Two-year follow-up of an interdisciplinary cognitive-behavioral intervention program for obese adults

Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review

Obesity is a chronic, complex, and multifactorial disease resulting from the interaction of genetic, environmental, and behavioral factors. It is characterized by excessive fat accumulation in adipose tissue, which damages health and deteriorates the quality of life. Although dietary treatment can significantly improve health, high attrition is a common problem in weight loss interventions with serious consequences for weight loss management and frustration. The strategy used to improve compliance has been combining dietary prescriptions and recommendations for physical activity with cognitive behavioral treatment (CBT) for weight management. This systematic review determined the dropout rate and predictive factors associated with dropout from CBT for adults with overweight and obesity. The data from the 37 articles selected shows an overall dropout rate between 5 and 62%. The predictive factors associated with attrition can be distinguished by demographics (younger age, educational status, unemployed status, and ethnicity) and psychological variables (greater expected 1-year Body Mass Index loss, previous weight loss attempts, perceiving more stress with dieting, weight and shape concerns, body image dissatisfaction, higher stress, anxiety, and depression). Common reasons for dropping out were objective (i.e., long-term sickness, acute illness, and pregnancy), logistical, poor job conditions or job difficulties, low level of organization, dissatisfaction with the initial results, lack of motivation, and lack of adherence. According to the Mixed Methods Appraisal quality analysis, 13.5% of articles were classified as five stars, and none received the lowest quality grade (1 star). The majority of articles were classified as 4 stars (46%). At least 50% of the selected articles exhibited a high risk of bias. The domain characterized by a higher level of bias was that of randomization, with more than 60% of the articles having a high risk of bias. The high risk of bias in these articles can probably depend on the type of study design, which, in most cases, was observational and non-randomized. These findings demonstrate that CBT could be a promising approach for obesity treatment, achieving, in most cases, lower dropout rates than other non-behavioral interventions. However, more studies should be conducted to compare obesity treatment strategies, as there is heterogeneity in the dropout assessment and the population studied. Ultimately, gaining a deeper understanding of the comparative effectiveness of these treatment strategies is of great value to patients, clinicians, and healthcare policymakers. Systematic review registration: PROSPERO 2022 CRD42022369995 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369995.

Fostering physical activity-related health competence after bariatric surgery with a multimodal exercise programme: A randomised controlled trial

Regular physical activity (PA) supports the long-term success of bariatric surgery. However, integrating health-enhancing physical activity in daily life requires specific competences. In this study, we evaluated a multimodal exercise programme to build these competences.Forty adults who underwent bariatric surgery were randomised to a multimodal exercise programme or control group. Primary outcomes were the facets of PA-related health competences, namely the control competence for physical training, PA-specific affect regulation, motivational competence and PA-specific self-control. Secondary outcomes were PA behaviour and subjective vitality. Outcomes were assessed before, directly after the intervention and at 3 months follow-up.Significant treatment effects were found for control competence for physical training and PA-specific self-control but not for PA-specific affect regulation and motivational competence. Significant treatment effects were further observed for self-reported exercise and subjective vitality, all in favour of the intervention group. In contrast, no treatment effect was found for device-based PA. Overall, this study provides a foundation for future research to optimise long-term post bariatric surgery outcomes.

Development, implementation and formative evaluation of a motivational-volitional intervention to promote sustainable physical activity in breast cancer survivors

OBJECTIVE

The aim of the current project was the development, implementation and evaluation of the programme, Motivational-Volitional Intervention-Movement After Breast Cancer (Mo-Vo-BnB), an intervention for the sustainable promotion of physical activity of breast cancer survivors.

METHODS

In a multi-stage interdisciplinary development process, the pedagogical-didactic, psychological and physical evidence-based programme was developed and implemented for women after breast cancer who were approved for medical rehabilitation and were minimally, physically active (<60 min/week). Train-the-trainer seminars were carried out for the implementation. Four sessions were implemented in two German clinics. The training quality, didactic methods and accompanying material were evaluated 6 weeks and 12 months after implementation by patients, trainers and project members (n = 127 evaluations).

RESULTS

The standardised and published MoVo-BnB programme can provide practical and quality training. Content and methods can be implemented according to the manual. Training quality, didactic methods, and accompanying materials were evaluated positively.

CONCLUSION

The results suggest that MoVo-BnB is a useful standardised intervention for promoting the physical activity of breast cancer survivors. The demonstrated process is also suitable for other projects.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00011122; Trial registration date: 2016 October 13.

Behaviour change techniques that constitute effective planning interventions to improve physical activity and diet behaviour for people with chronic conditions: a systematic review

OBJECTIVES

Action planning is a brief and effective behaviour change technique (BCT) to improve physical activity (PA) and diet behaviour (DB). This study aimed to identify critical BCTs and mechanisms of action (MoAs) to interpret the effectiveness of planning interventions based on the Health Action Process Approach (HAPA) model.

DESIGN

Systematic review.

DATA SOURCES

PubMed, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO), Psychology and Behavioural Sciences Collection (EBSCO), psyARTICLES and Medline were searched for studies from January 1990 to September 2021 published in English.

ELIGIBILITY CRITERIA

Experiment involving action planning intervention to improve PA or DB in community-dwelling adult patients with chronic conditions.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently coded the planning interventions into BCT combinations and MoA assemblies. Outcome was dichotomised according to the statistical power and Cohen's d. The Cochrane risk of bias assessment tool and the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool were used to assess the quality of randomised controlled trials (RCTs) and non-RCTs, respectively.

RESULTS

From the 52 included studies, 46 BCTs were identified and linked to 21 MoAs. Long-term facilitators for planning intervention included 'self-monitoring of behaviour', 'problem solving', 'instruction on how to perform the behaviour' and 'adding objects to the environments'. The three most frequently occurring MoAs were 'intention', 'behavioural regulation', 'beliefs about capabilities'. The effective intervention groups had higher MoA scores that corresponded to the HAPA model constructs than the ineffective groups.

CONCLUSIONS

The findings from this review may inform scientific and effective planning intervention designs for community-dwelling people with chronic conditions in the future.

PROSPERO REGISTRATION NUMBER

CRD42021241227.

Introducing zanadio—A Digitalized, Multimodal Program to Treat Obesity

While the prevalence of overweight and obesity has been increasing annually, the accessibility of on-site treatment programs is not rising correspondingly. Digital, evidence-based obesity treatment programs could potentially alleviate this situation. The application zanadio has been developed to enable patients with obesity (BMI 30–45 kg/m²) to participate in a digital, multimodal weight reduction program based on current treatment guidelines. This article is divided into two parts: (I) it introduces zanadio, its aims and therapeutic concept, and (II) provides a first impression and demographic data on more than 11,000 patients from across the country who have used zanadio within the last 16 months, which demonstrates the demand for a digital obesity treatment. zanadio has the potential to partially close the current gap in obesity care. Future work should focus on identifying predictors of successful weight loss to further individualize digital obesity treatment, and an important next step would be to prevent obesity, i.e., to start the treatment at lower BMI levels, and to invent digital treatment programs for children and adolescents.

[A Motivational-Volitional Program for Women after Breast Cancer Increases Physical Activity 12 Months Post Rehabilitation - Results of a Prospective Controlled Trial]

PURPOSE

To assess the effectiveness of a motivational-volitional program for women after breast cancer (MoVo-BnB) who engage less than 60 minutes per week in physical activity.

METHODS

This is a non-randomised, prospective bi-centered controlled trial in 2 in-patient medical rehabilitation centers. Data are assessed at 4 measurement points: at admission, discharge, 6 and 12 months post discharge. The control group (CG; n=266) has received the standard rehabilitation, and the intervention group (IG; n=279) attended additionally the group program (4 sessions lead by physiotherapeutic and health pedagogic personnel). The primary outcome is self-reported physical activity (BSA-F); secondary outcomes are health related quality of life (QLQ-C30), breast cancer specific quality of health (QLQ-BR23) and program acceptance. Analysis of change are performed by ANCOVA for each follow-up, adjusting for baseline values.

RESULTS

At 12 months follow up, the level of exercise in the intervention group is 22 min/week higher than in the control group (95% CI: 2,6 to 41.5; p=0.02). Further, 49.1% of the intervention group exercises for at least 60 min/week compared to 37.6% of the control group (p≤0.01). We have observed no significant differences between the groups for quality of life. The participants' evaluation of the intervention is positive and does not differ substantially between the 2 clinics (p=0.3).

CONCLUSION

Our findings demonstrate that a cognitive-behavioral program based on the motivation-volitional model can lead to long-term improvement in exercise behavior in breast cancer patients, who is initially minimally active. Physical activity should be encouraged after breast cancer diagnosis. The results suggest that practitioners working in cancer aftercare might like to consider using a motivational-volitional program for improving and maintaining physical activity behavior for physical sedentary target groups.

[Analysis of the psychometric properties of the Eating Behavior Self-efficacy Scale in Mexican adolescents]

Introduction

Introduction: self-efficacy plays an important role in eating behaviors; for example, excess weight is associated with low EC and poor nutrition. The Eating Behavior Self-Efficacy Scale (EACA) identifies the ability to control the intake of healthy, and of high-calorie foods. Objective: to evaluate the psychometric properties of EACA in adolescents residing in northeast Mexico, and to analyze the relationship of self-efficacy with sex, age, and nutritional status of participants. Methods: confirmatory factor analyses (CFA) were performed, and both reliability (internal consistency) and convergent validity of EACA were analyzed. A total of 467 adolescents who were studying the 7th to 9th grade of basic education, and who were residents in northeast Mexico were enrolled. Results: the goodness-of-fit indices of the proposed model were acceptable: CMIN/DF = 2.831; CFI = 0.952; GFI = 0.931; AGFI = 0.905; SRMS = 0.318, and RMSEA = 0.063), as was internal consistency (α = 0.90). Mean age was 13.54 years (SD = 0.93), and weight ranged from 30.9 to 130.4 kg (SD = 13.33). Conclusions: the CFA of the proposed model has a high internal consistency, and the four-factor structure has an adequate fit. It can be used to measure self-efficacy in relation to eating behavior in Mexican adolescents. It is recommended to test this model in similar populations.

“What Type of Activity Suits Me?”

Abstract. Counseling is seen as a promising method for promoting exercise behavior. The aims of this study were (1) to describe the design of a novel counseling approach based on motives and goals in exercise and sport (COMET). The COMET approach considers individual preferences, while focusing on identifying suitable types of activities. Furthermore, (2) implementation of the counseling was evaluated. A survey was carried out where 37 and 56 participants, were asked about their satisfaction with the counseling. In-depth interviews were conducted with a subsample of seven participants. Sixteen counsellors were questioned about implementation fidelity. The results showed that the COMET approach was implemented successfully in a nonclinical setting. Overall, participants were satisfied with the counseling. They found the trial exercise sessions helpful, as they offered diverse experiences and the opportunity to reflect on them. One-to-one conversations with the counselor were also beneficial, allowing participants to identify their preferences. Implementation fidelity was good. Further research could examine the implementation of the COMET approach in different settings.

Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings

Background

This study aims to explore exercise therapists' perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP.

Methods

This qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis.

Results

The exercise therapists demonstrated detailed didactic-methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice-theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services.

Conclusion

The topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP).

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term ‘food addiction’ is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

A 12-Month Lifestyle Intervention Program Improves Body Composition and Reduces the Prevalence of Prediabetes in Obese Patients

BACKGROUND

The present study investigated the effects of a 12-month interdisciplinary standardized lifestyle program addressing physical activity and changes in dietary and lifestyle behavior in 2,227 obese prediabetic participants.

METHODS

Measures of obesity (BMI, waist circumference), cardiopulmonary fitness, and metabolic parameters were determined before and after the intervention period.

RESULTS

From the 2,227 participants who were initially prediabetic, 839 participants (-37.7%) did no longer show the criteria of prediabetes after the intervention and had normal HbA1c levels.

CONCLUSION

The clinical effects are substantial, and it is likely that the applied intense and multidisciplinary lifestyle interventions could reduce the risk of developing diabetes and the prevalence of a full-blown metabolic syndrome in obese and prediabetic patients.

Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter- and Intraindividual Level

BACKGROUND

Health behavior change theories usually claim to be universally and individually applicable. Most research has tested behavior change theories at the interindividual level and within young-to-middle-aged populations. However, associations at the interindividual level can differ substantially from associations at the intraindividual level. This study examines the applicability of the Health Action Process Approach (HAPA) at the inter- and the intraindividual level among older adults.

METHODS

Two intensive longitudinal studies examined the HAPA model covering two different health behaviors and two different time spans: Study 1 (physical activity, N = 52 × 6 monthly observations) and Study 2 (medication adherence, N = 64 × 30 daily observations). The HAPA constructs (risk awareness, outcome expectancy, self-efficacy, intention, action planning, action control), and self-reported behaviors were assessed.

RESULTS

Overall, at the interindividual level, results of both studies largely confirmed the associations specified by the HAPA. At the intraindividual level, results were less in line with the HAPA. Only action control emerged as consistent predictor of behavior.

CONCLUSIONS

This study emphasises the importance of examining health behavior change theories at both, the inter- and the intraindividual level.

Does diabetes prevention pay for itself? Evaluation of the M.O.B.I.L.I.S. program for obese persons

In response to the growing burden of obesity, public primary prevention programs against obesity have been widely recommended. Several studies have estimated the cost-effectiveness of diabetes-prevention trials for different countries. Nevertheless, it is still controversial if prevention conducted in more real-world settings and among people with increased risk but not yet exhibiting increased glucose tolerance can be a cost-saving strategy to cope with the obesity epidemic. We examine this question in a simulation model based on the results of the M.O.B.I.L.I.S program, a German lifestyle intervention to reduce obesity, which is directed on the high-risk group of people who are already obese. The contribution of this paper is the use of 4-year follow-up data on the intervention group and a comparison with a control group formed by SOEP respondents as inputs in a Markov model of the long-term cost savings through this intervention due to the prevention of type 2 diabetes. We show that from the point of view of a health insurer, these programs can pay for themselves.

[Baseline- and health enhancing physical activity in adults with obesity]

Physical inactivity is one of the major risk factors for people to become overweight or obese. To achieve a substantial health benefit, adults should do at least 150 min of moderate or 75 min of high intensity aerobic activity per week and additionally they should do muscle strengthening exercises. This recommendation represents the lower limit and not the optimum. To loose body weight a significantly higher level of physical activity is required. Exercise programs can play an important part to reach the required level of health-enhancing physical activity. The Austrian pilot projects "Aktiv Bewegt" and "GEHE-Adipositas" showed that obese adults were interested in structured exercise programs and that they were also willing to use them. Clear defined quality criteria, the differentiation from conventional programs for already active and fit people and a recommendation from a doctor or other health professionals were important motivation reasons.

Increasing physical activity in patients with mental illness--A randomized controlled trial

OBJECTIVE

The objective of the study was to evaluate whether a motivational-volitional intervention program offered in addition to an existing sport program during stationary treatment is capable of establishing a post-stationary increase in physical activity in persons with mental illness.

METHODS

N=112 in-patients were initially randomly assigned to the control group (CG; standard rehabilitation) or intervention group (IG; standard rehabilitation plus intervention). Assessments were conducted at four measurement points.

RESULTS

At 6 months follow up, the level of exercise in the IG was 95 min/week higher than in the CG (p=.02). The participants of the IG were able to increase their level of goal intention until 6 months follow up (t2: p=.03; t4: p=.005); levels of self-efficacy of the IG increased during intervention (t2: p=.001). Changes in volitional aspects were significant over time (t1-t3), but not specifically for the IG.

CONCLUSIONS

The intervention was effective at increasing the level of physical activity in patients with mental illness who were initially minimally active.

PRACTICE IMPLICATIONS

Our results suggest that it could be of great use to place the emphasis of a physical activity-enhancing intervention on its motivational effect since volitional aspects are already taken into sufficient account in standard rehabilitation.

Soziale Unterstützung als Baustein eines betrieblichen Programms zur Sport- und Bewegungsförderung

Zusammenfassung. Untersucht wurde die spezifische Wirkung der Interventionstechnik „Planung sportbezogener sozialer Unterstützung“ (PssU) im Rahmen eines betrieblichen Programms zur Sportförderung („MoVo-work“). Die Mitarbeitenden (N = 69) wurden cluster-randomisiert 2 Gruppen zugeordnet: die Interventionsgruppe (IG) erhielt MoVo-work mit dem Modul PssU, die Kontrollgruppe (KG) MoVo-work ohne dieses Modul. Sportaktivität und soziale Unterstützung wurden vor (T1) und nach der Intervention (T2) erhoben, sowie nach 6 Wochen (T3) und 6 Monaten (T4). In der IG nahm der Anteil der sportlich aktiven Personen beim Vergleich T1 – T3 um 24 % zu (p < .05); in der KG dagegen nur um 9 %. Auch beim Vergleich T1 – T4 war in der IG noch ein Zuwachs an sportlich aktiven Personen von 8 % festzustellen, wohingegen in der KG deren Anteil sogar um 3 % abnahm. Es fanden sich keine Gruppenunterschiede hinsichtlich der wahrgenommenen sozialen Unterstützung. Die Resultate zeigen, dass betriebliche Bewegungsförderungsprogramme substanziell davon profitieren können, wenn sie auch die Ebene der sozialen Unterstützung berücksichtigen.

The Effect of Interdisciplinary Interventions on Risk Factors for Lifestyle Disease: A Literature Review

Interventions that comprise interdisciplinary collaboration including behavioral elements are effective in addressing lifestyle disease risk factors. However, it is not known how best to conduct this collaboration for sustainable change. The aim of this study was to systematically examine the evidence for the effects of interdisciplinary interventions on lifestyle disease risk factors including weight, lipid levels, glycemic control, and blood pressure. To do so, a systematic review of the literature was conducted using the databases Scopus, Medline, and Web of Science (all years to September 2014). Eighteen articles describing 16 studies of interdisciplinary interventions were identified. Consistent results were found for effects on weight loss but not for effects on blood lipids, blood glucose, and blood pressure. Effective interventions involved collaborations between dieticians, exercise physiologists, and psychologists and incorporated intensive initial participant engagement. Few studies investigated the long-term effect of interventions, but where this was done, the maintenance of favorable changes required ongoing participant support. Current evidence suggests that interdisciplinary interventions are effective in promoting weight loss and that ongoing support of participants is key to maintaining results beyond initial study duration. Future studies should examine long-term effects in pragmatic trials that address translation to practice.

The prevention and treatment of obesity

BACKGROUND

The high prevalence of obesity (24% of the adult population) and its adverse effects on health call for effective prevention and treatment.

METHOD

Pertinent articles were retrieved by a systematic literature search for the period 2005 to 2012. A total of 4495 abstracts were examined. 119 publications were analyzed, and recommendations were issued in a structured consensus procedure by an interdisciplinary committee with the participation of ten medical specialty societies.

RESULTS

Obesity (body-mass index [BMI] ge;30 kg/m2) is considered to be a chronic disease. Its prevention is especially important. For obese persons, it is recommended that a diet with an energy deficit of 500 kcal/day and a low energy density should be instituted for the purpose of weight loss and stabilization of a lower weight. The relative proportion of macronutrients is of secondary importance for weight loss. If the BMI exceeds 30 kg/m2, formula products can be used for a limited time. More physical exercise in everyday life and during leisure time promotes weight loss and improves risk factors and obesity-associated diseases. Behavior modification and behavioral therapy support changes in nutrition and exercise in everyday life. With respect to changes in lifestyle, there is no scientific evidence to support any particular order of the measures to be taken. Weight-loss programs whose efficacy has been scientifically evaluated are recommended. Surgical intervention is more effective than conservative treatment with respect to reduction of bodily fat, improvement of obesity-associated diseases, and lowering mortality. Controlled studies indicate that, within 1 to 2 years, a weight loss of ca. 4 to 6 kg can be achieved by dietary therapy, 2 to 3 kg by exercise therapy, and 20 to 40 kg by bariatric surgery.

CONCLUSION

There is good scientific evidence for effective measures for the prevention and treatment of obesity.

Qualitative and Quantitative Outcomes of a 1:1 Multidisciplinary Weight Management Clinic

BACKGROUND

Obesity management in Wales includes the provision of a 1:1 Multidisciplinary Weight Management Clinic (MDWMC). Strategic management of obesity in Wales is guided by The All Wales Obesity Pathway and recommends MDWMCs for people with obesity who have one or more co-morbidities and who have tried several interventions without success, or who have complex emotional relationships with food. No known previous studies have included a qualitative evaluation of a MDWMC.

OBJECTIVES

To conduct a service evaluation of a 1:1 Multi-disciplinary Weight Management Clinic to evaluate associated physiological benefits and qualitative data about the service.

METHODS

Semi-structured interviews were conducted with 180 patients attending the MDWMC at Aneurin Bevan Hospital, Ebbw Vale, Wales.

RESULTS

The MDWMC supports weight loss with 95% of patients reporting loss. For those for whom baseline data was available 73% lost at least 5% of initial body weight. Eighty-eight percent of patients prefer individual appointments and over 90% of patients who see each team member find consultations useful. Sixty-nine percent of patients report improved health mainly due to a decrease in obesity-related symptoms, and of patients taking obesity-related medication 48% report a reduction in dose of medication for asthma, 42% report a reduction in dose of antidepressants, and 36% report a reduction in dose for medication for diabetes. Of employed patients, 30% report a reduction of days taken off work due to sickness. Ninety-six percent of patients would recommend the clinic to others.

CONCLUSIONS

A 1:1 Multi-disciplinary Weight Management Clinic provides value in reducing obesity and symptoms of obesity-related diseases. It also is a treatment choice favoured by patients.

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.

Das Motivations-Volitions-Konzept

Ziel des Motivations-Volitions (MoVo)-Konzepts ist es, Menschen dabei zu helfen, einen gesundheitsförderlichen Lebensstil (ausreichend Bewegung, ausgewogene Ernährung) aufzubauen und fest in den Alltag zu integrieren. Das MoVo-Konzept besteht aus zwei Komponenten: dem MoVo-Prozessmodell (liefert den theoretischer Rahmen) und der MoVo-Intervention (standardisierte Programme für spezifische Zielgruppen). In mehreren Studien wurde die kurz- und längerfristige Wirksamkeit (12 Monate Follow-up) der beiden wichtigsten MoVo-Interventionsprogramme (MoVo-LISA, M.O.B.I.L.I.S.) gut belegt.

Surgical and Nonsurgical Interventions for Obesity in Service of Preserving Cognitive Function

OBJECTIVES

The purposes of this article are to highlight what is currently known about the mechanisms of obesity-related cognitive impairment and weight loss-related cognitive improvement, and to discuss the benefits and drawbacks of available treatments.

METHODS

The article is based on a live debate, presenting the main advantages and disadvantages of exercise interventions and bariatric surgery as related to cognitive functioning. The live debate took place during a 1-day conference, Diabetes, Obesity and the Brain, sponsored by the American Psychosomatic Society in October 2013.

RESULTS

Although it is well established that bariatric surgery tends to lead to greater weight loss, better glycemic control, and cognitive improvement (effect sizes ranging between 0.61 and 0.78) during the first 1 to 2 years postintervention compared with nonsurgical treatments, medical complications are possible, and follow-up data beyond 5 years are limited. In contrast, nonsurgical therapies have been extensively studied in a variety of clinical settings and have proved that they can sustain positive health outcomes up to 10 years later, but their cognitive benefits tend to be more modest (effect sizes ranging from 0.18 to 0.69) and long-term regimen compliance, especially in obese individuals, is uncertain.

CONCLUSIONS

Rather than focusing on debating whether surgical or no-surgical interventions for obesity are better, additional research is needed to identify the most efficient and practical combination of approaches to ensure sustained positive health outcomes for the largest number of patients possible.

The impact of a weight reduction program with and without meal-replacement on health related quality of life in middle-aged obese females

BACKGROUND

In addition to an increased risk for chronic illnesses, obese individuals suffer from social stigmatization and discrimination, and severely obese people may experience greater risk of impaired psychosocial and physical functioning. Lower health-related quality of life (HRQOL) has been reported among obese persons seeking intensive treatment for their disease. To aid in the treatment of obesity, meal replacements have been recommended as an effective therapeutic strategy for weight loss, particularly when consumed in the beginning of an intervention. Hence, the objective of this study was to assess the impact of two 12-month weight reduction interventions (one arm including a meal replacement) on changes in HRQOL among obese females.

METHODS

This controlled trial compared two versions of a standardized 12-month weight reduction intervention: the weight-reduction lifestyle program without a meal replacement (LS) versus the same lifestyle program with the addition of a soy-based meal replacement product (LSMR). 380 women (LS: n = 190, LSMR: n = 190) were matched by age, gender, and weight (51.4 ± 7.0 yrs., 35.5 ± 3.03 kg/m2). This sample of women all completed the 12-month lifestyle intervention that was part of a larger study. The lifestyle intervention included instruction on exercise/sport, psychology, nutrition, and medicine in 18 theoretical and 40 practical units. Led by a sport physiologist, participants engaged in group-based exercise sessions once or twice a week. To evaluate HRQOL, all participants completed the SF-36 questionnaire pre- and post-intervention. Anthropometric, clinical, physical performance (ergometric stress tests), and self-reported leisure time physical activity (hours/day) data were collected.

RESULTS

The LSMR sample showed lower baseline HRQOL scores compared to the LS sample in six of eight HRQOL dimensions, most significant in vitality and health perception (p < 0.01). After the intervention, body weight was reduced in both lifestyle intervention groups (LS: -6.6±6.6 vs. LSMR -7.6±7.9 kg), however, weight loss and HRQOL improvements were more pronounced in the LSMR sample (LSMR: seven of eight, LS: four of eight dimensions).

CONCLUSIONS

Our results show that HRQOL may improve among middle-aged obese females during a standardized lifestyle weight reduction program and may be enhanced by consuming a soy-based meal replacement product.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00356785.

Health behaviour change theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases

PURPOSE

The purpose of this perspective is (1) to incorporate recent psychological health behaviour change (HBC) theories into exercise therapeutic programmes, and (2) to introduce the International Classification of Functioning (ICF)-based concept of a behavioural exercise therapy (BET).

METHODS

Relevant personal modifiable factors of physical activity (PA) were identified based on three recent psychological HBC theories. Following the principles of intervention mapping, a matrix of proximal programme objectives specifies desirable parameter values for each personal factor. As a result of analysing reviews on behavioural techniques and intervention programmes of the German rehabilitation setting, we identified exercise-related techniques that impact the personal determinants. Finally, the techniques were integrated into an ICF-based BET concept.

RESULTS

Individuals' attitudes, skills, emotions, beliefs and knowledge are important personal factors of PA behaviour. BET systematically addresses these personal factors by a systematic combination of adequate exercise contents with related behavioural techniques. The presented 28 intervention techniques serve as a theory-driven "tool box" for designing complex BET programmes to promote PA.

CONCLUSION

The current paper highlights the usefulness of theory-based integrative research in the field of exercise therapy, offers explicit methods and contents for physical therapists to promote PA behaviour, and introduces the ICF-based conceptual idea of a BET. Implications for Rehabilitation Irrespective of the clients' indication, therapeutic exercise programmes should incorporate effective, theory-based approaches to promote physical activity. Central determinants of physical activity behaviour are a number of personal factors: individuals' attitudes, skills, emotions, beliefs and knowledge. Clinicians implementing exercise therapy should set it within a wider theoretical framework including the personal factors that influence physical activity. To increase exercise-adherence and promote long-term physical activity behaviour change, the concept of a behavioural exercise therapy (BET) offers a theory-based approach to systematically address relevant personal factors with a combination of adequate contents of exercise with exercise-related techniques of behaviour change.