RESUMO
BACKGROUND: Interventions to increase physical activity among adults with chronic illness are intended to improve quality of life and reduce disease complications or slow disease progression. OBJECTIVE: The aim of this study was to integrate quality-of-life outcomes from primary research studies testing interventions to increase physical activity among adults with chronic illness. METHODS: Extensive literature searching strategies were used to locate published and unpublished primary research testing physical activity interventions. Results were coded for studies that had at least 5 participants with chronic illness. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS: Eighty-five samples from 66 reports with 7,291 subjects were synthesized. The mean quality-of-life effect size for two-group comparisons (treatment vs. control) was.11 (higher mean quality-of-life scores for treatment subjects than for control subjects). The treatment group pre-post comparison effect size was.27 for quality of life. Heterogeneity was modest in two-group comparisons. Most design and sample attributes were unrelated to intervention effects on quality of life. Studies that exclusively used supervised center-based exercise reported larger quality-of-life improvements than did studies that included any educational/motivational content. Effect sizes were larger among unpublished and unfunded studies. The effect size for physical activity did not predict the quality-of-life effect size. DISCUSSION: Subjects experience improved quality of life from exposure to interventions designed to increase physical activity, despite considerable heterogeneity in the magnitude of the effect. Future primary research should include quality-of-life outcomes so that patterns of relationships among variables can be explored further.
Assuntos
Doença Crônica , Terapia por Exercício , Exercício Físico/psicologia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Atitude Frente a Saúde , Doença Crônica/prevenção & controle , Doença Crônica/psicologia , Interpretação Estatística de Dados , Modificador do Efeito Epidemiológico , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Qualidade de Vida/psicologia , Análise de Regressão , Pesquisa , Autocuidado/métodos , Autocuidado/psicologia , Resultado do TratamentoRESUMO
OBJECTIVE: This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses. METHODS: Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS: Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples. CONCLUSION: These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect. PRACTICE IMPLICATIONS: Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.
Assuntos
Doença Crônica/reabilitação , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/organização & administração , Adulto , Atitude Frente a Saúde , Doença Crônica/psicologia , Interpretação Estatística de Dados , Modificador do Efeito Epidemiológico , Terapia por Exercício/educação , Terapia por Exercício/organização & administração , Retroalimentação Psicológica , Objetivos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Prescrições , Resolução de Problemas , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Autocuidado/métodos , Autocuidado/psicologia , Apoio Social , Fatores SocioeconômicosRESUMO
Complex social networks and behaviors are difficult to observe for free-living marine species, especially those that move great distances. Using implanted acoustic transceivers to study the inter- and intraspecific interactions of sand tiger sharks Carcharias taurus, we observed group behavior that has historically been associated with higher order mammals. We found evidence strongly suggestive of fission-fusion behavior, or changes in group size and composition of sand tigers, related to five behavioral modes (summering, south migration, community bottleneck, dispersal, north migration). Our study shows sexually dimorphic behavior during migration, in addition to presenting evidence of a potential solitary phase for these typically gregarious sharks. Sand tigers spent up to 95 consecutive and 335 cumulative hours together, with the strongest relationships occurring between males. Species that exhibit fission-fusion group dynamics pose a particularly challenging issue for conservation and management because changes in group size and composition affect population estimates and amplify anthropogenic impacts.
RESUMO
CONTEXT: Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. EVIDENCE ACQUISITION: Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. EVIDENCE SYNTHESIS: Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose. CONCLUSIONS: These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.
Assuntos
Comportamentos Relacionados com a Saúde , Atividade Motora/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Local de Trabalho/estatística & dados numéricos , Modificador do Efeito Epidemiológico , Nível de Saúde , Humanos , Satisfação no Emprego , Atividades de Lazer , Saúde Ocupacional , Aptidão Física , Qualidade de VidaRESUMO
BACKGROUND: Extensive primary research has tested interventions to increase physical activity (PA) among adults with cardiovascular disease. This meta-analysis integrates the extant research about how to increase PA in cardiac samples. METHODS: Extensive literature searching located published and unpublished intervention studies that measured PA outcomes. Results were coded from primary studies. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS: Data were synthesized across 11,877 subjects from 79 eligible research reports. The overall mean PA effect size for 2-group comparisons was 0.35 (higher mean for treatment than control), which is consistent with a difference of 1984 kcal/week for treatment subjects versus 1615 for control subjects. The fitness effect size for 2-group comparisons was .17. Other statistically significantly positive 2-group effect sizes were .24 for quality of life and .23 for subsequent cardiac events. Effect sizes for anthropometric measures and blood pressure did not differ significantly from 0. Exploratory moderator analyses found large effect sizes for PA among studies that had (1) an exclusive focus on PA versus diverse health behaviors, (2) more contact between interventionists and subjects, (3) supervised exercise sessions, (4) fitness testing, (5) face-to-face encounters versus mediated intervention delivery, and (6) more minutes of activity per week. Effect sizes were unrelated to funding status, dissemination vehicle, gender distribution, or attrition rate. CONCLUSIONS: These findings document that interventions can be effective in increasing PA among patients with cardiovascular diseases. Primary research should compare interventions in randomized trials to confirm causal relationships.