Trial

Background

Home-based exercise programs can improve physical functioning and health status of elderly people. Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success. We developed a tablet-based system—ActiveLifestyle—that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features.

Objective

The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between (1) tablet-based and brochure-based interventions, (2) individual and social motivation strategies, and (3) active and inactive participants.

Methods

A total of 44 autonomous-living elderly people (mean 75, SD 6 years) were assigned to 3 training groups: social (tablet guided, n=14), individual (tablet guided, n=13), and brochure (brochure guided, n=17). All groups joined a 12-week progressive home-based strength-balance training program. Outcome measures were gait performance under single and dual task conditions, dual task costs of walking, falls efficacy, and physical performance as measured by the Short Physical Performance Battery (SPPB). Furthermore, active (≥75% program compliance) and inactive (<75% program compliance) individuals were compared based on their characteristics and outcome measures.

Results

The tablet groups showed significant improvements in single and dual task walking, whereas there were no significant changes observable in the brochure group. Between-groups comparisons revealed significant differences for gait velocity (U=138.5; P=.03, r=.33) and cadence (U=138.5, P=.03 r=.34) during dual task walking at preferred speed in favor of the tablet groups. The brochure group had more inactive participants, but this did not reach statistical significance (U=167, P=.06, r=.29). The active participants outperformed the inactive participants in single and dual task walking, dual task costs of walking, and SPPB scores. Significant between-groups differences were seen between the tablet groups and the brochure group, in favor of the tablet groups.

Conclusions

A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program. Social or individual motivation strategies were equally effective. The most prominent differences were observed between active and inactive participants. These findings suggest that in older adults a tablet-based intervention enhances training compliance; hence, it is an effective way to improve gait.     

Self-efficacy and the maintenance of exercise participation in older adults

The role played by exercise self-efficacy in the maintenance of exercise participation of previously sedentary middle-aged adults 4 months after the termination of a formal exercise program is reported. Correlational and multiple regression analyses examined the influence of self-efficacy, physiological (aerobic capacity, sex, body composition), and behavioral (past exercise frequency and intensity) parameters in the maintenance of exercise participation. Self-efficacy significantly predicted exercise behavior at follow-up when controlling for biological and behavioral influences. Aerobic capacity, exercise efficacy, and exercise behavior in combination were significantly related to current energy expenditure in aerobic physical activity. The discussion focuses on the need to examine the impact of different correlates of exercise behavior at different stages of the exercise process.This project was funded by Grant AG07907 from the National Institute on Aging.     

运动防治膝骨关节炎的关键因素及注意事项

文题释义： 运动疗法：是指利用器械、徒手或患者自身力量,通过某些运动方式(主动或被动运动等),使患者获得全身或局部运动功能、感觉功能恢复的训练方法。运动疗法主要采用“运动”这一机械性的物理因子对患者进行治疗,着重进行躯干、四肢的运动、感觉、平衡等功能的训练,包括：关节功能训练、肌力训练、有氧训练、平衡训练、易化训练、移乘训练、步行训练。 骨关节炎：为一种退行性病变,系由于增龄、肥胖、劳损、创伤、关节先天性异常、关节畸形等诸多因素引起的关节软骨退化损伤、关节边缘和软骨下骨反应性增生,又称骨关节病、退行性关节炎、老年性关节炎、肥大性关节炎等。临床表现为缓慢发展的关节疼痛、压痛、僵硬、关节肿胀、活动受限和关节畸形等。 背景：目前膝骨关节炎的治疗以缓解症状为主,真正根治较难。运动疗法是为了达到一些特定的治疗目标而专门设计和规范的体育活动计划,旨在恢复正常的肌肉骨骼功能和减少疾病或身体损伤引起的疼痛。有关运动疗法防治膝骨关节炎存在不同观点。 目的：探讨影响运动疗法防治膝骨关节炎疗效中的关键因素及注意事项,为运动疗法防治膝骨关节炎提供一定参考依据。 方法：应用计算机检索至2019年1月PubMed数据库、中国期刊全文数据库相关文章,英文检索词为：“exercise therapy,knee osteoarthritis,prevention and treatment”;中文检索词为：“运动疗法,膝骨关节炎,防治”。根据纳入排除标准,对检索到的关于运动疗法对膝骨关节炎作用的相关文献进行分析。 结果与结论：①运动疗法应尽早介入,早期需注意各部损伤时膝关节的角度问题,需逐渐增加活动度及强度,可以从非负重训练开始到后期训练可以负重;②运动疗法的强度应以中小强度为主,避免过度训练,特别是对于软骨磨损的患者。 ORCID: 0000-0002-1708-5181(宋校能) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Predictors of Weight Loss in Obese Older Adults: Findings from the USA and the UK

ObjectiveTo examine the prevalence and demographic predictors of clinically meaningful weight loss in community samples of obese older adults in the USA and the UK.MethodsData were from obese older adults (BMI ≥ 30 kg/m²; age ≥ 52 years), free of a cancer diagnosis, from the Health and Retirement Study (HRS; n = 3398) and the English Longitudinal Study of Ageing (ELSA; n = 998). Weight change was assessed from 2004 to 2008. Multivariable logistic regression tested whether age, sex, ethnicity, marital status, education, or BMI predicted ≥ 5% weight loss.ResultsOver a quarter (28.7%) of obese participants from HRS and 16.6% from ELSA lost ≥ 5% weight. Being female (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11-1.54) and heavier (BMI ≥ 35 kg/m²) (OR = 1.60, 95% CI = 1.37-1.87) predicted weight loss in HRS. Trends were similar in ELSA (female: OR = 1.18, 95% CI = 0.83-1.69; BMI ≥ 35 kg/m²: OR = 1.24, 95% CI = 0.85-1.82). ORs were increased in ≥ 65-year-olds in HRS (OR = 1.55, 95% CI = 1.33-1.81), and reduced in married people in ELSA (OR = 0.69, 95% CI = 0.48-1.00). Neither education nor ethnicity predicted weight loss in either cohort.ConclusionA high proportion of obese older adults experience clinically meaningful weight loss, but few demographic variables consistently predict weight loss in this population.Key Words: Weight loss, Aging, Obesity, Prevalence, Predictors     

Physical Activity and Social Physique Anxiety in Older Women: The Moderating Effects of Self-Presentation Efficacy

Given the inconsistent relationships observed between social physique anxiety (SPA) and physical activity, it is possible that other variables moderate this relationship. This study examined self-presentation efficacy (SPE) as a potential moderator. Participants were 81 older women. Multiple regression analysis revealed that SPA, SPE, and the SPA x SPE interaction significantly predicted physical activity, with the SPA x SPE interaction explaining 6% of the variance in activity. Evaluation of this interaction indicated that SPA was negatively correlated with activity only for women with high and mean SPE and was unrelated to activity for women with low SPE. These findings suggest that, for older women, lower levels of SPA are not always related to greater activity. Rather, SPE is an important moderator of the SPA-physical activity relationship.     

Exercise and severe depression: preliminary results of an add-on study

Background

Physical exercise has been extensively researched as a therapeutic option for treatment of major depression.

Methods

In a randomized controlled trial, we analyze the effects of aerobic physical exercise as an add-on strategy for treatment of severe depressed inpatients. The exercise has a “Dose” of 16.5 kcal/kg/week, three times a week during all the hospitalization.

Results

Our preliminary results show that there is no significant difference in scores of Hamilton in the second week between groups (Mean[SD] = 8.2[5.96] × 11.18[5.03], p = 0.192). However, there is a significant reduction in Hamilton scores of patients in exercise group at discharge (Mean[SD] = 5.93[4.46] × 9.45[3.56], p = 0.041). Regarding Quality of Life (QoL), no significant difference were found between groups in the second week in physical domain (Mean[SD] = 56.98[8.96] × 54.54[9.18], p = 0.511) and psychological domain (Mean[SD] = 50.88[13.88] × 42.04[12.42], p = 0.106). However, there is a significant difference in psychological domain (Mean[SD] = 55.88[9.92] v 41.66[13.04], p = 0.004) and a trend but no statistical significance in the physical (Mean[SD] = 58.80[9.14] × 52.12[8.70], p = 0.07) at discharge.

Limitations

Many patients receive different treatment strategies, like ECT (1 patient at exercise group × 3 at control group). Other limitation is the small number of participants included until this moment.

Conclusion

Our preliminary results suggest that physical exercise could be a feasible and effective add-on strategy for treatment of severe depressed inpatients, improving their depressive symptoms and QoL.     

身体锻炼与中学生社交能力的关系研究

目的探讨身体锻炼与中学生社交能力的关系。方法通过问卷调查法、文献资料法、数理统计法等方法,以5所中学的1379名学生为被试。结果①中学生的社交能力存在性别差异(P<0.05)。②经常性锻炼及结伴式的锻炼更能促进社交能力的提高。③中学生的社交能力与锻炼时间、锻炼频率、锻炼坚持性具有正相关关系。④回归分析表明:锻炼坚持性、每周锻炼频率、每次锻炼时间可以很好的预测中学生的社交能力(P<0.05)。结论身体锻炼对中学生的社交能力具有重要促进作用。     

Mobile Exercise Apps and Increased Leisure Time Exercise Activity: A Moderated Mediation Analysis of the Role of Self-Efficacy and Barriers

Background

There are currently over 1000 exercise apps for mobile devices on the market. These apps employ a range of features, from tracking exercise activity to providing motivational messages. However, virtually nothing is known about whether exercise apps improve exercise levels and health outcomes and, if so, the mechanisms of these effects.

Objective

Our aim was to examine whether the use of exercise apps is associated with increased levels of exercise and improved health outcomes. We also develop a framework within which to understand how exercise apps may affect health and test multiple models of possible mechanisms of action and boundary conditions of these relationships. Within this framework, app use may increase physical activity by influencing variables such as self-efficacy and may help to overcome exercise barriers, leading to improved health outcomes such as lower body mass index (BMI).

Methods

In this study, 726 participants with one of three backgrounds were surveyed about their use of exercise apps and health: (1) those who never used exercise apps, (2) those who used exercise apps but discontinued use, and (3) those who are currently using exercise apps. Participants were asked about their long-term levels of exercise and about their levels of exercise during the previous week with the International Physical Activity Questionnaire (IPAQ).

Results

Nearly three-quarters of current app users reported being more active compared to under half of non-users and past users. The IPAQ showed that current users had higher total leisure time metabolic equivalent of task (MET) expenditures (1169 METs), including walking and vigorous exercise, compared to those who stopped using their apps (612 METs) or who never used apps (577 METs). Importantly, physical activity levels in domains other than leisure time activity were similar across the groups. The results also showed that current users had lower BMI (25.16) than past users (26.8) and non-users (26.9) and that this association was mediated by exercise levels and self-efficacy. That relationship was also moderated by perceived barriers to exercise. Multiple serial mediation models were tested, which revealed that the association between app use and BMI is mediated by increased self-efficacy and increased exercise.

Conclusions

Exercise app users are more likely to exercise during their leisure time, compared to those who do not use exercise apps, essentially fulfilling the role that many of these apps were designed to accomplish. Data also suggest that one way that exercise apps may increase exercise levels and health outcomes such as BMI is by making it easier for users to overcome barriers to exercise, leading to increased self-efficacy. We discuss ways of improving the effectiveness of apps by incorporating theory-driven approaches. We conclude that exercise apps can be viewed as intervention delivery systems consisting of features that help users overcome specific barriers.     

Exercise and Diet Beliefs of Overweight Women Participating in an Exercise and Diet Program: An Elicitation Study Using the Theory of Planned Behavior1

The purpose of this study was to examine the exercise and diet beliefs of overweight women using the theory of planned behavior. Participants were 104 overweight community women and university students who completed a 4‐week exercise and diet program. The most salient exercise beliefs for the participants were (a) increased motivation, structure and accountability, and social support (behavioral beliefs); (b) job or school responsibilities and traveling (control beliefs); and (c) group members and the program trainer (normative beliefs). The most salient diet beliefs were (a) improved eating habits and convenience (behavioral beliefs), (b) lack of control over food preparation and inconvenience (control beliefs), and (c) family and spouse or significant other (normative beliefs). These results are discussed in comparison to beliefs held by different populations and in regard to implications for intervention design.     

Video Gaming Disorder and Sport and Exercise in Emerging Adulthood: A Longitudinal Study

Among the negative consequences of video gaming disorder, decreased participation in sport and exercise has received little attention. This study aimed to assess the longitudinal association between video gaming disorder and the level of sport and exercise in emerging adult men. A questionnaire was completed at baseline and 15-month follow-up by a representative national sample of 4,933 respondents. The seven items of the Game Addiction Scale were used to construct a latent variable representing video gaming disorder. Level of sport and exercise was also self-reported. Cross-lagged path modeling indicated a reciprocal causality between video gaming disorder and the level of sport and exercise, even after adjusting for a large set of confounders. These findings support the need for better promotion of sport and exercise among emerging adults in order to contribute to the prevention of video gaming disorder, and to raise the level of sport and exercise activity in addicted gamers.     

Pessimism and Physical Functioning in Older Women: Influence of Self-Efficacy

The purpose of the present study was to examine the nature of the relationships among dispositional optimism/pessimism, self-efficacy, and physical function in a cross-sectional sample of older women (N = 249, M age = 69 years). Initial bivariate analyses indicated that both pessimism and self-efficacy, but not optimism, were significantly correlated with objectively measured physical function. Subsequent analyses using covariance modeling with the full-information maximum likelihood estimator indicated that pessimism was no longer correlated with function when controlling for self-efficacy. That is, consistent with a social cognitive perspective, controlling for self-efficacy attenuated the relationship between pessimism and function. Our findings provide support for using a social cognitive perspective to understanding dispositional and modifiable influences on declines in function associated with aging.     

Self-Regulatory Skills Usage Strengthens the Relations of Self-Efficacy for Improved Eating,Exercise, and Weight in the Severely Obese: Toward an Explanatory Model

Lack of success with behavioral weight-management treatments indicates a need for a better understanding of modifiable psychological correlates. Adults with class 2 and 3 obesity (N = 183; Mean _BMI = 42.0 kg/m²) volunteered for a 26-week nutrition and exercise treatment, based on social cognitive theory, that focused on self-efficacy and self-regulation applied to increasing cardiovascular exercise and fruit and vegetable consumption. Improved self-efficacy for controlled eating significantly predicted increased fruit and vegetable consumption (R ² = .15). Improved self-efficacy for exercise significantly predicted increased exercise (R ² = .46). When changes in self-regulatory skill usage were stepped into the 2 previous equations, the variances accounted for significantly increased. Increases in fruit and vegetable consumption and exercise significantly predicted weight loss (R ² = .38). Findings suggest that behavioral theory should guide research on weight-loss treatment, and a focus on self-efficacy and self-regulatory skills applied to specific nutrition and exercise behaviors is warranted.