A full-factorial test of motivational and volitional intervention strategies for promoting exercise habit formation and exercise maintenance among new users of an online exercise class platform.

Interventions often fail to achieve long-term behavioral maintenance. Utilizing motivational and volitional strategies to promote behavioral maintenance factors may improve this. Using a full-factorial experiment, we tested the effects of three intervention components (focused on intrinsic motivation and identity, exercise preparation habit, and exercise instigation habit) on exercise participation over a year, among new users (N = 751; 91% identifying as female, 54% identifying as White race) of a global, online exercise class platform, run by Les Mills International Ltd, called LM+. We also tested the intervention components' theoretical mechanisms of action-habit formation, intrinsic motivation, identity, and self-efficacy. Multi-level models found some support for a main effect of the exercise preparation habit intervention component in promoting self-reported and objective exercise participation (behavioral outcomes measured via monthly surveys and the LM+ platform; mechanisms measured via monthly surveys)-in particular online exercise class frequency (fixed effect estimate = 0.84, p < 0.05, and = 0.12, p < 0.05, respectively). The preparation habit component also significantly increased preparation habit strength (0.30, p < 0.05) and instigation habit strength (0.33, p < 0.05). Other expected effects were nonsignificant. Helping individuals form an exercise preparation habit may facilitate initiating and maintaining exercise over time, in particular for attending online exercise classes, potentially through promoting greater preparation and exercise instigation habit strength.

Evaluating the feasibility and utility of telephonic motivational interviewing in older adults.

Older adults face unique barriers and challenges related to physical activity (PA) participation. Motivational interviewing (MI) is a commonly used health coaching strategy to support behavior change that holds potential for older adults. Previous research on MI strategies has focused primarily on face-to-face delivery, limiting insights regarding virtual programs. Objectives: The purpose of this study was to determine if MI could be delivered telephonically with high fidelity and high acceptability in older adult participants. The study is designed to inform future trials evaluating its effectiveness in supporting virtual PA programs. Methods: This study evaluated the feasibility and acceptability of telephonic MI among older adults that enrolled in an online version of the Walk with Ease program. Results: Of 39 participants referred, 29 enrolled and 27 provided feedback. Participants were highly accepting and adherent, with 74 % of patients attending at least five of six sessions, and 96 % of participants indicating satisfaction with the MI provided. Coaches improved program enjoyment by helping set effective goals and providing ongoing accountability. Conclusions: Evaluations documented adequate fidelity and high acceptability of telephonic delivery, and motivation results revealed large, significant increases in autonomous regulation (quality of motivation). Innovation: Telephonic MI using non-healthcare professional coaches is feasibly delivered with high fidelity, and is acceptable to older adult participants. The innovative delivery format offers novel opportunities supporting virtual and telehealth interventions to reduce chronic disease risk among older adults.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention.

BACKGROUND: Falls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians. METHODS: The study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of 'habit training' resources (relative to generic behavior prompts) to improve compliance with exercises in this population. DISCUSSION: The study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

An observational pilot evaluation of the Walk with Ease program for reducing fall risk among older adults.

BACKGROUND: Physical activity is an effective method of reducing fall risk among older adults. Previous evaluations of the six-week Walk with Ease (WWE) program have documented benefits to functional outcomes, but the potential effects on reducing fall risk have not been evaluated. This pilot study evaluates outcomes of a community delivered WWE program for potential suitability as a fall risk reduction program. METHODS: A total of 59 older adults (age > 60) enrolled in a group version of WWE delivered by trained community-based leaders. Complete data (pre- and post-program) from functional fitness tests and behavioral instruments were obtained from 41 participants (aged 74.4 ± 6.6 years, 70% female). Functional outcomes included the 10-foot timed up and go (TUG), 30-second chair stand (CST) and 4-stage balance test (BT) included as part of STEADI, as well as a two-minute step test (ST) and normal gait speed test (GST). Survey assessments included STEADI fall risk screening, self-reported physical activity, and fear of falling measures. Analyses focused on reporting pre-post effect sizes, but paired t-tests were used to test statistical significance of differences. RESULTS: Improvements in functional performance approached significance for both CST (d = 0.31, p = 0.06) and ST (d = 0.26, p = 0.12), but all other tests were nonsignificant. Survey results demonstrated significant increases in self-reported walking (d = 0.54, p = 0.02) and moderate-to-vigorous physical activity (MVPA; d = 0.56, p = 0.004), but perceived fear of falling and overall fall risk scores had smaller, non-significant, effects (d ranging from 0.01 to 0.31). Stratified analysis suggested that participants screened at an elevated risk for falls at baseline consistently had larger effects on all functional and survey assessments, though the analysis was underpowered to test significance. CONCLUSIONS: Walk with Ease participation significantly increased self-reported physical activity but did not significantly improve physical function or reduce fall risk. However, consistently larger effect sizes among participants screened as at-risk for falls suggest that the program may be beneficial for those with elevated risk for falls or functional limitations. Further research is needed to document the consistency of these effects among participants with elevated fall risk status.

Equating NHANES Monitor-Based Physical Activity to Self-Reported Methods to Enhance Ongoing Surveillance Efforts.

PURPOSE: Harmonization of assessment methods represents an ongoing challenge in physical activity research. Previous research has demonstrated the utility of calibration approaches to enhance agreement between measures of physical activity. The present study utilizes a calibration methodology to add behavioral context from the Global Physical Activity Questionnaire (GPAQ), an established report-based measure, to enhance interpretations of monitor-based data scored using the novel Monitor Independent Movement Summary (MIMS) methodology. METHODS: Matching data from the GPAQ and MIMS were obtained from adults (20-80 yr of age) assessed in the 2011-2014 National Health and Nutrition Examination Survey. After developing percentile curves for self-reported activity, a zero-inflated quantile regression model was developed to link MIMS to estimates of moderate to vigorous physical activity (MVPA) from the GPAQ. RESULTS: Cross-validation of the model showed that it closely approximated the probability of reporting MVPA across age and activity-level segments, supporting the accuracy of the zero-inflated model component. Validation of the quantile regression component directly corresponded to the 25%, 50%, and 75% values for both men and women, further supporting the model fit. CONCLUSIONS: This study offers a method of improving activity surveillance by translating accelerometer signals into interpretable behavioral measures using nationally representative data. The model provides accurate estimates of minutes of MVPA at a population level but, because of the bias and error inherent in report-based measures of physical activity, is not suitable for converting or interpreting individual-level data. This study provides an important preliminary step in utilizing information from both device- and report-based methods to triangulate activity related outcomes; however additional measurement error modeling is needed to improve precision.

Temporal Trends in the Cardiorespiratory Fitness of 2,525,827 Adults Between 1967 and 2016: A Systematic Review.

OBJECTIVE: To estimate international and national temporal trends in the cardiorespiratory fitness (CRF) of adults, and to examine relationships between trends in CRF and trends in health-related, socioeconomic, and environmental indicators. METHODS: Data were obtained from a systematic search of studies that explicitly reported temporal trends in the CRF of apparently healthy adults aged 18-59 years. Sample-weighted temporal trends were estimated using best-fitting regression models relating the year of testing to mean CRF. Post-stratified population-weighted mean changes in percent and standardized CRF were estimated. Pearson's correlations were used to describe associations between linear trends in CRF and linear trends in health-related, socioeconomic, and environmental indicators. RESULTS: 2,525,827 adults representing eight high- and upper-middle-income countries between 1967 and 2016 collectively showed a moderate decline of 7.7% (95% CI - 8.4 to - 7.0) or 1.6% per decade (95% CI - 1.7 to - 1.5). Internationally, CRF improved in the 1960s and 1970s, and progressively declined at an increasing rate thereafter. Declines were larger for men than for women, and for young adults (< 40 years) than for middle-aged adults (≥ 40 years). All countries experienced declines in CRF with a very strong negative correlation between CRF trends and obesity trends. CONCLUSIONS: There has been a meaningful decline in the CRF of adults since 1980, which has progressively increased in magnitude over time, suggestive of a corresponding decline in population health. Continuous national and international surveillance systems are needed in order to monitor health and fitness trends, especially among low- and middle-income countries for which data do not currently exist. PROSPERO registration number: CRD42013003678.

Relationship Between Skating Economy and Performance During a Repeated-Shift Test in Elite and Subelite Ice Hockey Players.

Lamoureux, NR, Tomkinson, GR, Peterson, BJ, and Fitzgerald, JS. Relationship between skating economy and performance during a repeated-shift test in elite and subelite ice hockey players. J Strength Cond Res 32(4): 1109-1113, 2018-The purpose of this study was to determine the importance of skating economy to fatigue during repeated high-intensity efforts of a simulated ice hockey shift. Forty-five collegiate and Junior A male ice hockey players (aged 18-24 years) performed a continuous graded exercise test using a skate treadmill. Breath-by-breath data for oxygen consumption (V[Combining Dot Above]O2) and respiratory exchange ratio were collected and used to derive energy expenditure (EE) averaged over the final 10 seconds of each stage. Economy was determined as the slope of the regression line relating V[Combining Dot Above]O2 and EE against skating speed separately. Participants also completed 8 bouts of maximal ice skating through a course designed to simulate typical shift, with timing gates determining first half, second half, and total fatigue decrement, calculated by a percent decrement score. Partial correlation was used to determine the association between economy measures and decrement during the repeated-shift test. Twenty-six participants met inclusion criteria and were included in data analysis. Skating economy measures (both relative V[Combining Dot Above]O2 and EE) were very likely moderate positive correlates of total fatigue decrement (r [95% confidence interval]: V[Combining Dot Above]O2, 0.46 [0.09, 0.72] and EE, 0.44, [0.06, 0.71]) but not with first or second gate decrement. Our results indicate that skating economy plays an important role in fatigue resistance over repeated on-ice sprints designed to simulate a typical shift. This supports the use of technical skating coaching and training techniques to enhance skating economy as a means of improving ice hockey performance.