Effect of Exercise on Mental Health and Health-related Quality of Life in Adults With Spinal Cord Injury: A Systematic Review and Meta-Analysis.

OBJECTIVES: To determine the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with SCI. DATA SOURCES: We searched Embase, CINAHL, Medline, PsychINFO, and SPORTDiscus from inception to September 2023. STUDY SELECTION: We included randomized controlled trials that (1) involved participants ≥18 years old with a SCI; (2) administered an exercise intervention; and (3) measured subjective well-being, psychological well-being, social well-being, and/or HRQoL as outcomes. We reported standardized means differences (d) with a 95% confidence interval (CI), assessed the risk of bias by using the Revised Cochrane Risk-of-bias Tool for Randomized Trials (RoB 2), and the certainty of the evidence using GRADE. DATA SYNTHESIS: Nineteen studies (797 participants, mean age <65 years in every study) were included. Exercise improved overall well-being (d=0.494; 95% CI 0.268, 0.720; low certainty evidence), subjective well-being (d=0.543; 95% CI 0.270, 0.816; low certainty evidence), psychological well-being (d=0.499; 95% CI 0.193, 0.805; low certainty evidence), social well-being (d=0.452; 95% CI 0.151, 0.752; low certainty evidence), and HRQoL (d=0.323; 95% CI 0.072, 0.574; low certainty evidence). Four serious adverse events probably attributable to the interventions were reported in 3 studies. CONCLUSIONS: Exercise interventions can improve well-being and HRQoL in adults with SCI <65 years of age. Additional research is needed to determine effectiveness in adults ≥65 years of age.

Do Exercise Programs Improve Fitness, Mobility, and Functional Capacity in Adults With Lower Limb Amputation? A Systematic Review on the Type and Minimal Dose Needed.

OBJECTIVE: To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? DESIGN: Systematic review. SETTING: Outpatient intervention, outside of the prosthetic rehabilitation phase. PARTICIPANTS: Adults with lower limb amputation living in the community. INTERVENTION: Any physical activity or exercise intervention. OUTCOMES AND MEASURES: Any fitness, mobility, or functional capacity indicators and measurements. RESULTS: Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower-limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. CONCLUSION: Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status.

Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities.

PURPOSE: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. METHOD: Participants (4-17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. RESULTS: Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = -21.2; 95% CI, -33.6 to -8.7) than children. More daily steps were taken by boys than girls (mean difference = -1040; 95% CI, -1465 to -615) and individuals with a nonphysical disability than a physical disability (mean difference = -1120; 95% CI, -1474 to -765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. CONCLUSION: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.

Design of a Planner-Based Intervention to Facilitate Diet Behaviour Change in Type 2 Diabetes.

Diet behaviour is influenced by the interplay of the physical and social environment as well as macro-level and individual factors. In this study, we focus on diet behaviour at an individual level and describe the design of a behaviour change artefact to support diet behaviour change in persons with type 2 diabetes. This artefact was designed using a human-centred design methodology and the Behaviour Change Wheel framework. The designed artefact sought to support diet behaviour change through the addition of healthy foods and the reduction or removal of unhealthy foods over a 12-week period. These targeted behaviours were supported by the enabling behaviours of water consumption and mindfulness practice. The artefact created was a behaviour change planner in calendar format, that incorporated behaviour change techniques and which focused on changing diet behaviour gradually over the 12-week period. The behaviour change planner forms part of a behaviour change intervention which also includes a preparatory workbook exercise and one-to-one action planning sessions and can be customised for each participant.

Does it matter what your reasons are when deciding to disclose (or not disclose) a disability at work? The association of workers' approach and avoidance goals with perceived positive and negative workplace outcomes.

Deciding whether to disclose a disability to others at work is complex. Many chronic mental and physical health conditions are associated with episodic disability and include times of relative wellness punctuated by intermittent periods of activity limitations. This research draws on the disclosure processes model to examine approach and avoidance disclosure and non-disclosure goals and their association with perceived positive and negative workplace outcomes. Participants were 896 employed individuals (57.7% women) living with a chronic physical or mental health/cognitive condition. They were recruited from an existing national panel and completed an online, cross-sectional survey. Participants were asked about disclosure decisions, reasons for disclosure/non-disclosure, demographic, work context and perceived positive and negative disclosure decision outcomes (e.g., support, stress, lost opportunities). About half the sample (51.2%) had disclosed a disability to their supervisor. Decisions included both approach and avoidance goals. Approach goals (e.g., desire support, want to build trust, maintain the status quo at work) were significantly associated with perceived positive work outcomes regardless of whether a participant disclosed or did not disclose a disability at work, while avoidance goals (e.g., concerns about losing one's job, feeling forced to disclose because others notice a problem) were associated with perceived negative work outcomes. The findings highlight benefits and challenges that workers perceive arise when they choose to disclose or not disclose personal health information. By better understanding disclosure decisions, we can inform organizational health privacy and support gaps to help sustain the employment of people living with disabilities.

Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study].

INTRODUCTION: Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI. METHODS AND ANALYSIS: This is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes. ETHICS AND DISSEMINATION: Ethical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated. TRIAL REGISTRATION NUMBER: NCT01718977; Pre-results. TRIAL STATUS: Recruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model.

OBJECTIVE: Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity. METHODS: A random sample provided baseline data (n=689; 63% female; M age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals. RESULTS: Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035). CONCLUSIONS: Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

Correction: Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline.

Authors Victoria L. Goosey-Tolfrey and Karen M. Smith were listed under the incorrect affiliations at the time of publication.

A randomized controlled trial to test the efficacy of the SCI Get Fit Toolkit on leisure-time physical activity behaviour and social-cognitive processes in adults with spinal cord injury.

STUDY DESIGN: Single blind, two-group randomized controlled trial. OBJECTIVES: To evaluate the efficacy of the SCI Get Fit Toolkit delivered online on theoretical constructs and moderate-to-vigorous physical activity (MVPA) among adults with SCI. SETTING: Ontario and Quebec, Canada. ELIGIBILITY: Inactive, English- and French-speaking Canadian adults with traumatic SCI with Internet access, and no self-reported cognitive or memory impairments. METHODS: Participants (N=90 Mage=48.12±11.29 years; 79% male) were randomized to view the SCI Get Fit Toolkit or the Physical Activity Guidelines for adults with SCI (PAG-SCI) online. Primary (intentions) and secondary (outcome expectancies, self-efficacy, planning and MVPA behaviour) outcomes were assessed over a 1-month period. RESULTS: Of the 90 participants randomized, 77 were included in the analyses. Participants viewed the experimental stimuli only briefly, reading the 4-page toolkit for approximately 2.5 min longer than the 1-page guideline document. No condition effects were found for intentions, outcome expectancies, self-efficacy, and planning (ΔR2⩽0.03). Individuals in the toolkit condition were more likely to participate in at least one bout of 20 min of MVPA behaviour at 1-week post-intervention compared to individuals in the guidelines condition (OR=3.54, 95% CI=0.95, 13.17). However, no differences were found when examining change in weekly minutes of MVPA or comparing whether participants met the PAG-SCI. CONCLUSIONS: No firm conclusions can be made regarding the impact of the SCI Get Fit Toolkit in comparison to the PAG-SCI on social cognitions and MVPA behaviour. The limited online access to this resource may partially explain these null findings.

Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND: Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c and body weight. METHODS: We performed a systematic review of papers published between 1975-2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA1c and body weight were meta-analysed and examined in relation to use of BCTs. RESULTS: Thirteen RCTs were identified. Meta-analyses revealed reductions in HbA1c at 3, 6, 12 and 24 months of -1.11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall reduction of -0.53 % (6 mmol/mol [95 % CI -0.74 to -0.32, P < 0.00001]) in intervention groups compared to control groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, P = 0.002). Four of 46 BCTs identified were associated with >0.3 % reduction in HbA1c: 'instruction on how to perform a behaviour', 'behavioural practice/rehearsal', 'demonstration of the behaviour' and 'action planning', as were intervention features 'supervised physical activity', 'group sessions', 'contact with an exercise physiologist', 'contact with an exercise physiologist and a dietitian', 'baseline HbA1c >8 %' and interventions of greater frequency and intensity. CONCLUSIONS: Diet and physical activity interventions achieved clinically significant reductions in HbA1c at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes.

Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer's disease.

BACKGROUND: The impending public health impact of Alzheimer's disease is tremendous. Physical activity is a promising intervention for preventing and managing Alzheimer's disease. However, there is a lack of evidence-based public health messaging to support this position. This paper describes the application of the Appraisal of Guidelines Research and Evaluation II (AGREE-II) principles to formulate an evidence-based message to promote physical activity for the purposes of preventing and managing Alzheimer's disease. METHODS: A messaging statement was developed using the AGREE-II instrument as guidance. Methods included (a) conducting a systematic review of reviews summarizing research on physical activity to prevent and manage Alzheimer's disease, and (b) engaging stakeholders to deliberate the evidence and formulate the messaging statement. RESULTS: The evidence base consisted of seven systematic reviews focused on Alzheimer's disease prevention and 20 reviews focused on symptom management. Virtually all of the reviews of symptom management conflated patients with Alzheimer's disease and patients with other dementias, and this limitation was reflected in the second part of the messaging statement. After deliberating the evidence base, an expert panel achieved consensus on the following statement: "Regular participation in physical activity is associated with a reduced risk of developing Alzheimer's disease. Among older adults with Alzheimer's disease and other dementias, regular physical activity can improve performance of activities of daily living and mobility, and may improve general cognition and balance." The statement was rated favourably by a sample of older adults and physicians who treat Alzheimer's disease patients in terms of its appropriateness, utility, and clarity. CONCLUSION: Public health and other organizations that promote physical activity, health and well-being to older adults are encouraged to use the evidence-based statement in their programs and resources. Researchers, clinicians, people with Alzheimer's disease and caregivers are encouraged to adopt the messaging statement and the recommendations in the companion informational resource.

The role of interpersonal communication in the process of knowledge mobilization within a community-based organization: a network analysis.

BACKGROUND: Diffusion of innovations theory has been widely used to explain knowledge mobilization of research findings. This theory posits that individuals who are more interpersonally connected within an organization may be more likely to adopt an innovation (e.g., research evidence) than individuals who are less interconnected. Research examining this tenet of diffusion of innovations theory in the knowledge mobilization literature is limited. The purpose of the present study was to use network analysis to examine the role of interpersonal communication in the adoption and mobilization of the physical activity guidelines for people with spinal cord injury (SCI) among staff in a community-based organization (CBO). METHODS: The study used a cross-sectional, whole-network design. In total, 56 staff completed the network survey. Adoption of the guidelines was assessed using Rogers' innovation-decision process and interpersonal communication was assessed using an online network instrument. RESULTS: The patterns of densities observed within the network were indicative of a core-periphery structure revealing that interpersonal communication was greater within the core than between the core and periphery and within the periphery. Membership in the core, as opposed to membership in the periphery, was associated with greater knowledge of the evidence-based physical activity resources available and engagement in physical activity promotion behaviours (ps < 0.05). Greater in-degree centrality was associated with adoption of evidence-based behaviours (p < 0.05). CONCLUSIONS: Findings suggest that interpersonal communication is associated with knowledge mobilization and highlight how the network structure could be improved for further dissemination efforts. KEYWORDS: diffusion of innovations; network analysis; community-based organization; knowledge mobilization; knowledge translation, interpersonal communication.

Operationalizing the RE-AIM framework to evaluate the impact of multi-sector partnerships.

BACKGROUND: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a reliable tool for the translation of research to practice. This framework has been widely applied to assess the impact of individual interventions. However, RE-AIM has rarely been used to evaluate implementation interventions, especially from multi-sector partnerships. The primary purpose of this paper is to operationalize the RE-AIM approach to evaluate large, multi-sector partnerships. SCI Action Canada, a community-university partnership aimed to promote physical activity among adults with spinal cord injury, is used as an example. A secondary purpose is to provide initial data from SCI Action Canada by using this conceptualization of RE-AIM. METHODS: Each RE-AIM element is operationalized for multi-sector partnerships. Specific to SCI Action Canada, seven reach calculations, four adoption rates, four effectiveness outcomes, one implementation, one organizational maintenance, and two individual maintenance outcomes are defined. The specific numerators based on SCI Action Canada activities are also listed for each of these calculations. RESULTS: The results are derived from SCI Action Canada activities. SCI Action Canada's reach ranged from 3% (end-user direct national reach) to 37% (total regional reach). Adoption rates were 15% (provincial level adoption) to 76% (regional level adoption). Implementation and organizational maintenance rates were 92% and 100%, respectively. CONCLUSIONS: We have operationalized the RE-AIM framework for larger multi-sectoral partnerships and demonstrated its applicability to such partnerships with SCI Action Canada. Future partnerships could use RE-AIM to assess their public health impact.

Assessing the research use and needs of organizations promoting healthy living for adults with disabilities.

The uptake of research in community-based organizations (CBOs) is low and still unknown in CBOs that promote active and healthy living in adults with a disability. Using the knowledge to action framework, the objectives of this study were to determine if a gap exists regarding the use of research in CBOs, to learn about the preferred method to receive/read research evidence and to identify the barriers and facilitators of research use. Sixty-two employees of CBOs answered an online questionnaire. A research use gap was found as only 53 % of employees indicated they often or always use research. Conferences, emails and short research summaries were the favoured method of receiving/reading research information. Education, time and financial resources were important barriers to research use, while attitudes, intentions and self-efficacy were facilitators. More efforts are needed to develop tools to help CBOs use research.

Peer-delivered physical activity interventions: an overlooked opportunity for physical activity promotion.

The purpose of this systematic review was to catalogue and synthesize published studies that have examined the effects of peer-delivered physical activity interventions on physical activity behavior. Ten published studies were identified that met the inclusion criteria. The following information was extracted from each study: study design and duration; characteristics of the sample, peers, and interventions; and physical activity outcomes. In all articles reporting within-groups analyses, peer-delivered interventions led to increases in physical activity behavior. When compared to alternatives, peer-delivered interventions were just as effective as professionally delivered interventions and more effective than control conditions for increasing physical activity. Only three studies included measures of social cognitive variables, yielding some evidence that peers may enhance self-efficacy and self-determined forms of motivation. Based on these findings, interventionists are encouraged to include peer mentors in their intervention delivery models. Investigators are encouraged to pursue a more comprehensive understanding of factors that can explain and maximize the impact of peer-delivered activity interventions.

Developing physical activity interventions for adults with spinal cord injury. Part 1: a comparison of social cognitions across actors, intenders, and nonintenders.

OBJECTIVE: This article is the first in a three-part series focused on designing theory-based interventions to increase leisure time physical activity (LTPA) in persons with spinal cord injury (SCI). The purpose of this first study was to compare social cognitions for LTPA between people classified as LTPA actors, intenders, and nonintenders, as per Schwarzer's Health Action Process Approach (HAPA) model. METHOD: Participants were 238 men and women living with a SCI (M age = 44.14, SD = 12.74; 44.5% paraplegic) who were subsequently classified as LTPA actors (n = 105), intenders (n = 73), or nonintenders (n = 60). Participants completed a questionnaire that assessed the following HAPA constructs: LTPA outcome expectancies, self-efficacy, intentions, planning, and action control. RESULTS: A MANCOVA revealed significant between-groups differences for all variables (ps < .001). For all of the measures, actors scored significantly higher than intenders who, in turn, scored significantly higher than nonintenders. CONCLUSION/IMPLICATIONS: It is both theoretically and practically important to distinguish between LTPA nonintenders, intenders, and actors when developing LTPA-enhancing interventions for people with SCI. These distinctions inform the design and testing of the interventions reported in the two accompanying articles.

The effects of physical activity vignettes on physical activity-related social cognitions among people with spinal cord injury.

PURPOSE: The purpose of this study was to explore the effectiveness of informational portrait vignettes for enhancing physical activity-related psychosocial cognitions in adults with spinal cord injury (n = 90). METHODS: Using the Health Action Process Approach (HAPA), participants were classified as being in the motivational or volitional phase of behavior change. Half of the participants were randomly allocated to read an experimental vignette, which described the physical activity behaviours, thoughts, and feelings of a character demographically similar to the reader. The remainder read a control vignette. Social cognitions were measured one-week before, and immediately after reading the vignette. RESULTS: Analyses revealed no significant effects of the vignettes on social cognitions (p > 0.05). CONCLUSIONS: Informational portrait vignettes describing a physically active person with SCI and targeting multiple HAPA-based social cognitions are not recommended as a physical activity promotional strategy for people with SCI. The effectiveness of other types of vignettes should be examined. IMPLICATIONS FOR REHABILITATION: Until further research is completed to determine whether social comparison strategies play a meditational role in accounting for the impact of a tailored informational portrait vignette to alter leisure time physical activity among those with spinal cord injury, these types of informational intervention should not be utilized in a rehabilitation, or real-world, setting. Although informational portrait vignettes may not be effective in altering leisure time physical activity social cognitions among those with spinal cord injury, different types of vignettes, such as composite vignettes, should be explored.

Predictors of leisure time physical activity among people with spinal cord injury.

BACKGROUND: Most studies of physical activity predictors in people with disability have lacked a guiding theoretical framework. Identifying theory-based predictors is important for developing activity-enhancing strategies. PURPOSE: To use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to identify predictors of leisure time physical activity among people with spinal cord injury (SCI). METHODS: Six hundred ninety-five persons with SCI (M age=47; 76% male) completed measures of Body Functions and Structures, Activities and Participation, Personal Factors, and Environmental Factors at baseline and 6-months. Activity was measured at 6 and 18 months. Logistic and linear regression models were computed to prospectively examine predictors of activity status and activity minutes per day. RESULTS: Models explained 19%-25% of variance in leisure time physical activity. Activities and Participation and Personal Factors were the strongest, most consistent predictors. CONCLUSIONS: The ICF framework shows promise for identifying and conceptualizing predictors of leisure time physical activity in persons with disability.

The effects of threatened social evaluation of the physique on cortisol activity.

Social self preservation theory asserts that situations high in social-evaluative threat elicit increases in cortisol, a hormone released by the hypothalamic-pituitary-adrenal axis. Most tests of the theory have examined threats associated with social evaluation of a performance. Two experiments examined the effects of threatened social evaluation of one's physique. In Experiments 1 (n = 50) and 2 (n = 40), participants allocated to an experimental (threat) condition had significantly higher post-manipulation cortisol than participants in a control (no threat) condition. In Experiment 1, perceptions of social-evaluative threat were significantly correlated with post-manipulation cortisol levels. These results suggest that the threatened social evaluation of one's body can activate the cortisol response. Women who frequently experience such threats may be at increased risk for a variety of health conditions associated with chronic cortisol exposure.