Depressive symptoms interfere with post-rehabilitation exercise: outcome expectancies and experience as mediators.

The aim of the study was to examine the relationship between depressive symptoms and physical exercise by unveiling how outcome expectancies regarding exercise and positive exercise experience could mediate between depressive symptoms and exercise. A longitudinal study included 178 cardiac and orthopedic rehabilitation patients in Germany. Patients responded to psychometric scales at two points in time with a six-week interval, assessing depressive symptoms (Time 1), outcome expectancies regarding exercise (Time 1), exercise experiences (Time 2), and exercise behavior (Times 1 and 2). Depressive symptoms were negatively related to physical exercise (r =- 0.18), to positive outcome expectancies (r =- 0.23), and to positive exercise experiences (r =- 0.26). In a multiple-step mediation model, expectancies and experiences mediated between depressive symptoms and exercise. In total, 15% of the exercise variance was accounted for. Outcome expectancies and a lack of positive experience seem to partly explain why depressed individuals are less likely to exercise.

Intervention effects of exercise self-regulation on physical exercise and eating fruits and vegetables: a longitudinal study in orthopedic and cardiac rehabilitation.

OBJECTIVE: The primary objective of this study was to unveil the mechanisms by which an exercise self-regulation intervention affects physical exercise in a rehabilitation context. The second aim was to investigate whether the intervention led to changes in fruit and vegetable intake that was not targeted in the intervention. Finally, it was tested whether changes in exercise habit strength may explain such a transfer effect. METHOD: A quasi-experimental design was conducted in Germany between 2009 and 2011 with 725 rehabilitation patients. Patients received either a self-regulation intervention or an online questionnaire. Six weeks after discharge, self-reported changes in exercise and dietary behaviors, exercise habit strength, and cognitions were measured. QUANTITATIVE RESULTS: The exercise self-regulation intervention led to a higher increment in exercise behavior, exercise habit strength, and fruit and vegetable intake than the control condition. Changes in physical exercise were mediated by changes in action control (slope=0.04; 99% CI=0.01 to 0.06) and satisfaction (slope=0.05; 99% CI:=0.02 to 0.08), but not in action planning. Changes in fruit and vegetable intake were mediated by changes in exercise habit strength (slope=0.05; 99% CI=0.01 to 0.08). CONCLUSION: Interventions could be optimized if they aim at fostering exercise habits. This in turn may also facilitate transfer effects from one health behavior to the other.

Rehabilitants' conscientiousness as a moderator of the intention-planning-behavior chain.

PURPOSE/OBJECTIVE: After rehabilitation, it is important to maintain adopted target behaviors such as physical activity and physical exercise. By generating detailed behavioral plans, rehabilitants may translate their intentions into actual behavior. The aim of this study was to investigate whether Conscientiousness would further facilitate this mechanism in a way that rehabilitants who are more conscientious would be more likely to act upon their plans. Research Method/Design: The study presents secondary analyses from a larger intervention in cardiac and orthopedic rehabilitation. N = 136 rehabilitants were surveyed via online questionnaires during treatment (Time 1 [T1]) and with computer-assisted telephone interviews (CATIs) 6 weeks (Time 2 [T2]) and 6 months (Time 3 [T3]) after discharge from the clinic. Intention, planning, Conscientiousness, and behavior were measured. A conditional process analysis examined whether Conscientiousness moderates the intention-planning-physical activity chain. RESULTS: Planning had a mediating effect on intentions and physical activity. Moreover, this mediation effect was conditional on the level of Conscientiousness: Highly conscientious rehabilitants were more successful in translating their plans into behavior than their less conscientious counterparts. CONCLUSIONS/IMPLICATIONS: Self-regulatory mechanisms such as action-facilitating planning strategies may be more efficient in conscientious rehabilitants. Conscientiousness reflects dispositional self-regulation and can be supportive when it comes to maintain difficult behaviors. Lack of Conscientiousness needs to be compensated by more intense support of rehabilitation patients, in order to plan appropriately and to act upon these plans in the face of barriers. (PsycINFO Database Record

What contributes to action plan enactment? Examining characteristics of physical activity plans.

OBJECTIVES: Individuals with chronic conditions can benefit from formulating action plans to engage in regular physical activity. However, the content and the successful translation of plans into action, so-called plan enactment, are rarely adequately evaluated. The aim of this study was to describe the content of user-specified plans and to examine whether participants were more likely to enact their plans if these plans were highly specific, viable, and instrumental. DESIGN AND METHODS: The study presents secondary analyses from a larger behavioural intervention in cardiac and orthopaedic rehabilitation. The content of 619 action plans from 229 participants was evaluated by two independent raters (i.e., qualitative analyses and ratings of specificity) and by participants themselves (i.e., instrumentality and viability). Plan enactment was also measured via self-reports. Multilevel analyses examined the relationship between these plan characteristics and subsequent plan enactment, and between plan enactment and aggregated physical activity. RESULTS: Participants preferred to plan leisure-time physical activities anchored around time-based cues. Specificity of occasion cues (i.e., when to act) and highly instrumental plans were positively associated with plan enactment. Interestingly, individuals who planned less specific behavioural responses (i.e., what to do) were more likely to enact their plans. Plan enactment was positively associated with aggregated behaviour. CONCLUSIONS: Interventions should not only emphasize the importance of planning, but also the benefits of formulating specific contextual cues. Planning of the behavioural response seems to require less precision. Allowing for some flexibility in executing the anticipated target behaviour seems to aid successful plan enactment. Statement of Contribution What is already known on this subject? Action planning interventions are efficacious in promoting health behaviour. Characteristics of plan content (i.e., specificity) matter for unconditional behaviour change. Plan enactment (i.e., degree to which plan is followed through) is positively linked to behaviour change. What does this study add? Specificity of occasion cues (i.e., when to act) and highly instrumental plans were positively associated with plan enactment. Individuals who planned less specific behavioural responses (i.e., what to do) were more likely to enact their plans. Planning interventions should focus on specificity of context cues but flexibility of behavioural action.

Associations of depressive symptoms with health behaviors, stress, and self-assessed health status in Hawai'i: a population study.

BACKGROUND: The aim of this cross-sectional study was to examine how depressive symptoms are associated with health behaviors, stress, and self-assessed health status in the population of Hawai'i. METHODS: Randomized phone calls were made using computer assistant telephone interviews. A regression analysis with depressive symptoms as the outcome and sociodemographic variables, health behaviors, stress, and health status as predictors was conducted in 1483 adults. RESULTS: Depressive symptoms were associated with stress (ß = .32), alcohol consumption (ß = .19), health status (ß = -.10), fast food consumption (ß = .06), avoidance of fat (ß = -.06), and fruit and vegetable consumption (ß = .06). Moreover, depressive symptoms were linked to being female (ß = .06), being single (ß = -.06), and being Caucasian compared with being Native Hawaiian (ß = -.06) or Japanese (ß = -.08). The overall explained variance was 22%. CONCLUSION: Depressive symptoms correlate with health risk behaviors and might be considered as a risk for chronic diseases.

'Sticking to a healthy diet is easier for me when I exercise regularly': cognitive transfer between physical exercise and healthy nutrition.

OBJECTIVE: Long-term rehabilitation success depends on regular exercise and healthy nutrition. The present study introduces a new framework to explain this association on a psychosocial level. The exercise-nutrition relationship was investigated by exploring the sequential mediation of habit strength and transfer cognitions. DESIGN: Analyses were performed at two measurement points in time (at 12 and 18 months after rehabilitation), involving 470 medical rehabilitation patients who participated in an exercise intervention. MAIN OUTCOME MEASURES: Patients filled in paper-pencil questionnaires assessing exercise (t1) and habit strength, transfer cognitions and healthy nutrition at follow-up (t2). RESULTS: Habit strength and transfer cognitions mediated the relationship between exercise and nutrition. CONCLUSION: Findings suggest that habit strength and transfer cognitions are important factors underlying the relationship between exercise and nutrition.

Positive Exercise Experience Facilitates Behavior Change via Self-Efficacy.

PURPOSE: Motivational processes can be set in motion when positive consequences of physical exercise are experienced. However, relationships between positive exercise experience and determinants of the motivational and the volitional phases of exercise change have attracted only sparse attention in research. METHOD: This research examines direct and indirect associations between positive experience and motivational as well as volitional self-efficacy, intention, action planning, and exercise in two distinct longitudinal samples. The first one originates from an online observational study in the general population with three measurement points in time (N = 350) and the second one from a clinical intervention study in a rehabilitation context with four measurement points (N = 275). RESULTS: Structural equation modeling revealed the following: Positive experience is directly related with motivational self-efficacy as well as intentions in both samples. In the online sample only, positive experience is associated with volitional self-efficacy. In each sample, experience is indirectly associated with action planning via motivational self-efficacy and intentions. Moreover, action planning, in turn, predicts changes in physical exercise levels. CONCLUSIONS: Findings suggest a more prominent role of positive experience in the motivational than in the volitional phase of physical exercise change. Thus, this research contributes to the understanding of how positive experience is involved in the behavior change process.

Promoting exercise maintenance: how interventions with booster sessions improve long-term rehabilitation outcomes.

OBJECTIVE: Follow-up intervention boosters are supposed to promote exercise maintenance beyond initial treatment. The current quasi-experimental study investigated the benefits of adding telephone-delivered intervention boosters to a self-management exercise intervention for rehabilitants. Psycho-social mechanisms by which the intervention boosters promote exercise maintenance were examined. RESEARCH DESIGN: Between 2009 and 2011, individuals in cardiac and orthopedic rehabilitation (N = 1,166) were allocated to either a self-management exercise intervention or a control group (i.e., questionnaire only). In addition to standard rehabilitation, participants in the intervention group were offered a series of telephone-delivered intervention boosters after 6 weeks and again after 6 months. Self-efficacy, action planning, and satisfaction with previous exercise outcomes were reassessed 12 months after discharge. Habit strength and exercise were measured 18 months after rehabilitation. RESULTS: The intervention with boosters promoted the maintenance of planning, self-efficacy, satisfaction, exercise, and habit strength. Changes in exercise were simultaneously mediated by changes in planning, self-efficacy, and satisfaction. Changes in habit strength were sequentially mediated by planning and exercise. CONCLUSIONS: Interventions with boosters that focus on action planning, self-efficacy, and satisfaction help to maintain self-directed postrehabilitation exercise. Frequent exercise performance, in turn, can strengthen exercise habits.

Validity of a stage algorithm for physical activity in participants recruited from orthopedic and cardiac rehabilitation clinics.

OBJECTIVE: For stage-matched interventions, individuals must be classified with respect to their previous behaviors and in conjunction with their future intentions. A novel procedure for the assessment of stages in physical activity was developed. For this, individuals' activity and their regarding intentions were compared with recommended levels of activity. The aim was to examine the psychometric properties. DESIGN: In a cross-sectional study, stages were assessed in 366 study participants (84 in cardiac and 282 in orthopedic rehabilitation) in terms of their previous physical activity and their intention to perform recommended activity levels in the future. MAIN OUTCOME MEASURES: Stages of change were compared to self-reported behavior, intention, planning, self-efficacy, risk perception, pros, cons, and social support. Misclassification, sensitivity, specificity, receiver operating characteristic (ROC) curves, non-linear trends, and planned contrasts were computed. RESULTS: In comparison to previous studies, sensitivity (44%-99%) was high and specificity was similar or low (3%-88%), depending on the type of validation outcome selected. When using less demanding criteria (i.e., less intensive activity), measurement quality decreased, although not always significantly. Applying contrast analyses, more than half of the predicted stage differences were confirmed. No main differences between orthopedic and cardiac, ambulant and stationary rehabilitation appeared and no interactions were found. CONCLUSION: The stage algorithm proved to have acceptable measurement qualities in study participants recruited in both cardiac and orthopedic rehabilitation. Especially in detecting Intenders and Actors the stage algorithm performed well. Mechanisms of adopting and maintaining recommended activity levels seem to operate equally in both groups.