A Research Agenda to Examine the Efficacy and Relevance of the Transtheoretical Model for Physical Activity Behavior

Developing a Conceptual Model for Collective Patterns and Leisure-Time Physical Activity Inequalities Among Adults

BACKGROUND

Despite extensive efforts to tackle the unequal levels of leisure-time physical activity (LTPA) among adults, our understanding of how these inequalities are sustained over time is minimal. Existing approaches often overlook the complex dynamic, and typically nonlinear interactions, which shape physical activity patterns. Therefore, this paper aims to capture these dynamic interactions and processes which influence an individual's decision to practice LTPA, with a specific focus on the influence of income.

METHODS

The conceptual model was developed in 4 main stages: (1) initial draft development, (2) realist reviews, (3) expert consultation, and (4) finalization.

RESULTS

The conceptual model has intention as its central construct to practice LTPA, and intention is directly influenced by dynamic interrelated processes between individual's economic, psychosocial, and perceived physical environment factors.

CONCLUSION

From the multiple theories, evidence, and expert agreement, we are confident that our conceptual model expresses the dynamic interactions which shape an individual's decision to practice LTPA in a context of socioeconomic inequalities. Going forward, this work will be used to conceptualize and inform the development of an agent-based model to simulate LTPA inequalities among adults and can be expanded or adapted to other uses, such as intervention development.

Impact of physical activity on cardiovascular health in firefighters: Scoping review

Background

Firefighters' duties include fire response, emergency medical treatment and rescue operations. Noncompliance with physical activity (PA) guidelines increases adverse health behaviours and the risk of on-duty fatalities. While PA is known to treat cardiovascular disease (CVD), its impact on risky health behaviours in firefighters is under-researched.

Aim

This scoping review aimed to evaluate PA's effects on firefighters' cardiovascular health.

Method

The review followed PRISMA-ScR and PRISMA Protocol standards, involving a comprehensive search across databases like Cochrane, PubMed, Medline, EbscoHost, Web of Science, Academic Search Complete, CINAHL (EBSCO), SAGE Journals, ScienceDirect and Scopus, covering publications up to June 2023. The purpose was to compile evidence on PA programs' effects on fire and rescue services (FRS).

Results

Five intervention studies were included, examining PA effects on firefighters with smoking habits, poor diet, alcohol consumption and sedentary lifestyles. These interventions recommend 150 minutes per week of aerobic, flexibility and strength activities. Firefighters should be guided to initiate and maintain 150 minutes of PA weekly to promote health strategies.

Conclusion

The study concludes that integrating lifestyle changes with low- and moderate-intensity PA into fire services is crucial for improving health risk behaviours (HRBs). Implementing multilevel interventions is necessary to drive policy changes supporting firefighters facing HRBs.

Contribution

Educating firefighters about these behaviours is essential, fostering an understanding of healthy alternatives.

The Effect of a Physical Activity Program Using WhatsApp on Adolescents' Exercise Behavior

This study aims to demonstrate the effect of a transtheoretical model (TTM)-based physical activity program on the exercise behavior of adolescents using WhatsApp. The study was conducted with high school students (N = 185) in a pre-/posttest, quasi-experimental design. TTM-based text messages were sent to the intervention group (n = 95) over WhatsApp every day for 8 weeks. The intervention group demonstrated more statistically significant progression in the exercising stages of change compared to the control group (n = 90) (χ2 = 20.10; p = .00). It was also found that this group had a higher exercising self-efficacy score (t = 2.647; p = .009) and a higher physical activity total metabolic equivalent of task score (Z = -3.521; p = .000). There was no significant difference in BMI and perception of pros and cons (p > .05). The program was found to be effective in terms of recording progress in the exercising stages of change, increasing exercising self-efficacy, and maintaining a physical activity program.

Cardiorespiratory exercise and self-management early after stroke to increase daily physical activity: results from a stepped-wedge cluster randomised trial

PURPOSE

This study aimed to determine if the Promoting Optimal Physical Exercise for Life (PROPEL) program increases participation in physical activity up to six months post-discharge from stroke rehabilitation, compared to participation in group cardiorespiratory exercise (GCE) alone.

METHODS

This was a stepped-wedge cluster superiority randomised controlled trial. People with sub-acute stroke participated in the PROPEL (n = 107) or GCE (n = 65) intervention phases. The primary outcome was adherence to physical activity guidelines over seven days at six months post-discharge from rehabilitation. Secondary outcomes were exercise self-efficacy (Short Self-Efficacy for Exercise scale), exercise-related beliefs and attitudes (Short Outcome Expectation for Exercise scale), and perceived barriers to physical activity (Barriers to Being Active Quiz).

RESULTS

Fifty-seven participants (PROPEL, n = 29; GCE, n = 28) were included in the analysis. At six months post-discharge, 6/17 PROPEL participants and 9/22 GCE participants met the guidelines for intensity and duration of physical activity; the odds of meeting physical activity guidelines did not differ between phases (p > 0.84). PROPEL participants reported higher self-efficacy for exercise than GCE participants (p = 0.0047).

CONCLUSIONS

While PROPEL participants reported higher self-efficacy for exercise than those who completed GCE alone, we were unable to find evidence that this translated to increased odds of meeting physical activity guidelines.

TRIAL REGISTRATION

NCT02951338IMPLICATIONS FOR REHABILITATIONIntegration of cardiorespiratory exercise with behaviour modification strategies to improve physical activity participation after discharge from stroke rehabilitation increases self-efficacy for exercise when compared to cardiorespiratory exercise alone.Increased self-efficacy for exercise may not increase the odds of meeting physical activity guidelines post-stroke.Improving self-efficacy for exercise during stroke rehabilitation may encourage participation in moderate to vigorous physical activity up to 6-months post-discharge from rehabilitation.

"Men Need Role Models": Exploring the Facilitators and Barriers for Yoga Participation Among Men

Yoga is a holistic form of physical activity taken up for various reasons, including physical and mental health, and sometimes spirituality. Despite the growing popularity of yoga as a form of health-enhancing physical activity, data show the uptake among men to be consistently low compared to women. To gain an understanding of barriers and facilitators for yoga uptake and adherence among men, four focus group discussions (three male groups, one female group) and three individual interviews were undertaken. Using thematic analysis, three themes were developed: (a) encouragement, advice, and support from trusted others, (b) confronting gender-related perceptions and issues, and (c) getting to the benefits. The findings suggest that men are more likely to take up yoga when encouraged by trusted others and male role models. Men face gender-related challenges that can be overcome by educating them about yoga, focusing on its physical benefits, and experiencing the benefits of yoga firsthand. To encourage more men into yoga, yoga teachers need to create an inclusive environment that welcomes men and caters to their needs. These findings provide valuable insight into the unique challenges experienced by men in pursuing and practicing yoga regularly. They may be used to develop targeted recruitment and marketing strategies to draw more men into yoga and encourage them to stay, which is essential for experiencing the many long-term health benefits of yoga.

Exploring Job-Related Factors and Exercise Intentions in Relation to Overall Physical Activity and Its Subdivisions

This study examined the relationships between job-related factors and overall physical activity (PA), including its subdivisions: leisure-time PA, transportation PA, and work-related PA. Additionally, this study investigated the associations between exercise intentions and different types of PA. A cross-sectional design was employed, utilizing a questionnaire to collect data on participants' demographics, job-related characteristics, exercise intentions, and levels of PA. A total of 400 full-time workers voluntarily participated in this study. The findings identified women, white-collar workers, those with longer working hours, and individuals with low exercise intentions as high-risk groups for insufficient overall PA in multiple linear regression analysis. After controlling for covariates, occupation was found to be associated with both overall PA (β = 0.146) and work-related PA (β = 0.236). Shift workers exhibited higher levels of work-related PA (β = 0.234). Furthermore, exercise intentions showed associations with overall PA (β = 0.243), leisure-time PA (β = 0.523), and transportation PA (β = 0.176) but did not demonstrate a significant relationship with work-related PA. This study highlights the importance of implementing comprehensive approaches in workplace health promotion programs aimed at enhancing various types of PA. Strategies should focus on improving exercise intentions to boost leisure-time and transportation PA, while work-related PA requires tailored interventions based on job-specific factors.

Dual processing approach to sedentary behavior and physical activity in the workplace

Regular physical activity is an important health promoting behavior. Yet, many adults live sedentary lifestyles, especially during their workday. The current study applies an extended theory of planned behavior model, incorporating affective attitudes and instrumental attitudes, along with habit, to predict limiting sedentary behavior and physical activity within an office environment. Theory of planned behavior constructs and habit were assessed with an online survey on a sample of 180 full-time office workers, with self-reported behavior assessed 1 week later (Mage = 25.97, SDage = 10.24; 44 males, 134 females, and 2 nonbinary). Model fit was indicated by BRMSEA (M = 0.057, SD = 0.023), B γ^ (M = 0.984, SD = 0.010) and BCFI (M = 0.959, SD = 0.026), accounting for 46.1% of variance in intention, 21.6% of variance in sedentary behavior, and 17.4% of variance in physical activity behavior. A Bayesian structural equation model revealed direct effects of instrumental attitudes and perceived behavioral control on intention to limit sedentary behavior, direct effects of intention and perceived behavioral control on limiting sedentary behavior, and direct effects of perceived behavioral control and habit on engaging in physical activity. The current study indicates intentions to be active in the office are primarily driven by beliefs about the benefits of activity and individuals' perceived level of control, rather than normative or affective beliefs. As behavior was predicted by both intention and habit, findings also indicate office-based activity is likely not always a consciously driven decision. These findings may have implications for improving activity levels in this highly sedentary population.

Estimating County Level Health Indicators Using Spatial Microsimulation

Given the importance of understanding health outcomes at fine spatial scales, iterative proportional fitting (IPF), a form of small area estimation, was applied to a fixed number of health-related variables (obesity, overweight, diabetes) taken from regionalized 2019 survey responses (n = 5474) from the Idaho Behavioral Risk Factor Surveillance System (BRFSS). Using associated county-level American Community Survey (ACS) census data, a set of constraints, which included age categorization, race, sex, and education level, were used to create county-level weighting matrices for each variable, for each of the seven (7) Idaho public health districts. Using an optimized modeling construction technique, we identified significant constraints and grouping splits for each variable/region, resulting in estimates that were internally and externally validated. Externally validated model results for the most populated counties showed correlations ranging from .79 to .85, with p values all below .05. Estimates indicated higher levels of obesity and overweight individuals for midsouth and southwestern Idaho counties, with a cluster of higher diabetes estimates in the center of the state (Gooding, Lincoln, Minidoka, and Jerome counties). Alternative external sources for health outcomes aligned extremely well with our estimates, with wider confidence intervals in more rural counties with sparse populations.

[Prevention and health promotion in dementia: motivation for change within preventive interventions-Empirical results]

BACKGROUND

Aging healthily and prevention of diseases are statutory and a national health target. There is convincing evidence that describes the modifiable risk factors, which are principally suitable for preventive measures.

OBJECTIVE

Definition of terms, presentation of the roots of prevention in laws, strategies and guidelines. Presentation of the risk factors for dementia, outline of effective preventive measures and their promising components.

MATERIAL AND METHODS

Prevention is systematically described. The available evidence on risk factors, health behavior and preventive measures is analyzed. A multimodal intervention is presented and the influence of motivation on a change in behavior is outlined, exemplified by physical activity.

RESULTS AND DISCUSSION

Aging healthily is a national health target and prevention of disease is rooted and defined in both the legislation and guidelines. The current evidence on modifiable risk factors for dementia originates from 12 factors. These include behavior-associated factors, such as inactivity, diabetes and smoking. The efficacy of preventive measures can be described by their effectiveness, the utilization when available and the principal availability for all people for whom they are indicated. Changing a health behavior is complex and dependent among other things on the motivation to want to change a behavior. Currently, multimodal prevention programs appear to be very promising for the prevention of cognitive disorders and dementia.

Development of a multi-component tobacco cessation training package utilizing multiple approaches of intervention development for health care providers and patients attending non-communicable disease clinics of Punjab, India

Background

Providing patients with personalized tobacco cessation counseling that is culturally sensitive, and disease-specific from healthcare providers (HCPs) as part of their routine consultations is an approach that could be incorporated, using existing healthcare systems such as the Non-Communicable Disease (NCD) clinics. This paper describes the development of a multi-component culturally tailored, patient-centric, disease-specific tobacco cessation package utilizing multiple approaches of intervention development for healthcare providers and patients attending these clinics in Punjab, India, along with a proposed framework for implementation.

Methods

The proposed intervention package was developed in 6 stages. These included a review of literature for identifying successful cessation interventions for ethnic minority groups, co-production of the package with all stakeholders involved via a series of consultative meetings and workshops, understanding contextual factors of the state and 'factor-in' these in the package, pre-test of the package among HCPs and tobacco users using in-depth interviews, micro detailing and expansion of the package by drawing on existing theories of the Cascade Model and Trans-Theoretical Model and developing an evolving analysis plan through real-world implementation at two pilot districts by undertaking a randomized controlled trial, assessing implementer's experiences using a mixed-method with a primary focus on qualitative and economic evaluation of intervention package.

Results

A multi-component package consisting of a booklet (for HCPs), disease-specific pamphlets and short text messages (for patients; bilingual), and an implementation framework was developed using the 6-step process. A major finding from the in-depth interviews was the need for a specific capacity-building training program on tobacco cessation. Therefore, using this as an opportunity, we trained the in-service human resource and associated program managers at the state and district-level training workshops. Based on the feedback, training objectives were set and supported with copies of intervention package components. In addition, the role and function of each stakeholder were defined in the proposed framework.

Conclusion

Consideration of tobacco users' socio-cultural and patient-centric approach makes a robust strategy while developing and implementing an intervention providing an enlarged scope to improve care services for diversified socio-cultural communities.

The 're-norming' of working from home during COVID-19: A transtheoretical behaviour change model of a major unplanned disruption

Significant disruptive events have the potential to change travel behaviour in the long-term. COVID-19 has caused the most significant disruption of travel behaviour in living memory. One of the most notable changes has been the increase in working from home, which was forced upon many workers during lockdowns and 'stay at home' orders. But much is still unknown about the long-term impacts of those changes. This study explores the influence of the COVID-19 pandemic on changing work from behaviours using the Transtheoretical Model of behaviour change. The Transtheoretical Model has been widely used to study behaviour change in health, with some application to travel behaviour change. In this paper, we explore whether people's 'stage of change' before COVID-19 has an impact on their long-term intent to work from home. We found that only 12% of respondents had considered working from home more before COVID, yet those that had were far more likely to intend to work from home in the long term. In addition, we unpack the influence of 'process of change' factors, some of which point to a potential 're-norming' of attitudes toward working from home. Although self-efficacy (feeling capable to work from home) was an important factor, it was not as important as the attitudes of employers and colleagues toward working from home. Implications of the findings for research and practice are explored.

The relationship between physical exercise and school adaptation of junior students: A chain mediating model

Objective

This study explores the relationship between physical exercise and school adaptation of junior middle school students and constructs a chain intermediary model through the intermediary role of psychological resilience and sports learning motivation.

Methods

Using the stratified cluster sampling method, 930 junior middle school students in Anhui Province were measured in group psychology by using the physical exercise rating scale, adolescent psychological resilience scale, physical learning motivation scale and school adaptation scale. The statistical software SPSS 23.0 and process plug-in were used for statistical processing, and the common method deviation test was carried out by Harman single-factor control method. Finally, the bootstrap sampling test method and process plug-in were used to test the significance of intermediary effect.

Results

(1) The direct prediction effect of physical exercise on school adaptation is remarkable (t = 4.60, p < 0.01); (2) psychological resilience and sports learning motivation are the intermediary variables of the relationship between physical exercise and school adaptation; (3) psychological resilience and sports learning motivation play a chain mediation role in the relationship between physical exercise and school adaptation. The intermediary effect is composed of three indirect effects: physical exercise → psychological resilience → school adaptation (95% Cl: 0.004, 0.041), physical exercise → physical learning motivation → school adaptation (95% Cl:0.019, 0.065), physical exercise → psychological resilience → physical learning motivation → school adaptation (95% Cl:0.002, 0.021).

Conclusions

Physical exercise can directly improve the school adaptation of junior middle school students, which can also affect junior middle school students’ school adaptation indirectly through psychological resilience or sports learning motivation, and it can influence school adaptation through the chain mediation of psychological resilience and sports learning motivation.

The Wahls Behavior Change Model for Complex Chronic Diseases: A Clinician's Guide

Behavior change models are used to understand and intervene on health-related behaviors and outcomes. However, there is a gap in the literature regarding how to create and maintain behavior change in patients with complex chronic diseases such as Multiple Sclerosis (MS). To address this gap, the Wahls Behavior ChangeTM Model (WBCM) (The trademark applies to subsequent mention of the model.) was developed based on existing behavior change theory, empirical evidence, and extensive clinical experience caring for patients with complex chronic diseases. A patient-centered, comprehensive, and multimodal approach, this model provides a framework for understanding and implementing lifestyle behavior change. The overall goals of this paper are to: (1) review existing behavior change theories; (2) introduce the WBCM, including the model's 11 Principles for behavior change in patients with complex chronic diseases; and (3) share how providers can be trained to implement the WBCM. The WBCM can potentially improve short- and longer-term function and quality of life outcomes for people with complex chronic diseases.

Theoretical constructs of smoking cessation among current tobacco smokers in India: a secondary analysis of Global Adult Tobacco Survey-2 (2016-2017)

BACKGROUND

Quitting tobacco smoking is a complex process, and the transtheoretical model describes the various stages of behaviour change that smokers experience to stop smoking. Predictors of intention to quit and stage of behavioural change could assist policy-makers in establishing tailor-made strategies to offer support.

OBJECTIVE

In the current study, we analysed the determinants of cessation among 9499 current smokers of India recorded during the second Global Adult Tobacco Survey (2016-2017).

METHODS

Bivariate analysis, multivariate analysis (binary logistic regression was performed for past quit attempts and intention to quit smoking in the future; multinomial logistic regression to understand predictors of various stages of change determining cessation behaviour of current smokers) was undertaken.

RESULTS

The majority of the smokers was men (91.0%), in 25-44 years age group, (42.3%), daily wagers (37.4%) and resided in the rural area (73.3%), with bidi being the most commonly smoked product (72%). Nearly 72% tried to quit without any assistance with 36.6% (precontemplation), 27% (contemplation), 28% (preparation (or action)) and 8.1% in (relapse) stage. Men ((1.049); 95% CI 1.047 to 1.051), the primary (1.192; 95% CI 1.190 to 1.193) as well as higher education, being married (1.231; 95% CI 1.229 to 1.234) and urban residence (1.167; 95% CI 1.1.65 to 1.168) were found to be associated with higher prevalence of previous quit attempts. The regression modelling found out that intent to quit reduced with increasing age and was similarly prevalent with any level of education.

CONCLUSION

Understanding stages of behavioural change could assist the stakeholders in developing individualised interventions along with the development of intensive cessation protocols in clinical and public health settings.

Sleep hygiene education and children with developmental disabilities: Findings from a co-design study

This qualitative study develops a programme theory demonstrating the complexity embedded in sleep hygiene education (SHE) as an intervention to improve sleep problems in children with developmental disabilities. In co-design workshops, eight parents and six sleep practitioners deliberated themes developed from findings of an earlier exploratory study of stakeholder perceptions of SHE. A SHE tool underpinned by programme theory was developed evidenced by mid-range theories of change. Analytical themes were developed to explain the programme theory and the complexities of a successful SHE intervention: the need to legitimize children's sleep problems and consider the nature of customization, knowledge sharing, health expectation and impact of sleep service rationing and gaming strategies on implementation success. Policy and practice implications include a need to raise the public profile of children's sleep problems and promote parental involvement in intervention implementation. Further research is needed to test out this theory-driven framework for evaluating SHE.

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model

OBJECTIVE

Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity.

METHODS

A random sample provided baseline data (n=689; 63% female; M _age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals.

RESULTS

Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035).

CONCLUSIONS

Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

The sport participation legacy of major events in the UK

This paper examines the extent to which attending major sporting events leads to subsequent changes in the sport participation behaviour of spectators. The research covered seven single-sport events of World or European level held in the UK in 2014 and was concerned with spectators (aged 16 and over) who attended one of these events. Baseline data was gathered from a sample of spectators at each event using a face-to-face survey. Follow-up data was captured using an online survey at least nine months post-event. Our analysis is based on 258 people for whom both baseline and follow-up data were available (matched pairs). Using the Transtheoretical Model (TTM), the evidence from this research points to a small (net) positive staged change in sport participation among the sample overall. Variations in the nature and scale of changes associated with events featuring different sports were observed. Progression between the TTM stages was evident for individuals who were previously in the pre-preparation, preparation and action stages. The likelihood of progression appears to be strongest where prior contemplation for behaviour change was prevalent. Event attendance emerged as an important contributor for moving individuals along the TTM continuum, alongside a range of other factors. The demonstration or trickle-down effect was the primary mechanism by which any sport participation legacy supported by these events occurred. The practical applications of the research and the wider health benefits of leveraging event-induced sport participation increases are discussed.

ROUTINE: The Development of a Physical Activity Promoting Journey Planner Web App

Behavior change apps are widespread, but the scientific base of the app-concept is rarely disclosed. The aim of this article is to present the methodological approach used for the development of a so-called “fitness feedback demonstrator” within an already existing journey planner web app to motivate people to increase their physical activity behavior while using public transport. Firstly, we introduce the behavior change theories applied for the design of the feedback, followed by the analysis of focus-group discussions about the desired content of the fitness feedback. Secondly, we describe how we conducted a field test to measure the number of steps taken when using public transport. Finally, we used the feedback from potential users in terms of design/attractiveness and comprehensibility of the added fitness information. The “fitness feedback demonstrator” is a good practical example of how to make use of the different research expertise to develop a theory-based tool to encourage persons to integrate physical activity into their daily routines.

The Intervention Effect of SMS Delivery on Chinese Adolescent's Physical Activity

To examine the effects of short messaging service (SMS) frequency and timing on the efficacy of an SMS-intervention for Hong Kong Chinese adolescents, sixty nine students aged between 12 and 16 (mean age 13.75 ± 0.90) were recruited from five schools in Hong Kong. Participants were randomly assigned into one of five groups: high-frequency + self-selected timing (HST), low-frequency + self-selected timing (LST), high-frequency + assigned timing (HAT), low-frequency + assigned timing (LAT) and the control group. The total duration of the intervention was four weeks. No significant intervention effects were detected in adolescent's PA among the five groups (F = 1.14, p = 0.346). No significant differences were observed in the stage movement among the five groups (χ² = 6.18, p = 0.627). No significant differences appeared in the exercise benefits, barriers and benefits/barriers differential scores. However, a growth trend in the exercise benefits score in the LST and HAT groups was found in contrast to the downswing in the control group. The exercise barriers score in the HST group showed the largest reduction after intervention. The benefits/barriers differential score in all the intervention groups increased, whereas it decreased in the control group. Although an increase is demonstrated in the high dosage SMS frequency and timing, no significant intervention effects were found among the five groups in PA behavior, stage of change and exercise benefits and barriers among Hong Kong Chinese adolescents.

The effect of cardiorespiratory fitness assessment in preventive health checks: a randomised controlled trial

Background

Poor cardiorespiratory fitness (CRF) increases morbidity and mortality risks. Routine CRF assessment in clinical practice has thus been advocated, but little is known about the effect. In this study, we investigated the effect of CRF assessment on CRF in a preventive health check programme.

Methods

We used a randomised design, in which we invited 4153 middle-aged adults and included 2201 participants who received a preventive health check with CRF assessment (intervention) or without CRF assessment (control). After 1 year, participants were examined. The primary outcomes were adjusted absolute (l/min), relative (ml/kg/min), and poor (%) CRF assessed by the Astrand-Ryhming test. We adjusted for baseline physical activity and intra-cluster correlation within general practices.

Results

A total of 901 attended the 1-year follow-up. In the intervention group, absolute CRF, relative CRF, and poor CRF were 2.7 l/min (95% confidence interval [CI]: 2.6; 2.8), 34.5 ml/kg/min (95% CI: 33.5; 35.4), and 31.0% (95% CI: 26.8; 35.2). In the control group, the corresponding figures were 2.8 l/min (95% CI: 2.7; 2.9), 35.2 ml/kg/min (95% CI: 34.2; 36.1), and 25.9% (95% CI: 21.8; 30.0). Adjusted absolute CRF was lower in the intervention group (-0.1 l/min [95% CI: -0.2; -0.01]). Adjusted relative CRF (-0.7 ml/kg/min [95% CI: -2.0; 0.6]) and poor CRF (5.0% [95% CI: -0.002; 10.1]) did not differ between groups. No differences were found when adjusting for potential confounding factors.

Conclusion

Preventive health checks with CRF assessment did not provide higher CRF levels at 1-year follow-up than preventive health checks without CRF assessment.

Etapas de cambio comportamental frente al consumo de sustancias psicoactivas en escolares de 9 a 17 años de Bogotá D.C., Colombia

Introducción. El consumo de sustancias psicoactivas (SPA) es una problemática que afecta a estudiantes desde edades tempranas.Objetivo. Describir las etapas de cambio de comportamiento frente al consumo de SPA en escolares de Bogotá D.C., Colombia.Materiales y métodos. Estudio transversal en 6 965 escolares de Bogotá D.C. El cambio de comportamiento se evaluó por autoreporte a través de un cuestionario estructurado a partir del Modelo Transteórico en las etapas de precontemplación, contemplación, preparación y acción/mantenimiento.Resultados. 58.4% fueron mujeres con edad promedio de 12.7±2.3 años. Frente al consumo de drogas alucinógenas, 6% de los escolares se ubicaron en la categoría de precontemplación, 44% en contemplación, 30% en preparación y 20% en acción/mantenimiento. Respecto al consumo de alcohol, 5% se encontraban en precontemplación, 36% en contemplación, 12% en preparación y 46% en acción/mantenimiento. El tabaquismo mostró prevalencias de 4% para precontemplación, 33% para contemplación, 12% para preparación y 51% para acción/mantenimiento.Conclusiones. El consumo de SPA es una problemática que se presenta cada vez con mayor frecuencia en población escolar. La mayoría de entrevistados se ubican en etapa de mantenimiento en el consumo de tabaco y alcohol y en la etapa de contemplación de consumo de drogas alucinógenas. Se requieren esfuerzos gubernamentales que fomenten programas preventivos de consumo de SPA en el ámbito escolar.

Perceived weight and barriers to physical activity in parent-adolescent dyads

OBJECTIVE

Family-based physical activity interventions have the potential to reduce obesity, but more information is needed regarding physical activity in the family context. This study used an actor-partner interdependence model to estimate the dyadic association between perceived weight status and barriers to physical activity in dyads of adults and their adolescent children. It was hypothesized that greater perceived weight would be associated with greater barriers perceived by both one's self and one's partner.

METHOD

Data from 1,568 dyads in the Family Life, Activity, Sun, Health, and Eating study were used to examine the dyadic association between perceived weight status (i.e., greater perceived weight category) and barriers to physical activity. Models were stratified by actual weight (an overweight or obese dyad member vs. two normal weight dyad members) and adjusted for parent education, parent and adolescent age, gender, and race.

RESULTS

Among dyads with at least 1 overweight/obese member, greater perceived weight status was positively associated with one's own perceived barriers (significant actor effects, βs = 1.17 and 1.03, ps < 0.01) and one's partner's perceived barriers (significant partner effects, βs = 0.38 and 0.62, ps < 0.01). No statistically significant relationships were found for dyads with only normal weight members.

CONCLUSIONS

Among dyads with at least 1 overweight or obese member, significant partner effects for parents and adolescents demonstrate that the weight perception of 1 dyad member correlates with the barriers of the other member. These dyadic associations highlight the potential importance of family-based interventions for physical activity. (PsycINFO Database Record

Health Behavior Change in Pregnant Women With Obesity

OBJECTIVE

To identify various motivators and barriers in the pre-contemplation and contemplation stages of change that can occur during pregnancy, which can influence lifestyle interventions that are implemented during pregnancy.

DATA SOURCES

An electronic search of the literature was conducted using Web of Science and all databases within EBSCOhost.

STUDY SELECTION

A study was included if the population was identified as pregnant women ages 13 to 44 years to include women of childbearing age and if it incorporated a lifestyle intervention that integrated nutrition and/or physical activity. Eleven manuscripts were reviewed, including nine quantitative studies, one qualitative study, and one mixed-methods study. Seven of the nine quantitative studies were randomized controlled trials.

DATA EXTRACTION

Articles were reviewed to identify barriers and motivators related to lifestyle interventions in pregnant women with obesity.

DATA SYNTHESIS

Data were analyzed according to the pre-contemplation and contemplation stages of change and how women felt during pregnancy in relation to making a positive behavioral change during this time period.

CONCLUSION

Pregnancy is an opportunity to address health behavior change. Recognizing both barriers and motivators during this time frame can allow for more focused interventions to be created and applied to the population.

Communicating health-Optimising young adults' engagement with health messages using social media: Study protocol

BACKGROUND

Obesity is a global health problem. Understanding how to utilise social media (SM) as a platform for intervention and engagement with young adults (YAs) will help the practitioners to harness this media more effectively for obesity prevention.

AIM

Communicating health (CH) aims to understand the use of SM by YAs, including Aboriginal YAs, and in doing so will improve the effectiveness of SM strategies to motivate, engage and retain YAs in interventions to reduce the risk of obesity, and identify and disseminate effective ways for health professionals to deliver obesity prevention interventions via SM.

METHODS

The present study describes the theoretical framework and methodologies for the CH study, which is organised into four interrelated phases, each building on the outcomes of preceding phases. Phase 1 is a mixed methods approach to understand how YAs use SM to navigate their health issues, including healthy eating. Phase 2 utilises co-creation workshops where YAs and public health practitioners collaboratively generate healthy eating messages and communication strategies. Phase 3 evaluates these messages in a real-world setting. Phase 4 is the translation phase where public health practitioners use outcomes from CH to inform future strategies and to develop tools for SM for use by stakeholders and the research community.

DISCUSSION

The outcomes will include a rich understanding of psychosocial drivers and behaviours associated with healthy eating and will provide insight into the use of SM to reach and influence the health and eating behaviours of YAs.

Psychosocial factors associated with physical activity behavior among patients with psychosis

INTRODUCTION

Although physical activity helps to improve functioning and reduce the symptoms of mental illness, physical inactivity remains common in the mental illness population. This study aims to explore the associations between theoretical constructs in relation to physical activity behavior based on psychological theories to examine reasons for physical inactivity in psychosis population.

METHODS

One hundred and eighty one Chinese outpatients diagnosed with psychotic disorders were recruited for this cross-sectional study. Sociodemographic data and responses to questionnaires measuring self-efficacy, decisional balance, processes of change, and stages of change on physical activity habit were collected.

RESULTS

Ninety three subjects (51.4%) had the intention to engage in regular physical activity within the next six months. Significant differences were found in self-efficacy, pros of decisional balance and processes of change across the stages of change. Moreover, overall classification accuracy was 60.8% across the stages of change.

CONCLUSIONS

This study supports self-efficacy, pros of decisional balance and processes of change as useful factors in understanding physical activity behavior among patients with psychosis. Future promotions of regular physical activity can focus on improving self-efficacy, emphasizing on the benefits of regular physical activity and facilitating cognitive and behavior strategies from processes of change.

When Adults Don't Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults

Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical activity among sedentary adults and others at risk for health problems. This involves a personalized approach to motivation and behavior change, which includes social support, goal setting, and positive affect coupled with cognitive restructuring of negative and self-defeating attitudes and misconceptions. These strategies can lead to increases in exercise self-efficacy and control beliefs as well as self- management skills such as self-regulation and action planning, which in turn are expected to lead to long-term increases in activity. These changes in activity frequency and intensity can ultimately lead to improvements in physical and psychological well-being among middle-aged and older adults, including those from underserved, vulnerable populations. Even a modest increase in physical activity can have a significant impact on health and quality of life. Recommendations for future interventions include a focus on ways to achieve personalized approaches, broad outreach, and maintenance of behavior changes.

Measuring healthy behaviours using the stages of change model: an investigation into the physical activity and nutrition behaviours of Australian miners

Background

Obesity is one of the fastest growing modern day epidemics affecting preventable disease and premature deaths. Healthy lifestyle behaviours, such as physical activity and nutritional consumption, have been shown to reduce the likelihood of obesity and obesity related health risks. Originally designed for measurement of unhealthy behaviours, the Stages of Change model, describes 'precontemplators' as individuals who engage in the unhealthy behaviour, are unaware that their behaviour is problematic, and are resistant to change. The aim of this study was to refine and assess the measures of the Stages of Change model in order to achieve a concise and reliable classification of precontemplators, in the context of healthy behaviours.

Methods

Eight hundred and ninety-seven employees participated in a health survey measuring current health behaviours and stage of change. This study compared a traditional precontemplation measure to a modified version in the assessment of two healthy behaviours: physical activity and fruit and vegetable consumption.

Results

The modified measure was more accurate and captured fewer individuals currently meeting the guideline for both physical activity and nutrition, compared to the traditional measure of stages of change. However, across all stages of change, the measure incorrectly classified some employees with regards to meeting health guidelines.

Conclusions

When applied to healthy behaviours, the stages of change measure for precontemplation should be further refined to reflect knowledge that the behaviour is unhealthy, and apathy to change. Additionally, measures should define health guidelines to increase reliable classification across all stages of change. The findings can be applied to inform the design and implementation of health promotion strategies targeting obesity related lifestyle behaviours in the general population.

Feasibility of Gamified Mobile Service Aimed at Physical Activation in Young Men: Population-Based Randomized Controlled Study (MOPO)

Background

The majority of young people do not meet the recommendations on physical activity for health. New innovative ways to motivate young people to adopt a physically active lifestyle are needed.

Objective

The study aimed to study the feasibility of an automated, gamified, tailored Web-based mobile service aimed at physical and social activation among young men.

Methods

A population-based sample of 496 young men (mean age 17.8 years [standard deviation 0.6]) participated in a 6-month randomized controlled trial (MOPO study). Participants were randomized to an intervention (n=250) and a control group (n=246). The intervention group was given a wrist-worn physical activity monitor (Polar Active) with physical activity feedback and access to a gamified Web-based mobile service, providing fitness guidelines, tailored health information, advice of youth services, social networking, and feedback on physical activity. Through the trial, the physical activity of the men in the control group was measured continuously with an otherwise similar monitor but providing only the time of day and no feedback. The primary outcome was the feasibility of the service based on log data and questionnaires. Among completers, we also analyzed the change in anthropometry and fitness between baseline and 6 months and the change over time in weekly time spent in moderate to vigorous physical activity.

Results

Mobile service users considered the various functionalities related to physical activity important. However, compliance of the service was limited, with 161 (64.4%, 161/250) participants visiting the service, 118 (47.2%, 118/250) logging in more than once, and 41 (16.4%, 41/250) more than 5 times. Baseline sedentary time was higher in those who uploaded physical activity data until the end of the trial (P=.02). A total of 187 (74.8%, 187/250) participants in the intervention and 167 (67.9%, 167/246) in the control group participated in the final measurements. There were no differences in the change in anthropometry and fitness from baseline between the groups, whereas waist circumference was reduced in the most inactive men within the intervention group (P=.01). Among completers with valid physical activity data (n=167), there was a borderline difference in the change in mean daily time spent in moderate to vigorous physical activity between the groups (11.9 min vs −9.1 min, P=.055, linear mixed model). Within the intervention group (n=87), baseline vigorous physical activity was inversely associated with change in moderate to vigorous physical activity during the trial (R=−.382, P=.01).

Conclusions

The various functionalities related to physical activity of the gamified tailored mobile service were considered important. However, the compliance was limited. Within the current setup, the mobile service had no effect on anthropometry or fitness, except reduced waist circumference in the most inactive men. Among completers with valid physical activity data, the trial had a borderline positive effect on moderate to vigorous physical activity. Further development is needed to improve the feasibility and adherence of an integrated multifunctional service.

Trial registration

Clinicaltrials.gov NCT01376986; http://clinicaltrials.gov/ct2/show/NCT01376986 (Archived by WebCite at http://www.webcitation.org/6tjdmIroA)

The Application of the Transtheoretical Model to Identify Physical Activity Behavior in Women

Background:

The low level of physical activity is a risk factor behind several chronic diseases. Evidence shows the level of physical activity is decreasing, especially in women. This study aimed to apply the transtheoretical model to identify physical activity behavior in women who referred to health centers of Isfahan.

Materials and Methods:

This cross-sectional study was carried out among 400 women in Isfahan's health centers. Data were collected using a questionnaire including demographic factors, the standard of exercise behavior, stages-of-change questionnaire, processes of change, self-efficacy, and decisional balance. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) (version 16). Descriptive statistics, the Mann–Whitney test, one-way analysis of variance (ANOVA), and Pearson correlation were used.

Results:

The mean (SD) of age was 31.46 (8.92); 81.5% of women were housewives and the others employees. The mean score of physical activity per day for women was 10.66 min. Ninety-six persons (24%) were classified in the pr-contemplation stage, 100 (33.3%) in the contemplation stage, 102 (25.5%) in the preparation stage, 29 (7.2%) in the action stage, and 40 (10%) in the maintenance stage. The results showed the stages of change significantly correlated with the decisional balance (P = 0.04), processes of change, and self-efficacy (P < 0.01).

Conclusions:

With regard to the low level of physical activity in women and the role of the stages-of-change model in determining effective factors behind behavior, there should be an attempt to develop continuous and organized educational programs to promote physical activity in women by using the transtheoretical model.

Processes of change in preventing alcohol exposed pregnancy: A mediation analysis

OBJECTIVE

To examine mechanisms of the treatment effect for CHOICES, a motivational intervention to reduce risk of alcohol exposed pregnancy (AEP). Grounded in constructs from the transtheoretical model (TTM) and motivational interviewing (MI), the intervention targeted: risk drinking (>4 drinks/day or >7 drinks/week); ineffective contraception; and AEP risk (both behaviors). The experiential and behavioral processes of change (POC), posited to describe the mechanisms through which individual behavior change occurs, were examined. It was hypothesized that each of the targeted treatment outcomes at 9-month follow-up would be mediated by the experiential POC at 3 months, and that these would then be mediated by the behavioral POC at 9 months.

METHOD

Eight hundred thirty women at-risk for AEP were randomized to CHOICES (information plus counseling; IPC) condition (n = 416) or information only (IO) condition (n = 414). Primary outcomes and proposed mediators (POC) were assessed at 3 and 9 months. Path analyses using weighted least squares estimation with mean- and variance-adjusted chi-square statistic were conducted separately for each outcome.

RESULTS

Model fit indices indicated good fit, and the indirect effect of treatment on outcome via POC was significant for hypothesized models predicting risky drinking and ineffective contraception. The indirect effect of treatment on AEP risk through POC for ineffective contraception was significant, but the indirect effect of POC for risky drinking was not.

CONCLUSIONS

These findings support the temporal relationship between experiential and behavioral POC consistent with the TTM. Opportunistic, motivation-based interventions may benefit from directly targeting experiential POC early in treatment and behavioral POC later in treatment. (PsycINFO Database Record

Physical activity among employee women based on transtheoretical model

INTRODUCTION

Today, many jobs are associated with the inactivity or sedentary lifestyle. Employees' health will be affected by their depriving of the benefits of physical activity (PA). Therefore, the present study was undertaken to determine the PA among employee women in Isfahan University of Medical Sciences based on the transtheoretical model.

MATERIALS AND METHODS

This is a cross-sectional study has been performed in Isfahan University of Medical Sciences employee women (2013). A convenience sample of 100 women was selected. Data were collected by validated and reliable questionnaire in three parts (demographics information, PA scale, and TTM constructs). Data were analyzed by SPSS SPSS (version 16.0; SPSS, IBM, Inc, Chicago, IL, USA) and descriptive and analytical statistics such as ANOVA and independent t-test were used. A two-tailed P < 0.05 was considered statistically significant.

RESULTS

The mean of PA was 21.17 ± 27.30 min in a day. Weekly heavy, moderate, and light exercise mean was 0.72 ± 1.81, 0.89 ± 1.87 and 0.57 ± 1.57 days, respectively. In this study, 26% of women were in contemplation, 22% in contemplation, 20% in preparation, 13% in action, and 19% in the maintenance stage. Furthermore, there were significant differences between consciousness raising, dramatic relief, counter-conditioning, stimulus control, helping relationships, reinforcement management, and self-liberation with stages of change constructs.

CONCLUSION

Because of a significant relationship between cognitive and behavioral processes and PA in this group, designing and implementing an educational program based on the transtheoretical model may be useful in promoting PA of a female employee.

Psychometric Properties of a Short Measure for Psychosocial Factors and Associations With Phase of Physical Activity Change Among Finnish Working-Aged Men

Insufficient physical activity (PA) and poor physical fitness are risks for several noncommunicable diseases among working-aged men. PA programs have been launched to increase activity levels in the population but working-aged men have been underrepresented in these programs. The aim of the present cross-sectional study was to evaluate validity of a short scale for psychosocial factors among Finnish working-aged men who participated in a PA campaign. The study examined also the associations between psychosocial factors and phase of PA change across fitness groups. Physical fitness was assessed with a body fitness index constructed on the basis of a handgrip test, the Polar OwnIndex Test, and body composition analysis (InBody 720). The men were classified into low ( n = 162), moderate ( n = 358), and high ( n = 320) body fitness index groups. Psychosocial factors and self-reported phase of PA change were assessed with a questionnaire. Psychometric properties of the scale were assessed with confirmatory factor analysis and differences between phases of PA change were examined with one-way analysis of variance. The evaluated scale included factors for self-efficacy, goal setting, skills, and social support. Good physical fitness was related to better perceived self-efficacy and ability to manage one's PA environment. Goal setting was critical for PA change at all fitness levels. Better understanding of the interactions between psychosocial factors and PA change could help in targeting PA programs to low-fit men. Further study should examine the validity of the improved psychosocial measure.

Predictors of physical activity change among adults using observational designs

BACKGROUND

Regular physical activity (PA) is foundational to human health, yet most people are inactive. A sound understanding of the determinants of PA may be instructive for building interventions and/or identifying critical target groups to promote PA. Most research on PA correlates has been biased by cross-sectional or passive prospective designs that fail to examine within-person analysis of PA change.

OBJECTIVE

The purpose of this review was to collect and appraise the available literature on the predictors of PA change conceived broadly in terms of increases/decreases from baseline assessment as well as specifically in terms of adoption and maintenance.

METHODS

Eligible studies were from English, peer-reviewed published articles that examined predictors of natural change of PA over 3 months + using observational (non-experimental) data in adult samples. Searches were performed from June 2012 to January 2014 in eight databases.

RESULTS

Sixty-seven independent data-sets, from 12 countries, primarily of medium quality/risk of bias, were identified with 26 correlates spanning demographic, behavioral, intra-individual, inter-individual, and environmental categories. Only intention and the onset of motherhood could reliably predict overall PA change. Among datasets configured to predict PA adoption, affective judgments and behavioral processes of change were the only reliable predictors, although both only have a small number of available studies. There were no reliable predictors of maintenance when compared to PA relapse.

CONCLUSION

The results underscore the importance of individual-level motivation and behavioral regulation in PA change, but also denote critical social variables. These findings, however, are constrained by PA measurement bias and limited studies that employed time-varying covariation between predictor variables and PA.

Development and practical implications of the Exercise Resourcefulness Inventory

OBJECTIVE

To determine the validity and reliability of the Exercise Resourcefulness Inventory (ERI) designed to assess the self-regulatory strategies used to promote regular exercise.

METHODS

In Study 1, the inventory's relationship with other established scales in the exercise behavior change field was examined. In Study 2, the test-retest reliability and predictive validity of the ERI was established by having participants from Study 1 complete the inventory a second time.

RESULTS

Internal consistency, and convergent, discriminant, and concurrent validity were supported in both studies. The test-retest correlation of the ERI was .80. As well, participants scoring higher on the ERI in Study 1 were more likely to be at a higher stage of change in Study 2, and greater increases in exercise resourcefulness over time were predictive of advancement to higher stages of change.

CONCLUSIONS

ERI is a reliable and valid measure to assess the self-regulatory strategies used to promote regular exercise.

PRACTICAL IMPLICATIONS

Facilitators may want to tailor exercise programs for individuals scoring lower in resourcefulness to prevent them from relapsing.

Models accounting for intention-behavior discordance in the physical activity domain: a user's guide, content overview, and review of current evidence

There is a growing concern among researchers with the limited effectiveness and yet subsequent stagnation of theories applied to physical activity (PA). One of the most highlighted areas of concern is the established gap between intention and PA, yet the considerable use of models that assume intention is the proximal antecedent of PA. The objective of this review was to: 1) provide a guide and thematic analysis of the available models that include constructs that address intention-behavior discordance and 2) highlight the evidence for these structures in the PA domain. A literature search was conducted among 13 major databases to locate relevant models and PA studies published before August 2014. Sixteen models were identified and nine overall themes for post-intentional constructs were created. Of the 16 models, eight were applied to 36 PA studies. Early evidence supported maintenance self-efficacy, behavioral regulation strategies, affective judgments, perceived control/opportunity, habit, and extraversion as reliable predictors of post-intention PA. Several intention-behavior discordance models exist within the literature, but are not used frequently. Further efforts are needed to test these models, preferably with experimental designs.

Lifestyle of the employees working in hamadan public sectors: application of the trans-theoretical model

BACKGROUND

A healthy lifestyle is a valuable source to reduce the prevalence of health problems, and promoteehealth.

OBJECTIVES

The current study aimed to evaluate the lifestyle and obesity status of Hamadan public employees and their status based on the trans-theoretical model (TTM).

PATIENTS AND METHODS

This analytical cross-sectional study was performed in 2014 on 1200 public employees in Hamadan city, Iran selected through proportional stratified random sampling. Data collection was performed using a three-section questionnaire including demographic characteristics, The FANTASTIC lifestyle questionnaire, and the five-part algorithm. Data were analyzed by SPSS-20 using linear regression, Chi-square, Fisher exact test, and ANOVA.

RESULTS

The mean age of the employees was 38.12 ± 8.04 years. Most of the employees (61.7%) had favorable lifestyle. About half of the employees were at the preparation stage of TTM. Most of the employees were in a poor condition regarding the physical activity and healthy eating habits. In most of the evaluated items, females got higher scores than males. The associations between lifestyle and age, gender, work experience, income satisfaction, and marital status were significant. Moreover, the associations between obesity and work experience, marital status, number of offspring, and gender were significant (P < 0. 05). Significant predicting variables of obesity were age and work experience; they explained 31.2% variance of obesity (adjusted R(2) = 0.312, R(2) change = 0.01).

CONCLUSIONS

Planning health education interventions for employees through effective approaches seems necessary.

Individual factors affecting preferences for feedback message tactics in the contexts of physical activity

Tailored feedback on personal physical activity behavior has been used to inform individuals and promote physical activity among different populations. This study aimed to increase the understanding of factors associated with young men's preferences for feedback message tactics in the context of physical activity and exercise. How preferences vary was analyzed in terms of the self-reported physical activity, stage of exercise behavior change, exercise self-efficacy, objectively measured physical health status, and sociodemographic characteristics of young Finnish men. Population-based survey data, including physiological measurements (n = 525), were collected at the Finnish Defence Forces' call-ups in the city of Oulu, Finland, in September 2011. The results indicate that the stage of exercise behavior change, exercise self-efficacy, physical health status, and educational level are associated with a preference for normative and ipsative comparison. Multivariate logistic regression models show that an advanced stage of exercise behavior change and education in the academic track of an upper secondary school are independent predictors of preferring ipsative and normative physical activity feedback among young men. The study provides new insights into how the stage of behavior change influences health information behavior and is in line with studies emphasizing social factors--including education--as being important in shaping health-related behavior. These factors could form the basis for tailoring information when designing health promotion.

Theory-based interventions in physical activity: a systematic review of literature in Iran

Lack of physical activity is ranked fourth among the causes of human death and chronic diseases. Using models and theories to design, implement, and evaluate the health education and health promotion interventions has many advantages. Using models and theories of physical activity, we decided to systematically study the educational and promotional interventions carried out in Iran from 2003 to 2013.Three information databases were used to systematically select papers using key words including Iranian Magazine Database (MAGIRAN), Iran Medical Library (MEDLIB), and Scientific Information Database (SID). Twenty papers were selected and studied .Having been applied in 9 studies, The Trans Theoretical Model (TTM) was the most widespread model in Iran (PENDER in 3 studies, BASNEF in 2, and the Theory of Planned Behavior in 2 studies). With regards to the educational methods, almost all studies used a combination of methods. The most widely used Integrative educational method was group discussion. Only one integrated study was done. Behavior maintenance was not addressed in 75% of the studies. Almost all studies used self-reporting instruments. The effectiveness of educational methods was assessed in none of the studies. Most of the included studies had several methodological weaknesses, which hinder the validity and applicability of their results. According to the findings, the necessity of need assessment in using models, epidemiology and methodology consultation, addressing maintenance of physical activity, using other theories and models such as social marketing and social-cognitive theory, and other educational methods like empirical and complementary are suggested.

Improving understanding of and adherence to pulmonary rehabilitation in patients with COPD: a qualitative inquiry of patient and health professional perspectives

OBJECTIVES

Although patients with Chronic Obstructive Pulmonary Disease (COPD) who adhere to a pulmonary rehabilitation program are better able to manage their illness and experience a better health-related quality of life, pulmonary rehabilitation remains underused. This study aims to describe the experiences of patients who are in a pulmonary rehabilitation program, and explore the perceptions of both patients and health professionals about what improves effective pulmonary rehabilitation.

METHODS

A qualitative research design, including focus groups and individual interviews with 25 patients and 7 program health professionals, was used to obtain combined perspectives about the factors underpinning the COPD patient's reasons for participation in a rehabilitation program.

RESULTS

Three themes were derived from the descriptive content analysis: (1) building confidence, (2) a perception of immediate tangible results, and (3) being ready and having access to the program.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Qualitative findings from this study suggest that a patient's adherence to a COPD rehabilitation program can be improved by quickly building up the participant's confidence, promoting tangible results, and by timely recognizing and responding to the issues of readiness and access. Based on these findings, health care providers could develop strategies to better serve COPD patients who face multiple barriers to access and successfully complete a pulmonary rehabilitation program.

Effect of including fitness testing in preventive health checks on cardiorespiratory fitness and motivation: study protocol of a randomized controlled trial

Background

Preventive health checks may identify individuals with an unhealthy lifestyle and motivate them to change behaviour. However, knowledge about the impact of the different components included in preventive health checks is deficient. The aim of this trial is to evaluate whether including cardiorespiratory fitness testing in preventive health checks 1) increases cardiorespiratory fitness level and motivation to change physical activity behaviour and 2) reduces physical inactivity prevalence and improves self-rated health compared with preventive health checks without fitness testing.

Methods/Design

An open-label, household-cluster, randomized controlled trial with a two-group parallel design is used. The trial is embedded in a population-based health promotion program, “Check your Health Preventive Program”, in which all 30–49 year-old citizens in a Danish municipality are offered a preventive health check. In each arm of the trial, 750 citizens will be recruited (1,500 in total). The primary outcome is cardiorespiratory fitness level assessed by submaximal cycle ergometer testing after one year. An intermediate outcome is the percentage of participants increasing motivation for physical activity behaviour change between baseline and two-weeks follow-up assessed using the Transtheoretical Model´s stages of change. Secondary outcomes include changes from baseline to one-year follow-up in physical inactivity prevalence measured by a modified version of the questions developed by Saltin and Grimby, and in self-rated health measures using the Short-Form 12, Health Survey, version 2.

Discussion

This trial will contribute to a critical appraisal of the value of fitness testing as part of preventive health checks. The conduction in real-life community and general practice structures makes the trial findings applicable and transferable to other municipalities providing support to decision-makers in the development of approaches to increase levels of physical activity and improve health.

Trial registration

ClinicalTrials.gov Identifier: NCT02224248. Registered 8 August 2014.

Measuring stages of change, perceived barriers and self efficacy for physical activity in Saudi Arabia

BACKGROUND

The benefits of physical activity are well established and recognized to prevent adults from many chronic diseases and particularly some forms of cancers.

OBJECTIVES

The present study was conducted to investigate the present status of physical activity among Saudi adults in Al-Ahsa, and to examine the association between the stages of change for physical activity and perceived barriers, and self efficacy.

METHODS

A cross- sectional study of 242 subjects (118 males and 124 females) attending health centers aged between 20-56 years, were personally interviewed for demographic data, anthropometric measurement, physical activity level, stages of change for physical activity, self efficacy and perceived barriers.

RESULTS

Forty eight percent of the females were overweight and 16.9% of the males were obese with no significant difference between the genders for BMI categories. More than half of the females were inactive and 39% of the males were physically active with a significant difference (P=0.007). Twenty percent of the males were in maintenance stage, while similar percentage of the females were in contemplation stage. However the majority of the subjects were in pre-contemplation stage with a significant difference across the stages. Males had a higher mean score of self efficacy and less external barriers of physical activity. The major barrier among the females was lack of time (7.2±1.4) and in the males, lack of motivation (7.7±1.4). The females had less internal (21.2±3.8) barriers comparable to the males (23.08±4.7). Both genders had a significant relationship between stages of changes of physical activity and perceived barriers (internal and external), but in the females no significant difference across the stages was observed for self efficacy unlike the males who had a significant difference for self efficacy and self efficacy categories.

CONCLUSION

The present study provided useful data on stages of change for physical activity and some psychosocial factors (self efficacy and perceived barriers) that can help to tailor strategies aiming at increasing physical activity level according to self efficacy and to the barriers detected, to prevent many chronic diseases including certain types of cancer in Saudi Arabia.

Validation of the TTM processes of change measure for physical activity in an adult French sample

BACKGROUND

Processes of change (POC) are constructs from the transtheoretical model that propose to examine how people engage in a behavior. However, there is no consensus about a leading model explaining POC and there is no validated French POC scale in physical activity

PURPOSE

This study aimed to compare the different existing models to validate a French POC scale.

METHOD

Three studies, with 748 subjects included, were carried out to translate the items and evaluate their clarity (study 1, n = 77), to assess the factorial validity (n = 200) and invariance/equivalence (study 2, n = 471), and to analyze the concurrent validity by stage × process analyses (study 3, n = 671).

RESULTS

Two models displayed adequate fit to the data; however, based on the Akaike information criterion, the fully correlated five-factor model appeared as the most appropriate to measure POC in physical activity. The invariance/equivalence was also confirmed across genders and student status. Four of the five existing factors discriminated pre-action and post-action stages.

CONCLUSION

These data support the validation of the POC questionnaire in physical activity among a French sample. More research is needed to explore the longitudinal properties of this scale.

Testing the effects of message framing, kernel state, and exercise guideline adherence on exercise intentions and resolve

OBJECTIVES

To study the effects of framed messages on exercise intention and resolve.

DESIGN

Two (type of frame: gain or loss) × 2 (type of kernel state: desirable or undesirable outcome) post-test study.

METHODS

Participants were recruited online and questioned about their previous exercise behaviour and their exercise risk perception. After this, they were randomly allocated to one of four messages that were different in terms of positive or negative outcomes (type of frame) and in terms of attained or avoided outcomes (type of kernel state). After reading the message, participants indicated their intention and resolve to engage in sufficient exercise.

RESULTS

No effects were found for intention. For resolve, there was a significant interaction between type of frame, type of kernel state, and exercise adherence. Those who did not adhere to the exercise guideline and read the loss-framed message with attained outcomes reported significantly higher resolve than all other participants.

CONCLUSIONS

This study indicates the relevance of including attained outcomes in message framing exercise interventions as well as a focus on exercise resolve.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Message framing is commonly used to increase exercise intentions and behaviour. Meta-analyses do not provide consistent support for this theory. Very little attention has been paid to resolve and message factors on framing effects. What does this study add? Framed messages have an effect on exercise resolve, but not on intention. Loss-framed messages with attained outcomes are most persuasive for those who do not adhere to exercise guidelines. Exercise framing studies should include behavioural resolve next to intention. .

Reducing resistance to treatment, through group intervention, improves clinical measurements in patients with type 2 diabetes

BACKGROUND

Studies have shown that group Therapeutic Patient Education (TPE) may empower patients with type 2 diabetes to better manage their disease. The mechanism of these interventions is not fully understood. A reduction in resistance to treatment may explain the mechanism by which TPE empowers participants to improve self-management. The Objective of this study was to examine the effectiveness of diabetes groups in reducing resistance to treatment and the association between reduced resistance and better management of the disease.

METHODS

In a program evaluation study, we administered validated questionnaires to measure resistance to treatment (RTQ) in 3 time periods: before the intervention (T1), immediately after the intervention (T2) and six months later (T3). Clinical measures (HbA1C, blood pressure, HDL, LDL and total cholesterol, Triglycerides and BMI) were retrieved from Maccabi Healthcare Services computerized systems, for T1;T2 and a year post intervention (T3). Linear mixed models were used adjusting for age, gender, social support and family status.

RESULTS

157; 156 and 106 TPE participants completed the RTQ in T1; T2 and T3 respectively. HbA1C and systolic and diastolic blood pressure were significantly reduced in the group which achieved a reduction in three out of the five RTQ components. For the other clinical measurements no significant changes were observed.

CONCLUSION

Our findings suggest that reducing resistance to treatment, through an educational program for patients with diabetes, is associated with a better disease control. Identifying patients with higher resistance to treatment, and including components that reduce resistance in patient education programs, have the potential to increase the effectiveness of these programs.