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.

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.

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).

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.

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.

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.

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.

Initial validation of the exercise chronic pain acceptance questionnaire.

BACKGROUND AND AIMS: Pain acceptance, measured by the chronic pain acceptance questionnaire (CPAQ), is related to exercise adherence for those with arthritis. The CPAQ measure has 20 items comprising two subscales -- pain willingness and activities engagement about pursuing "valued daily activities" despite pain. However, exercise is not specified as a valued activity and respondents may be considering other activities raising generalizability and strength of prediction concerns. METHODS: Accordingly, a modified CPAQ solely for exercise (CPAQ-E) was developed to heighten salience to pursuit of exercise in the face of pain. An exercising sample with arthritis (N=98) completed the CPAQ-E at baseline and exercise 2 weeks later. Exploratory factor analysis of the CPAQ-E was performed using Mplus. Regression was used to predict exercise. RESULTS: Analysis revealed a two-factor, 14 item model with good psychometric properties reflecting pain willingness and activities engagement subscales (χ2=85.695, df=64, p<.037; RMSEA=.055; CFI=.967; TLI=.954). Both subscales and the total score positively predicted future weekly exercise bouts (range ps from <.05 to <.001). Activities engagement predicted future weekly exercise volume (p<.05). CONCLUSIONS: This study offers preliminary support for the factorial and predictive validity of the CPAQ-E among exercising individuals with arthritis. IMPLICATIONS: This measure could help researchers increase the specificity and sensitivity of pain acceptance responses to exercising among individuals with arthritis. A more sensitive measure might help clinicians interpret patient responses to exercise for pain self-management.

Self-Regulatory Efficacy Encourages Exercise Persistence Despite Arthritis Flare Symptoms.

BACKGROUND: The study of exercise adherence during an arthritis flare is recommended by arthritis researchers. Studies to date have been correlational. METHODS: Social cognitions of exercising individuals with arthritis who consider exercise adherence under different levels of challenge of an arthritis flare were examined using an experimental design. Exercising individuals with differential self-regulatory efficacy for managing arthritis flare symptoms (SRE-flare) were randomly assigned to conditions where flare symptoms were perceived as either many or few. Individuals in each condition responded about the strength of their anticipated persistence to continue exercise, and their self-regulatory efficacy to use coping strategies to enable exercise. RESULTS: Higher SRE-flare individuals expressed significantly (a) greater persistence (Cohen's d = 1.17) and (b) more confidence to use their flare coping solutions (Cohen's d = 1.44). CONCLUSION: Main findings were as hypothesised. When exposed to the condition with more limiting flare symptoms (i.e. greater challenge), high SRE participants were the most confident in dealing with flare symptoms and exercising. Identifying lower SRE-flare individuals less likely to persist with exercise during arthritis flares may improve tailored exercise counselling.

Perceptions of exercise consistency: Relation to exercise-related cognitive errors and cognitions.

This study examined psychological differences between individuals (1) with varying perceptions of their exercise adherence pattern and (2) who do and do not make exercise-related cognitive errors. A total of 364 adults completed an exercise pattern and cognitive errors questionnaire. Individuals perceiving themselves as consistent exercisers reported more adaptive social cognitive outcomes (e.g. higher self-regulatory efficacy) than those perceiving themselves as inconsistent. Individuals expressing stronger exercise-related cognitive errors exercised less and reported problematic cognitions (e.g. more struggle with exercise decisions). These results link inconsistent adherence perceptions to weaker social cognitions and exercise-related cognitive errors, a novel form of bias related to limited exercise engagement.

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.

Predicting planned physical activity of individuals with arthritis: A self-regulatory perspective.

Few individuals with arthritis are sufficiently active. We surveyed a convenience sample of exercisers ( N = 134) to examine the utility of social cognitive theory variables, namely, self-regulatory efficacy, negative outcome expectations, and pain acceptance for predicting planned physical activity according to Weinstein's two prediction suggestions. Logistic regression revealed, after controlling for pain intensity, self-regulatory efficacy, negative outcome expectations, and pain acceptance distinguished groups achieving/not achieving planned physical activity, p < 0.001 (28% variance). A second model adding past physical activity also predicted the groups, p < 0.001 (57% variance). This is one of the first arthritis studies examining planned physical activity relative to Weinstein's recommendations.

Illness perceptions and adherence to exercise therapy in cardiac rehabilitation participants.

PURPOSE/OBJECTIVE: Two complementary frameworks, the common sense model, and social-cognitive theory, were used. The first purpose of this study was to compare 2 groups varying in their illness perceptions (strong vs. weak) on baseline differences in theory-based exercise cognitions (self-regulatory efficacy and outcome expectations), and health-related quality of life (HRQL). The second purpose was to examine illness perception group differences in cardiac rehabilitation exercise participation following 3 months of exercise therapy. RESEARCH METHOD/DESIGN: Newly enrolled cardiac rehabilitation participants (N = 49) completed baseline measures of illness perceptions, self-regulatory efficacy, outcome expectations, and HRQL. Cardiac rehabilitation exercise minutes were measured at baseline (after 2 weeks of participation) and following 3 months of cardiac rehabilitation. RESULTS: Individuals were successfully classified into strong and weak illness perception groups using cluster analysis. Analyses of variance indicated significant group differences on negative outcome expectations (p < .05), where the strong illness perception group reported greater negative outcome expectations. The strong illness perception group also reported significantly lower physical and mental HRQL as compared to their weak illness perception counterparts (p < .01). Parallel differences in cardiac rehabilitation exercise participation at 3 months were also observed (p < .05). CONCLUSIONS/IMPLICATIONS: This study was a first attempt to utilize the common sense model and social-cognitive theory to examine individuals engaged in rehabilitation to reduce cardiac risk. The findings suggest that complementary use of these 2 frameworks to study individual illness perception differences relative to psychological beliefs and adherence to exercise therapy may aid understanding of correlates of exercise adherence among cardiac rehabilitation participants.

Physical Activity in the Transition to University: The Role of Past Behavior and Concurrent Self-regulatory Efficacy.

OBJECTIVE: Two studies were conducted to examine the relationship between past physical activity, concurrent self-regulatory efficacy (CSRE), and current physical activity during the transition to university. PARTICIPANTS: Study 1 included 110 first-year undergraduate students recruited during October/November of 2012. Study 2 involved 86 first-year undergraduate students recruited during October/November of 2013. METHODS: Surveys were completed online, concurrently (Study 1) and prospectively (Study 2). RESULTS: CSRE was found to positively predict current physical activity participation in both studies. However, the relation of CSRE to physical activity was attenuated when past behavior was taken into account. CONCLUSIONS: Physical activity is one goal that university students pursue concurrently with other goals. Not only is current planned activity related to one's past participation in physical activity, it is also related to self-regulatory beliefs about managing that activity in the new context of university life.

Prediction of adaptive self-regulatory responses to arthritis pain anxiety in exercising adults: does pain acceptance matter?

BACKGROUND: Exercising for ≥ 150 min/week is a recommended strategy for self-managing arthritis. However, exercise nonadherence is a problem. Arthritis pain anxiety may interfere with regular exercise. According to the fear-avoidance model, individuals may confront their pain anxiety by using adaptive self-regulatory responses (eg, changing exercise type or duration). Furthermore, the anxiety-self-regulatory responses relationship may vary as a function of individuals' pain acceptance levels. OBJECTIVES: To investigate pain acceptance as a moderator of the pain anxiety-adaptive self-regulatory responses relationship. The secondary objective was to examine whether groups of patients who differed in meeting exercise recommendations also differed in pain-related and self-regulatory responses. METHODS: Adults (mean [± SD] age 49.75 ± 13.88 years) with medically diagnosed arthritis completed online measures of arthritis pain-related variables and self-regulatory responses at baseline, and exercise participation two weeks later. Individuals meeting (n=87) and not meeting (n=49) exercise recommendations were identified. RESULTS: Hierarchical multiple regression analysis revealed that pain acceptance moderated the anxiety-adaptive self-regulatory responses relationship. When pain anxiety was lower, greater pain acceptance was associated with less frequent use of adaptive responses. When anxiety was higher, adaptive responses were used regardless of pain acceptance level. MANOVA findings revealed that participants meeting the recommended exercise dose reported significantly lower pain and pain anxiety, and greater pain acceptance (P<0.05) than those not meeting the dose. CONCLUSIONS: Greater pain acceptance may help individuals to focus their efforts to adapt to their pain anxiety only when it is higher, leaving self-regulatory capacity to cope with additional challenges to exercise adherence (eg, busy schedule).

Pain, anxiety, and negative outcome expectations for activity: do negative psychological profiles differ between the inactive and active?

OBJECTIVE: Adherence to physical activity at ≥150 minutes/week has proven to offer disease management and health-promoting benefits among adults with arthritis. While highly active people seem undaunted by arthritis pain and are differentiated from the moderately active by adherence-related psychological factors, knowledge about inactive individuals is lacking. This knowledge may identify what to change in order to help inactive people begin and maintain physical activity. The present study examined the planned, self-regulated activity of high, moderate, and inactive individuals to determine if differences existed in negative psychological factors. METHODS: Adults with a medical diagnosis of arthritis completed online measures of physical activity, perceived pain intensity, pain anxiety, and negative disease-related outcome expectations from being active. High active (n = 94), moderately active (n = 77), and inactive (n = 104) groups were identified. RESULTS: A significant multivariate analysis of covariance revealed group differences (P < 0.001). Followup analyses indicated that inactive participants had the most negative psychological profile. Inactive participants reported that negative disease-related outcomes expectancies were more distressing and likely to occur than either group of active participants and expressed greater pain intensity and pain anxiety than the highly active participants (P < 0.05 for all). CONCLUSION: Identifying differences in negative psychological factors aids in the understanding of differential adherence between activity groups and highlights possible factors to change in future intervention and research.

Examination of self-regulatory efficacy and pain among individuals challenged by arthritis flares.

PURPOSE/OBJECTIVE: Public health guidelines for physical activity (PA) for individuals with arthritis are 150 min/week. Self-regulatory efficacy to plan and schedule activity (SRE-SP) was greater for individuals meeting guidelines in studies when symptoms were usual. Extreme symptoms of a flare presumably challenge or block PA adherence. We found it surprising that the question of whether pain intensity and SRE-SP differ within the same person as a function of symptom severity (i.e., flare vs. no-flare) and PA level has not been addressed. RESEARCH METHOD/DESIGN: Participants (N = 53) reported SRE-SP and SRE to overcome arthritis barriers (SRE-AB) during the following month, average usual and flare-pain intensity, and PA volume in the past 6 months. Mixed-model ANOVAs compared those meeting or not meeting PA guidelines in both flare and no-flare conditions. RESULTS: Main effects for SRE (SP and AB) were significant for within flare/no-flare comparisons (p < .001) and for SRE-SP were significant between PA groups (p < .05). Individuals meeting PA guidelines have the advantage of greater SRE-SP to motivate adherence than those of the less active. All participants' activity was less efficacious during a flare. For pain intensity, a within-subjects flare versus no-flare effect (p < .001) confirmed that flares are perceived as more of an obstacle or challenge for engaging in PA. CONCLUSION/IMPLICATIONS: Regardless of meeting or not meeting PA guidelines, participants reported lower SRE and higher pain intensity during a flare. PA adherence during a flare may require self-regulation of PA to be active, and in particular, to be able to meet recommended guidelines, relative to symptom severity.

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.