Mediators of Increased Physical Activity and Change in Subjective Well-being: Results from the Activity Counseling Trial (ACT)

Balance and deep connections: the impact of physical activity on body and sexual self-esteem, psychological distress, and marital satisfaction among adults

To date, no research has examined the relationship between sexual self-esteem, body self-esteem, psychological distress, marital satisfaction, and engagement in physical activities. Through a study involving 443 adults the aim of this research was to analyze the connections between engaging in physical activities, body self-esteem, sexual self-esteem, marital satisfaction, and psychological distress among adults. The results obtained through Partial Least Squares (PLS) modeling with SmartPLS reveal significant interconnections among these variables. The correlation between body self-esteem and psychological distress, the positive relationship between sexual satisfaction and positive sexual self-esteem, as well as the beneficial influence of engaging in physical activities on marital satisfaction, are key highlights of this study. The robustness of the measures, confirmed by high coefficients, strengthens the credibility of the results. Despite these advancements, the cross-sectional nature of the study emphasizes the need for longitudinal research to gain a deeper understanding of psychological and relational dynamics over time. In conclusion, this study offers significant contributions to promoting balanced marital relationships, highlighting the importance of considering body and sexual self-esteem, psychological distress, and physical activity within the context of human relationships.

Combinations of physical activity, screen time and sleep, and their association with subjective wellbeing in children

BACKGROUND

Subjective wellbeing is an important indicator of health outcomes in children. 24-hour movement behaviours (i.e., physical activity, sedentary behaviour, sleep and their combination), a set of modifiable lifestyle behaviours, have been demonstrated to be associated with subjective wellbeing. Thus, the aim of this study was to investigate the relationship between the compliance of the 24-h movement guidelines and subjective wellbeing in a sample of Chinese children.

METHODS

Cross-sectional data from primary and secondary school students in Anhui Province, China were used for the analysis. A total of 1098 study participants (mean age: 11.6 years, body mass index: 19.7 ± 2.9) were included, of which 51.5% were boys. Physical activity, screen time, sleep, and subjective wellbeing were measured using validated self-reported questionnaires. Multivariable logistic regression analysis was used to assess the relationships between the compliance of different combinations of 24-h movement guidelines and subjective wellbeing in participants.

RESULTS

The compliance of (i.e., physical activity recommendations, screen time recommendations and sleep recommendations) 24-h movement guidelines was associated with better subjective wellbeing (OR: 2.09; 95CI%: 1.01-5.90) compared to the compliance of none of the guidelines. Furthermore, there was a dose-response relationship between the number of guidelines met (3 > 2 > 1 > 0) and improved subjective wellbeing (p < 0.05). Despite some exceptions, there was a significant relationship between the compliance of different combinations of the guidelines and better subjective wellbeing.

CONCLUSION

This study found that the compliance of 24-h movement guidelines was associated with greater subjective wellbeing in Chinese children.

The impact of Dietary Weight loss, Aerobic Exercise, and Daylong Movement on Social Cognitive Mediators of Long-term Weight loss

This report contrasts the impact of a dietary weight loss intervention (WL) paired with aerobic exercise (EX) and/or sitting less and moving throughout the day (SL) on self-efficacy for walking (hereafter walking self-efficacy) and satisfaction with physical functioning (hereafter satisfaction). Additional analyses examined dose-response associations between change in weight and changes in these key outcomes. Older adults (N = 112; age = 70.21[Formula: see text]4.43) were randomized to 6 months of WL+EX, WL+SL, or WL+EX+SL followed by a 12-month maintenance period. All groups reported increases in walking self-efficacy at month 6 with greater improvements in WL+EX and WL + EX+SL. Only WL+SL demonstrated improved walking self-efficacy at month 18. All conditions demonstrated improved satisfaction scores at both time points. Changes in walking self-efficacy and satisfaction were negatively associated with change in weight over the 6-month intervention and after the maintenance period. These results support the utility of WL + SL for improving key social cognitive outcomes in aging.

Physical activity and life satisfaction among individuals with spinal cord injury: Exploring loneliness as a possible mediator

Context: There has been no known research investigating the association between leisure time physical activity (LTPA), loneliness, and life satisfaction among people with spinal cord injury or dysfunction (SCI/D). The relationship between these constructs is worthy of consideration given the positive health impacts of LTPA, the negative health impacts of loneliness, and heightened negative effects of loneliness on life satisfaction for individuals with SCI/D.Objectives: To examine the relationship between LTPA and loneliness, and examine loneliness as a possible mediator of the relationship between LTPA and life satisfaction among individuals with SCI/D.Design and Participants: Community dwelling individuals with SCI/D (N = 170) participated in a telephone-based survey as part of a larger project.Measures: LTPA (i.e. The Leisure Time Physical Activity Questionnaire-SCI, UCLA Loneliness Scale-3, and the Life Satisfaction Questionnaire-11 were administered to the participants.Results: Significant bivariate relationships were observed between LTPA and life satisfaction (r = .18, P = .02), LTPA and loneliness (r = -.15, P = .045), and loneliness and life satisfaction (r = -.69, P < .001). Mediation analyses suggest that loneliness significantly mediated the relationship between LTPA and life satisfaction (indirect effect = .003, 95% bootstrap CI = .0004 to .0062, CSI = .113).Conclusion: This was the first study to show evidence of a negative association between LTPA and loneliness among people with SCI/D, and to establish a conceptual model for understanding the potential mediating role of loneliness in the relationship between LTPA and life satisfaction among people with SCI/D.

Role of the Leisure Attributes of Shared Bicycles in Promoting Leisure Benefits and Quality of Life

Given that the use of shared economic resources has increased for leisure, the main goal of the present study is to investigate the influence of the leisure attributes of the sharing economy on leisure benefits and quality of life. For this, the related sub-factors were derived for the verification of the sharing economy’s leisure attributes. Next, the sub-components of the concept were integrated and analyzed using a second confirmatory factor analysis. The results of a study using the structural equation model demonstrated that the sharing economy’s leisure attributes statistically affect the four levels of leisure benefits (i.e., social, physical, personal, and psychological benefits). We also identified two (social and psychological benefits) out of four leisure benefits that ultimately affect quality of life. This study is meaningful in that it elucidates the relationships between the sharing economy’s leisure attributes, leisure benefits, and quality of life.

Change in health-related quality of life and social cognitive outcomes in obese, older adults in a randomized controlled weight loss trial: Does physical activity behavior matter?

This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M _age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7-10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.

Perceived somatic and affective barriers for self-efficacy and physical activity

According to Bandura's social-cognitive theory, perceptions of somatic and affective barriers are sources of self-efficacy. This longitudinal study compares general indicators of health barriers with measures of perceived somatic and affective barriers to predict self-efficacy and accelerometer-assessed physical activity in a subsample of n = 153 (selected at random from N = 310) community-dwelling German older adults. Perceived somatic and affective barriers longitudinally predicted physical activity mediated by self-efficacy, whereas general health barriers did not. Perceived health barriers to physical activity might be more important than more objective health barriers for older adults' physical activity levels.

Sport Participation, Psychological Well-Being, and Psychosocial Development in a Group of Young Black Adults

The purpose of this study was to determine whether young black adults who participate in sport differ in psychological well-being and psychosocial development from those who do not participate actively in sport. An availability sample of 293 students between 20 and 35 years old from three tertiary institutions in South Africa completed self-report measures of psychological well-being and psychosocial development. The reliability and validity of the instruments were acceptable for use in this particular group. Students who participate actively in sport had significantly lower levels of negative affect, somatic symptoms, symptoms of depression, and pessimistic life orientation, and significantly higher levels of positive affect, sense of coherence, and self-efficacy beliefs. They also manifested higher levels of purpose and autonomy. Educational and policy implications of the findings are indicated.

The effects of different exercise programmes on female body composition

The purpose of this study was to verify the effects of 16 weeks of practicing different exercise programmes on body composition. This is an exploratory and descriptive study of 89 women aged 25 to 55 years (41.42 ± 9.23 years). The subjects were randomly divided into three experimental groups (EG): practitioners of strength training (SG), dance (DG), hydrogymnastics (HG), and a control group (CG) with sedentary women. Measurements of body mass and height, circumferences of the chest, waist, abdomen, hips, thighs, calves, and skinfolds of the triceps, suprailiac and thigh were registered in three different moments: prior to the commencement of the training program, again after 8 weeks of training, and finally after 16 weeks of training. Body density was estimated by using the trifold protocol by Jackson, Pollock and Ward. The ANOVA and deltas of change (Δ%) were used for data analysis. The level of significance was set at p<0.05. The effects of greater statistical significance on body composition related the variables “time”, “group” and the interaction between the two (time × group) were observed for the percentage of fat - F% (F (1.79, 152.52) = 24.59, p <0.001, η ² = 0.22), fat mass - FM (F (1.75, 149.01) = 12.65, p <0.001, η ² = 0.13) and lean mass - LM (F (1.77, 150.66) = 47.38, p <0.001, η ² = 0.36). The HG and SG were more beneficial in reducing F%. It was observed that the EG indicated healthier anthropometric aspects compared to the CG, regardless of the type of exercise programmes practiced. The time factor was more representative over the effects of exercise on anthropometric dimensions.

A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: effects on social and psychological function

BACKGROUND

PAD is a disabling, chronic condition of the lower extremities that affects approximately 8 million people in the United States. The purpose of this study was to determine whether an innovative home-based walking exercise program for patients with peripheral artery disease (PAD) improves self-efficacy for walking, desire for physical competence, satisfaction for physical functioning, social functioning, and acceptance of PAD related pain and discomfort.

METHODS

The design was a 6-month randomized controlled clinical trial of 194 patients with PAD. Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition.

RESULTS

Of the 194 participants randomized, 178 completed the baseline and 6-month follow-up visit. The mean age was 70.66 (±9.44) and was equally represented by men and women. Close to half of the cohort was African American. Following 6-months of treatment, the intervention group experienced greater improvement on self-efficacy (p = .0008), satisfaction with functioning (p = .0003), pain acceptance (p = .0002), and social functioning (p = .0008) than the control group; the effects were consistent across a number of potential moderating variables. Change in these outcomes was essentially independent of change in 6-minute walk performance.

TRIAL REGISTRATION

[ClinicalTrials.gov Identifier: NCT00693940].

Physical activity and screen-based media use: cross-sectional associations with health-related quality of life and the role of body satisfaction in a representative sample of German adolescents

Purpose: Although it is widely accepted that physical activity (PA) positively, and screen-based media use (SBM) negatively, affects well-being, there is a lack of studies relating PA and SBM to health-related quality of life (HRQoL) in adolescents. We examined these associations in German adolescents for different HRQoL subdomains and explored the role of body satisfaction as a possible mediator. Methods: The 11–17-year-old subsample of the German Health Interview and Examination Survey (2003–2006) was analysed (N = 6813; 51.3% male). Cross-sectional associations of self-reported PA frequency and amount of daily SBM with HRQoL subscale scores (according to KINDL-R) were examined by hierarchical linear regression models, adjusting for the clustering of the sample and for a variety of possible confounders. The size and significance of indirect effects via body (dis)satisfaction (BDS) were examined by mediation analyses. Results: Higher PA frequency was significantly associated with higher HRQoL on nearly all subscales and dose–response-relationships were observable. Variations were greatest in terms of social well-being in boys (effect size d = 0.59) and physical well-being in girls (d = 0.43). Higher SBM was related to lower HRQoL on all subscales in girls and on some subscales in boys, with the largest effects for school functioning in both genders (d = 0.31 and 0.37, respectively). The mediated effects for PA and SBM were significant in both genders, but the sizes and the proportions of total effects mediated by body satisfaction were rather small. Conclusions: Higher PA frequency was associated with higher self-reported HRQoL, and higher SBM was associated with lower self-reported HRQoL in both genders, even after adjusting for relevant covariates. The results support the assumption of independent health impacts of both behaviours, although no causal relationship can be confirmed with these cross-sectional data. Mechanisms other than body satisfaction must largely account for the effects of PA and SBM on well-being.

Social cognitive changes following weight loss and physical activity interventions in obese, older adults in poor cardiovascular health

BACKGROUND

The study objectives were to determine (a) the effects of group-mediated cognitive-behavioral interventions on change in performance self-efficacy, satisfaction with function, and with appearance among older, overweight/obese adults in poor cardiovascular health and (b) whether self-efficacy mediated change in 400-m walk time.

METHODS

This translational, randomized controlled trial of physical activity and weight loss was conducted within community Cooperative Extension Centers. Participants were randomized to three intervention arms: Physical Activity, Weight Loss + Physical Activity, or a Successful Aging education control.

RESULTS

Across 18 months, the Weight Loss + Physical Activity intervention demonstrated greater improvements in self-efficacy, satisfaction with function, and appearance versus other trial arms. Physical Activity intervention participants also experienced significant improvements in self-efficacy and satisfaction with function versus those in Successful Aging. Self-efficacy mediated 400-m walk time at 18 months.

CONCLUSIONS

Both group-mediated cognitive-behavioral interventions yielded desirable improvements in social cognitions and preserved mobility improvements post-intervention.

Reducing psychological distress and obesity through Yoga practice

Background:

Yoga practice has been effectively prescribed in conjunction with other medical and yogic procedures in the management of severe psychosomatic diseases, including cancer, bronchial asthma, colitis, peptic and ulcer. It improves strength and flexibility, and may help control physiological variables such as blood pressure, lipids, respiration, heart rate, and metabolic rate to improve overall exercise capacity.

Aim of the study:

The aim of this study is to evaluate the effects of Yogic Practice on anxiety/depression associated with obesity.

Materials and Methods:

Patients were recruited from the Department of Physiology, C.S.M. Medical University (erstwhile KGMU), Lucknow, Uttar Pradesh, India. A total of 272 subjects were divided into two groups: 1) group of 205 subjects (with yogic practice) and 2) a control group of 67 subjects (with aerobic exercise). Assessment of anxiety and depression were done by Hamilton Rating Scale.

Result:

This study supports yoga as an effective tool with no diet restriction to improve anxiety and depression symptoms as well as obesity in obese subjects

Conclusion:

Incorporating yogic asana in the treatment protocol of patients suffering from anxiety and depression may prove beneficial in the long run

The Group Oriented Arterial Leg Study (GOALS) to improve walking performance in patients with peripheral arterial disease

People with lower extremity peripheral artery disease (PAD) have greater functional impairment and faster functional decline than those without PAD. We describe methods for the Group Oriented Arterial Leg Study (GOALS), an ongoing randomized controlled clinical trial designed to determine whether a Group-Mediated Cognitive Behavioral (GMCB) intervention improves functional performance in PAD participants, compared to a health education control condition. In GOALS, PAD participants were randomized to either an intervention or a health education control condition in a parallel design. Both conditions consist of weekly group sessions with other PAD participants. In the intervention, cognitive behavioral techniques are used to assist participants in setting and adhering to home-based walking exercise goals. Participants are encouraged to walk for exercise at home at least 5 days/week. In the control condition, participants receive lectures on health-related topics. After 6 months of on-site weekly sessions, participants are transitioned to telephone follow-up for another 6 months. Participants in the intervention are asked to continue home walking exercise. The primary outcome is change in six-minute walk performance between baseline and six-month follow-up. Secondary outcomes include change in six-minute walk performance at 12-month follow-up, and change in treadmill walking performance, the Walking Impairment Questionnaire, quality of life, and physical activity at six and 12-month follow-up. In conclusion, if our group-mediated cognitive behavioral intervention is associated with improved walking performance in individuals with PAD, results will have major public health implications for the large and growing number of people with PAD.

The relation of medical conditions to depressive symptoms among Latinos: Leisure time physical activity as a mediator

Individuals with medical conditions report more depressive symptoms than those without such conditions. This study assessed whether physical activity (PA) plays a mediational role in the association between medical conditions and depressive symptoms among Latino adults. Adjusting for socioeconomic factors, those who reported having been diagnosed with diabetes, cardio-related disease, hypertension, high cholesterol, arthritis, or sleep problems endorsed more symptoms of depression. Vigorous PA mediated the relation between depressive symptoms and hypertension. In other words, people with hypertension who engaged in vigorous PA reported less depressive symptoms. PA may be a promising avenue for improving hypertension and depressive symptoms.

Effects of a 12-week resistance exercise program on physical self-perceptions in college students

There is an increase in literature suggesting exercise can promote positive changes in physical self-perceptions that can manifest as an increase in global self-esteem. In the present study, we assessed self-esteem using the hierarchical framework of the Exercise and Self-Esteem Model (EXSEM) along with cognitive facets at the subdomain level (e.g., competence, certainty, importance, and ideal self-discrepancy). This allowed for an analysis of cognitive facets as possible contributors to changes in physical self-perceptions. We addressed these aims with a sample of 120 college-age adults who completed a 12-week resistance exercise program. Results indicated significant improvements in self-perception constructs at all levels of the EXSEM. The hierarchical structure of the EXSEM was partially supported, as we observed successively smaller improvements at each level of the model (e.g., self-esteem showed lesser improvements than physical self-worth). In addition, a path model developed to explain the impact of strength changes on self-esteem proved a good fit for the data. Results are discussed in terms of contemporary models of self-perception, potential mediators of exercise on self-esteem, and the need to consider cognitive facets of self-perception.

Reducing psychological distress and obesity in Australian farmers by promoting physical activity

BACKGROUND

Studies have confirmed that the rate of mental illness is no higher in rural Australians than that of urban Australians. However, the rate of poor mental health outcomes, and in particular suicide, is significantly raised in rural populations. This is thought to be due to lack of early diagnosis, health service access, the distance-decay effect, poor physical health determinants and access to firearms. Research conducted by the National Centre for Farmer Health between 2004 and 2009 reveals that there is a correlation between obesity and psychological distress among the farming community where suicide rates are recognised as high. Chronic stress overstimulates the regulation of the hypothalamic-pituitary-adrenal (HPA) axis that is associated with abdominal obesity. Increasing physical activity may block negative thoughts, increase social contact, positively influence brain chemistry and improve both physical and mental health. This paper describes the design of the Farming Fit study that aims to identify the effect of physical activity on psychological distress, obesity and health behaviours such as diet patterns and smoking in farm men and women.

METHODS/DESIGN

For this quasi-experimental (convenience sample) control-intervention study, overweight (Body Mass Index ≥25 kg/m(2)) farm men and women will be recruited from Sustainable Farm Families™ (SFF) programs held across Victoria, Australia. Baseline demographic data, health data, depression anxiety stress scale (DASS) scores, dietary information, physical activity data, anthropometric data, blood pressure and biochemical analysis of plasma and salivary cortisol levels will be collected. The intervention group will receive an exercise program and regular phone coaching in order to increase their physical activity. Analysis will evaluate the impact of the intervention by longitudinal data (baseline and post intervention) comparison of intervention and control groups.

DISCUSSION

This study is designed to examine the effect of physical activity on psychological health and other co-morbidities such as obesity, impaired glucose tolerance, hypertension and dyslipidaemia within a high-risk cohort. The outcomes of this research will be relevant to further research and service delivery programs, in particular those tailored to rural communities.

TRIAL REGISTRATION

ACTRN12610000827033.

What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour--and are they the same?

There is convincing evidence that targeting self-efficacy is an effective means of increasing physical activity. However, evidence concerning which are the most effective techniques for changing self-efficacy and thereby physical activity is lacking. The present review aims to estimate the association between specific intervention techniques used in physical activity interventions and change obtained in both self-efficacy and physical activity behaviour. A systematic search yielded 27 physical activity intervention studies for 'healthy' adults that reported self-efficacy and physical activity data. A small, yet significant (P < 0.01) effect of the interventions was found on change in self-efficacy and physical activity (d = 0.16 and 0.21, respectively). When a technique was associated with a change in effect sizes for self-efficacy, it also tended to be associated with a change (r(s) = 0.690, P < 0.001) in effect size for physical activity. Moderator analyses found that 'action planning', 'provide instruction' and 'reinforcing effort towards behaviour' were associated with significantly higher levels of both self-efficacy and physical activity. 'Relapse prevention' and 'setting graded tasks' were associated with significantly lower self-efficacy and physical activity levels. This meta-analysis provides evidence for which psychological techniques are most effective for changing self-efficacy and physical activity.

COPD, chronic bronchitis and capacity for day-to-day activities: negative impact of illness on the health-related quality of life

The aim of this study was to investigate the negative impact of illness on health-related quality of life (HRQoL) of people with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The study population consisted of the participants (N = 8028) of a health examination survey conducted in Finland. The sample in the present substudy was composed of 4718 participants who had complete information about spirometry. Variables age, gender, body mass index (BMI), illnesses, smoking in lifetime, education, FEV1% and incomes were entered in blockwise bivariate regression analysis to examine the relationships between capability for day-to-day activities (physical, psychological and social functioning) of those with COPD. Also, COPD (n = 277) and chronic bronchitis (n = 630) were compared with the general population (n = 3817). Study results showed that women with COPD had worse HRQoL than men, regarding the activities in daily living (ADL; odds ratio [OR] 2.63, 95% confidence interval [Cl] 1.15-5.99), instrumental activities of daily living (IADL; OR 4.23, 95% Cl 1.92-9.29) and exercise (OR 2.66, 95% Cl 1.21-5.84). Compared with the general population, people with chronic bronchitis were associated with poor ADL, IADL and exercise, (OR 1.58, 95% Cl 1.32- 1.92). Those with COPD, had difficulties managing in ADL (OR 4.02, 95% Cl 2.98-5.44), IADL (OR 3.27, 95% Cl 2.43-4.39), exercise (OR 3.35, 95% Cl 2.47 to 4.53). In this representative population-based sample, COPD and chronic bronchitis mean a significantly poor capability in physical functioning. People with chronic bronchitis experienced their daily life to be worse compared with the general population. Reductions in physical functioning for women and especially with COPD were also noteworthy.

Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators

BACKGROUND

There is increasing evidence that depressive symptoms and obesity are positively related, but the mechanisms that explain the association between them are unclear.

OBJECTIVE

We examined direct and indirect associations between depressive symptoms, emotional eating, physical activity (PA) self-efficacy (ie, an individual's confidence in his or her ability to overcome barriers to maintain PA behaviors), and adiposity indicators.

DESIGN

Structural equation modeling was used to test the hypothesized mediation model in Finnish men (n = 2312) and women (n = 2674) aged 25-74 y from the National Cardiovascular Risk Factor Survey conducted in 2007. The Center for Epidemiologic Studies-Depression Scale, the Three-Factor Eating Questionnaire-R18, and a PA barriers self-efficacy scale were used. Body mass index (BMI), waist circumference (WC), and percentage body fat of participants were measured in a health examination.

RESULTS

Depressive symptoms and emotional eating had positive correlations and PA self-efficacy had negative correlations with BMI, WC, and percentage body fat. Elevated depressive symptoms were related to higher emotional eating (β = 0.38 for men and 0.31 for women) and lower PA self-efficacy (β = -0.41 for men and -0.31 for women), whereas emotional eating and PA self-efficacy were inversely correlated (r = -0.12 and -0.18, respectively). The positive bivariate associations between depressive symptoms and adiposity indicators became nonsignificant in models that included emotional eating and PA self-efficacy, and both of these factors significantly mediated the effects of depressive symptoms on adiposity indicators.

CONCLUSIONS

Psychological factors related to both eating and PA may be relevant in explaining the positive relation between depressive symptoms and adiposity. Interventions that target obesity should take into account the effects of these factors on weight regulation.

Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods

Although the Diabetes Prevention Program (DPP) developed a lifestyle weight loss intervention that has been demonstrated to prevent type 2 diabetes in high-risk individuals, it has yet to be widely adopted at the community level. The Healthy Living Partnership to Prevent Diabetes study (HELP PD) was designed to translate the DPP approach for use in community settings as a cost-effective intervention led by Community Health Workers (CHW's) and administered through a Diabetes Care Center (DCC). Approximately 300 overweight and obese (BMI 25-40 kg/m(2)) individuals with prediabetes (fasting blood glucose 95-124 mg/dl) were randomly assigned to either a lifestyle weight loss intervention (LW) or an enhanced usual care comparison condition (UC). The goal of LW is >or=7% weight loss achieved through increases in physical activity (180 min/wk) and decreases in caloric intake (approximately 1500 kcal/day). The intervention consists of CHW-led group-mediated cognitive behavioral meetings that occur weekly for 6 months and monthly thereafter for 18 months. UC consists of 2 individual meetings with a registered dietitian and a monthly newsletter. The primary outcome is change in fasting blood glucose. Secondary outcomes include cardiovascular risk factors, health-related quality of life, and social cognitive variables. Outcomes are masked and are collected every 6 months. The cost-effectiveness of the program will also be assessed. A community-based program that is administered through local DCC's and that harnesses the experience of community members (CHW's) may be a promising strategy for the widespread dissemination of interventions effective at preventing type 2 diabetes in high risk individuals.

Subjective well-being as a determinant of individuals' responses to symptoms: a biopsychosocial perspective

BACKGROUND

Although many models have been developed to explain health behaviour, differences in individual response to symptoms remain largely unexplained; moreover, they tend to underestimate affective (i.e., emotional) processes and they neglect the construct of well-being, despite its predominant role in the definition of health.

AIM

The development of a novel conceptual framework to explain and predict variability in individuals' responses to symptoms, through a bio-psychosocial perspective, considering also the potential role of subjective well-being.

MATERIALS & METHODS

The most widely used health behaviour models were being reviewed, as well as their limitations. Based on the evidence in the literature, major domains that influence response to symptoms are identified and analysed.

RESULTS

A new conceptual framework that is not limited to explanation of common health behaviours such as treatment seeking or problem identification, but draws attention to a broad spectrum of individual reactions and experiences following the physical experience of a symptom or medical condition. The role of subjective well-being and its determinants are considered as a central concept in the proposed framework.

DISCUSSION

The present conceptual framework provides a comprehensive bio-psychosocial perspective on behavioural outcomes related to individual response to symptoms.

CONCLUSION

The proposed framework opens a new window to patient centred care. Research to evaluate the proposed framework may improve the quality of clinical care and overall patient satisfaction.

What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis

PURPOSE

Increasing self-efficacy is an effective method to increase physical activity. Despite this, the evidence concerning the most effective techniques to increase self-efficacy in physical activity interventions has not been systematically reviewed. The aim of the present research is to systematically gather, and meta-analyse, intervention studies which aimed to increase self-efficacy for physical activity; to estimate the association between intervention techniques used, and change in self-efficacy achieved.

METHODS

A systematic database search was conducted for papers reporting lifestyle or recreational physical activity interventions. Published intervention studies explicitly targeting self-efficacy in order to change physical activity behaviour in 'healthy' adults were eligible for inclusion.

RESULTS

The search strategy identified 27 unique physical activity intervention studies, with a total of 5,501 participants. A significant, yet small, relationship between the interventions and changes in self-efficacy was found (mean d=0.16, p<.001). Owing to significant heterogeneity, moderator analyses were conducted, examining the association of changes in self-efficacy with whether or not specific intervention techniques were used. Interventions that included feedback on past or others' performance produced the highest levels of self-efficacy found in this review. Vicarious experience was also associated with higher levels of self-efficacy. Persuasion, graded mastery, and barrier identification were associated with lower levels of self-efficacy.

CONCLUSIONS

This meta-analysis forms an evidence base for which psychological techniques are most effective in increasing self-efficacy for physical activity. The results are presented in terms of recommendations for those developing interventions and directions for future research.

Enhancing quality of life in older adults: a comparison of muscular strength and power training

Background

Although progressive resistance strength training (ST) has been found to improve various measures of physical functioning in older adults, the benefit to quality of life is unclear. Additionally, recent evidence suggests that high velocity power training (PT) may be more beneficial for physical functioning than ST, but it is not known whether this type of training impacts quality of life. The purpose of this study was to compare changes in multiple measures of quality of life resulting from ST vs. PT in older adults. A no exercise group was also included as control comparison condition.

Methods

Forty-five older adults (M age = 74.8 years; SD = 5.7) were randomly assigned to either a) PT, b) ST, or c) control group (no exercise). Measures of self-efficacy (SE), satisfaction with physical function (SPF), and the Satisfaction with Life Scale (SWL) were assessed at baseline and following training. The resistance training conditions met 3 times per week for 12 weeks at an intensity of 70% 1 repetition maximum.

Results

A series of ANCOVA's comparing between group differences in change and controlling for baseline values revealed significant group differences in all three measures: SE (F_(2,31) = 9.77; p < .001); SPF (F_(2,32) = 3.36; p = .047); SWL (F_(2,31) = 4.76; p = .016). Follow up analyses indicated that the PT group reported significantly more change in SE, SPF, and SWL than the control group whereas the ST group reported greater change than the control group only in SE.

Conclusion

These pilot data indicate that high velocity power training may influence multiple levels of quality of life over and above the benefits gained through traditional strength training.

Physical activity in prefrail older adults: confidence and satisfaction related to physical function

We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70+ years of age who have deficits in mobility. We randomized a total of 412 adults aged 70-89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months. Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention. Gender, age, and scores on a short physical performance battery did not moderate these effects. Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning. This is an important finding in light of the importance of these process variables in behavior change and quality of life.

Social cognitive constructs and the promotion of physical activity in patients with peripheral artery disease

PURPOSE

The purpose of this study was to provide measures and accompanying psychometric support for key constructs from social cognitive theory relevant to the promotion of physical activity in patients with peripheral artery disease (PAD).

METHODS

Patients (n = 205) were identified from 2 ongoing studies involving PAD, who completed the Geriatric Depression Scale, a 6-minute walk, and the social cognitive measures of interest: pain acceptance, self-efficacy, desire for physical competence, perceived control for walking, and satisfaction with function. Psychometric support for each measure included factor analyses, test-retest reliability, and an evaluation of construct validity by investigating how each measure was related to depression and performance on the 6-minute walk test.

RESULTS

The measures of interest had good structural integrity, were reliable, and shared expected variance with depressed affect; most had significant linear trends with the 6-minute walk test, suggesting that compromised psychological status is related to poorer mobility.

CONCLUSIONS

Constructs from social cognitive theory are clearly relevant to the promotion of physical activity in PAD patients. To this end, this study offers measures of relevant constructs that can now be implemented into intervention research.

The lifestyle interventions and independence for elders (LIFE) pilot study: design and methods

The LIFE study is a multicenter pilot for a proposed full scale, two-arm randomized controlled trial that will contrast the effect of a physical activity intervention with a successful aging education program on the occurrence of incident major mobility disability (the inability to complete a 400 m walk) or death in at-risk sedentary older adults. Four hundred older adults from 4 clinical sites will be recruited for this purpose. All participants will be followed for at least 1-year; however, we will continue to follow all participants until the final randomized individual has reached the 1-year mark. This will enable us to acquire additional information about maintenance. Additional outcomes will include lower extremity physical performance as well as gait speed over 4 m and 400 m. These latter measures will provide data on the efficacy of the intervention on intermediate endpoints linked to the primary outcome of interest. The goals of the pilot study are to (a) estimate the sample size needed for a full scale trial, (b) examine the consistency of the effects of the physical activity intervention on several continuous measures of physical function, (c) assess the feasibility of recruitment, (d) evaluate study adherence and retention, (d) evaluate the efficacy of a stepped care approach for managing intercurrent illness in this at-risk population, and (e) develop a comprehensive system for monitoring and ensuring participant safety. Other goals of this pilot phase include assessments of health-related quality of life and cost-effectiveness.

Perceived difficulty, importance, and satisfaction with physical function in COPD patients

BACKGROUND

Research suggests that patients' satisfaction with their physical functioning (SPF) is a critical component of HRQL. This study was designed to examine the extent to which perceptions of physical function and the value placed on physical function are related to satisfaction ratings. The sample consisted of older adults suffering from a progressively debilitating disease, chronic obstructive pulmonary disease (COPD).

METHODS

During baseline assessments, COPD patients participating in a randomized controlled physical activity trial completed measures of SPF, perceived difficulty, and perceived importance.

RESULTS

An ANCOVA controlling for age and gender indicated that perceived difficulty, perceived importance, and their interaction accounted for 43% of the variance in SPF. Additionally, participants were most satisfied with important tasks that they performed with little difficulty. Participants were least satisfied with important tasks that they perceived as highly difficult.

CONCLUSION

The results of the present study indicate that not being able to perform valued tasks produces discontent that is reflected in lower rating of satisfaction with physical functioning. Clearly, the significance of loss in function to individual patients is related to the importance of the functional activities that may be compromised. These data have implications for the scope of patient assessment in clinical care and for the conceptual basis of future research in the area of physical functioning.

Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life

This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.