Mental health clients' receptiveness to and recommendations for integrating physical activity discussions into therapy: a mixed methods study.

OBJECTIVE: The mental health benefits of physical activity are well-established. Integrating physical activity counseling into therapy would expand the reach of this evidence-based treatment for mental illness. This mixed methods study examined mental health clients' receptiveness and recommendations for effectively discussing physical activity in therapy. METHODS: A diverse sample of U.S. adults in therapy (N = 478) completed a survey that included the open-ended question: What specific recommendations would you have for your therapist to effectively discuss physical activity with you? We conducted a qualitative content analysis to identify their most common recommendations. RESULTS: Most participants indicated they would be comfortable discussing physical activity with their therapist. The content analysis resulted in 26 unique categories; most common recommendations included: provide information about what to do (n = 81), discuss physical activity benefits (n = 63), be understanding and nonjudgmental (n = 49), provide accountability (n = 41), and consider physical/mental health conditions (n = 35). Overarching themes emphasized making mental health central to discussions, tailoring discussions to each client, and reframing physical activity as a feasible, enjoyable activity. CONCLUSIONS: Mental health clients are open to discussing physical activity during therapy if it is approached in a supportive, understanding, and personalized way. Clients' recommendations can inform future professional development for therapists.

Promoting Strength Training Among Baby Boomers: Message Framing Effects on Motivation and Behavior.

BACKGROUND: Regular participation in strength training significantly enhances older adults' physical and functional health, yet only 14% of adults over age 50 report engaging in strength training at least twice per week. Exercise messages about why and how older adults should engage in strength training could influence their perceptions of and participation in the behavior. This study was designed to promote strength training among adults aged 50-70 and to determine whether the message frame accompanying a brief workout would have an impact on participants' motivation, self-efficacy, and/or physical activity behavior. METHODS: Participants (N = 308) were randomly assigned to one of four message conditions: Easy Intrinsic, Hard Intrinsic, Easy Extrinsic, or Hard Extrinsic. Immediately after completing baseline measures of motivation and physical activity, participants received the recommended strength training workout and corresponding motivational message. They completed follow-up measures of motivation and physical activity 2 weeks later. RESULTS: Controlled regulation was higher at follow-up among participants exposed to an extrinsic message relative to an intrinsic message (F(3,208) = 3.08, p = .03). Strength training (Z = - 5.95, p < .001) and moderate physical activity (Z = - 3.23, p = .001) increased among participants not engaging in regular strength training at baseline. CONCLUSIONS: These results suggest message framing may have a short-term impact on Baby Boomers' physical activity motivation, such that emphasizing extrinsic goals (i.e., weight loss and appearance) may contribute to controlled motivation. However, repeated measurements are needed to determine the longer-term maintenance and influence of these effects.

"Everything else comes first": a mixed-methods analysis of barriers to health behaviors among military spouses.

BACKGROUND: Military spouses are integral to the health of their families, but have demonstrated elevated levels of stress, depression, and anxiety. Participating in health behaviors such as physical activity and healthy eating may have a positive impact on spouses' physical and mental health, but emerging evidence suggests spouses' participation in these behaviors is scarce. Thus, the purpose of this study was to examine the most frequently reported barriers to health behaviors among military spouses. METHODS: Military spouses were recruited to complete surveys (N = 230) or participate in focus group sessions (N = 22). On the surveys, participants indicated up to 3 of their most frequent barriers to physical activity, diet, social connection, and stress management. Responses were coded and summed to identify the most commonly reported barriers to each health behavior. Subsequently, focus group sessions were conducted to gain a more in-depth understanding of the challenges military spouses face when trying to maintain a healthy lifestyle. Focus group transcripts were coded using thematic data analysis to identify the most frequently discussed barriers for each behavior. RESULTS: On the surveys, lack of time was the most prevalent barrier for physical activity, social connection, and stress management, and the second most prevalent barrier for diet. Financial concerns were the most prevalent barrier to maintaining a healthy diet. Barriers related to parent/family responsibilities were commonly reported across all health behaviors. During the focus group sessions, the transient military lifestyle was reported to have a significant impact on all of the health behaviors. Other military-related stressors including deployments and the necessity to "do it all" alone were frequently discussed. Many participants exhibited rigid definitions of what "counts" as exercise or health eating. Overall, participants reported sacrificing participation in health behaviors to attend to other priorities. CONCLUSIONS: Military spouses reported numerous barriers to health behaviors that made it difficult for them to prioritize their own health and well-being. Although some of the barriers reported were similar to barriers reported by civilians, unique stressors associated with military life further impeded participation in health behaviors. These findings can be used to inform future health promotion interventions for military spouses.

Overcoming barriers to exercise among parents: a social cognitive theory perspective.

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n = 226) and fathers (n = 70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and 1 year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise.

Objectively measured physical activity and sedentary behavior and quality of life indicators in survivors of breast cancer.

BACKGROUND: The primary purpose of the current study was to determine prospective associations of accelerometer-assessed physical activity intensity and sedentary time with health-related quality of life (HRQOL) indicators among survivors of breast cancer. METHODS: A total of 358 survivors of breast cancer wore an accelerometer for 7 days at baseline to assess different activity intensities (light, lifestyle, and moderate to vigorous) and sedentary behavior. Six months later, survivors completed online questionnaires that assessed HRQOL indicators (disease-specific HRQOL, fatigue, depression, and anxiety) and relevant covariates. Relationships between activity and sedentary behavior quartiles and HRQOL indicator scores were examined using generalized liner models with Bonferroni multiple comparison adjustment. RESULTS: After adjustment for covariates and sedentary time, each increasing lifestyle activity quartile was associated with reduced fatigue duration (P for trend, .03). Each increasing baseline moderate-to-vigorous physical activity (MVPA) quartile was found to be significantly associated with higher Physical Well-Being, Functional Assessment of Cancer Therapy-Breast (FACT-B) total, and trial outcome index scores; fewer breast cancer-specific concerns; and lower fatigue interference, and these differences were statistically and clinically significant between survivors in quartile 1 and quartile 4. After controlling for covariates and MVPA, relationships between sedentary time and HRQOL were mostly null with the exception of lower fatigue duration. CONCLUSIONS: Objectively measured MVPA was found to be positively associated with many HRQOL indicators. Lifestyle activity was found to be only inversely associated with fatigue duration whereas sedentary time was found to be positively associated with fatigue duration. Future research is warranted to explore these relationships further.

Physical activity barriers and facilitators among working mothers and fathers.

BACKGROUND: The transition to parenthood is consistently associated with declines in physical activity. In particular, working parents are at risk for inactivity, but research exploring physical activity barriers and facilitators in this population has been scarce. The purpose of this study was to qualitatively examine perceptions of physical activity among working parents. METHODS: Working mothers (n = 13) and fathers (n = 12) were recruited to participate in one of four focus group sessions and discuss physical activity barriers and facilitators. Data were analyzed using immersion/crystallization in NVivo 10. RESULTS: Major themes for barriers included family responsibilities, guilt, lack of support, scheduling constraints, and work. Major themes for facilitators included being active with children or during children's activities, being a role model for children, making time/prioritizing, benefits to health and family, and having support available. Several gender differences emerged within each theme, but overall both mothers and fathers reported their priorities had shifted to focus on family after becoming parents, and those who were fitting in physical activity had developed strategies that allowed them to balance their household and occupational responsibilities. CONCLUSIONS: The results of this study suggest working mothers and fathers report similar physical activity barriers and facilitators and would benefit from interventions that teach strategies for overcoming barriers and prioritizing physical activity amidst the demands of parenthood. Future interventions might consider targeting mothers and fathers in tandem to create an optimally supportive environment in the home.

Impact of a brief intervention on physical activity and social cognitive determinants among working mothers: a randomized trial.

Working mothers exhibit high levels of inactivity, and theory-based interventions to bolster physical activity within this population are needed. This study examined the effectiveness of a brief social cognitive theory-based intervention designed to increase physical activity among working mothers. Participants (N = 141) were randomly assigned to an intervention only, intervention plus follow-up support, or waitlist control condition. The intervention consisted of two group-based workshop sessions designed to teach behavior modification strategies using social cognitive theory. Data were collected at baseline, immediately post-intervention, and 6-month follow-up. Results showed intervention participants exhibited short-term increases in physical activity, which were partially maintained 6 months later. Improvements in physical activity were mediated by increases in self-regulation and self-efficacy. This study provides some support for the effectiveness of a brief intervention to increase physical activity among working mothers. Future programs should explore alternative support mechanisms which may lead to more effective maintenance of initial behavior changes.

Physical activity intervention effects on perceived stress in working mothers: the role of self-efficacy.

Working mothers often report elevated stress, and efforts to improve their coping resources are needed to buffer the detrimental effects of stress on health. This study examined the impact of changes in physical activity, self-efficacy, and self-regulation across the course of a brief intervention on subsequent levels of stress in working mothers. Participants (N = 141) were randomly assigned to an intervention or control condition (2:1 ratio). The intervention was conducted in Illinois between March 2011 and January 2012 and consisted of two group-mediated workshop sessions with content based on social cognitive theory. Participants completed measures of physical activity, self-efficacy, self-regulation, and perceived stress at baseline, immediately postintervention, and 6-month follow-up. Stress levels declined across the 6-month period in both groups. Changes in stress were negatively associated with changes in self-efficacy and self-regulation among intervention participants only. Regression analyses revealed the intervention elicited short-term increases in physical activity, self-efficacy, and self-regulation, but only changes in self-efficacy predicted perceived stress at 6-month follow-up. These results suggest that enhancing self-efficacy is likely to improve working mothers' perceived capabilities to cope with stressors in their lives. Future interventions should continue to focus on increasing self-efficacy to promote improvements in physical activity and psychological well-being in this population.

Influence of allowable interruption period on estimates of accelerometer wear time and sedentary time in older adults.

The criteria one uses to reduce accelerometer data can profoundly influence the interpretation of research outcomes. The purpose of this study was to examine the influence of 3 different interruption periods (i.e., 20, 30, and 60 min) on the amount of data retained for analyses and estimates of sedentary time among older adults. Older adults (N = 311, M age = 71.1) wore an accelerometer for 7 d and reported wear time on an accelerometer log. Accelerometer data were downloaded and scored using 20-, 30-, and 60-min interruption periods. Estimates of wear time, derived using each interruption period, were compared with self-reported wear time, and descriptive statistics were used to compare estimates of sedentary time. Results showed a longer interruption period (i.e., 60 min) yields the largest sample size and the closest approximation of self-reported wear time. A short interruption period (i.e., 20 min) is likely to underestimate sedentary time among older adults.

EmpowerHER: A Pilot Study to Increase Physical Activity and Strength Through Powerbuilding.

Engaging in empowering exercise develops movement competency (MC) and strength and supports physical health, mental well-being, and quality of life. Powerbuilding combines powerlifting and bodybuilding to increase physical activity (PA), MC, and strength. To our knowledge, powerbuilding has not been explored as an exercise intervention. This pilot study investigated the impact of an eight-week powerbuilding intervention on women's PA, MC, strength, and empowerment. Eighteen women aged 25.1±9.8 with no powerbuilding experience participated in the intervention, meeting three times weekly for one hour. PA and MC were assessed pre- and post-intervention. Three-repetition maximum (3-RM) tests in the squat, bench press, and deadlift were completed in weeks one and eight of the intervention. Data were checked for normality; the Wilcoxon signed-rank test was used for non-normally distributed data. The McNemar test was used to analyze differences in dichotomous variables. Effect size was calculated and interpreted as follows small (r=0.1, d=0.2, ω=0.1), medium (r=0.3, d=0.5, ω=0.3), and large (r=0.5, d=0.8, ω=0.5) Total PA ([t(17)=3.52, p=0.003, d=0.83]) and participants who met the PA guidelines (Z=6.13, p=0.008, ω=0.82) increased significantly from pre- to post-intervention. Participants' MC scores improved significantly from pre- (24.3±3.5) to post-intervention (29.5±2.5; [t(17)=10.04, p<0.001; d=2.37]). Significant increases in strength were observed (squat [Z=-3.73, p<0.001, r=0.88], bench press [Z=-3.73, p<0.001, r=0.88], and deadlift [t(17)=16.41, p<0.001; d=3.87]). Empowerment in exercise scores averaged 56.3±6.6 (on a scale of 5-65). The intervention significantly increased total PA, improved MC, increased strength, and facilitated empowerment. Women's participation in powerbuilding may enhance their quality of life.

The influence of aerobic fitness on cerebral white matter integrity and cognitive function in older adults: results of a one-year exercise intervention.

Cerebral white matter (WM) degeneration occurs with increasing age and is associated with declining cognitive function. Research has shown that cardiorespiratory fitness and exercise are effective as protective, even restorative, agents against cognitive and neurobiological impairments in older adults. In this study, we investigated whether the beneficial impact of aerobic fitness would extend to WM integrity in the context of a one-year exercise intervention. Further, we examined the pattern of diffusivity changes to better understand the underlying biological mechanisms. Finally, we assessed whether training-induced changes in WM integrity would be associated with improvements in cognitive performance independent of aerobic fitness gains. Results showed that aerobic fitness training did not affect group-level change in WM integrity, executive function, or short-term memory, but that greater aerobic fitness derived from the walking program was associated with greater change in WM integrity in the frontal and temporal lobes, and greater improvement in short-term memory. Increases in WM integrity, however, were not associated with short-term memory improvement, independent of fitness improvements. Therefore, while not all findings are consistent with previous research, we provide novel evidence for correlated change in training-induced aerobic fitness, WM integrity, and cognition among healthy older adults.

Neurobiological markers of exercise-related brain plasticity in older adults.

The current study examined how a randomized one-year aerobic exercise program for healthy older adults would affect serum levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor type 1 (IGF-1), and vascular endothelial growth factor (VEGF) - putative markers of exercise-induced benefits on brain function. The study also examined whether (a) change in the concentration of these growth factors was associated with alterations in functional connectivity following exercise, and (b) the extent to which pre-intervention growth factor levels were associated with training-related changes in functional connectivity. In 65 participants (mean age=66.4), we found that although there were no group-level changes in growth factors as a function of the intervention, increased temporal lobe connectivity between the bilateral parahippocampus and the bilateral middle temporal gyrus was associated with increased BDNF, IGF-1, and VEGF for an aerobic walking group but not for a non-aerobic control group, and greater pre-intervention VEGF was associated with greater training-related increases in this functional connection. Results are consistent with animal models of exercise and the brain, but are the first to show in humans that exercise-induced increases in temporal lobe functional connectivity are associated with changes in growth factors and may be augmented by greater baseline VEGF.

A profile for predicting attrition from exercise in older adults.

The purpose of this study was to determine a profile for predicting attrition among older adults involved in a 12-month exercise program. The parent study was a single-blinded randomized controlled trial. The study took place between 2006 and 2009 within a university setting. Older adults (N = 179) completed baseline assessments of functional performance and psychosocial measures. Participants who were randomized, elected to receive treatment, and did not complete the exercise program were considered "dropouts" (n = 35). Those who completed the program (n = 144) were classified as "completers." A latent profile analysis revealed two distinct patterns of memory complaints, self-efficacy to overcome barriers to exercise, balance performance, and stair performance. Dropouts were nearly twice as likely to be members of the profile that exhibited a higher degree of memory complaints, lower self-efficacy for overcoming exercise barriers, poorer single leg balance, and longer times to walk down stairs. The results provide an initial validation of a profile for discriminating between "dropouts" and "completers," one that may have considerable utility for screening older adults prior to study entry.

Differences in physical activity behaviors between university women from metropolitan, micropolitan, and rural areas.

Objective: Rural and emerging adult women report low physical activity (PA) levels. This study identified differences in current self-reported PA levels and perceived resources among US university women from metropolitan, micropolitan, and rural areas. Participants: Women were ages 18-24 y, full-time students who attended in-person university classes before COVID-19. Methods: They completed an online cross-sectional survey between July-September 2020 collecting demographic, university PA (via IPAQ), and perceived PA resource data. Results: Most participants reported metropolitan area high school (70.4%) and university (92.3%) attendance. Metropolitan participants did less job-related moderate PA during university (0.0 (0.0-360.0) MET-min) than rural (160.0 (0.0-1320.0) MET-min) participants. Metropolitan and micropolitan participants identified more high school community and natural resources than rural participants. Rural participants identified more university campus and community resources than metropolitan participants. Conclusions: University women reported similar levels of PA regardless of the rurality of their high school community.

Effects of Sedentary Behavior Interventions on Mental Well-Being and Work Performance While Working from Home during the COVID-19 Pandemic: A Pilot Randomized Controlled Trial.

Sedentary behavior negatively impacts mental health, which can decrease employee productivity. Employee mental well-being and work performance may improve with sedentary reduction interventions, especially strategies that include environmental workplace modifications and behavior-changing strategies. However, such interventions have not been examined among employees working remotely during the COVID-19 pandemic. As part of the Stand Up Kansas program, 95 sedentary university employees working from home were randomized into one of four intervention arms: height-adjustable desk provision (Desk Only), online sedentary behavior modification program (Program Only), Desk + Program, or Control. The outcomes were measured at a baseline (November 2020) and following the 12-week intervention (February 2021). Employees reported mood (positive and negative affect), stress, fatigue (duration, interference with activities and severity) and work performance (irritability, focus, work satisfaction, non-work satisfaction and productivity) were measured using established self-report instruments. The effect sizes, by comparing the Control arm to the Desk + Program arm, revealed large improvements in mood (positive affect, d = 1.106). Moderate improvements were also seen in fatigue (duration, d = -0.533, and interference with activities, d = -0.648) and several aspects of work performance (focus, d = 0.702, work satisfaction, d = 0.751, and productivity, d = 0.572). Moderate effect sizes were also seen for positive affect (d = 0.566) and fatigue severity (d = 0.577) among the Program Only arm, whereas no noteworthy effect sizes were observed among the Desk Only arm. Combining an online sedentary behavior modification program with height-adjustable desk provisions appeared to positively affect mental well-being and work performance among remote employees.

Reducing Occupational Sitting While Working From Home: Individual and Combined Effects of a Height-Adjustable Desk and an Online Behavioral Intervention.

OBJECTIVE: This study examined the individual and combined effects of a height-adjustable desk and an online behavioral intervention on sedentary behavior and health among university employees working from home. METHODS: Participants (N = 95) were randomly assigned to one of four conditions: Desk Only, Program Only, Desk + Program, or Control. Desk participants received a height-adjustable desk; program participants received a 12-week web-based intervention. Outcomes measured at baseline and post-intervention included workday sitting and cardiometabolic health outcomes. RESULTS: Reductions in sitting were largest in the Desk + Program condition (-206 min/workday; d = 1.84), followed by the Desk Only condition (-122 min/workday; d = 0.98), and the Program Only condition (-96 min/workday; d = 1.13). There were no significant changes in the health outcomes assessed. CONCLUSIONS: Both a height-adjustable desk and an online behavioral intervention effectively reduced occupational sitting, and a combined approach was most effective.

Measuring enjoyment of physical activity in older adults: invariance of the physical activity enjoyment scale (paces) across groups and time.

The purpose of this study was to validate the Physical Activity Enjoyment Scale (PACES) in a sample of older adults. Participants within two different exercise groups were assessed at two time points, 6 months apart. Group and longitudinal invariance was established for a novel, 8-item version of the PACES. The shortened, psychometrically sound measure provides researchers and practitioners an expedited and reliable instrument for assessing the enjoyment of physical activity.

Longitudinal invariance and construct validity of the abbreviated late-life function and disability instrument in healthy older adults.

OBJECTIVE: To cross-validate the psychometric properties of the abbreviated Late-Life Function and Disability Instrument (LL-FDI), a measure of perceived functional limitations and disability. DESIGN: Baseline and 12-month follow-up assessments conducted across the course of a 12-month exercise program. SETTING: University research community. PARTICIPANTS: Older healthy adults (N=179; mean ± SD age, 66.43±5.67y) at baseline; 145 were retained at follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: LL-FDI and functional performance measures. RESULTS: Factor analyses confirmed the factor structure of the abbreviated LL-FDI, and all subscales met minimal criteria for temporal invariance. Significant correlations also were found between functional limitations subscales and an array of physical function performance measures, supporting the scale's construct validity. CONCLUSIONS: The abbreviated LL-FDI with some modifications appears to be temporally invariant in community-dwelling older adults. Additionally, moderate relationships between functional limitations and functional performance provide further support for these being conceptually distinct constructs.

Trajectories of change in self-esteem in older adults: exercise intervention effects.

This 12-month, 2 arm, single blind randomized controlled exercise trial examined relationships among changes in multidimensional self-esteem as a function of intervention mode (i.e., walking vs. flexibility-toning-balance). Data were collected on three equidistant occasions (baseline, 6 and 12 months). One-hundred seventy-nine older adults (M(age) = 66.38) began the study and 145 completed assessments at all time points. Participants completed measures of physical and global self-esteem as well as demographic information. There were no significant group differences at baseline on these demographic indicators or esteem variables. Data were analyzed using linear and parallel process growth modeling procedures. Results supported the position that across both groups, domain-level (i.e., physical self-worth) was dependent upon sub-domain-level (i.e., perceived attractiveness, strength, and condition) esteem change. Furthermore, greater improvements were observed in the flexibility-toning-balance group, in terms of perceived strength and attractiveness esteem, compared to the walking group. Our findings support theoretically-based predictions and extend the literature showing unique psychological responses conditional on specific types of physical activities.

Effects of the COVID-19 Pandemic on Physical Activity Behavior across Domains and Settings.

COVID-19 restrictions and alterations to daily living (e.g. working from home, caregiving responsibilities) necessitated changes in physical activity (PA) behavior. The purpose of this study was to understand how PA within specific domains and behavior settings changed during the COVID-19 pandemic, as well as the extent to which PA increased or decreased as a function of participants' gender, work location (i.e., home vs. jobsite) and caregiving responsibilities. An e-survey, conducted April-June 2020, examined changes in PA across domains and settings in a national sample of 805 adults. Respondents reported domain-specific increases in household and recreational PA, but decreases in active transportation, occupational PA, and public transportation use. Weekly minutes of PA changed significantly across all behavior settings, with reported increases in home-based, neighborhood, parks/trails, and total PA, and decreases in PA through recreational sports and fitness facilities. Total weekly PA minutes increased by 10.6%. Those with caregiving responsibilities reported increases in household PA and PA frequency, whereas those without caregiving responsibilities were more likely to report increases in sitting. Those working from home reported a larger increase in neighborhood PA. Those working at a jobsite with caregiving responsibilities reported less weekly PA, while those working from home with caregiving responsibilities reported greater weekly PA. The overall increase in weekly PA minutes and ability to adapt to different domains/settings was encouraging. Future interventions should capitalize on domain- and setting-specific changes, while considering work location and caregiving responsibilities to develop innovative PA promotion strategies.