Exploring biases in self-reported exercising behavior heuristics based on recency, frequency, and preference

The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study

OBJECTIVE

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum.

METHODS

In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance.

RESULTS

At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months.

CONCLUSION

The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum.

IMPACT

Physical therapists should encourage women to start with low-impact exercise early after pregnancy.

LAY SUMMARY

This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

Exercise training upregulates intracellular nicotinamide phosphoribosyltransferase expression in humans: a systematic review with meta-analysis

Objective

Aging is associated with decreased nicotinamide adenine dinucleotide (NAD) levels, which in turn cause dysfunctional mitochondria and indirectly affect a myriad of diseases. Intracellular nicotinamide phosphoribosyltransferase (iNAMPT) serves as a central rate-limiting enzyme in NAD synthesis, making it an indispensable health mediator. This meta-analysis examined the effect of exercise training on the expression of iNAMPT in humans.

Methods

We searched PubMed, Scopus, ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies published between the inception of the database and July 5, 2023. Using the common-effect model, evidence for the change in iNAMPT following exercise training was synthesized as Cohen's d.

Results

The search yielded five eligible studies. The overall effect size is 0.81, with a 95% confidence interval of 0.55 to 1.07. Therefore, a random adult will have a 71.7% probability that iNAMPT will be up-regulated following exercise training. In general, exercise training resulted in a 1.46-fold increase in iNAMPT. Our probability statistics indicate that subgroups of interest may differ practically. Specifically, there is a 79.3% probability of increased iNAMPT in men, compared to a 69.0% probability in the overall population; young adults have a 75.6% probability of having an increased iNAMPT, whereas aged adults have a 68.7% probability; and, iNAMPT has a 75.1% probability increase after aerobic exercise and a 66.4% probability increase after resistance exercise.

Conclusion

Exercise training is effective for increasing iNAMPT levels in skeletal muscles. This essential enzyme regulates not only cellular energetics but also healthspan. Therefore, exercise should be promoted as a natural slow-aging lifestyle.

Medical Communication Perceived Self-Efficacy (ME-CO) Scale: Construction and Validation of a New Measuring Instrument from a Socio-Cognitive Perspective

The study presents the validation of a scale measuring physicians’ efficacy beliefs about their ability to manage issues related to communication with patients. Specifically, the tool focused on three fundamental phases of the clinical interview: collecting information, returning information to patients, and creating and maintaining a relationship with them. The research included two studies. Study 1 generated an item pool based on the literature review and developed a self-report questionnaire administered to a pilot sample of 150 physicians (M_Age = 49.36; SD = 1.98). The responses were subjected to exploratory analysis. In total, 636 physicians (M_Age = 47.99; SD = 8.68) took part in Study 2. Exploratory and confirmatory analyses yielded a final version of the tool consisting of an eight-factor structure with 31 items. Findings provided evidence of the robust psychometric properties of the scale and its usefulness in assessing physicians’ self-efficacy and defining effective interventions aimed at strengthening the doctors’ communication skills. The scale detected different aspects of physicians’ communication self-efficacy (asking questions, active listening, giving information, communicating an inauspicious diagnosis, non-verbal communication, recognition of patient’s clues and suggestions, information checking, and empathy).

Development and validation of a very brief questionnaire measure of physical activity in adults with coronary heart disease

Background

The aim of this study was to validate the Total Activity Measure, a brief questionnaire, to measure physical activity in an older adult population with heart disease.

Methods

Two versions of the Total Activity Measure were administered twice, 7 days apart. The Total Activity Measure 1 asked respondents for the frequency and average duration of bouts of physical activity at three different intensity levels per week, whereas the Total Activity Measure 2 asked respondents for the total time spent in activity at each activity level per week. Questionnaire accuracy was studied in 62 men and 15 women aged 47-84 years, by repeatability and comparison of both administrations of the Total Activity Measure 1 and Total Activity Measure 2 with 7-day RT3 accelerometer data.

Results

Seventy-three adults (58 men, 15 women) were used for all statistical analyses. Intraclass correlation coefficients for the Total Activity Measure 1 and Total Activity Measure 2 total activity scores (metabolic equivalent per minute) were r = 0.73 (95% confidence intervals, 0.56-0.83) and r = 0.82 (95% confidence intervals, 0.71-0.88), respectively. Correlations between the Total Activity Measure 1 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were significant, r = 0.26 at time 1 and r = 0.27 at time 2 for moderate intensity activities. Correlations between the Total Activity Measure 2 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were also significant, r = 0.38 at time 1 and r = 0.36 at time 2, r = 0.31 at time 2 for strenuous intensity activities and r = 0.29 at time 1 and r = 0.25 at time 2 for moderate intensity activities. Participants overestimated the amount of physical activity on both questionnaires as compared with the RT3 accelerometer.

Conclusions

The Total Activity Measure 2 was reasonably accurate in assessing total and moderate intensity activity over a 7-day period and demonstrated good test-retest reliability. The Total Activity Measure 1 was less accurate. The Total Activity Measure 2 is a suitable measure of total or moderate intensity physical activity for surveys and audits in an adult cardiac population. Eur J Cardiovasc Prev Rehabil 14:615-623 © 2007 The European Society of Cardiology

The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial

OBJECTIVE

To assess if attendance to a preoperative counseling program improved weight loss or adherence to treatment guidelines in patients who underwent bariatric surgery.

METHODS

One-hundred-forty-one patients were included in the study. Sixty-nine percent chose to participate in the counseling groups. They were randomized to a Treatment group and a Control group. Thirty-one percent chose not to participate in the counseling. However, they gave their consent to assessment before and after surgery (Reference group).

RESULTS

One year after bariatric surgery, 88% had a weight loss of ≥ 50% EWL, 37% reported more than 30 min of physical activity daily, 74% had 5-7 meals daily, and 87% took recommended vitamins. There were no differences in weight loss, eating habits, or physical exercise between the Treatment group, the Control group and the Reference group one year after surgery.

CONCLUSION

Preoperative group counseling did not increase treatment adherence to recommended life-style changes.

PRACTICE IMPLICATIONS

In accordance with findings in the present study, it is not reasonable to offer a preoperative counseling program for all patients undergoing bariatric surgery. Further research should focus on developing and evaluating programs for postsurgical follow-up, and identifying patients that are in need for more comprehensive treatment programs.

A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments

OBJECTIVES

To investigate the effect of a referral-based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED.

DESIGN

Randomized controlled trial. Assessors of outcomes were unaware of group allocation.

SETTING

Seven EDs in metropolitan Melbourne, Australia.

PARTICIPANTS

Inclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently.

INTERVENTION

Targeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment.

MEASUREMENTS

Primary outcome measures were falls and resultant injuries occurring over the 12-month follow-up period. Falls and injury data were collected using falls calendars supported by medical record reviews.

RESULTS

Three hundred sixty-one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12-month follow-up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95-1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86-1.29).

CONCLUSION

This study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.

Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention

OBJECTIVES

To decrease the rate of falls in high-risk community-dwelling older adults.

DESIGN

Randomized, controlled trial.

SETTING

Community-based.

PARTICIPANTS

Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems.

INTERVENTION

Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment.

MEASUREMENTS

The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year.

RESULTS

There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008).

CONCLUSION

This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required.

Failure to validate the Health Survey for England physical activity module in a cardiac population

OBJECTIVES

The Health Survey for England physical activity module interview, although not validated, is used as a performance indicator to see if people are achieving current physical activity targets and is the primary source of information for physical activity related policy making. The aim of this study was to assess the validity of the Health Survey for England physical activity module as a measure of physical activity in older adults with coronary heart disease.

METHODS

Seventy-two older adults who had experienced a cardiac event completed the Health Survey for England physical activity interview and wore an accelerometer for seven consecutive days. Physical activity classification levels were derived from accelerometry and from the Health Survey for England physical activity interview, together with the number of episodes in which participants were moderately active for 30 min or more.

RESULTS

The Health Survey for England physical activity interview exhibited high sensitivity (1.0) and specificity (0.76) for people engaged in high levels of physical activity, moderate sensitivity (0.40) and specificity (0.56) for people engaged in medium levels of physical activity and low sensitivity (0.35) and high specificity (0.92) for people engaged in low levels of physical activity. Compared with the accelerometer, the survey misclassified 63% of participants.

CONCLUSIONS

The Health Survey for England physical activity interview misclassified true activity levels in older adults with heart disease by overestimating actual activity in the less active participants. Similar biases on self-report physical activity measures have been demonstrated in the general population, suggesting that the Health Survey for England physical activity module interview may be providing inaccurate information on national activity levels.

Communication Interventions Make A Difference in Conversations Between Physicians and Patients

OBJECTIVE

We sought to synthesize the findings of studies examining interventions to enhance the communication behaviors of physicians and patients during outpatient encounters.

METHODS

We conducted searches of 6 databases between 1966 and 2005 to identify studies for a systematic review and synthesis of the literature. Eligible studies tested a communication intervention; were randomized controlled trials (RCTs); objectively assessed verbal communication behaviors as the primary outcome; and were published in English. Interventions were characterized by type (eg, information, modeling, feedback, practice), delivery strategy, and overall intensity. We abstracted information on the effects of the interventions on communication outcomes (eg, interpersonal and information exchanging behaviors). We examined the effectiveness of the interventions in improving the communication behaviors of physicians and patients.

RESULTS

Thirty-six studies were reviewed: 18 involved physicians; 15 patients; and 3 both. Of the physician interventions, 76% included 3 or 4 types, often in the form of practice and feedback sessions. Among the patient interventions, 33% involved 1 type, and nearly all were delivered in the waiting room. Intervention physicians were more likely than controls to receive higher ratings of their overall communication style and to exhibit specific patient-centered communication behaviors. Intervention patients obtained more information from physicians and exhibited greater involvement during the visit than controls.

CONCLUSIONS

The interventions were associated with improved physician and patient communication behaviors. The challenge for future research is to design effective patient and physician interventions that can be integrated into practice.

The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: follow-up after withdrawal of exercise

OBJECTIVES

To determine whether exercise-induced reductions in fall risk are maintained in older women 1 year after the cessation of three types of interventions--resistance training, agility training, and general stretching.

DESIGN

One-year observational study.

SETTING

Community.

PARTICIPANTS

Ninety-eight women aged 75 to 85 with low bone mass.

MEASUREMENTS

Primary outcome measure was fall risk, measured using the Physiological Profile Assessment tool. Secondary outcome measures were current physical activity level, assessed using the Physical Activity Scale for the Elderly, and formal exercise participation, assessed using an interview.

RESULTS

At the end of the follow-up, the fall risk of former participants of all three exercise programs was maintained (i.e., still reduced) from trial completion. Mean fall risk value at the end of follow-up was 43.3% lower than mean baseline value in former participants of the resistance-training group, 40.1% lower in the agility-training group, and 37.4% lower in the general stretching group. Physical activity levels were also maintained from trial completion. Specifically, there was a 3.8% increase in physical activity from baseline for the resistance-training group, a 29.2% increase for the agility-training group, and a 37.7% increase for the general stretching group.

CONCLUSION

After three types of group-based exercise programs, benefits are sustained for at least 12 months without further formal exercise intervention. Thus, these 6-month exercise interventions appeared to act as a catalyst for increasing physical activity with resultant reductions in fall risk profile that were maintained for at least 18 months in older women with low bone mass.

Maintenance of physical activity following an individualized motivationally tailored intervention

This study examined predictors of exercise maintenance following completion of a physical activity intervention. Sedentary adults recruited through newspaper advertisements were randomly assigned to receive either (a) a motivation-matched intervention with feedback reports that were individually tailored (IT) to psychological variables from social cognitive theory and the Transtheoretical Model via computer expert system, or (b) a standard, print-based intervention (ST). The intervention phase of the study included mailed assessments and intervention materials at baseline, 1, 3, and 6 months. An assessment-only follow-up was conducted 6 months after the end of the intervention (Month 12). Participants were assessed for current physical activity participation, motivational readiness for physical activity, a number of psychological constructs posited to influence participation in physical activity (e.g., self-efficacy), and current affect. Significantly more participants in the IT condition met or exceeded exercise participation goals at the end of the intervention period and maintained this level of physical activity through the Month 12 follow-up compared to ST participants. Prospective analyses revealed significant differences in several psychological constructs both at program entry (baseline) and the end of the intervention period between individuals who maintained their physical activity participation through Month 12 and those who did not. Results suggest that the maintenance of physical activity following the end of an active intervention program may be influenced by attitudes and behaviors acquired along with increased participation in physical activity, as well as by preexisting characteristics that individuals bring into treatment.