Stirring the motivational soup: within-person latent profiles of motivation in exercise.

BACKGROUND: The purpose of the present study was to use a person-oriented analytical approach to identify latent motivational profiles, based on the different behavioural regulations for exercise, and to examine differences in satisfaction of basic psychological needs (competence, autonomy and relatedness) and exercise behaviour across these motivational profiles. METHODS: Two samples, consisting of 1084 and 511 adults respectively, completed exercise-related measures of behavioural regulation and psychological need satisfaction as well as exercise behaviour. Latent profile analyses were used to identify motivational profiles. RESULTS: Six profiles, representing different combinations of regulations for exercise, were found to best represent data in both samples. Some profiles were found in both samples (e.g., low motivation profile, self-determined motivation profile and self-determined with high introjected regulation profile), whereas others were unique to each sample. In line with the Self-Determination Theory, individuals belonging to more self-determined profiles demonstrated higher scores on need satisfaction. CONCLUSIONS: The results support the notions of motivation being a multidimensional construct and that people have different, sometimes competing, reasons for engaging in exercise. The benefits of using person-oriented analyses to examine within-person interactions of motivation and different regulations are discussed.

Moderators of Implicit-Explicit Exercise Cognition Concordance.

Investigating implicit-explicit concordance can aid in understanding underlying mechanisms and possible intervention effects. This research examined the concordance between implicit associations of exercise with health or appearance and related explicit motives. Variables considered as possible moderators were behavioral regulations, explicit attitudes, and social desirability. Participants (N = 454) completed measures of implicit associations of exercise with health and appearance and questionnaire measures of health and appearance motives, attitudes, social desirability, and behavioral regulations. Attitudes significantly moderated the relationship between implicit associations of exercise with health and health motives. Identified regulations significantly moderated implicit-explicit concordance with respect to associations with appearance. These results suggest that implicit and explicit exercise-related cognitions are not necessarily independent and their relationship to each other may be moderated by attitudes or some forms of behavioral regulation. Future research that takes a dual-processing approach to exercise behavior should consider potential theoretical moderators of concordance.

Exercise, physical activity, and self-determination theory: a systematic review.

BACKGROUND: Motivation is a critical factor in supporting sustained exercise, which in turn is associated with important health outcomes. Accordingly, research on exercise motivation from the perspective of self-determination theory (SDT) has grown considerably in recent years. Previous reviews have been mostly narrative and theoretical. Aiming at a more comprehensive review of empirical data, this article examines the empirical literature on the relations between key SDT-based constructs and exercise and physical activity behavioral outcomes. METHODS: This systematic review includes 66 empirical studies published up to June 2011, including experimental, cross-sectional, and prospective studies that have measured exercise causality orientations, autonomy/need support and need satisfaction, exercise motives (or goal contents), and exercise self-regulations and motivation. We also studied SDT-based interventions aimed at increasing exercise behavior. In all studies, actual or self-reported exercise/physical activity, including attendance, was analyzed as the dependent variable. Findings are summarized based on quantitative analysis of the evidence. RESULTS: The results show consistent support for a positive relation between more autonomous forms of motivation and exercise, with a trend towards identified regulation predicting initial/short-term adoption more strongly than intrinsic motivation, and intrinsic motivation being more predictive of long-term exercise adherence. The literature is also consistent in that competence satisfaction and more intrinsic motives positively predict exercise participation across a range of samples and settings. Mixed evidence was found concerning the role of other types of motives (e.g., health/fitness and body-related), and also the specific nature and consequences of introjected regulation. The majority of studies have employed descriptive (i.e., non-experimental) designs but similar results are found across cross-sectional, prospective, and experimental designs. CONCLUSION: Overall, the literature provides good evidence for the value of SDT in understanding exercise behavior, demonstrating the importance of autonomous (identified and intrinsic) regulations in fostering physical activity. Nevertheless, there remain some inconsistencies and mixed evidence with regard to the relations between specific SDT constructs and exercise. Particular limitations concerning the different associations explored in the literature are discussed in the context of refining the application of SDT to exercise and physical activity promotion, and integrating these with avenues for future research.

Motivation, self-determination, and long-term weight control.

This article explores the topics of motivation and self-regulation in the context of weight management and related behaviors. We focus on the role of a qualitative approach to address motivation--not only considering the level but also type of motivation--in weight control and related behaviors. We critically discuss the operationalization of motivation in current weight control programs, present a complementary approach to understanding motivation based on self-determination theory, and review empirical findings from weight control studies that have used self-determination theory measures and assessed their association with weight outcomes. Weight loss studies which used Motivational Interviewing (MI) are also reviewed, considering MI's focus on enhancing internal motivation. We hypothesize that current weight control interventions may have been less successful with weight maintenance in part due to their relative disregard of qualitative dimensions of motivation, such as level of perceived autonomy, often resulting in a motivational disconnect between weight loss and weight-related behaviors. We suggest that if individuals fully endorse weight loss-related behavioral goals and feel not just competent but also autonomous about reaching them, as suggested by self-determination theory, their efforts are more likely to result in long-lasting behavior change.

Body image change and improved eating self-regulation in a weight management intervention in women.

BACKGROUND: Successful weight management involves the regulation of eating behavior. However, the specific mechanisms underlying its successful regulation remain unclear. This study examined one potential mechanism by testing a model in which improved body image mediated the effects of obesity treatment on eating self-regulation. Further, this study explored the role of different body image components. METHODS: Participants were 239 overweight women (age: 37.6 ± 7.1 yr; BMI: 31.5 ± 4.1 kg/m²) engaged in a 12-month behavioral weight management program, which included a body image module. Self-reported measures were used to assess evaluative and investment body image, and eating behavior. Measurements occurred at baseline and at 12 months. Baseline-residualized scores were calculated to report change in the dependent variables. The model was tested using partial least squares analysis. RESULTS: The model explained 18-44% of the variance in the dependent variables. Treatment significantly improved both body image components, particularly by decreasing its investment component (f² = .32 vs. f² = .22). Eating behavior was positively predicted by investment body image change (p < .001) and to a lesser extent by evaluative body image (p < .05). Treatment had significant effects on 12-month eating behavior change, which were fully mediated by investment and partially mediated by evaluative body image (effect ratios: .68 and .22, respectively). CONCLUSIONS: Results suggest that improving body image, particularly by reducing its salience in one's personal life, might play a role in enhancing eating self-regulation during weight control. Accordingly, future weight loss interventions could benefit from proactively addressing body image-related issues as part of their protocols.

Taste perception and implicit attitude toward sweet related to body mass index and soft drink supplementation.

These studies examined the differences in sweet taste perception and implicit attitude toward sweet between normal-weight and overweight/obese adults; and tested the effects of soft drink consumption on sweet taste, explicit preference and implicit attitude toward sweet in normal-weight subjects. In study 1, normal-weight (n = 22) and overweight/obese (n = 11) adults were assessed for sweet taste intensity and pleasantness. Implicit attitude toward sweet was assessed by implicit association test (IAT). In study 2, normal-weight, lightly active adults (n = 12) underwent one month soft drink supplementation (≈760 ml/day). This increased their daily carbohydrate intake by 2.1 ± 0.2g/kg body weight. Sweet taste perception, explicit preference and implicit attitudes to sweet were assessed. In both studies salty taste was also assessed as a contrasting perception. Overweight/obese subjects perceived sweet and salty tastes as less intense (-23% and -19%, respectively) and reported higher IAT scores for sweet than normal-weight controls (2.1-fold). The supplementation changed sweet intensity/pleasantness ratings and it increased explicit preference (2.3-fold) for sweet in a subgroup of initial sucrose-dislikers. In conclusion, overweight/obese individuals are more implicitly attracted to sweet. One month of soft drink supplementation changed sweet taste perception of normal-weight subjects.

Motivational Strategies Used by Exercise Professionals: A Latent Profile Analysis.

BACKGROUND: Using self-determination theory as a framework, the aim of this study was 2-fold: (1) identify different profiles of motivational strategies used by exercise professionals and (2) examine associations of these motivational profiles with work-related variables: measures, perceived job pressures, need satisfaction/frustration, and perceived exercisers' motivation. METHODS: Participants were 366 exercise professionals (193 males; experience = 7.7 [5.8] y) currently working in health and fitness settings. RESULTS: Latent profile analysis identified a 3-profile model: (1) most need-supportive and least controlling (NS+; n = 225), (2) less need-supportive and slightly controlling (NS-; n = 42), and (3) most controlling and slightly need-supportive (mixed; n = 99). Professionals working less than 20 hours per week, more experienced, and female were more likely to integrate NS+, which was also associated with higher levels of work-related need satisfaction and clients' perceived self-determination, and lower levels of job pressures and need-frustration. Conversely, NS- displayed the most maladaptive pattern of associations. CONCLUSIONS: The present findings highlight the importance of analyzing the correlates of different professional profiles, namely to help health and fitness organizations to provide high-quality motivational practices within an appropriate environment both for professionals and clients.

Perceptions of the effects of exercise on joint health in rheumatoid arthritis patients.

OBJECTIVES: Exercise is important in RA management. However, RA patients are less active than the general population. This qualitative study explores the perceptions of patients regarding the effects of exercise on joint health. METHODS: A purposive sample of 12 female and 6 male RA outpatients [age: 23-76 years; disease duration: 2.5 months to 33 years; HAQ score: 0-2.13] participated in four moderated focus groups. The main questions addressed were: (i) How do you feel exercise affects your joints?; and (ii) What affects your exercise behaviour? Transcriptions were independently analysed with 455 meaning units identified. An inductive, thematic analysis was conducted using established techniques. Discussion with a third analyst contributed to consensus validation. RESULTS: Sixteen constructs emerged, clustering into five themes, reflecting the issues relating to exercise and joint health in RA patients. Emergent themes were: 'health professionals showing a lack of exercise knowledge', 'not knowing what exercise should be done', 'worry about causing harm to joints', 'not wanting to exercise as joints hurt' and 'having to exercise because it is helpful'. CONCLUSIONS: RA patients demonstrated awareness of the advantages of exercise for their joints, both experientially and through education. However, they perceived that health professionals lacked certainty and clarity regarding specific exercise recommendations and the occurrence of joint damage. Thus, to enhance patient-centred exercise prescription in the RA population, uncertainties surrounding joint health, pain symptoms and exercise specificity need to be addressed, alongside continual emphasis of exercise benefits.

Interpretation of self-talk and post-lecture affective states of higher education students: a self-determination theory perspective.

BACKGROUND: Self-determination theory posits that informational versus controlling interpretations of intra-personal events have positive and negative implications, respectively, for well-being. Self-talk represents an intra-personal event that could be interpreted as informational or controlling and may attenuate or exacerbate the negative effects of a stressful experience. AIMS: The present study investigated relationships between students' informational and controlling interpretations of self-talk, and their post-lecture affective state. An interactive hypothesis, whereby self-talk would be more strongly associated with well-being when students reported experiencing the lecture as stressful, was also tested. SAMPLE: Participants were 146 male and female undergraduate students (M age=19.25, SD=2.57) enrolled on research methods/statistics modules. METHODS: Immediately post-lecture, participants completed a measure of informational and controlling self-talk, short forms of the State-Trait Anxiety Inventory and the Positive and Negative Affect Scale, and self-report measures of their experience and understanding of the lecture. RESULTS: Findings from moderated hierarchical regression analyses indicated that informational self-talk was positively associated with positive affect regardless of students' experience or understanding of a lecture. Significant interactions were found between controlling self-talk and experience and understanding, in that a negative experience or poor understanding predicted higher state anxiety and negative affect when students used high, but not low, levels of controlling self-talk. CONCLUSIONS: The functional significance of students' self-talk may have implications for affect in higher education, suggesting that providers should promote the use of self-talk that emphasizses students' autonomy and competence.

Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis.

BACKGROUND: Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment. METHODS: Participants (BMI = 31.1 +/- 4.1 kg/m2; age = 38.4 +/- 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables. RESULTS: At 12 months, the intervention group had greater weight loss (-5.6 +/- 6.8% vs. -1.2 +/- 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed. CONCLUSION: Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.

A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description.

BACKGROUND: Research on the motivational model proposed by Self-Determination Theory (SDT) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors, and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation. Although obesity is notoriously difficult to reverse and its recidivism is high, adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term. The purposes of this study are twofold: i) to describe a 3-year randomized controlled trial (RCT) aimed at testing a novel obesity treatment program based on SDT, and ii) to present the rationale behind SDT's utility in facilitating and explaining health behavior change, especially physical activity/exercise, during obesity treatment. METHODS: Study design, recruitment, inclusion criteria, measurements, and a detailed description of the intervention (general format, goals for the participants, intervention curriculum, and main SDT strategies) are presented. The intervention consists of a 1-year group behavioral program for overweight and moderately obese women, aged 25 to 50 (and pre-menopausal), recruited from the community at large through media advertisement. Participants in the intervention group meet weekly or bi-weekly with a multidisciplinary intervention team (30 2 h sessions in total), and go through a program covering most topics considered critical for successful weight control. These topics and especially their delivery were adapted to comply with SDT and Motivational Interviewing guidelines. Comparison group receive a general health education curriculum. After the program, all subjects are follow-up for a period of 2 years. DISCUSSION: Results from this RCT will contribute to a better understanding of how motivational characteristics, particularly those related to physical activity/exercise behavioral self-regulation, influence treatment success, while exploring the utility of Self-Determination Theory for promoting health behavior change in the context of obesity. TRIAL REGISTRATION: Clinical Trials Gov. Identifier NCT00513084.

Health Professionals' Perceptions of the Effects of Exercise on Joint Health in Rheumatoid Arthritis Patients.

OBJECTIVES: Although exercise is an important factor in the management of rheumatoid arthritis (RA), research indicates that patients perceive that health professionals (HPs) are uncertain about the place of exercise in treatment and its relationship with joint damage. The present study investigated the perceptions of HPs regarding the effects of exercise on joint health in RA patients. METHODS: A questionnaire investigating perceptions of exercise and joint health was distributed via professional networks and websites. Confirmatory factor analysis (CFA) was used to analyse questionnaire data and develop a focus group interview guide. Focus groups were conducted with multidisciplinary teams (MDTs) of rheumatology HPs and analysed using framework analysis. RESULTS: A total of 137 rheumatology HPs (95 female; 27-65 years of age) completed questionnaires. CFA showed that a four-factor model provided a marginally acceptable fit. Analysis of four focus groups (n = 24; 19 female; 30-60 years of age) identified five themes relating to HPs' perceptions of exercise and joint health in RA patients: 'Exercise is beneficial', 'Concerns about damage to joints', 'Patients have barriers to exercise', 'HP knowledge differs' and 'Patients may think service delivery is vague'. CONCLUSIONS: HPs were highly aware of the benefits and importance of exercise for RA patients. However, to remove the patient perception that HPs lack certainty and clarity regarding exercise it is important to ensure: (i) consistent promotion of exercise across the whole MDT; (ii) clear provision of information regarding rest, joint protection and exercise; (iii) HP education to ensure consistent, accurate knowledge, and understanding of the potential for conflicting advice when promoting exercise as part of an MDT. Copy © 2016 John Wiley & Sons, Ltd.

Predicting muscularity-related behavior, emotions, and cognitions in men: The role of psychological need thwarting, drive for muscularity, and mesomorphic internalization.

We examine the relationships that internalization, need thwarting (NT), and drive for muscularity (DFM), along with their interactions, had with weightlifting, muscle dissatisfaction (MD), and muscle-related-worry (MRW). A sample of 552 men (MAge=20.5 years, SD=3.1) completed the Psychological Need Thwarting Scale, the Internalization subscale of the male version of the Sociocultural Attitudes Towards Appearance Questionnaire, the Drive for Muscularity Scale-Attitudes subscale, the Male Body Attitudes Scale-Muscularity subscale, the Body Change Inventory-Worry subscale, and an inventory assessing weightlifting behavior. DFM significantly predicted weightlifting, MRW, and MD. Internalization significantly predicted weightlifting and MRW. NT significantly predicted weightlifting and MD, and its relationship with MRW approached significance. The interaction terms did not predict weightlifting or MRW. The NT/DFM and NT/Internalization interaction terms predicted MD. These results highlight the role of NT in predicting appearance variables in men.

Perceived social pressures and the internalization of the mesomorphic ideal: The role of drive for muscularity and autonomy in physically active men.

We examined if there were both direct and indirect relationships (via the drive for muscularity) between the perceived pressure to be muscular and internalization of the mesomorphic ideal, and if autonomy moderates these relationships in physically active men. A sample of 330 men, who were undergraduate students studying sport, completed the Behavioral Regulation in Exercise Questionnaire-2, the Mesomorphic Ideal Internalization subscale of the revised male version Sociocultural Attitudes Toward Appearance Questionnaire, the Perceived Sociocultural Pressure Scale-Modified, and the Drive for Muscularity Scale Attitudes subscale. Perceived pressure predicted internalization directly, and indirectly through the drive for muscularity. The direct relationship between pressure and internalization was weaker under higher levels of autonomy. The indirect path, via drive for muscularity, was stronger under higher levels of autonomy. These results provide insights into why men vary in the degree to which they internalize pressure to develop a mesomorphic ideal, supporting further examination of autonomy.

High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation.

INTRODUCTION: Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the 'modern' patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes. METHODS AND ANALYSIS: This pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK. HIIT will consist of 10 high-intensity (85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO) intervals, each lasting 1 min. MISS training will follow usual care recommendations, adhering to currently accepted UK guidelines (ie, >20 min continuous exercise at 40-70% heart rate reserve). Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in VO2 peak as determined by maximal cardiopulmonary exercise testing. Secondary measures will assess physiological, psychosocial and economic outcomes. ETHICS AND DISSEMINATION: The study protocol V.1.0, dated 1 February 2016, was approved by the NHS Health Research Authority, East Midlands-Leicester South Research Ethics Committee (16/EM/0079). Recruitment will start in August 2016 and will be completed in June 2018. Results will be published in peer-reviewed journals, presented at national and international scientific meetings and are expected to inform future national guidelines for exercise training in UK CR. TRIAL REGISTRATION NUMBER: NCT02784873; pre-results.

Work-related goal perceptions and affective well-being.

The aim was to clarify how perceptions of work-related goals influence affective well-being and goal commitment. Participants (N = 201) completed a Goal Perceptions Questionnaire and affect scales. A model was refined using structural equation modelling. Value and success expectation substantially mediated the effects of other goal perceptions on affects and commitment. Both value and success expectation increased commitment, but whereas value increased positive affects, success expectation reduced negative affects. The determinants of value (e.g. personal origin) were different from those of success expectation (e.g. personal control). Through astute goal setting, it is possible to promote well-being without compromising commitment.

Distinguishing perceived competence and self-efficacy: an example from exercise.

UNLABELLED: This article examined the conceptual and statistical distinction between perceived competence and self-efficacy. Although they are frequently used interchangeably, it is possible that distinguishing them might assist researchers in better understanding their roles in developing enduring adaptive behavior patterns. Perceived competence is conceived in the theoretical framework of self-determination theory and self-efficacy is conceived in the theoretical framework of social-cognitive theory. PURPOSE: The purpose of this study was to empirically distinguish perceived competence from self-efficacy for exercise. METHOD: Two studies evaluated the independence of perceived competence and self-efficacy in the context of exercise. Using 2 extant instruments with validity and reliability evidence in exercise contexts, the distinctiveness of the 2 constructs was assessed in 2 separate samples (n = 357 middle-aged sedentary adults; n = 247 undergraduate students). RESULTS: Confirmatory factor analysis supported the conceptual and empirical distinction of the 2 constructs. CONCLUSIONS: This study supports the conceptual and statistical distinction of perceived competence from perceived self-efficacy. Applications of these results provide a rationale for more precise future theorizing regarding their respective roles in supporting initiation and maintenance of health behaviors.

Perceived Environmental Supportiveness Scale: Portuguese Translation, Validation and Adaptation to the Physical Education Domain

Abstract Aim: Grounded on Self-Determination Theory, this study aimed to translate, adapt and validate the Perceived Environmental Supportiveness Scale (PESS) in a sample of Portuguese physical education students. Methods: The global sample was comprised of 964 students (518 females), divided in two groups: the calibration (n = 469) and the validation one (n = 483), all of them enrolled in two Physical Education (PE) classes/week. Results: The analysis provided support for a one factor and 12 items model, which are in line with the values adopted in the methodology (χ² = 196.123, df = 54, p = <.001, SRMR = .035, NNFI = .943, CFI = .954, RMSEA = .074, 90% CI .063-.085). Results express that the models are invariant in all analysis (i.e., calibration vs. validation, male vs. female, and 3rd vs. secondary cycle; three and single factor models). Conclusion: The present study suggests that the PESS with one factor and 12 items has good psychometric properties and can be used to assess perceived need supportive motivational environments provided by PE teachers. Additionally, invariance analysis showed support for the use of the scale in both genders and in the 3rd and secondary cycles.

Perceptions of issues relating to exercise and joint health in rheumatoid arthritis: a UK-based questionnaire study.

OBJECTIVES: This questionnaire study investigated the perceptions of rheumatoid arthritis (RA) patients across the UK in relation to exercise and joint health. The validity of the measure was also assessed. METHODS: Members of the National Rheumatoid Arthritis Society (NRAS) with self-reported RA completed the questionnaire online. Items related to five factors that emerged from previous qualitative research. Participants responded using a five-point Likert-style scale (strongly disagree to strongly agree). The International Physical Activity Questionnaire (IPAQ) assessed physical activity. The model was tested using confirmatory factor analysis (LISREL 8.8); statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS). RESULTS: A total of 247 responses were collected over 47 days (88% females; age: 18-77 years; disease duration: <1-51 years). Acceptable factorial validity was revealed (Satorra-Bentler χ(2) = 774.47, df = 454, p < 0.001, root mean squared error of approximation (RMSEA) = 0.05, 90% confidence interval RMSEA = 0.05-0.06, comparative fit index = 0.94, standardized root mean square residual = 0.09), with the following factor endorsements: 'Health professionals show exercise knowledge' (19%); 'Knowing what exercise should be done' (43%); 'Having to exercise because it is helpful' (72%); 'Worry about causing harm to joints' (44%); and 'Not wanting to exercise as joints hurt' (52%). Patient concerns about joint pain, joint harm and how to exercise were significantly associated with lower physical activity (p < 0.05). CONCLUSIONS: These results confirm that patients perceive exercise as beneficial. However, concerns about how to exercise, joint pain, causing harm to joints and a perceived lack of exercise knowledge among health professionals remain. Addressing these concerns may have implications for increasing physical activity within the RA population.

Physical activity predicts changes in body image during obesity treatment in women.

PURPOSE: This study examined effects of a behavioral weight management intervention on body image (evaluative and investment dimensions) and explored the potential mediating role of structured and lifestyle physical activity (PA). METHODS: The study was a longitudinal randomized controlled trial, including a 1-yr behavior change intervention and a 2-yr follow-up (225 women, 37.6 ± 7 yr, body mass index = 31.5 ± 4.1 kg·m). Statistical analyses comprised mixed-design ANOVAs with repeated measures, bivariate/partial correlations, and mediation analyses. RESULTS: Body image improved considerably in both groups, favoring the intervention group (small to moderate effect sizes: 0.03-0.05), but began to deteriorate from 12 to 24 months, especially in the intervention group. Consequently, at 24 months, between-group differences were small and did not reach significance. Yet, levels of body dissatisfaction and dysfunctional investment remained below initial values (for both groups). Results were similar for both body image dimensions. Structured PA (at 12 and 24 months) and lifestyle PA (at 24 months) were positively associated with (r > -0.25, P < 0.05) and partially mediated body image improvements, especially in the investment component (95% confidence interval of -1.88 to -0.27 for structured PA at 12 months, 95% confidence interval of -1.94 to -0.21 for lifestyle PA at 24 months). In general, change in evaluative body image was not mediated by exercise participation, seeming more dependent on weight change. CONCLUSIONS: These findings highlight the importance of PA as a contributing factor in the improvement of body image in overweight/obese women, mainly by reducing excessive salience of appearance to one's life and self. Lifestyle PA may also be a valid option, particularly in the long term. Exercise might provide a buffer against body image deterioration overtime, favoring lasting weight loss maintenance.