Feasibility and acceptability of a group-mediated exercise intervention for gynecological cancer survivors.

PURPOSE: Examine feasibility and acceptability of a group-mediated cognitive-behavioral (GMCB) intervention targeting planned, self-managed physical activity (PA). DESIGN: Sequential mixed methods, single arm pre-/post-test design with a 4-week follow-up. PARTICIPANTS: Post-treatment gynecologic cancer survivors. METHODS: Participants attended 8 weekly facilitator-led group sessions and completed assessments at baseline, post-intervention and follow-up. Feasibility was assessed by recruitment rate, retention rate, capture of outcomes, intervention usability and intervention fidelity. Acceptability was examined via qualitative interviews. Preliminary estimates of intervention effectiveness (PA, PA social cognitions and sleep) were collected. FINDINGS: 355 participants were approached and 38 consented. Twenty took part in the study and 17 (85%) completed the intervention. Thematic content analysis revealed positive group experiences. Cognitive-behavioral strategies were beneficial. Goal-setting and shared cancer recovery experience facilitated connection among group members. IMPLICATIONS: Program acceptability was high among a diverse sample of gynecologic cancer survivors and delivery of the program is feasible to this group of gynecologic cancer survivors. Recruitment challenges were present but study retention was high.

Videoconference-Delivered Group-Based Physical Activity Self-Regulatory Support for Adults With Spinal Cord Injury: A Feasibility Study.

Videoconferencing is a novel method for overcoming time and transportation barriers to leisure-time physical activity (LTPA) interventions. This study examined the feasibility of a group videoconference intervention on LTPA self-regulatory skills training in a sample of nine adults with spinal cord injury (SCI). Session implementation checklists and self-report surveys were administered during four weekly sessions to assess intervention management, group processes, intervention resources, and initial efficacy. Attendance rate was high (91.7%), and the average weekly session duration was 79.6 min. Participants reported high ratings of group cohesion, facilitator collaboration, session content comprehension, and ease in operating the videoconference platform. Knowledge sharing among the group ranged from 18 to 58 exchanges per session, demonstrating learning and group cohesion. LTPA frequency increased among 44% of participants, and 22% of participants achieved the SCI-specific aerobic guidelines. Overall, group videoconferencing holds promise for LTPA support among adults with SCI. Long-term research is warranted to test LTPA self-regulatory and behavioral effects.

Change in health-related quality of life and social cognitive outcomes in obese, older adults in a randomized controlled weight loss trial: Does physical activity behavior matter?

This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7-10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.

Perceived success/failure and attributions associated with self-regulatory efficacy to meet physical activity recommendations for women with arthritis.

The relationship between attributional dimensions women assign to the cause of their perceived success or failure at meeting the recommended physical activity dose and self-regulatory efficacy for future physical activity was examined among women with arthritis. Women (N = 117) aged 18-84 years, with self-reported medically-diagnosed arthritis, completed on-line questions in the fall of 2013 assessing endurance physical activity, perceived outcome for meeting the recommended levels of endurance activity, attributions for one's success or failure in meeting the recommendations, and self-regulatory efficacy to schedule/plan endurance activity over the next month. The main theoretically-driven finding revealed that the interaction of the stability dimension with perceived success/failure was significantly related to self-regulatory efficacy for scheduling and planning future physical activity (ß = 0.35, p = .002). Outcomes attributed to more versus less stable factors accentuated differences in self-regulatory efficacy beliefs following perceived success and failure at being active. It appears that attributional dimensions were associated with self-regulatory efficacy in women with arthritis. This suggests that rather than objectively observed past mastery experience, women's subjective perceptions and explanations of their past experiences were related to efficacy beliefs, especially following a failure experience.

Do older adults' beliefs about their community mobility predict walking performance?

Among older adults, preserving community mobility (CM) is important for maintaining independent living. We explored whether perceptions of the environment and self-efficacy for CM (SE-CM) would predict walking performance for tasks reflecting CM. We hypothesized that perceptions of the environment and SE-CM would be additive predictors of walking performance on tasks reflecting the complexity of CM. Independent living older adults (N = 60) aged 64-85 completed six complex walking tasks (CWTs), SE-CM, and the environmental analysis of mobility questionnaire (EAMQ). Multiple regression analyses indicated that for each CWT, the EAMQ scales predicted walking performance (range: model R2Adj. = .078 to .139, p < .04). However, when SE-CM was added to the models, it was the sole significant predictor (p < .05). Contrary to our hypotheses, SE-CM was the best predictor in the additive models. SE-CM may be more correspondent to walking tests and thus a more sensitive predictor of CM walking performance.

Can persuasive messages encourage individuals to create action plans for physical activity?

Given the positive influence of action planning on physical activity, persuasive messages could be designed to promote action planning. The purpose of this paper was to test action planning messages in two studies. Participants were allocated to one of two message groups, reading either a physical activity only or physical activity plus action planning message (Study 1) and either a gain-framed or loss-framed action planning message (Study 2). The percent of individuals who created an action plan and the quality of the plans were evaluated. In Study 1, individuals in the physical activity plus action planning group created as many action plans as the physical activity only group, but their plans were higher quality. In Study 2, Week 2 differences between the gain- and loss-framed message groups were found for action planning. To our knowledge, these studies were the first to investigate message-induced action planning as a behavior. More research is needed to optimize these messages.

Exercise identity and attribution properties predict negative self-conscious emotions for exercise relapse.

Research on exercise identity (EXID) indicates that it is related to negative affect when exercisers are inconsistent or relapse. Although identity theory suggests that causal attributions about this inconsistency elicit negative self-conscious emotions of shame and guilt, no EXID studies have examined this for exercise relapse. Weiner's attribution-based theory of interpersonal motivation (2010) offers a means of testing the attribution-emotion link. Using both frameworks, we examined whether EXID and attributional properties predicted negative emotions for exercise relapse. Participants (n = 224) read an exercise relapse vignette, and then completed EXID, attributions, and emotion measures. Hierarchical multiple regression models using EXID and the attributional property of controllability significantly predicted each of shame and guilt, R² adjusted = .09, ps ≤ .001. Results support identity theory suggestions and Weiner's specific attribution-emotion hypothesis. This first demonstration of an interlinking of EXID, controllability, and negative self-conscious emotions offers more predictive utility using complementary theories than either theory alone.

Effect of Group Counseling Plus Tailored Exercise on Mobility Function in Multiple Sclerosis.

BACKGROUND: Multiple sclerosis (MS) impairs muscular function and limits individuals' ability to perform everyday activities requiring mobility. People with MS frequently exhibit mobility problems (ie, slower walking speed, shorter strides). General exercise training (eg, resistance, aerobic) provides modest physiological and walking mobility benefits. However, researchers suggest tailoring of interventions to address mobility specifically. We conducted a phase 2a pre-post intervention development study (Obesity-Related Behavioral Intervention Trials [ORBIT] intervention development model) of mobility exercise plus cognitive behavioral counseling to improve function and social cognitions known to encourage exercise. METHODS: The intervention was conducted twice per week for 8 weeks followed by 1 month of self-managed mobility exercise. Participants (N = 29; mean ± SD age = 52.24 ± 11.36 years, mean time since MS diagnosis ≥11 years) were assessed at baseline and after follow-up for mobility function, social cognitions, and intervention fidelity indicators. RESULTS: Results indicated significant improvements in a variety of valid measures of mobility function (eg, 400-m walk), self-regulatory efficacy for mobility exercise and symptom control, and fidelity measures with small to medium effect sizes. CONCLUSIONS: Positive findings suggest that the intervention seems to merit testing as a randomized pilot study following the ORBIT model.

A proof-of-concept study on the impact of a chronic pain and physical activity training workshop for exercise professionals.

OBJECTIVES: Physical activity is essential for long-term chronic pain management, yet individuals struggle to participate. Exercise professionals, including fitness instructors, and personal trainers, are preferred delivery agents for education and instruction on chronic pain, physical activity, and strategies to use adherence-promoting behavioral skills. However, exercise professionals receive no relevant training during certification or continuing education opportunities to effectively support their participants living with chronic pain. Based on the ORBIT model for early pre-efficacy phases of development and testing of new behavioral treatments, the present Phase IIa proof-of-concept study was conducted. The purpose was to examine the impacts of a newly developed chronic pain and physical activity training workshop on psychosocial outcomes among exercise professionals. Outcomes included knowledge and attitudes regarding chronic pain, attitudes and beliefs about the relationship between pain and impairment, and self-efficacy to educate and instruct participants with chronic pain. METHODS: Forty-eight exercise professionals (Mage=44.4±11.0 years) participated in a three-hour, in-person workshop that was offered at one of four different locations. Participants completed pre- and post-workshop outcome assessment surveys. RESULTS: Mixed MANOVA results comparing time (pre- versus post-workshop) by workshop location (sites 1 to 4) illustrated a significant within-subjects time effect (p<0.001). All outcomes significantly improved from pre- to post-workshop (p's<0.001), demonstrating large effect sizes (partial eta-squared values ranging from 0.45 to 0.59). CONCLUSIONS: Findings offer early phase preliminary support for the effectiveness of the chronic pain and physical activity training workshop for exercise professionals. Based on ORBIT model recommendations, findings warrant future phased testing via a pilot randomized clinical trial as well as testing for impacts that trained professionals have on activity adherence among their clients living with chronic pain. Eventual workshop adoption by exercise professional certification organizations would ensure widespread and sustainable access to qualified exercise professionals to help individuals engage in physical activity. By increasing the capacity of available exercise professionals to deliver effective support, active individuals could better manage their chronic pain and live well.

A systematic review of three approaches for constructing physical activity messages: What messages work and what improvements are needed?

BACKGROUND: To motivate individuals to adhere to a regular physical activity regime, guidelines must be supplemented with persuasive messages that are disseminated widely. While substantial research has examined effective strategies for disseminating physical activity messages, there has been no systematic effort to examine optimal message content. This paper reviews studies that evaluate the effectiveness of three approaches for constructing physical activity messages including tailoring messages to suit individual characteristics of message recipients (message tailoring), framing messages in terms of gains versus losses (message framing), and targeting messages to affect change in self-efficacy (i.e., a theoretical determinant of behavior change). METHODS: We searched the MEDLINE, PsycINFO, EMBASE and CINAHL databases up to July 2008. Relevant reference lists also were searched. We included intervention trials, field experiments, and laboratory-based studies that aimed to test the efficacy or effectiveness of tailored messages, framed messages and self-efficacy change messages among healthy adults. We used a descriptive approach to analyze emerging patterns in research findings. Based on this evidence we made recommendations for practice and future research. RESULTS: Twenty-two studies were identified. Twelve studies evaluated message tailoring. In 10 of these studies, tailored messages resulted in greater physical activity than a control message. Six studies evaluated framed messages. Five of these studies demonstrated that gain-framed messages lead to stronger intentions to be active compared to a control message. Moreover, a gain-frame advantage was evident in three of the four studies that assessed physical activity. Four studies evaluated self-efficacy change messages. The two studies that used an experimental design provide a clear indication that individuals' beliefs can be affected by messages that incorporate types of information known to be determinants of self-efficacy. Overall, strong evidence to support definitive recommendations for optimal message content and structure was lacking. CONCLUSIONS: Additional research testing the optimal content of messages used to supplement physical activity guidelines is needed. Tailored messages, gain-framed messages, and self-efficacy change messages hold promise as strategies for constructing physical activity messages and should be a focus of future research.

Self-regulatory efficacy for exercise in cardiac rehabilitation: Review and recommendations for measurement.

PURPOSE: Self-regulatory efficacy (SRE) is a psychological resource necessary for cardiac rehabilitation (CR) exercise adoption and maintenance. A 2008 review of self-efficacy for CR exercise identified the need for more high-quality research on SRE. The present review had 4 purposes: (a) to review the characteristics of empirical SRE and CR exercise research since 2008; (b) to examine the quality of SRE measurement; (c) to determine whether varying quality of SRE measurement moderated the relationship between SRE, exercise, and CR social cognitions; and (d) to make recommendations for better measurement for future research. METHOD: An initial search of 766 possible studies identified 29 for review. These included individuals engaged in or completing CR where SRE for exercise and relevant outcomes was assessed. Meta-analysis examined whether SRE measurement quality was associated with the magnitude of effects observed and to determine potential moderation by quality. RESULTS: There were 11 unique operationalizations of SRE for exercise. Problematic factors included: non-SRE variables assessed as the construct, using global versus specific measures, and lack of a time frame over which SRE applied. Effect size was related to stronger relationships as level of study and measurement quality increased. CONCLUSION: Since 2008, an increase in studies examining SRE and CR exercise was observed. To advance SRE and CR exercise research, measurement and research quality improvements are recommended that have implications for future mediation and CR intervention assessment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

ParticipACTION: awareness of the participACTION campaign among Canadian adults--examining the knowledge gap hypothesis and a hierarchy-of-effects model.

BACKGROUND: ParticipACTION was a pervasive communication campaign that promoted physical activity in the Canadian population for three decades. According to McGuire's hierarchy-of-effects model (HOEM), this campaign should influence physical activity through intermediate mediators such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often develop within the population about the messages being conveyed. The purposes of this study were to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b) confirm if awareness of the ParticipACTION initiative varied as a function of levels of education and household income; and, (c) to examine whether awareness of ParticipACTION was associated with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION (unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity status. METHODS: A population-based survey was conducted on 4,650 Canadians over a period of 6 months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM included questions related to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to test the knowledge gap hypotheses and to examine whether awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age and older in 2007/2008 (N = 4424). RESULTS: Approximately 8% of Canadians were still aware of ParticipACTION unprompted and 82% were aware when prompted. Both education and income were significant correlates of awareness among Canadians. The odds of people being aware of ParticipACTION were greater if they were more educated and reported higher income. Awareness of ParticipACTION was also associated with outcome expectations, self-efficacy, intention, and LTPA status. CONCLUSION: Awareness of ParticipACTION is associated with LTPA. Knowledge gaps in awareness are associated with level of education and household income. Thus, future promotion campaigns should include specific strategies to target different segments of the population, especially people who are living in deprived conditions with lower levels of education.

Healthy-eater identity and self-efficacy predict healthy eating behavior: a prospective view.

Identity and Self-efficacy Theories were used to examine the relationship between healthy-eater identity, self-efficacy for healthy eating and healthy eating. Measures of healthy-eater identity, perception of healthy eating, nutrition knowledge, self-efficacy for both intake of fruits and vegetables and foods of low nutritional value were completed by 101 university students and staff. Two weeks later, participants recalled recent consumption of (a) fruits and vegetables and (b) foods of low nutritional value. For both eating outcomes, healthy-eater identity was a significant predictor after controlling for nutrition knowledge. The addition of self-efficacy improved prediction in the case of both eating outcomes.

Facing Multiple Barriers to Exercise: Does Stronger Efficacy Help Individuals with Arthritis?

BACKGROUND: Research about exercise adherence amongst adults with arthritis has been largely correlational, and theoretically based causal studies are needed. We used an experimental design to test the social cognitive theory premise that high self-efficacy helps to overcome challenging barriers to action. METHODS: Exercising individuals (N = 86; female = 78%; M age = 53; BMI = 27) with differential self-regulatory efficacy for managing salient, non-disease barriers were randomly assigned to many or few barrier conditions. Individuals responded about the strength of their anticipated persistence to continue exercise, and their self-regulatory efficacy to use exercise-enabling coping strategies. RESULTS: In the many barriers condition, higher barriers-efficacy individuals expressed (a) greater persistence (Cohen's d = 0.75 [-0.029, 1.79]) and (b) more confidence in their coping solutions (Cohen's d = 0.65 [-0.30, 1.60]) than lower barriers-efficacy counterparts. CONCLUSION: Experimental support was obtained for the theoretical premise that when facing the greatest barrier challenge, individuals highest in self-regulatory efficacy still view exercise as possible. Findings suggest that identifying lower efficacy exercisers with arthritis to tailor their exercise to increase self-regulatory efficacy might also improve their adherence.

Reactions to a perceived challenge to identity: a focus on exercise and healthy eating.

Based upon Identity and Social Cognitive theories, two studies examined reactions to challenges to exercise identity (Study 1) and healthy-eater identity (Study 2). For both studies, participants responded to a perceived challenge relative to the health behavior in terms of affect, intentions, self-regulatory efficacy and generated self-regulatory strategies. High identity participants in both studies showed the theory-based, hypothesized response pattern suggesting they were seeking identity-behavior congruency and this response pattern was stronger than exhibited by moderate identity individuals. Collectively, findings support the compatible use of Identity and Social Cognitive theories in studying identity and suggest that identities may be important in understanding health behavior regulation.

Self-efficacy for exercise in cardiac rehabilitation: review and recommendations.

Despite the numerous physical and psychosocial benefits of exercise for coronary heart disease survivors, non-adherence to cardiac rehabilitation (CR) exercise is a major problem. Adherence to the lifestyle behavior change associated with CR involves both physical and self-regulatory skills. While self-regulatory efficacy is clearly linked to exercise adherence and adjustment, the literature on the relationship between self-efficacy and exercise among CR participants has not been systematically reviewed. A search of relevant databases identified 41 CR studies. Few studies measured self-regulatory efficacy for actions that facilitate adherence. Most studies examined self-efficacy during the intensive center-based phase of CR, with little attention to long-term maintenance. The CR literature could benefit by examining (a) self-efficacy as a major rehabilitation outcome, (b) measurement of self-regulatory efficacy for behavior change, (c) suspected moderators of self-efficacy (i.e. gender, age), and (d) self-efficacy relative to maintenance.

Making one-sided exercise decisions: The influence of exercise-related cognitive errors.

Exercise-related cognitive errors reflect biased processing of exercise-relevant information. The purpose of this study was to examine whether differences existed between individuals reporting low and high exercise-related cognitive errors on information processed about a relevant exercise decision-making situation. In all, 138 adults completed an online questionnaire. The high exercise-related cognitive error group primarily focused on negative content about the situation compared to the low exercise-related cognitive error group who focused on both positive and negative content. The high exercise-related cognitive error group displayed biased processing of exercise information, as suggested by the cognitive errors model. Future research should examine whether biasing information processing caused by exercise-related cognitive errors can be modified and attenuated.

Perceiving Cardiac Rehabilitation Staff as Mainly Responsible for Exercise: A Dilemma for Future Self-Management.

BACKGROUND: Cardiac rehabilitation (CR) exercise therapy facilitates patient recovery and better health following a cardiovascular event. However, post-CR adherence to self-managed (SM)-exercise is suboptimal. Part of this problem may be participants' view of CR staff as mainly responsible for help and program structure. Does post-CR exercise adherence for those perceiving high CR staff responsibility suffer as a consequence? METHODS: Participants in this prospective, observational study were followed over 12 weeks of CR and one month afterward. High perceived staff responsibility individuals were examined for a decline in the strength of adherence-related social cognitions and exercise. Those high and low in perceived staff responsibility were also compared. RESULTS: High perceived staff responsibility individuals reported significant declines in anticipated exercise persistence (d = .58) and number of different SM-exercise options (d = .44). High versus low responsibility comparisons revealed a significant difference in one-month post-CR SM-exercise volume (d = .67). High perceived staff responsibility individuals exercised half of the amount of low responsibility counterparts at one month post-CR. Perceived staff responsibility and CR SRE significantly predicted SM-exercise volume, R2adj = .10, and persistence, R2adj = .18, one month post-CR. CONCLUSION: Viewing helpful well-trained CR staff as mainly responsible for participant behavior may be problematic for post-CR exercise maintenance among those more staff dependent.

Physical activity guides for Canadians: messaging strategies, realistic expectations for change, and evaluation.

Physical activity guidelines offer evidence-based behavioural benchmarks that relate to reduced risk of morbidity and mortality if people adhere to them. Essentially, the guidelines tell people what to do, but not why and how they should do it. Thus, to motivate adherence, messages that translate guidelines should convey not only how much physical activity one should attempt and why it is recommended, but also how to achieve such a recommendation. Canada's physical activity guides exemplify how guidelines can be translated. This paper (i) provides a brief overview of the challenges encountered in creating the existing guides and (ii) highlights important practical issues and empirical evidence that should be considered in the future when translating guidelines into messages and disseminating these messages. We draw on the successes of past efforts to translate the goals of physical activity guidelines and on recent literature on messages and media campaigns to make recommendations. Information to motivate people to move toward the goals in physical activity guidelines should be translated into a set of messages that are informative, thought provoking, and persuasive. These messages should be disseminated to the public via a multi-phase social-marketing campaign that is carefully planned and thoroughly evaluated.

Research that informs Canada's physical activity guides: an introduction.

The Canadian Society for Exercise Physiology (CSEP), in partnership with Health Canada and others, released Canada's first physical activity guide for adults in 1998, with specific versions for older adults in 1999 and for children and youth in 2002. Research in the physical activity sciences (e.g., basic science, behavioural assessment, dose-response relationships, epidemiology, health messaging, physical activity measurement) has advanced rapidly since these publications. A detailed review of relevant current research is thus required, to assess whether the existing guidelines and resulting guides need revision or renewal. This introductory paper provides a brief chronology of events leading to the preparation of this journal supplement, including a statement of purpose and an overview of organization and content. A brief discussion of the purpose of the physical activity guidelines and guides, intended biological, psychological, and behavioural outcomes, and the way in which guidelines relate to on-going measurement and surveillance is provided as a context for the papers that follow.