Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis.

BACKGROUND: Adherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy. METHODS: Seven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis. RESULTS: Of 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious. CONCLUSIONS: The overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient's needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021267355.

Erratum: Demographic and socio-economic predictors of physical activity among people living with HIV of low socio-economic status.

[This corrects the article DOI: 10.4102/hsag.v24i0.1127.].

Mental Well-Being or Ill-Being through Coaching in Adult Grassroots Sport: A Systematic Mapping Review.

There is convincing evidence on the effects of sport and exercise on mental health and well-being. Less evidence is provided about how to achieve these benefits in the context of grassroots sport coaching. We systematically reviewed the scientific literature of three databases to narratively synthesize the current knowledge about which coaching-related factors influence well-being or ill-being, and how to promote mental health in adult athletes through sport coaches. The review includes 52 studies with different methodological and theoretical approaches and mental health outcomes. The wide range of themes were mapped and synthesized within two clusters, i.e., coaching behavior, antecedents, and context; and coach-athlete relationship and social support. The results highlight the importance of the promotion of empowering environments, autonomy-supportive coaching behavior, and coach-athlete relationship quality that relate to the satisfaction of basic psychological needs. The review also calls for a critical perspective, in the sense that the coaching context and working environment may not be empowering and supportive to the well-being of coaches and consequently to the athletes, and that coaches who want to provide autonomy-supportive environments may face various obstacles. Finally, the review synthesizes recommendations for the training of coaches, as one piece of a holistic mental health promotion.

Participation Motives of Sport and Exercise Maintainers: Influences of Age and Gender.

Promotion of physical activity has become a global priority for public health. While many people do not adhere to the recommendations, sport and exercise maintainers have found their right or fitting practice. Thus, assessing and knowing the participation motives across maintainers helps to improve our understanding of the sports and exercise practices and, thus, to recommend and to design physical activities and programmes that fit to individuals' motives. A modified version of the Bernese Motive and Goal Inventory was used in an Austria-wide cross-sectional study with 10646 sport and exercise maintainers (43% female). The study performed confirmatory factor analysis, examined measurement invariance, and compared participation motives. The results showed a good model fit and measurement invariance, indicating that the inventory can be applied independently of gender, age and years of sport/exercise experiences. Motives differed among gender, age and type of sports/exercise. Therefore, these variables should be considered in tailoring sport recommendations and interventions to promote adherence. Finally, the results are discussed by using the Self-Determination Theory indicating that sport and exercise maintainers pursue predominantly motives with intrinsic goal contents.

Demographic and socio-economic predictors of physical activity among people living with HIV of low socio-economic status.

BACKGROUND: Physical activity (PA) is beneficial for the health of people living with HIV and AIDS (PLWHA). AIM: The aim of this study was to determine if age, body weight, height, gender, waist-to-hip ratio (WHR), educational attainment, employment status, CD4+ cell count and body mass index (BMI) can predict overall PA among PLWHA of low socio-economic status (SES). SETTING: Participants in this study were HIV-infected patients on first-line antiretroviral therapy (ART) regimen offered by the South African National Department of Health, and those not on ART. Participants were conveniently sampled from a list at a community health care centre in Cape Town. METHODS: This study sample consisted of 978 HIV-infected South Africans. Physical activity data were collected using the Global Physical Activity Questionnaire. Backward multiple linear regression modelling was used to determine the relative influence of variables (age, body weight, height, gender, WHR, educational attainment, employment status, CD4+ count and BMI) on total moderate-to-vigorous PA. Alpha level was set at 0.05. RESULTS: The mean age of the participants was 38.2 (standard deviation [SD] = 8.76) years for men and 33.9 (SD = 8.53) years for women. Physical activity was significantly higher in men (480.2 [SD = 582.9] min/week) than among women (369.35 [SD = 222.53] min/week). The results of the multiple linear regression showed that educational attainment (ß = 0.127; p = 0.00), employment (ß = -0.087; p = 0.01) and gender (ß = 0.235; p = 0.00) significantly predicted total moderate-to-vigorous PA. Gender had the greatest effect, followed by educational attainment and employment status. CONCLUSION: There is a need for PA programmes that are designed to (1) target women, (2) strengthen programmes for education and promotion of PA and (3) engage the unemployed into PA for PLWHA. Physical activity interventions for this particular group should be tailored for persons of low SES.

Physical activity, social support and socio-economic status amongst persons living with HIV and AIDS: a review.

Physical activity can be used for the effective and comprehensive management of HIV and AIDS. Social support and socio-economic status (SES) are two factors that shape physical activity behaviours. Individuals of low SES carry a disproportionate burden of the HIV and AIDS epidemic. In addition, limited resources constitute socio-ecological barriers predisposing such individuals to physical inactivity. The purpose of this narrative review is to examine the available literature on physical activity, social support and SES and to generate recommendations for designing and implementing physical activity interventions targeting people living with HIV and AIDS (PLWHA) of low SES. The review used literature from Google, Google Scholar and PubMed on physical activity of PLWHA, social support for physical activity, and SES and physical activity. Qualitative and quantitative studies in English were included from 1970 to 2016. The results show that social support plays a major role in promoting physical activity and counteracting the barriers to PA in PLWHA of low SES. The results on the role of social support and the influence of SES are integrated to help design appropriate physical activity interventions for PLWHA of low SES. Well-designed interventions should utilise social support and be contextualised for PLWHA of low SES, whose living conditions present multiple barriers to physical activity.

"In the Sport I Am Here": Therapeutic Processes and Health Effects of Sport and Exercise on PTSD.

Current evidence suggests positive effects of exercise on posttraumatic stress symptoms; however, knowledge about how these effects are achieved is limited. Thus, this study aims to contribute to a more holistic understanding of these effects. We performed a single case study of a war and torture survivor, who was diagnosed with posttraumatic stress disorder (PTSD) and depression, and who was participant of the sport and exercise therapy program Movi Kune. Participant observation was conducted as well as semi-structured interviews with the participant and his psychotherapist. Data analysis resulted in the proposal of different processes: The focus on bodily sensations related to an exposure effect, contributing to improvements in body awareness, coping behavior, and affect regulation, whereas the focus on playing related to an improved performance, presence, enjoyment, and mastery experiences, pointing toward distraction and motivational-restorative effects. The findings also advice to be cautious as participants may be exposed to negative sensations and trauma-related triggers.

Social-Ecological, Motivational and Volitional Factors for Initiating and Maintaining Physical Activity in the Context of HIV.

Sport and exercise can have several health benefits for people living with HIV. These benefits can be achieved through different types of physical activity, adapting to disease progression, motivation and social-ecological options. However, physical activity levels and adherence to exercise are generally low in people living with HIV. At the same time, high drop-out rates in intervention studies are prevalent; even though they often entail more favourable conditions than interventions in the natural settings. Thus, in the framework of an intervention study, the present study aims to explore social-ecological, motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme. The qualitative data was produced in the framework of a non-randomised pre-post intervention study that evaluated structure, processes and outcomes of a 10-week sport and exercise programme. All 25 participants of the programme were included in this analysis, independent of compliance. Data was produced through questionnaires, participatory group discussions, body image pictures, research diaries and individual semi-structured interviews. All participants lived in a low socioeconomic, disadvantaged setting. Hence, the psychological correlates are contextualised and social-ecological influences on perception and behaviour are discussed. The results show the importance of considering social-cultural and environmental influences on individual motives, perceptions and expectancies, the fear of disclosure and stigmatisation, sport and exercise-specific group dynamics and self-supporting processes. Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed.

Effects of an exercise programme with people living with HIV: research in a disadvantaged setting.

This study aimed to analyse the physical health effects of a community based 10-week physical activity programme with people living with HIV. It was developed, implemented and evaluated in a disadvantaged community in South Africa. A pre-post research design was chosen. Major recruitment and adherence challenges resulted in a small sample. Among the 23 participants who took part in both baseline and final testing, compliant participants (n = 12) were compared to non-compliant participants (n = 11). Immunological (CD4, viral load), anthropometric (height, weight, skinfolds and waist to hip ratio), muscular strength (h1RM) and cardiopulmonary fitness (time on treadmill) parameters were measured. The compliant and non-compliant groups were not different at baseline. Muscular strength was the parameter most influenced by compliance with the physical activity programme (F = 4.516, p = 0.047). Weight loss and improvement in cardiopulmonary fitness were restricted by the duration of the programme, compliance and influencing factors (e.g. nutrition, medication). The increase in strength is significant and meaningful in the context, as the participants' goals were to look healthy and strong to avoid HIV related stigma. The improvements in appearance were a motivational factor, especially since the changes were made visible in a short time. Practical implications for health promotion are described. More research contextualised in disadvantaged settings is needed.

Evaluation of a psychosocial health programme in the context of violence and conflict.

A psychosocial health programme using movement, games and sport was developed and evaluated in the rural area of Guatemala, with two groups of women who suffered violence. Participatory observation and 32 interviews were conducted; 33 of the 56 participants filled out initial and final questionnaires. Research challenges were discussed and contextualised. Various health factors such as sense of coherence and self-esteem improved. The psychosocial approach and culturally grounded use of movement, games and sport as active and participatory tools in combination with verbal expression, provide a significant way to foster health in the context of violence and conflict.

A narrative review of research on the effects of physical activity on people living with HIV and opportunities for health promotion in disadvantaged settings.

The article explores different types and effects of physical activity for people living with HIV. Considering the lack of studies done in African contexts and the disparity between research settings and natural settings, a narrative review of the literature was conducted and contextualised to South Africa. Various physical, psychological and social-cultural constraints impair the wellbeing of people living with HIV, in part by restricting their participation in physical activities. Apart from the well-studied immediate physiological benefits on health, we argue that physical-sportive group activities, such as sport or recreational games, can improve psychosocial factors and generate holistic health effects for people living with HIV. Group-activity effects could improve individuals' motivation and adherence to participating in physical activities, provided that positive interaction and non-stigmatisation are guaranteed. However, most studies in this field have been limited to the benefits of aerobic exercise and resistance training. There has been little research on the types and different effects of physical activity and adherence to physical activity of people living with HIV in African contexts. Based on an analysis of the different types and effects, we suggest opportunities for and challenges to implementing physical activities for people living with HIV, especially in disadvantaged settings, and also identify gaps in the research to date.