Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis

[Cardiac tele-rehabilitation in times of pandemic. Experience at the National Cardiovascular Institute INCOR in Lima-Peru]

Objective

Cardiac Rehabilitation (CR) programs based on telehealth are an alternative in the context of a pandemic and represent an opportunity to continue in the intervention of cardiovascular diseases (CVD). The present study aims to evaluate the effect of a Cardiac Tele-Rehabilitation (CTR) program on quality of life, anxiety/depression index, exercise safety and Level Of disease awareness in patients discharged from a national referral institute in times of pandemic.

Methods

A pre-experimental study in cardiac patients who entered the cardiac rehabilitation program at INCOR from August to December 2020. The study included low-risk patients who were administered a questionnaire (on cardiovascular disease, exercise safety, anxiety/depression, and quality of life) at the beginning and end of the program, which was applied through a virtual platform. Descriptive and comparative before-after analysis was used through hypothesis testing.

Results

Sixty-four patients were included (71.9% male). The mean age was 63.6 ±11.1 years. Regarding exercise safety, an increase in the mean score was found after the application of the program (3.06 ± 0.8 to 3.18 ± 0.7, p=0.324). Concerning anxiety, the mean score was reduced from 8.61 to 4.75, while for depression, the reduction was from 7.27 to 2.92. Regarding the quality-of-life score, the global component improved from 111.48 to 127.92.

Conclusions

The CTR program implemented through a virtual platform during the COVID-19 pandemic enhanced quality of life and decreased stress and depression in cardiac patients discharged from a national cardiovascular referral center.

Effect of a home-based resistance exercise program in elderly participants with osteoporosis: a randomized controlled trial

The effectiveness of home-based resistance exercise in elder participants with osteoporosis remains unclear. This study demonstrates the beneficial effects of this mode of exercise on improving physical function, increasing confidence in exercise, and reducing fear of falling.

INTRODUCTION

This study aims to evaluate the effect of a home-based resistance exercise (HBRE) program versus control on physical function, exercise self-efficacy, falling efficacy, and health-related quality of life (HRQOL).

METHODS

This randomized controlled trial included 72 elderly participants with osteoporosis. Participants in the intervention group received a 12-week HBRE program, and the control group received usual care. The primary outcome was physical function, including muscle strength and balance ability; secondary outcomes were exercise self-efficacy, falling efficacy, and HRQOL. Within-group and between-group changes in outcome were evaluated by t-test and rank-sum test.

RESULTS

A total of 68 subjects were included in the final analysis. Improvement in physical function was significantly greater in the HBRE group compared with controls. On a psychological level, exercise self-efficacy and falling efficacy improved significantly in the HBRE group; no significant change was observed in the control group. Most of the dimensions of HRQOL demonstrated improvements as well. The adherence was 85.29%, with no adverse events related to the exercise.

CONCLUSION

A 12-week HBRE program was safe non-pharmacological therapy for elderly participants with osteoporosis, improving physical function, exercise self-efficacy, reduced fear of falling, and improved HRQOL.

TRIAL REGISTRATION

Chinese Clinical Trial Register: ChiCTR2100051455. Registered 23.09.21. Retrospectively registered.

Influencing Factors of Physical Activity in Patients with Lung Cancer Surgery and Its Correlation with Exercise Self-Efficacy and Perceived Social Support

Purpose

The aim of the study is to understand the current status of physical activity in patients with lung cancer surgery, explore its influencing factors, and analyze the correlation between physical activity and exercise self-efficacy and perception of social support.

Methods

The General Information Questionnaire was designed for 145 patients, Chinese version of EPIC-PAQ physical activity scale for lung cancer patients. The Exercise Self-Efficacy Scale (SEE) is used to evaluate the ability of people to organize and execute motor behaviors in various difficult situations. The Perceived Social Support Scale (PSSS) was used to emphasize individual self-understanding and self-feeling.

Results

The median and quartile of total physical activity scores in lung cancer surgery patients were 73.0 (34.8, 129.7) points; univariate analysis showed that there were statistically significant differences in physical activity levels among lung cancer surgery patients with different ages, work status before hospitalization, and perceived disease severity. The results of multivariate analysis showed that age, perceived disease severity, exercise self-efficacy, and total score of perceived social support affected the physical activity level of patients (P < 0.05). Efficacy were positively correlated with perceived social support (P < 0.01).

Conclusion

The level of physical activity of patients undergoing lung cancer surgery needs to be further improved. Physical activity is affected by patient age, perceived disease severity, exercise self-efficacy, and perceived social support and is positively correlated with exercise self-efficacy and perceived social support. Medical staff should provide targeted activity guidance according to the age and other characteristics of patients undergoing lung cancer surgery, enhance patients' exercise self-efficacy and comprehend social support, and improve their physical activity level, thereby promoting patients' early recovery.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

Association Between Hypertension Management Education and Multiple Healthy Behaviors: A Cross-Sectional Study

PURPOSE

This study aimed to evaluate the association between hypertension management education and the adoption of multiple healthy behaviors.

DESIGN

Cross-sectional study.

SETTING

Data from the 2019 Community Health Survey in Korea.

SUBJECTS

Of the 213,900 participants in the 2019 database, 89,773 (42.0%) were hypertensive and 124,127 (58.0%) were normotensive.

MEASURES

Secondary data analysis included a 1:1 computer-assisted personal interview. "Multiple healthy behaviors" included not smoking, not drinking excessively, and walking briskly. "Hypertension management education" referred to information on hypertension management that participants received from clinics, hospitals, and public health centers, outside consultation with a doctor.

ANALYSIS

The association between hypertension management education and the adoption of multiple healthy behaviors was evaluated using multiple logistic regression.

RESULTS

In total, 89,773 (42.0%) participants were hypertensive. Among 61,589 patients with diagnosed hypertension, only 7,719 (12.5%) received hypertension management education. Participants who received such education were more likely to adopt multiple healthy behaviors (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.21-1.34) than their counterparts (OR = 0.91, 95% CI: 0.89-0.93). Participants with undiagnosed hypertension were least likely to adopt multiple healthy behaviors (OR = 0.89, 95% CI: 0.86-0.92). No causal relationships were ascertained because of the cross-sectional study design.

CONCLUSIONS

Education can improve the adoption of multiple healthy lifestyles among hypertensive patients. Patients should be encouraged to participate in hypertension management education.

Education based on the health belief model to improve the level of physical activity

[Purpose]

This study aimed to investigate the effect of education based on the health belief model on the physical activity of the staff of the University of Medical Sciences.

[Methods]

This semi-experimental study was conducted on 130 university staff aged 25-50 years from the Hamadan University of Medical Sciences. Inclusion criteria were having at least 1 year of work experience, lack of acute and chronic physical and mental illnesses, and not using drugs that affect physical activity. The samples were randomly divided into two groups. The experimental group received three training sessions based on the health belief model. Before and 2 months after training, the control and experimental groups were evaluated via the following questionnaires: (1) demographic information questionnaire, (2) Health Belief Model Questionnaire, and (3) International Physical Activity Questionnaire. Finally, data were analyzed statistically.

[Results]

The training process resulted in a significant increase in the mean scores of the health belief model constructs in the experimental group, but changes in the control group were not significant. Self-efficacy was the strongest predictor of physical activity.

[Conclusion]

The health belief model is a useful model for improving individuals' understanding of the benefits of physical activity.

How Do Social Network Sites Influence Workout Intentions: A Social Norm Approach

People share their workout experiences on social network sites (SNSs). The present study examined how perceived exposure to these workout-related SNS posts may affect individuals' engagement in physical activities through perceived descriptive and injunctive norms of workout in their network, and how self-efficacy in workout moderated the effect of perceived descriptive norm on their workout intention, which was measured in general and specific ways. An online survey was conducted with a convenience sample of 807 responses in China. Results show that perceived descriptive norm of workout in one's network mediated the relationship between perceived exposure to workout-related SNS posts and perceived injunctive norm. In addition, self-efficacy in workout moderated the effect of perceived descriptive norm on workout intention-both general and specific-but the normative influence was stronger at a low level of self-efficacy compared to a high level. Furthermore, perceived injunctive norm only predicted the general rather than specific workout intention, suggesting that the perception of most people's approval might not be priority when people consider details about workout. These findings develop the theory of normative social behavior by illustrating the relationship between perceived descriptive and injunctive norm and shed light on the relative strength of the motivating factors of workout in different situations.

Exercise Self-efficacy, Perceived Benefits, and Barriers to Exercise Among Patients Following Acute Myocardial Infarction

BACKGROUND

Increasing patient adherence to regular exercise post acute myocardial infarction (AMI) is a major goal after hospitalization. It is therefore essential to identify perceived benefits and barriers to exercise and its association with exercise self-efficacy among patients post AMI.

AIMS

The purpose of this study was to identify the perceived benefits and barriers to exercise and the predictors of exercise self-efficacy among patients after AMI.

METHODS

A cross-sectional study design was used with a convenience sample of 254 patients, recruited from the 3 main hospitals in Jordan. Instruments included the Exercise Benefits and Barriers Scale and the Exercise Self-Efficacy Scale. Mean scores were computed to determine the perceived benefits and barriers responses. Multiple linear regression was conducted to explore the predictors of exercise self-efficacy. Data were collected over 5 months.

RESULTS

The greatest perceived benefits were related to personal factors, for example, "I enjoy exercise" (2.45 [0.98]), and physical performance, for example, "My muscle tone is improved with exercise" (2.44 [0.86]) and "Exercise increases my stamina" (2.43 [0.86]). The greatest perceived barriers were related to environmental barriers, for example, "Lack of exercise places" (2.67 [0.82]), and internal factors related to physical exertion itself, for example, "Concerned about getting tired during exercise participation" (2.65 [0.72]). The Exercise Self-Efficacy Scale showed that patients post ST-elevation AMI had higher exercise self-efficacy than those with other treatment modalities (AMI, 44.71 [19.07] vs 36.59 [17.34]; P = .001). Patients treated by primary percutaneous coronary intervention had higher exercise self-efficacy, 49.2 (18.61), than patients treated by thrombolysis and percutaneous coronary intervention, 39.28 (18.3), and patients treated by medications other than thrombolytic therapy, 36.59 (17.4) (F2,251 = 11.612, P = .001). The multiple linear regression model explained approximately 29% of the variance in exercise self-efficacy (F11,242 = 7.914, P < .001). Five variables contributed significantly to the prediction of self-efficacy: type of AMI (standardized β = -0.173, t = -3.311, P = .01), perceived exercise benefits (standardized β = 0.322, t = 4.912, P = .01), perceived exercise barriers (standardized β = -0.291, t = -4.521, P = .01), being Argela smokers (water pipe smoking) (standardized β = -0.132, t = -2.617, P = .029), and cholesterol level (standardized β = -0.158, t = -2.174, P = .003).

CONCLUSIONS

Primary perceived benefits of exercise reported were in the areas of personal factors and improved physical performance. The main perceived barriers to exercise were in the areas of environmental factors and physical exertion. Identification of benefits and barriers to exercise, type of AMI, and treatment modalities of AMI as predictors of exercise self-efficacy is a significant step for developing appropriate interventions that effectively improve exercise self-efficacy and exercise among post-AMI patients.

Are self-efficacy measures confounded with motivation? An experimental test

Standard measures of self-efficacy (SE) may confound perceived capability and motivation because respondents interpret the word "can" as "will". Objective: To test whether priming for the meaning of the word "can" changes self-efficacy ratings. Design: In an experimental test, 134 university students responded to an on-line standardized measure of exercise SE and provided definitions of the words "can" and "will". One month later participants were randomized to complete (a) the same questionnaire (control), (b) the same questionnaire but with presentation of each participant's definition of "can" prior to the SE measure (definition priming), or (c) the same questionnaire but with SE items ("I can exercise…") placed side-by-side with behavioral intention items ("I will exercise…") (side-by-side priming). Results: SE increased relative to controls for side-by-side (b = 12.08, SE = 2.70, p<.01) but not definition priming (ns), with the former even stronger among participants (n = 91) who provided strict (i.e., literal) rather than liberal definitions of "can" (b = 15.38, SE = 3.21, p<.001). Conclusion: Priming of the meaning of the word "can" led to increases in self-efficacy ratings among those who hold a literal meaning of the word "can". This suggests that for many respondents standard assessments of SE may be confounded by motivation.

Physical activity, benefits, and barriers across the aging continuum

BACKGROUND

A growing body of evidence indicates the importance of physical activity during midlife period linked to the likelihood of healthy aging, while the likelihood of an individual engaging in physical activity depends largely on their perceived benefits and barriers to being physically active.

AIM

This study was to examine physical activity levels of midlife Korean American adults and their perceived benefits and barriers to physical activity compared with young and older adults.

METHODS

We conducted a secondary analysis of data collected for a larger descriptive, cross-sectional study that was conducted with a sample of 517 Korean American adults in a Midwestern city. Data were collected using a survey questionnaire.

RESULTS

A little more than half of the sample were women (57.1%), with a mean age of 41.6 (± 13.4). The study sample met the current guidelines for physical activity far less than the general U.S. population (30.4% -34.6 vs. 51.7%). Less midlife adults met the guidelines for moderate-intensity physical activity than older adults (34.2% vs. 57.4%), while less midlife adults met the guidelines for vigorous-intensity physical activity than young adults (24.8% vs. 40.6%). Midlife adults perceived fewer benefits than did young and older adults.

CONCLUSION

The findings indicate that midlife adults are less likely to engage in physical activity and probably more at risk for unhealthy ageing than young and older adults. Understanding benefits and barriers of target population is the first step in developing culturally and age-appropriate intervention to promote physical activity.

Validation and Assessment of Osteoporosis Self-Efficacy Among Iraqi General Population

Background

Poor quality of life, fractures and disability are the consequences of preventable osteoporosis.

Objectives

The aims of this study were to validate and assess Osteoporosis Self-efficacy Scale (OSES-A) Arabic version among Iraqi general population.

Methods

A cross-sectional study with a random cluster sampling method from the community was used. Forward-backward-forward translation method was used to translate the questionnaire from English to Arabic. Beside OSES-A, Osteoporosis Knowledge Tool (OKT) and Osteoporosis Health Belief Scale (OHBS) Arabic versions were used to assess osteoporosis preventive behaviours.

Results

The results showed good face validity and reliability. The construct validity showed two factors which explain 80.86% of the variance. In addition, the result showed low self-efficacy score (658.43±222.014) with 83.33% were found to have low OSES-A level. There were significant associations between age, gender, and self-reported osteoporosis with OSES-A levels. In addition, there were significant differences between age, gender, marital status, family history of osteoporosis, self-reported osteoporosis and osteoporosis diagnosis or screening in relation to total OSES-A scores. Moreover, there were positive correlations between the OSES-A total score with total knowledge and health belief. Multivariate analysis revealed that OKT levels, OHBS levels, age and gender were predictors for OSES-A levels.

Conclusion

This study showed good cultural adaptation and psychometric properties of OSES-A tool and could be used in any osteoprotective educational program.

Turning disability into ability: barriers and facilitators to initiating and maintaining exercise among older men living with HIV

Physical activity reduces the risk for comorbidities, but little is known about barriers to exercise among older adults living with HIV. Three focus groups were conducted among 19 adults living with HIV, aged ≥ 50 years, who were enrolled in or recently completed a supervised exercise intervention. Sessions were recorded, transcribed, and coded first using inductive methods. All participants were male, and the majority were white, non-Hispanic; 53% were receiving disability benefits. All had suppressed HIV infection on antiretroviral therapy, with almost 20 years since HIV diagnosis. Participants noted a lack of self-efficacy, motivation, and physical limitations that contributed to a sense of "disability" as barriers to exercise prior to the intervention. Through social support and improvements in self-efficacy, participants were motivated to start and continue exercising. Perceived sense of disability may impede (or interfere with) exercise initiation and maintenance; self-efficacy and social support may facilitate exercise maintenance in older adults living with HIV.

Randomized Trial of Modified Stretching Exercise Program for Menstrual Low Back Pain

This study aimed to examine the effectiveness of a modified stretching exercise program on young women with menstrual low back pain. Overall, 127 young women were randomly assigned to the experimental ( n = 63) and control ( n = 64) groups. The experimental group followed the modified stretching exercise program, whereas the control group performed their usual activities. At 1, 4, 8, and 12 months, the experimental group had significantly lower scores on the visual analog scale for pain (95% confidence interval [CI] = [0.73, 1.96]; p < .05) and the Oswestry Low Back Pain Disability Questionnaire than the control group (95% CI = [0.68, 2.03]; p < .001). At 12 months, the experimental group showed significantly higher exercise self-efficacy than the control group (95% CI = [-6.87, 0.62]; p = .003). These findings can be used to enhance self-care capabilities by using the modified stretching exercise program for young women with menstrual low back pain.

Cultural Factors Influencing Osteoarthritis Care in Asian Communities: A Review of the Evidence

With the prevalence of osteoarthritis (OA) increasing internationally, there is a need to study the impact of this disease on culturally diverse populations. Individuals of Asian descent make up more than 60% of the world population, yet comprehensive information on the cultural factors that impact OA care is not available. Scoping review methodology using directed content analysis was employed to identify and analyze existing research on OA care for Asians. A categorization matrix was developed using the six care areas from the OA clinical practice guidelines along with an additional three non-clinical areas (cross-cultural adaptation of clinical tools; psychological well-being; family systems and informal care) identified in an initial scan resulting in a total of nine OA care areas to guide initial coding. A full scoping review was conducted across five databases resulting in 656 abstracts screened. All text was coded using the categorization matrix and resulting subthemes were identified. A total of 74 articles were analyzed with 23 subthemes identified across the nine categories. Four new perspectives emerged to support OA care for Asian populations: (1) the importance of family and peer assistance, (2) the importance of culturally specific activities, (3) distrust in western medicine, and (4) impact of positive coping mechanisms on health appraisals. While Asians are more susceptible to knee and hand OA because of their cultural lifestyle factors (e.g. squatting for chores, hygiene and religious activities), and traditional beliefs on OA management (e.g. traditional diet, topical oils, physical therapy), many do not present themselves for conventional treatments (e.g. surgery) until all traditional treatments are exhausted. The results suggest that cultural factors influence the uptake of OA management practices among Asians. Greater awareness of these cultural factors may improve diagnosis, treatment, and management of OA among Asian patients.

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

INTRODUCTION

The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.

METHODS

A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.

RESULTS

A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.

CONCLUSION

The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.

Exercise Self-Efficacy Scale: Validation of the Arabic Version Among Jordanians With Chronic Diseases

This study assessed the psychometric properties of the Arabic version of Exercise Self-Efficacy scale (ESE-A) among Jordanian outpatients with a variety of chronic diseases using descriptive cross-sectional design. Participants’ scores of ESE-A significantly correlated with their reported weekly exercise frequency ( r = .23, p< .001), duration ( r = .31, p< .001), and evaluation of their physical exercise ( r = .39, p< .001). The construct validity was tested using exploratory factor analysis, which retained all items, and the scree plot showed one meaningful factor with an eigenvalue of 10.38 and an explained variance of 57.7%. Furthermore, Cronbach’s alpha was .89 and split-half coefficient was .83 indicating that the ESE-A is a reliable scale. The ESE-A was found to be a robust measure to evaluate exercise self-efficacy among Arabic patients with chronic diseases. Arabic researchers interested in exercise self-efficacy are invited to utilize the ESE-A in their studies to confirm its psychometric properties.

Influence of upper limb disability, manual dexterity and fine motor skill on general self-efficacy in institutionalized elderly with osteoarthritis

STUDY DESIGN

Descriptive, cross-sectional.

INTRODUCTION

The impact of upper limb (UL) disability, dexterity and fine motor skill on self-efficacy in older adults with osteoarthritis (OA) is not well known yet.

PURPOSES OF THE STUDY

To evaluate the self-efficacy and its relationship with UL function/disability in institutionalized OA.

METHODS

Institutionalized adults (n = 45) over the age of 65 years with OA were evaluated in a single session, to determine pinch strength, active range of motion of the hand and UL disability and functionality. They were classified as self-efficacious or not based on their general self-efficacy level. The influence on self-efficacy on upper limb function was statistically analyzed using bivariate and multivariate regression analyses.

RESULTS

Self-effective older adults showed significantly lower scores in disability and higher scores in pinch strength, dexterity and motion of thumb than those who were classified as non-self-effective. Self-efficacy was associated with pinch strength (p ≤ 0.038), disability (p < 0.001) and dexterity (p ≤ 0.048). Multiple regression analyses showed that disability explained almost 40% of the variability of self-efficacy.

CONCLUSIONS

Older adults classified as non-self-effective have higher UL disability and less pinch strength, manual dexterity and thumb motion than those who are self-effective, suggesting a relationship between impairment and perceived ability.

Predictive Ability of Pender’s Health Promotion Model for Physical Activity and Exercise in People With Spinal Cord Injuries

The main objective of this study was to validate Pender’s Health Promotion Model (HPM) as a motivational model for exercise/physical activity self-management for people with spinal cord injuries (SCIs). Quantitative descriptive research design using hierarchical regression analysis (HRA) was used. A total of 126 individuals with SCI were recruited through the National Spinal Cord Injury Association, other SCI support groups, and professors in rehabilitation counseling across the United States. Outcome measures used were the International Physical Activity Questionnaire and the Physical Activity Stages of Change Instrument. The HRA results indicated that preinjury physical activity/exercise level, severity of SCI, and commitment to a plan for exercise and physical activity were predictive of postinjury exercise and physical activity level. In addition, friend/family support, perceived self-efficacy, and perceived benefits were the strongest predictors of commitment to a plan of action for exercise and physical activity. The research findings support the applicability of Pender’s HPM as a motivational model for exercise/physical activity for people with SCI. The information can be used to design health promotion behavioral interventions for people with SCI living in the community.

[Perceptions of Tunisian women based on the health beliefs model and their practices related to osteoporosis]

Introduction

L'étude a pour objectif de décrire les croyances des femmes et leurs pratiques liées à la santé et à l'ostéoporose, afin d'élaborer des interventions efficaces et ciblées pour la prévention de cette maladie dans le contexte tunisien.

Méthodes

Une étude descriptive transversale a été effectuée auprès de 100 femmes tunisiennes, âgées de 45 ans et plus, qui consultent au centre de santé de base d'une zone périurbaine de la région de Sousse (Tunisie). La collecte de l'information a été réalisée à l'aide de « l'échelle des croyances relatives à la santé sur l'ostéoporose» développée par Kim et ses collègues traduit en arabe et validé en Tunisie et le questionnaire de «Calcul des apports calciques quotidiens» développé par Fardellone Patrice. L'interprétation des résultants s'est basée sur le «Health Belief Model ».

Résultats

La perception des participantes pourrait être considérée comme au dessus de la moyenne pour la vulnérabilité de l'ostéoporose (58%), la gravité de la maladie, les avantages de la pratique de l'activité physique, les avantages de l'apport en calcium et la motivation à la santé; par contre, elle pourrait être considérée comme modérée concernant les obstacles à la prévention. Cependant, les pratiques exposant au risque de la maladie sont relativement fréquentes et ceci essentiellement en rapport avec des facteurs socio-économiques et culturels.

Conclusion

Les programmes de promotion doivent viser la création d'un environnement physique et social favorable à l'adoption des comportements à moindre risque et viser l'éducation ciblée de la population.

Perceived barriers to healthy lifestyle activities in midlife and older Australian women with type 2 diabetes

BACKGROUND

Type 2 diabetes is a leading cause of morbidity and mortality in midlife and older Australian women with known modifiable risk factors for type 2 diabetes including smoking, nutrition, physical activity and obesity. In Australia little research has been done to investigate the perceived barriers to healthy lifestyle activities in midlife and older women with type 2 diabetes.

AIMS

The primary aim of this study was to explore the level and type of perceived barriers to health promotion activities. The secondary aim was to explore the relationship of perceived barriers to smoking behaviour, fruit and vegetable intake, physical activity, and body mass index.

METHODS

The study was a cross sectional survey of women, aged over 45 with type 2 diabetes, recruited from four metropolitan community health clinics (n = 41). Data were collected from self-report questionnaires and analysed using quantitative methods.

RESULTS

Women in the study had average total barriers scores similar to those reported in the literature for women with a range of physical disabilities and illnesses. The leading barriers for this group of women were: lack of interest, concern about safety, too tired, lack of money and feeling what they do does not help. There was no association between total barriers scores and body mass index, physical activity, fruit and vegetable intake or socio-demographic variables.

CONCLUSION

This study contributes to understanding the perceptions of midlife and older women with type 2 diabetes about the level and type of barriers to healthy lifestyle activities that they experience. The participants reported a high level perceived barriers with a range of personal, social and environmental issues identified and described. This study suggests that health promo- tion education and interventions for risk factor reduction in women with type 2 diabetes may be enhanced by explicitly addressing perceived barriers to healthy lifestyle activities.

Predictors of initial weight loss among women with abdominal obesity: a path model using self-efficacy and health-promoting behaviour

AIM

To identify predictors of initial weight loss among women with abdominal obesity by using a path model.

BACKGROUND

Successful weight loss in the initial stages of long-term weight management may promote weight loss maintenance.

DESIGN

A longitudinal study design.

METHODS

Study participants were 75 women with abdominal obesity, who were enrolled in a 12-month Community-based Heart and Weight Management Trial and followed until a 6-month assessment. The Weight Efficacy Lifestyle, Exercise Self-Efficacy and Health Promoting Lifestyle Profile-II measured diet self-efficacy, exercise self-efficacy and health-promoting behaviour respectively. All endogenous and exogenous variables used in our path model were change variables from baseline to 6 months. Data were collected between May 2011-May 2012.

FINDINGS

Based on the path model, increases in both diet and exercise self-efficacy had significant effects on increases in health-promoting behaviour. Increases in diet self-efficacy had a significant indirect effect on initial weight loss via increases in health-promoting behaviour. Increases in health-promoting behaviour had a significant effect on initial weight loss.

CONCLUSION

Among women with abdominal obesity, increased diet self-efficacy and health-promoting behaviour were predictors of initial weight loss. A mechanism by which increased diet self-efficacy predicts initial weight loss may be partially attributable to health-promoting behavioural change. However, more work is still needed to verify causality. Based on the current findings, intensive nursing strategies for increasing self-efficacy for weight control and health-promoting behaviour may be essential components for better weight loss in the initial stage of a weight management intervention.

Individual, social and environmental correlates of physical activity in overweight and obese African American and Hispanic women: A structural equation model analysis

Objective

Ecologic frameworks account for multilevel factors related to physical activity (PA) and may be used to develop effective interventions for women. The purpose of this study was to examine the influence of individual, social and environmental factors on PA among African American and Hispanic women using structural equation modeling.

Methods

Overweight and obese women (N = 164, 65.9% African American) completed a 7-day accelerometer protocol, a physical assessment, and questionnaires on body image, self-efficacy, motivational readiness, social support, home environment for physical activity and perceived environment. Trained assessors evaluated each participant's neighborhood and collected objective measures of physical activity resources and the pedestrian environment. Assessments were completed between 2006 and 2008.

Results

Structural model fit was acceptable (RMSEA = .030). Body composition and image was negatively associated with PA, and motivational readiness had an indirect effect on PA through body composition and image. PA resources and the pedestrian environment operated through the perceived environment to positively influence neighborhood cohesion, which was positively associated with body composition and image.

Conclusion

PA is more heavily influenced by intrapersonal factors related to weight. Improving intrapersonal factors related to weight and perceptions of the environment may lead to increased PA in African American and Hispanic women.

•

Physical inactivity contributes to health disparities among ethnic minority women.

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Individual factors directly and indirectly influence physical activity.

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The physical environment influences individual factors via the social environment.

Effectiveness of a Releasing Exercise Program on Anxiety and Self-Efficacy Among Nurses

The purpose of this study was to evaluate the effectiveness of a releasing exercise program (REP) on anxiety and exercise self-efficacy among nurses. The REP consisted of warm-up and tension-releasing exercises and mood adjustment. Ninety-nine nurses (age = 33.38 ± 7.38 years) experiencing anxiety (average Visual Analog Scale for Anxiety [VASA] score of 5.63 ± 1.44 at baseline) were randomly assigned to an experimental group ( n = 50) that received 50-min REP sessions 3 times a week or a control group ( n = 49) that did not attend REP sessions. The outcome measures were VASA, the Chinese Version of the Beck Anxiety Inventory, and Exercise Self-Efficacy Scale scores. At Weeks 12 and 24, the experimental group had significantly lower anxiety levels and higher exercise self-efficacy scores than the control group. Therefore, the REP effectively reduces anxiety and enhances self-confidence in exercise capability.

Commitment to health theory: a graphic model

Graphic models can improve understanding of theoretical concepts and the relationship between concepts. This article introduces a model of Commitment to Health Theory, which describes the process of behavior change from action to the maintenance stage of change. Commitment to health means that a new or modified health behavior will be used regardless of socioeconomic factors, race, gender, employment category, and age. Findings were based on three cross-sectional survey studies of approximately 1,085 predominantly manufacturing workers sampled from across the United States. Commitment to Health Theory was used to identify those in the action stage of change with mid-level commitment and predict the likelihood of successfully changing health behavior. Monitoring levels of commitment to health can determine appropriate intervention strategies to assist clients who currently exhibit unhealthy diet and exercise behaviors.

Physical activity and sedentary time in persons with obstructive sleep apnea and overweight enrolled in a randomized controlled trial for enhanced physical activity and healthy eating

BACKGROUND

The aim of the study was to describe the amount of physical activity and sedentary time in patients with obstructive sleep apnea syndrome (OSAS) and overweight and to explore potential disease-related and psychological correlates.

METHODS

A descriptive and correlational study was performed. Prospective data of physical activity and sedentary time were collected through accelerometry, and body mass index (BMI), daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms were measured at one point. Seventy-three participants with overweight (mean BMI, 35 kg/m(2) (5 SD)) and moderate/severe OSAS (apnea-hypopnea index ≥15) were consecutively recruited. Multivariate associations were determined through multiple linear regression analysis.

RESULTS

The participants took a daily average of 7,734 (3,528 SD) steps, spent an average of 77 min (54 SD) in moderate-to-vigorous physical activity (MVPA), and spent 11 h and 45 min (2 h and 8 min SD) sedentary. BMI, daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms did not explain variance in MVPA or steps but explained 22.9 % of variance in sedentary time. In backward selection analysis, BMI contributed to the explanatory degree of MVPA with 9 % whereas, fear of movement explained 6.3 % of the variance in steps and 14.3 % of the variance in sedentary time.

CONCLUSIONS

An important implication for future physical activity interventions is that both physical activity and sedentary behaviors should be targeted, and fear of movement may be an important determinant for change in patients with OSAS and overweight.

Sedentary behavior, physical activity, and psychological health of Korean older adults with hypertension: effect of an empowerment intervention

The aim of this study was to determine the effect of an 8-week empowerment intervention on sedentary behavior, physical activity, and psychological health in Korean older adults with hypertension. Using a quasi-experimental design, older adults participated in either an experimental group (n = 27) or control group (n = 21). The experimental group received an empowerment intervention including lifestyle modification education, group discussion, and exercise training for 8 weeks, and the control group received standard hypertension education. After 8 weeks, participants in the experimental group had significantly decreased sedentary behavior, increased physical activity, increased self-efficacy for physical activity, and increased perceived health (p < 0.05). However, no significant group difference was found for depression. Findings from this study suggest that empowerment interventions may be more effective than standard education in decreasing sedentary behavior and increasing physical activity, self-efficacy for physical activity, and perceived health in Korean older adults with hypertension.

Mediating effects of group cohesion on physical activity and diet in women of color: health is power

PURPOSE

To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention.

DESIGN

Longitudinal design.

SETTING

Harris County and Travis County, Texas.

PARTICIPANTS

Community-dwelling African-American and Hispanic or Latina women.

INTERVENTION

Three hundred ten women were randomized to a PA (n  =  204) or VF (n  =  106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption.

MEASURES

Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention.

ANALYSES

The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis.

RESULTS

Women were middle aged (mean  =  44.4 years) and overweight or obese (mean body mass index  =  34.0 kg/m(2)). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p < .05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes.

CONCLUSIONS

Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.

Psychometric properties of the Spanish version of the Health-Promoting Lifestyle Profile II

The Health-Promoting Lifestyle Profile II (HPLPII) has been psychometrically validated across several linguistic and cultural groups; however the Spanish version has not been psychometrically tested for the Spanish population. The purpose of this research was to evaluate the reliability and factor structure of the Spanish version of the HPLPII for Spanish people. Principal component analysis (PCA) revealed that a six-component model for 44 items accounted for 40% of the variance, and the scale had an internal consistency of .87. Confirmatory factor analysis demonstrated that a better fit of the six-component structure emerged from the PCA than from the model proposed in the original version of the HPLPII, suggesting that the health-promoting lifestyle might be sensitive to context and culture.

Balance dysfunction and falls in people with lower limb arthritis: factors contributing to risk and effectiveness of exercise interventions

Chronic musculoskeletal conditions in the lower extremities, particularly arthritis, and the chronic pain associated with them, are independent risk factors for falls, with approximately 50% of people with arthritis reporting one or more falls. Despite this, few studies have specifically addressed balance dysfunction, falls risk and falls incidence in people with arthritis. This review aimed to identify potential factors contributing to the increased risk of falls in people with lower limb osteoarthritis or rheumatoid arthritis and to summarise the evidence base for effective exercise interventions targeted to reduce their risk of falls. A systematic search of the literature was conducted in February 2010 and included the following databases: MEDLINE (Ovid), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Cochrane Library and PsycINFO. Only three studies that investigated exercise programmes for people with lower limb arthritis met all inclusion criteria, but none used falls as an outcome measure. To broaden the review, systematic reviews that assessed the effectiveness of exercise interventions for fall prevention in older people were also included. The presence of any form of lower limb arthritis and the associated consequences including pain, balance impairment, reduced muscle strength and reduced function are all associated with increased risk of falling. Due to the link between musculoskeletal pain and the increased risk of falls, further research needs to investigate which type of exercise programme will be effective in reducing the risk of falls in populations with arthritis in the lower limbs.

Activity pacing for osteoarthritis symptom management: study design and methodology of a randomized trial testing a tailored clinical approach using accelerometers for veterans and non-veterans

BACKGROUND

Osteoarthritis (OA) is a prevalent chronic disease and a leading cause of disability in adults. For people with knee and hip OA, symptoms (e.g., pain and fatigue) can interfere with mobility and physical activity. Whereas symptom management is a cornerstone of treatment for knee and hip OA, limited evidence exists for behavioral interventions delivered by rehabilitation professionals within the context of clinical care that address how symptoms affect participation in daily activities. Activity pacing, a strategy in which people learn to preplan rest breaks to avoid symptom exacerbations, has been effective as part of multi-component interventions, but hasn't been tested as a stand-alone intervention in OA or as a tailored treatment using accelerometers. In a pilot study, we found that participants who underwent a tailored activity pacing intervention had reduced fatigue interference with daily activities. We are now conducting a full-scale trial.

METHODS/DESIGN

This paper provides a description of our methods and rationale for a trial that evaluates a tailored activity pacing intervention led by occupational therapists for adults with knee and hip OA. The intervention uses a wrist accelerometer worn during the baseline home monitoring period to glean recent symptom and physical activity patterns and to tailor activity pacing instruction based on how symptoms relate to physical activity. At 10 weeks and 6 months post baseline, we will examine the effectiveness of a tailored activity pacing intervention on fatigue, pain, and physical function compared to general activity pacing and usual care groups. We will also evaluate the effect of tailored activity pacing on physical activity (PA).

DISCUSSION

Managing OA symptoms during daily life activity performance can be challenging to people with knee and hip OA, yet few clinical interventions address this issue. The activity pacing intervention tested in this trial is designed to help people modulate their activity levels and reduce symptom flares caused by too much or too little activity. As a result of this trial, we will be able to determine if activity pacing is more effective than usual care, and among the intervention groups, if an individually tailored approach improves fatigue and pain more than a general activity pacing approach.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01192516.

Active living--the perception of older people with chronic conditions

OBJECTIVES

To describe and understand factors which enhance and impede participation in physical activity for older adults with and without chronic illness and develop a framework of health behaviours for 'active living'.

METHODS

A contrasting group framework was used to compare discussions in two sets of focus groups with relatively healthy and less healthy older adults. The thematic analysis was informed by the Transtheoretical Model, the Health Belief Model and Social Cognitive Theory.

RESULTS

All participants affirmed the health benefits of physical activity and there was broad agreement that social support and conductive environments contributed to the promotion of opportunities for physical activity. However, perceptions of specific factors needed to maintain and promote good health differed between healthy and less healthy participants. Connection to community, sense of place and 'walkability' of neighbourhoods were identified as motivators for undertaking physical activity, whilst barriers were associated with health, the environment, family and attitudes to physical activity.

DISCUSSIONS

The focus groups highlighted the importance of social, behavioural and contextual factors in promoting opportunities for physical activity in older adults with and without chronic illness. The findings were used to propose an Active Living Framework which is the subject of ongoing research.

Implementation of a physical activity intervention for people with rheumatoid arthritis: a case study

OBJECTIVES

To investigate the potential facilitators and barriers regarding the implementation on a larger scale of an internet-based physical activity intervention which had previously proved to be effective in a randomized, controlled trial concerning sedentary patients with rheumatoid arthritis (RA).

METHODS

Assuming a central delivery of the intervention by two trained physical therapists in four regions in the Netherlands, the following activities were employed: the recruitment of potential participants (RA patients), the acquisition of cooperation from referring rheumatologists and the acquisition of reimbursement from regional health insurance companies. Evaluation was done by means of the Reach, Evaluation, Adoption, Implementation and Maintenance framework, of which the following three dimensions were considered relevant: Reach (the number of potential participants), Adoption (readiness for adopting the programme in real life among rheumatologists) and Implementation (the extent to which the intervention could be delivered as intended). Evaluation measures comprised a postal survey among 927 patients with RA in two regions, a telephone survey among rheumatology centres in four regions and consultations with five regional health insurance companies.

RESULTS

Seventy-six out of 461 responding RA patients (20%) met the original study inclusion criteria (being sedentary and having access to the internet) and were interested in participation. However, the potential costs of the purchase of a bicycle ergometer and the interference with patients' current physical therapy were obstacles for eligible patients actually to participate. Rheumatologists in four out of five rheumatology centres were willing to participate. All five health insurance companies were willing to reimburse the guidance and feedback by the physical therapist, and the costs of the internet site (estimated costs 271 euro [203 pound] per patient per year), but not the bicycle ergometer (estimated costs 350 euro [262 pound]), provided that current physical therapy would be discontinued.

CONCLUSIONS

Facilitators for the implementation of an internet-based physical activity intervention were: (i) a considerable proportion of RA patients were eligible and interested in the programme; (ii) the majority of rheumatologists were willing to refer patients; and (iii) health insurance companies were willing partially to reimburse the intervention. Barriers were the additional costs for patients and their unwillingness to discontinue current physical therapy. These findings underscore the need for additional research into barriers to participation in physical activity interventions among patients with RA, and in reimbursement strategies in particular.

Risk Factors For Fragility Fracture in Seremban District, Malaysia: A Comparison of Patients With Fragility Fracture in the Orthopedic Ward Versus Those in the Outpatient Department

Osteoporosis is a silent disease and becomes clinically significant in the presence of fragility fracture. Identifying risk factors that are associated with osteoporosis in the community is important in reducing the incidence of fragility fracture. The aim of this study is to identify risk factors associated with fragility fracture in the Seremban District of Malaysia. This is a population comparison study between orthopedic ward patients and outpatients attending a community health clinic for 6 months. Epidemiological data and the possible risk factors for osteoporosis were collected by direct interview. This study demonstrates that advancing age, low body weight, smoking, lack of regular exercise, low consumption of calcium containing foods, and using bone depleting drugs (steroids, thyroid hormone, and frusemides) are major risk factors for fragility fracture. Most of these risk factors are modifiable through effective lifestyle intervention.