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Steckhan GM, Fleig L, Wurm S, Wolff JK, Schwarzer R, Warner LM. Fear of Falling Carries Over into Overprotection in Old Age: A Cross-Lagged Panel Analysis. Int J Aging Hum Dev 2024; 98:436-451. [PMID: 37615122 PMCID: PMC11062071 DOI: 10.1177/00914150231196819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Fear of falling might result in overprotection by one's social environment. In turn, feeling dependent could increase fear of falling. However, the association between fear of falling and perceived overprotection and its temporal order is unknown. This longitudinal study explores this potential mutual longitudinal association. This study presents secondary analyses from a larger trial. We tested the association between fear of falling and perceived overprotection in a cross-lagged path model controlled for falls, health-related quality of life, age, gender, and trial condition. N = 310 participants (M = 70 years, range: 64-92) completed self-reports at Time 1, 7 (Time 2), and 11 weeks (Time 3) after baseline assessment. We found a positive association from fear of falling to perceived overprotection (β = .12, 95% CI[0.02, 0.21], p = .02; β = .10; [0.01, 0.18], p = .03). The reversed cross-lagged paths were not significant. Findings suggest higher fear of falling translates into perceived overprotection, which may in turn increase loss of independence in old age.
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Affiliation(s)
- Greta M. Steckhan
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- MSB Medical School Berlin, Department Psychology, Institute of Psychosocial Research for Health Promotion and Intervention, Berlin, Germany
| | - Lena Fleig
- MSB Medical School Berlin, Department Psychology, Institute of Psychosocial Research for Health Promotion and Intervention, Berlin, Germany
| | - Susanne Wurm
- University of Medicine Greifswald, Department of Prevention Research and Social Medicine, Institute for Community Medicine, Greifswald, Germany
| | - Julia K. Wolff
- University of Medicine Greifswald, Department of Prevention Research and Social Medicine, Institute for Community Medicine, Greifswald, Germany
- IGES Institute Berlin, Berlin, Germany
| | - Ralf Schwarzer
- Freie Universität Berlin, Division of Health Psychology, Berlin, Germany
- SWPS University, Faculty of Psychology, Wroclaw, Poland
| | - Lisa M. Warner
- MSB Medical School Berlin, Department Psychology, Institute of Psychosocial Research for Health Promotion and Intervention, Berlin, Germany
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2
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Jekauc D, Gürdere C, Englert C, Strobach T, Bottesi G, Bray S, Brown D, Fleig L, Ghisi M, Graham J, Martinasek M, Tamulevicius N, Pfeffer I. The contribution and interplay of implicit and explicit processes on physical activity behavior: empirical testing of the physical activity adoption and maintenance (PAAM) model. BMC Public Health 2024; 24:1239. [PMID: 38711051 DOI: 10.1186/s12889-024-18589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/14/2024] [Indexed: 05/08/2024] Open
Abstract
The adoption and maintenance of physical activity (PA) is an important health behavior. This paper presents the first comprehensive empirical test of the Physical Activity Adoption and Maintenance (PAAM) model, which proposes that a combination of explicit (e.g., intention) and implicit (e.g., habit,, affect) self-regulatory processes is involved in PA adoption and maintenance. Data were collected via online questionnaires in English, German, and Italian at two measurement points four weeks apart. The study included 422 participants (Mage= 25.3, SDage= 10.1; 74.2% women) from Germany, Switzerland, Italy, Canada, and the U.S. The study results largely supported the assumptions of the PAAM model, indicating that intentions and habits significantly mediate the effects of past PA on future PA. In addition, the effect of past PA on future PA was shown to be significant through a mediation chain involving affect and habit. Although the hypothesis that trait self-regulation moderates the intention-behavior relationship was not supported, a significant moderating effect of affect on the same relationship was observed. The results suggest that interventions targeting both explicit and implicit processes may be effective in promoting PA adoption and maintenance.
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Affiliation(s)
- Darko Jekauc
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
| | - Ceren Gürdere
- Department of Psychology, Bilkent University, Ankara, Turkey
| | - Chris Englert
- Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Tilo Strobach
- Medical School Hamburg, Institute of Cognitive and Affective Neuroscience (ICAN), Hamburg, Germany
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
- U.O.C. Hospital Psychology, University-Hospital of Padova, Padova, Italy
| | - Steven Bray
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Denver Brown
- Department of Psychology, The University of Texas at San Antonio, San Antonio, USA
| | - Lena Fleig
- Medical School Berlin, Department of Psychology, Berlin, Germany
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Jeffrey Graham
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, USA
| | - Mary Martinasek
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, USA
| | - Nauris Tamulevicius
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, USA
| | - Ines Pfeffer
- Medical School Hamburg, Institute of Cognitive and Affective Neuroscience (ICAN), Hamburg, Germany
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Levy E, Warner LM, Fleig L, Kaufman MR, Gidron Y. Associations Between Implicit and Explicit Condom Use Measures With Condom Use Barriers: Relationships Make A Difference. Psychol Rep 2023:332941231164334. [PMID: 36927133 DOI: 10.1177/00332941231164334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The association between explicit and implicit psychological measures might be affected by the similarity of the assessment method and by the overlap of the components of the constructs being assessed. This study examined the association between condom use barriers and explicit and implicit measurements of condom use and the moderating role of sexual intercourse in these associations. DESIGN This was a cross sectional correlational study. An analysis of baseline data from a randomized controlled trial including 149 university students was included. MAIN MEASURES These included a questionnaire assessing condom use barriers, an implicit condom use test (a structured semi-projective test), and an explicit condom use question. Hierarchical regressions and correlations were examined in the full sample and by groups of participants with and without sexual intercourse. RESULTS In those without sexual intercourse, all barriers sub-scales were significantly and negatively correlated with implicit condom use and unrelated to explicit condom use. In contrast, among those engaged in sexual intercourse, barriers were significantly and negatively correlated with the explicit condom use measure, and only barriers concerning partner and motivation correlated with implicit condom use tendencies. CONCLUSION Having a sexual partner plays a major role in the relations between barriers and implicit and explicit condom use measures. The pattern of the results is discussed in relation to cognitive and social factors.
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Affiliation(s)
- Einav Levy
- Department of Social Work, Ringgold: 54625Tel Hai College, Qiryat Shemona, Israel.,The Israeli School of Humanitarian Action, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Lisa M Warner
- Department of Psychology, Ringgold: 381458MSB Medical School Berlin, Berlin, Germany
| | - Lena Fleig
- Department of Psychology, Ringgold: 381458MSB Medical School Berlin, Berlin, Germany
| | - Michelle R Kaufman
- Blomberg School of Public Health, Department of Health, Behavior & Society, Ringgold: 25802Johns Hopkins University Baltimore, Baltimore, MD, USA
| | - Yori Gidron
- Department of Nursing, Ringgold: 26748Haifa University, Haifa, Israel
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Labudek S, Fleig L, Jansen CP, Kramer-Gmeiner F, Nerz C, Clemson L, Klenk J, Becker C, Schwenk M. Changes in Psychological Determinants of Behavior Change after Individual versus Group-Based Lifestyle-integrated Fall Prevention: Results from the LiFE-is-LiFE Trial. Gerontology 2023; 69:212-226. [PMID: 35691288 DOI: 10.1159/000524701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The Lifestyle-integrated Functional Exercise (LiFE) intervention has been shown to promote physical activity in fall-prone older adults. However, the underlying mechanisms of how LiFE functions remain unclear. This study compares the effects of the individual and group-based LiFE formats on psychological determinants of behavior change derived from the health action process approach, habit formation theory, and self-determination theory. METHODS Secondary analysis on basis of the randomized, non-inferiority LiFE-is-LiFE trial were performed. Questionnaire data on psychological determinants were obtained from older adults (M = 78.8 years, range 70-95) who took part in either the individual (n = 156) or the group-based (n = 153) LiFE intervention. Measurement points varied from three to six times, and from baseline (T1) up to a 12-month follow-up (T6). A generalized linear mixed model was specified for each determinant. RESULTS Both LiFE and gLiFE participants reported lower levels of motivational determinants at T6. LiFE participants showed significantly higher values of action planning and coping planning at T6. Participants in both formats showed increased levels of action control at T6, whereas participants' habit strength decreased post-intervention but then stabilized over time. LiFE participants showed higher levels of autonomy, competence, and relatedness throughout the study, but levels of intrinsic motivation did not differ between formats and from T1 to T6. CONCLUSION In both formats, but especially in the individual LiFE, the behavior change techniques used affected volitional rather than motivational or general determinants of behavior change. Habit strength as an important indicator of the sustainability of the LiFE exercises stabilized over time, indicating that participants, at least partly, sustained their formed habits long-term.
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Affiliation(s)
- Sarah Labudek
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
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Vogelsang A, Hinrichs C, Fleig L, Pfeffer I. Study protocol for the description and evaluation of the "Habit Coach" - a longitudinal multicenter mHealth intervention for healthy habit formation in health care professionals. BMC Public Health 2022; 22:1672. [PMID: 36058904 PMCID: PMC9440859 DOI: 10.1186/s12889-022-13986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The adoption of a healthy lifestyle plays a crucial role for the health and well-being of health care professionals. Previous e- and mHealth interventions relied on deliberative psychological processes (e.g., intention, planning) to target lifestyle changes, while revealing mixed efficacy. The additional potential of non-deliberative, automatic processes (i.e., habits) for behavior change has been understudied in interventions so far. The Habit Coach mHealth intervention combines deliberative and non-deliberative processes to support health care professionals in forming healthy physical activity, nutrition and mindfulness habits in daily life. The aim of this paper is to outline the study protocol including a detailed description of the mHealth intervention, evaluation plan, and study design. The purpose of this trial is to understand healthy habit formation in health care professionals over time. METHODS A one-arm, multicenter mHealth intervention study will be conducted. Behavioral and psychosocial predictors will be collected via within-app questionnaires across a 100-day period at baseline, post, as well as at weekly assessments. To understand habit formation across time, linear mixed models will be used. DISCUSSION This trial aims to unravel the role of motivational and volitional determinants for healthy habit formation across multiple health behaviors in health care professionals embedded in a mHealth intervention. TRIAL REGISTRATION This trial is registered in the German Clinical Trials Register, DRKS-ID DRKS00027156. Date of registration 17 November 2021.
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Affiliation(s)
- Anna Vogelsang
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany. .,Faculty of Sport Science - Department of eHealth and Sports Analytics, Ruhr-University Bochum, Gesundheitscampus - Nord 10, 44801, Bochum, Germany.
| | - Clara Hinrichs
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Lena Fleig
- Faculty of Natural Sciences- Department of Psychology, Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Ines Pfeffer
- Faculty of Humanities, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
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Di Maio S, Keller J, Kwasnicka D, Knoll N, Sichert L, Fleig L. What helps to form a healthy nutrition habit? Daily associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity. Appetite 2022; 175:106083. [PMID: 35580819 DOI: 10.1016/j.appet.2022.106083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND High automaticity in healthy nutrition behaviors is related to long-term maintenance of these behaviors. Drawing upon theoretical frameworks of habit formation, proposed antecedents such as intrinsic reward, anticipated regret, and self-efficacy are important correlates of automaticity, but not much is known about their day-by-day relationships with automaticity in healthy nutrition behaviors. This study tested previous-day within-person (i.e., from one day to the next) and same-day within-person associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity of a healthy nutrition behavior, for which participants attempted to form a new habit. METHODS Secondary analyses of a randomized controlled trial with two planning intervention conditions including a longitudinal sample of n = 135 participants (age: M = 24.82 years; SD = 7.27) are reported. Participants formed a plan on a self-selected healthy nutrition behavior to become a new habit and were followed up over 12 weeks assessing daily levels of plan-specific intrinsic reward, anticipated regret, self-efficacy, and automaticity. Lagged multilevel models with 84 study days nested in participants estimated previous-day within-person, same-day within-person, and between-person relationships of intrinsic reward, anticipated regret, and self-efficacy with automaticity. FINDINGS Regarding within-level relationships, higher-than-usual levels of intrinsic reward, anticipated regret, and self-efficacy of the same day but not of the previous day were associated with higher within-person automaticity. With respect to between-level relationships, higher between-levels (i.e., higher person mean levels across the study period) of intrinsic reward, anticipated regret, and self-efficacy were linked with higher automaticity. DISCUSSION Findings point towards the potential to intervene on intrinsic reward, anticipated regret, and self-efficacy when aiming to promote a new healthy nutrition habit.
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Affiliation(s)
- Sally Di Maio
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Jan Keller
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Aleksandra Ostrowskiego 30B, 53-238, Wroclaw, Poland; NHMRC Centre in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, 5/ Exhibition Street, Melbourne, VIC, 3004, Australia.
| | - Nina Knoll
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Lena Sichert
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195, Berlin, Germany.
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Hochschule für Gesundheit und Medizin, Rüdesheimer Straße 50, 14197, Berlin, Germany.
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Grover S, Fitzpatrick A, Azim FT, Ariza-Vega P, Bellwood P, Burns J, Burton E, Fleig L, Clemson L, Hoppmann CA, Madden KM, Price M, Langford D, Ashe MC. Defining and implementing patient-centered care: An umbrella review. Patient Educ Couns 2022; 105:1679-1688. [PMID: 34848112 DOI: 10.1016/j.pec.2021.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Patient- or person-centered care (PCC) integrates people's preferences, values, and beliefs into health decision-making. Gaps exist for defining and implementing PCC; therefore, we aimed to identify core elements of PCC and synthesize implementation facilitators and barriers. METHODS We conducted an overview of systematic reviews (umbrella review) and included peer-reviewed literature for adults in community/primary care settings. Two reviewers independently screened at Level 1 and 2, extracted data and appraised the quality of reviews. Three reviewers conducted a thematic analysis, and we present a narrative synthesis of findings. RESULTS There were 2371 citations screened, and 10 systematic reviews included. We identified 10 PCC definitions with common elements, such as patient empowerment, patient individuality, and a biopsychosocial approach. Implementation factors focused on communication, training healthcare providers, and organizational structure. CONCLUSIONS We provide a synthesis of key PCC elements to include in a future definition, and an overview of elements to consider for implementing PCC into practice. We extend existing literature by identifying clinician empowerment and culture change at the systems-level as two future areas to prioritize to enable routine integration of PCC into practice. PRACTICE IMPLICATIONS Findings may be useful for researchers and or health providers delivering and evaluating PCC.
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Affiliation(s)
| | | | | | | | | | - Jane Burns
- The University of British Columbia, Vancouver, Canada; Vancouver Coastal Health Authority, Vancouver, Canada
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | | | | | - Christiane A Hoppmann
- Department of Psychology, The University of British Columbia, Vancouver, Canada; Centre for Hip Health and Mobility, Vancouver, Canada
| | - Kenneth M Madden
- The University of British Columbia, Vancouver, Canada; Vancouver Coastal Health Authority, Vancouver, Canada; Centre for Hip Health and Mobility, Vancouver, Canada
| | - Morgan Price
- The University of British Columbia, Vancouver, Canada
| | - Dolores Langford
- The University of British Columbia, Vancouver, Canada; Vancouver Coastal Health Authority, Vancouver, Canada
| | - Maureen C Ashe
- The University of British Columbia, Vancouver, Canada; Centre for Hip Health and Mobility, Vancouver, Canada.
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Ashe MC, Azim FT, Ariza‐Vega P, Burns J, Clemson L, Grover S, Hoppmann CA, Langford D, Fleig L, Burton E. Determinants of implementing reablement into research or practice: A concept mapping study. Physiotherapy Res Intl 2022; 27:e1949. [DOI: 10.1002/pri.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/04/2022] [Accepted: 03/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Maureen C. Ashe
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
| | - Farah Tabassum Azim
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
| | | | - Jane Burns
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
- Department of Physical Therapy The University of British Columbia Vancouver British Columbia Canada
| | - Lindy Clemson
- Sydney School of Health Sciences The University of Sydney Sydney New South Wales Australia
| | - Sanya Grover
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
| | - Christiane A. Hoppmann
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
- Department of Psychology The University of British Columbia Vancouver British Columbia Canada
| | - Dolores Langford
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
- Department of Physical Therapy The University of British Columbia Vancouver British Columbia Canada
| | - Lena Fleig
- Department of Psychology Medical School Berlin Berlin Germany
| | - Elissa Burton
- Curtin School of Allied Health Curtin University Perth Western Australia Australia
- enAble Institute Curtin University Perth Western Australia Australia
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9
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Keller J, Kwasnicka D, Wilhelm LO, Lorbeer N, Pauly T, Domke A, Knoll N, Fleig L. Hand Washing and Related Cognitions Following a Brief Behavior Change Intervention During the COVID-19 Pandemic: a Pre-Post Analysis. Int J Behav Med 2021; 29:575-586. [PMID: 34843096 PMCID: PMC8628490 DOI: 10.1007/s12529-021-10042-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/12/2022]
Abstract
Background Effective hand washing (for at least 20 s, with water and soap) is one of the health behaviors protecting against infection transmissions. Behavior change interventions supporting the initiation and maintenance of hand washing are crucial to prevent infection transmissions. Based on the Health Action Process Approach, the aim of this research was to conduct a pre-post analysis of hand washing and related cognitions (i.e., intention, self-efficacy, self-monitoring), measured up to 100 days following an intervention. Methods A convenience sample of N = 123 participants (age: M = 23.96 years; SD = 5.82; 80% women) received a brief intervention (key behavior change techniques: information about health consequences of hand washing; action planning) and responded to daily diaries and questionnaires up to a 100-day follow-up. Two-level models were used to analyze data of n = 89 participants who provided longitudinal data. Results Hand washing and self-monitoring increased, whereas intention and self-efficacy decreased over time. Only self-monitoring was a consistent positive correlate of hand washing on a between-person level. Conclusions Hand washing and self-monitoring considerably increased over several weeks following the intervention. Future research testing the intervention against a control condition is needed to rule out that changes in behavior and cognitions might have been prompted by completing the daily diaries. Trial Registration German Clinical Trials Register; https://www.drks.de; registration number: DRKS00022067. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10042-w.
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Affiliation(s)
- Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Noemi Lorbeer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Theresa Pauly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Antonia Domke
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nina Knoll
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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10
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Warner LM, Fleig L, Wolff JK, Keller J, Schwarzer R, Nyman SR, Wurm S. What makes implementation intentions (in)effective for physical activity among older adults? Br J Health Psychol 2021; 27:571-587. [PMID: 34609039 DOI: 10.1111/bjhp.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For most populations, implementation intentions (IIs) facilitate physical activity (PA). However, for older adults, previous studies found mixed evidence for the effectiveness of this behaviour change technique. To examine which characteristics of IIs predict successful enactment, the content of older participants' IIs formed within a self-regulatory intervention to prompt PA was analysed. DESIGN A sample of N = 126 German speaking adults aged 64 and older formed up to six IIs for PA and reported their enactment 5 weeks later. METHODS Controlling for age and sex, multilevel models tested associations between characteristics of IIs (e.g., chronological rank of II, hetero- and homogeneity, specificity, presence of certain cues) and enactment. RESULTS Significantly related to enactment were: the chronological rank of an II (first IIs superior to last IIs), greater heterogeneity in activities, greater specificity of when-cues, and greater use of pre-existing routines. CONCLUSIONS Participants were more likely to enact their IIs 5 weeks later if they planned different (heterogeneous) activities, created IIs with more specific when-cues (e.g., on Monday at 9 am), and in particular a routine (e.g., after breakfast). They also enacted the first three IIs (chronological rank of II) more often than the last three IIs. Future experimental studies should test whether providing instructions to create IIs based on the above significant characteristics lead to more effective health behaviour change among older adults.
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Affiliation(s)
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Germany
| | - Julia Katharina Wolff
- IGES Institute Berlin, Germany.,Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Jan Keller
- Health Psychology, Freie Universität Berlin, Germany
| | - Ralf Schwarzer
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Samuel R Nyman
- Bournemouth University Clinical Research Unit, Bournemouth University, UK
| | - Susanne Wurm
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Germany
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11
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Lippke S, Keller F, Derksen C, Kötting L, Ratz T, Fleig L. Einsam(er) seit der Coronapandemie: Wer ist besonders betroffen? – psychologische Befunde aus Deutschland. Präv Gesundheitsf 2021. [PMCID: PMC7947937 DOI: 10.1007/s11553-021-00837-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund Soziale Isolation ist ein Risikofaktor für Einsamkeit und damit für gesundheitliche Beeinträchtigungen. Veränderungen im Zusammenhang mit der Coronapandemie in Deutschland gilt es besser zu verstehen. Fragestellung Ziel der Studie war es, Einsamkeit und assoziierte Faktoren vor und während der Coronapandemie in Deutschland systematisch zu untersuchen. Die Fragestellungen waren: 1. Wie einsam fühlen sich Menschen vor und während der Coronapandemie? 2. Wie viele Menschen fühlen sich seit Beginn der Coronapandemie einsamer? 3. Wie viele Menschen berichten über gesundheitliche Belastungen während der Coronapandemie? Material und Methoden Im Jahr 2019 (vor der Coronapandemie) wurden 1003 und im Jahr 2020 (während der Coronapandemie) 1050 Erwachsene online befragt (51 % Frauen; 18–90 Jahre). Ergebnisse Es fühlten sich 10,8 % vs. 26,6 % der Befragten vor bzw. seit der Coronapandemie mehrfach pro Woche oder täglich einsam. Alleinlebende, Frauen und Jüngere fühlten sich häufiger einsam. Seit der Coronapandemie fühlten sich 30,8 % einsamer, v. a. Jüngere. Von starken gesundheitlichen Belastungen berichteten 18,9 %, dies hing mit jüngerem Alter, verschiedenen Sorgen/Ängsten und Einsamkeit zusammen. Diskussion Die höhere Ausprägung der Einsamkeit und Sorgen während der Coronapandemie sollte bei verhaltensbezogenen Maßnahmen zur Prävention der psychischen und körperlichen Beeinträchtigungen sowie behördlichen Maßnahmen berücksichtigt werden. Jüngere Menschen und Alleinlebende könnten profitieren, indem sie zu gezielten Bewältigungsstrategien (z. B. angemessener Nutzung digitaler Medien) ermutigt werden.
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Affiliation(s)
- Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Deutschland
| | - Franziska Keller
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Deutschland
| | - Christina Derksen
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Deutschland
| | - Lukas Kötting
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Deutschland
| | - Tiara Ratz
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Deutschland
| | - Lena Fleig
- MSB Medical School Berlin/Hochschule für Gesundheit und Medizin, Berlin, Deutschland
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12
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Ashe MC, Santos IKD, Edward NY, Burnett LA, Barnes R, Fleig L, Puyat JH, Sale JEM, McKay HA, Giangregorio LM. Physical Activity and Bone Health in Men: A Systematic Review and Meta-Analysis. J Bone Metab 2021; 28:27-39. [PMID: 33730781 PMCID: PMC7973404 DOI: 10.11005/jbm.2021.28.1.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/31/2020] [Indexed: 01/19/2023] Open
Abstract
Background Research on osteoporosis and physical activity often focuses on women. We aimed to conduct a systematic review to assess the benefits and harms of physical activity interventions for men’s bone health. Methods We used standard methods and searched for randomized controlled trials (RCTs) (duration, ≥6 months) published in all languages across multiple databases and trial registries. The last search was conducted on July 22, 2020. Results We included 11 studies (14 publications), resulting in a sample of N=723 men (range, 17–132 participants). We found low-certainty evidence that physical activity has little influence on the areal bone mineral density (aBMD) at the total hip (5 RCTs, N=324; mean difference [MD], 0.03 [95 confidence interval (CI), 0.01 to 0.05]) and little or no influence on the aBMD at the femoral neck (3 RCTs, N=186; MD, 0.00 [95% CI, −0.04 to 0.04]), lumbar spine (3 RCTs; N=213; MD, 0.05 [95% CI, −0.01 to 0.11]), and whole body (4 RCTs, N=203; MD, −0.00 [95% CI, −0.03 to 0.02]). Conclusions We found low-certainty evidence that physical activity (≥6 months) has some effect on the total hip in men, but new evidence may change this finding. This review highlights the gap in the evidence on specific intervention prescriptions that can benefit the bone geometry, structure, microarchitecture, and, ultimately, bone strength in men. Future research should engage in comprehensive reporting of harms, quality of life outcomes, advanced imaging findings, and long-term interventions.
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Affiliation(s)
- Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Isis Kelly Dos Santos
- Department of Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Nicola Y Edward
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada
| | - Laura A Burnett
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada
| | - Rosanne Barnes
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Joseph H Puyat
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Joanna E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Canada.,Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Canada
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13
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Keller J, Kwasnicka D, Klaiber P, Sichert L, Lally P, Fleig L. Habit formation following routine-based versus time-based cue planning: A randomized controlled trial. Br J Health Psychol 2021; 26:807-824. [PMID: 33405284 DOI: 10.1111/bjhp.12504] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/23/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Habit formation has been identified as one of the key determinants of behaviour change. To initiate habit formation, self-regulation interventions can support individuals to form a cue-behaviour plan and to repeatedly enact the plan in the same context. This randomized controlled trial aimed to model habit formation of an everyday nutrition behaviour and examined whether habit formation and plan enactment differ when individuals plan to enact their behaviour in response to a routine-based versus time-based cue. DESIGN Following a baseline assessment, N = 192 adults (aged 18-77 years) were randomly assigned to a routine-based cue or a time-based cue planning intervention, in which they selected an everyday nutrition behaviour and linked it to a daily routine or a time cue. METHODS Participants responded to daily questionnaires over 84 days assessing plan enactment and the behaviour's automaticity (as an indicator of habit formation). Multilevel models with days nested in participants were fitted. RESULTS As indicated by asymptotic curves, it took a median of 59 days for participants who successfully formed habits to reach peak automaticity. Group-level analyses revealed that both routine-based and time-based cue planning led to increases in automaticity and plan enactment, but no between-condition differences were found. Repeated plan enactment was a key predictor for automaticity. CONCLUSIONS Linking one's nutrition behaviour to a daily routine or a specific time was similarly effective for habit formation. Interventions should encourage persons to repeatedly carry out their planned behaviour in response to the planned cue to facilitate habit formation.
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Affiliation(s)
- Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Dominika Kwasnicka
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Patrick Klaiber
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lena Sichert
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
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14
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Steckhan GMA, Fleig L, Schwarzer R, Warner LM. Perceived Physical Functioning and Gait Speed as Mediators in the Association Between Fear of Falling and Quality of Life in Old Age. J Appl Gerontol 2020; 41:421-429. [PMID: 33305984 DOI: 10.1177/0733464820979188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = -.27; 95% CI [-0.007, -0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = -.03; 95% CI [-0.06, -0.001]; R2 = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.
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Affiliation(s)
| | | | - Ralf Schwarzer
- Freie Universität Berlin, Germany.,SWPS University of Social Sciences and Humanities, Warsaw, Poland
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15
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Arnautovska U, Fleig L, O'callaghan F, Hamilton K. Older Adults’ Physical Activity: The Integration of Autonomous Motivation and Theory of Planned Behaviour Constructs. Australian Psychologist 2020. [DOI: 10.1111/ap.12346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Urska Arnautovska
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University,
| | - Lena Fleig
- Health Psychology/Social, Organisational and Economic Psychology, Freie Universität Berlin, and
| | - Frances O'callaghan
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University,
| | - Kyra Hamilton
- School of Psychology and Health Psychology and Behavioural Medicine Research Group, Curtin University
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16
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Cooke R, Beccaria F, Demant J, Fernandes-Jesus M, Fleig L, Negreiros J, Scholz U, de Visser R. Patterns of alcohol consumption and alcohol-related harm among European university students. Eur J Public Health 2020; 29:1125-1129. [PMID: 31079149 DOI: 10.1093/eurpub/ckz067] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To compare patterns of alcohol consumption and alcohol-related harm from a survey of university students sampled from universities in Denmark, England, Germany, Italy, Portugal and Switzerland. METHODS A total of 2191 university students (70% female, 90% white ethnic group, age range 18-25) completed the survey. Participants completed measures of demographic variables (age, age of onset, ethnic group and sex) and the Alcohol Use Disorders Identification Test (AUDIT), which was the primary outcome. RESULTS Sixty-three percent of the sample scored negative for harmful drinking on the AUDIT (<8), with 30% categorized as hazardous drinkers, 4% harmful drinkers and 3% with probable dependence. Analysis of variance, including demographic factors as covariates, identified a main effect of country on AUDIT scores F(5, 2086) = 70.97, P < 0.001, partial eta square = 0.15. AUDIT scores were highest in England (M = 9.99; SD = 6.17) and Denmark (M = 9.52; SD = 4.86) and lowest in Portugal (M = 4.90; ° = 4.60). Post hoc tests indicated large effect size differences between scores in Denmark and England and scores in all other countries (0.79 < d < 0.94; all P's < 0.001). CONCLUSIONS European university students in our sample mainly reported low risk patterns of alcohol consumption and alcohol-related harm. However, students from Northern European countries had significantly higher AUDIT scores compared with students from Central and Southern European countries. Research is needed to replicate the present study using nationally representative samples to estimate the prevalence of alcohol use disorders among university students in different European countries.
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Affiliation(s)
| | | | | | | | - Lena Fleig
- MSB Medical School Berlin, Berlin, Germany
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17
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Levy E, Warner LM, Fleig L, Kaufman MR, Deschepper R, Gidron Y. The effects of psychological inoculation on condom use tendencies and barriers; a randomized controlled trial. Psychol Health 2020; 36:575-592. [PMID: 32498613 DOI: 10.1080/08870446.2020.1775832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Condom use prevents the contraction of the HIV. Research shows limited effects of education on increasing condom use. Psychological inoculation (PI) has been found to be more effective in this domain, however, its mechanism is unknown. This study examined effects of PI versus education on condom use barriers and tendencies, and its relations with cognitive dissonance, using a fully automatized online system. DESIGN The study was a randomized controlled trial (RCT) and included 149 students from a German University randomly assigned to PI or a control condition. MAIN OUTCOME MEASURES An indirect condom use test (I-CUTE), a condom use barriers questionnaire, self-reported condom use, and cognitive dissonance estimations were all assessed at baseline and one-month post-intervention. RESULTS PI significantly increased I-CUTE scores when participants had sexual relations. Control participants increased in self-reported condom use and on I-CUTE scores in people without sexual relations. No changes in barriers were seen in either group. The cognitive dissonance tended to be higher in PI participants as compared to control participants. CONCLUSIONS PI increases I-CUTE scores compared to controls (based on effect sizes), and significantly in those with sexual relations. The role of relationship status and the mechanisms of PI should be further examined.
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Affiliation(s)
- Einav Levy
- Faculty of Medicine and Pharmacy, Free University of Brussels (VUB), Brussels, Belgium.,The Israeli School of Humanitarian Action, Tel Aviv, Israel
| | - Lisa M Warner
- Department of Psychology, Health Psychology, Faculty of Natural Sciences, MSB Medical School Berlin, Berlin, Germany
| | - Lena Fleig
- Department of Psychology, Health Psychology, Faculty of Natural Sciences, MSB Medical School Berlin, Berlin, Germany
| | - Michelle R Kaufman
- Department of Health, Behavior & Society, Blomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Reginald Deschepper
- Faculty of Medicine and Pharmacy, Free University of Brussels (VUB), Brussels, Belgium
| | - Yori Gidron
- The Israeli School of Humanitarian Action, Tel Aviv, Israel.,Department of Nursing, Haifa University, Haifa, Israel
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18
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Zusman EZ, Dawes M, Fleig L, McAllister MM, Cook WL, Guy P, Brasher PMA, McKay HA, Khan KM, Ashe MC. Older Adults' Sedentary Behavior and Physical Activity After Hip Fracture: Results From an Outpatient Rehabilitation Randomized Controlled Trial. J Geriatr Phys Ther 2020; 42:E32-E38. [PMID: 30028352 DOI: 10.1519/jpt.0000000000000193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Prolonged sedentary time and limited physical activity can result in deleterious effects on health and mobility, especially for older adults with fall-related hip fracture. Therefore, the purpose of this study was to examine the effect of a multidisciplinary clinic on sedentary behavior and physical activity (prespecified secondary outcomes) and provide descriptions of activity patterns over 1 year for men and women. METHODS We conducted a parallel-group, single-blinded randomized controlled trial comparing a multidisciplinary clinic and usual care (intervention) with usual care (control). We recruited 53 community-dwelling older adults aged 65+ years who were 3 to 12 months postfracture and collected data at baseline, 6, and 12 months; study staff were blinded to group allocation. The clinic included a geriatric assessment by the geriatrician, physiotherapist, and occupational therapist. Referrals were made to other professionals, when indicated. We collected the accelerometer-measured sedentary behavior and physical activity at 3 time points. We used linear mixed-effects models to compare groups at 6 and 12 months and mixed models to compare outcomes between men and women. RESULTS Participants were sedentary for more than 10 hours of a 13-hour day, and there were no significant differences between the study groups at 6 months (2.4 [95% confidence interval: -22.4 to 27.2] minutes) or 12 months (-3.7 [95% confidence interval: -33.6 to 26.1] minutes). Compared with women, men spent 47.2 min/d more in sedentary time (P = .052) and 43.8 min/d less in light physical activity (P = .047). DISCUSSION Older adults after hip fracture spend prolonged periods of waking hours sedentary with very little activity.
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Affiliation(s)
- Enav Z Zusman
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Martin Dawes
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Lena Fleig
- Health Psychology/Social, Organizational and Economic Psychology, Freie Universität Berlin, Berlin, Germany
| | - Megan M McAllister
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Wendy L Cook
- Division of Geriatric Medicine, Department of Medicine, The University of British Columbia, Vancouver, Canada.,Providence Healthcare, Toronto, Ontario, Canada
| | - Pierre Guy
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada.,School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
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19
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Kramer F, Labudek S, Jansen CP, Nerz C, Fleig L, Clemson L, Becker C, Schwenk M. Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing. Pilot Feasibility Stud 2020; 6:6. [PMID: 31993213 PMCID: PMC6975023 DOI: 10.1186/s40814-019-0539-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Lifestyle-integrated Functional Exercise (LiFE) programme is a fall prevention programme originally taught in a resource-intensive one-to-one format with limited feasibility for large-scale implementation. The aim of this paper is to present the conceptual framework and initial feasibility evaluation of a group-based LiFE (gLiFE) format developed for large-scale implementation. METHODS The conceptual gLiFE framework (part I) is based on three pillars, LiFE Activities and Principles, Theory of Behaviour Change and Behaviour Change Techniques, and Instruction. The feasibility of gLiFE was tested (part II) within a multimodal approach including quantitative questionnaires measuring safety, acceptability (1 = best to 7 = insufficient), and adherence to the LiFE activities (range = 0-14) as well as a focus group interview. Exploratory self-reported measures on behaviour change including self-determined motivation (range = 1-5), intention, planning, action control, and habit strength (range = 1-6) were assessed pre and post intervention. Data analyses were performed using descriptive statistics and qualitative content analysis. RESULTS The development process resulted in a manualised gLiFE concept containing standardised information on gLiFE's content and structure. Feasibility testing: Six older adults (median = 72.8 years, 5 female) completed the feasibility study and rated safety (median = 7.0, IQR = 0.3) and acceptability as high (median = 1, IQR = 1). Participants implemented 9.5 LiFE activities (IQR = 4.0) into their daily routines. No adverse events occurred during the study. In the focus group, the group format and LiFE activities were perceived as positive and important for maintaining strength and balance capacity. Self-determined motivation intention, planning, and habit strength were rated higher post intervention. CONCLUSION The developed conceptual gLiFE framework represents the basis for a gLiFE format with potential for standardised large-scale implementation. Proof-of-concept could be demonstrated in a group of community-dwelling older adults at risk of falling. The public health potential of gLiFE in terms of (cost-)effectiveness is currently being evaluated in a large trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03412123. Registered on January 26, 2018.
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Affiliation(s)
- Franziska Kramer
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | | | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Lena Fleig
- Faculty of Natural Sciences, Department of Psychology, Health Psychology, Medical School Berlin, Berlin, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
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20
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Domke A, Keller J, Fleig L, Knoll N, Schwarzer R. What makes a good action plan? Characteristics and enactment of fruit and vegetable plans. Appetite 2019; 142:104351. [PMID: 31279822 DOI: 10.1016/j.appet.2019.104351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND One promising intervention strategy to increase fruit and vegetable (FV) consumption is action planning. However, conditions of successful plan enactment, i.e., the translation of plans into action, have rarely been studied. Therefore, the relationship between plan characteristics and plan enactment is being examined. METHODS Secondary analyses of an existing data set were conducted, based on a larger behavioral intervention study with a baseline assessment as well as a 2-weeks and a 4-weeks follow-up. After baseline assessment, participants completed action plan calendars for the following seven days and subsequently reported on each plan's enactment. Two independent raters coded 1732 morning, noon/afternoon, and evening plans by n = 92 individuals regarding the level of specificity (unspecific vs. specific) and type of planned behavior (fruit vs. vegetable intake). To predict plan enactment, multilevel logistic regression analyses were conducted. FINDINGS Overall specificity of plans was unrelated to plan enactment, but interacted with time of day in predicting plan enactment. Only in the morning, specific plans were more likely being enacted than unspecific plans. Overall, plan enactment decreased during the day and throughout the seven days of the plan calendar. Furthermore, fruit plans were more likely being enacted than vegetable plans. DISCUSSION Specific morning plans were found most beneficial for the enactment of FV plans. Here, possible underlying mechanisms such as stable morning routines should be further investigated. Moreover, the nutritional choice appeared to make a difference for plan enactment: Increasing one's fruit consumption may be easier than integrating more vegetables into one's daily diet.
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Affiliation(s)
- Antonia Domke
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Jan Keller
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Berlin, Germany
| | - Lena Fleig
- Department of Natural Sciences, Health Psychology, Medical School Berlin, Berlin, Germany
| | - Nina Knoll
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Berlin, Germany
| | - Ralf Schwarzer
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Berlin, Germany; SWPS University of Social Sciences and Humanities, Wroclaw, Poland
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21
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Ashe MC, Edwards NY, Taylor A, Burnett L, Giangregorio L, Milne K, Clemson L, Fleig L. Return to Everyday Activity in the Community and Home: a feasibility study for a lifestyle intervention to sit less, move more, and be strong. Pilot Feasibility Stud 2019; 5:84. [PMID: 31297236 PMCID: PMC6599351 DOI: 10.1186/s40814-019-0467-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Many interventions designed to meet physical activity guideline recommendations focus on a single component (e.g., walking), to the detriment of other elements of a healthy lifestyle, such as reducing prolonged sitting and doing balance and strength exercises (i.e., bundled multiple behaviors). Adopting these multiple health behaviors within daily life routines may facilitate uptake and support longer-term behavior change. We tested feasibility for a three-part lifestyle intervention to support older women to sit less, move more, and complete balance and strength exercises. METHODS We used a convergent parallel mixed-methods, single-arm study design to test feasibility for a 6-week lifestyle intervention: Return to Everyday Activities in the Community and Home (REACH). We collected information at baseline, 3 and 6 weeks (final), and 6 months (follow-up) using questionnaires, semi-structured interviews, and performance-based measures. We describe three key elements: (1) implementation factors such as recruitment, retention, program delivery, and adherence; (2) participants' acceptability and experience with the program; and (3) health outcomes, including participants' global mobility, activity, and perceptions of their physical activity identity, and habit strength for (i) physical activity, (ii) breaking up sitting time, and (iii) balance and strength exercises. RESULTS We were able to recruit enough participants in the allotted time to conduct one cycle of the REACH group-based program. There were 10 community-dwelling women, median (p25, p75) age 61 (57.5, 71) years, who completed the study. The program was feasible to deliver, with high attendance (mean 5/6 sessions) and positive overall ratings (8/10). Participants rated session content and length high, and educational materials as highly acceptable and understandable. Although participants were active walkers at baseline, few were breaking up prolonged sitting or participating in any balance and strength exercises. At final and follow-up assessments, participants reported developing habits for all three health behaviors, without diminishing physical activity. CONCLUSION These results show acceptability of the program and its materials, and feasibility for bundling multiple health behaviors within the REACH program. It also provides confirmation to advance to testing feasibility of this three-part lifestyle intervention with older, less active, adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT02786394; May 18, 2016.
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Affiliation(s)
- Maureen C. Ashe
- Department of Family Practice, Centre for Hip Health and Mobility, 7F–2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- The University of British Columbia, Vancouver, Canada
- The University of Adelaide, Adelaide, Australia
| | - Nicola Y. Edwards
- Department of Family Practice, Centre for Hip Health and Mobility, 7F–2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | | | - Laura Burnett
- Department of Family Practice, Centre for Hip Health and Mobility, 7F–2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Lora Giangregorio
- University of Waterloo, Waterloo, Canada
- Schlegel Research Institute for Aging, Waterloo, Ontario Canada
| | - Kate Milne
- Cardea Health Consulting, Vancouver, Canada
| | | | - Lena Fleig
- MSB Medical School Berlin, Berlin, Germany
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Fleig L, C. Ashe M, Keller J, Lippke S, Schwarzer R. Putting psychology into telerehabilitation: Coping planning as an example for how to integrate behavior change techniques into clinical practice. AIMS Medical Science 2019. [DOI: 10.3934/medsci.2019.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
PURPOSE/OBJECTIVE After rehabilitation, it is important to maintain adopted target behaviors such as physical activity and physical exercise. By generating detailed behavioral plans, rehabilitants may translate their intentions into actual behavior. The aim of this study was to investigate whether Conscientiousness would further facilitate this mechanism in a way that rehabilitants who are more conscientious would be more likely to act upon their plans. Research Method/Design: The study presents secondary analyses from a larger intervention in cardiac and orthopedic rehabilitation. N = 136 rehabilitants were surveyed via online questionnaires during treatment (Time 1 [T1]) and with computer-assisted telephone interviews (CATIs) 6 weeks (Time 2 [T2]) and 6 months (Time 3 [T3]) after discharge from the clinic. Intention, planning, Conscientiousness, and behavior were measured. A conditional process analysis examined whether Conscientiousness moderates the intention-planning-physical activity chain. RESULTS Planning had a mediating effect on intentions and physical activity. Moreover, this mediation effect was conditional on the level of Conscientiousness: Highly conscientious rehabilitants were more successful in translating their plans into behavior than their less conscientious counterparts. CONCLUSIONS/IMPLICATIONS Self-regulatory mechanisms such as action-facilitating planning strategies may be more efficient in conscientious rehabilitants. Conscientiousness reflects dispositional self-regulation and can be supportive when it comes to maintain difficult behaviors. Lack of Conscientiousness needs to be compensated by more intense support of rehabilitation patients, in order to plan appropriately and to act upon these plans in the face of barriers. (PsycINFO Database Record
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Affiliation(s)
- Sonia Lippke
- Department of Psychology & Methods/Focus Area Diversity, Jacobs University Bremen
| | - Sarah Pomp
- Department of Prävention, AOK Bundesverband
| | - Lena Fleig
- Department of Education and Psychology, Freie Universität Berlin
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Hamilton K, Fleig L, Henderson J, Hagger MS. Being active in pregnancy: Theory-based factors associated with physical activity among pregnant women. Women Health 2018; 59:1-16. [PMID: 30040597 DOI: 10.1080/03630242.2018.1452835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 12/22/2022]
Abstract
Although regular physical activity is recommended for pregnant women, compared to pre-pregnancy, antenatal physical activity often reduces or ceases completely. Drawing from the theory of planned behavior, self-determination theory, and theory on self-control, we aimed to test an integrative model of physical activity in a sample of pregnant women. The current study was conducted in Brisbane, Australia, in 2014-2015 using a prospective-correlational design with a one-week follow-up. Participants (N = 207, Time 1; Meanage = 30.03 years, SDage = 4.49 years) completed an initial survey measuring: intrinsic motivation from the self-determination theory, social cognitive constructs from the theory of planned behavior, and self-control from the self-control theory, followed by a self-report measure of physical activity one-week later (n = 117, Time 2). A well-fitting structural equation model accounted for 73 and 42 percent of the variance in intention and physical activity behavior, respectively. Perceived behavioral control and attitude, but not subjective norm, mediated the effect of intrinsic motivation on intention. Intention, perceived behavioral control, and self-control were positively associated with physical activity behavior. Future behavioral interventions aiming to promote physical activity during pregnancy, a period when the physical activity levels typically decline, should consider the multiple processes advocated in the integrative model as necessary for motivated action.
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Affiliation(s)
- Kyra Hamilton
- a School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Brisbane , Australia
- b School of Psychology, Health Psychology and Behavioural Medicine Research Group , Curtin University , Perth , Australia
| | - Lena Fleig
- c Department of Educational Science and Psychology , Freie Universität Berlin , Berlin , Germany
| | - Joanna Henderson
- a School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Brisbane , Australia
| | - Martin S Hagger
- a School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Brisbane , Australia
- b School of Psychology, Health Psychology and Behavioural Medicine Research Group , Curtin University , Perth , Australia
- d Faculty of Sport and Health Sciences , University of Jyväskylä , Jyväskylä , Finland
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Langford D, Edwards N, Gray SM, Fleig L, Ashe MC. "Life Goes On." Everyday Tasks, Coping Self-Efficacy, and Independence: Exploring Older Adults' Recovery From Hip Fracture. Qual Health Res 2018; 28:1255-1266. [PMID: 29460698 DOI: 10.1177/1049732318755675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Older adults face many challenges in the first few months after hip fracture. Rehabilitation holds promise to assist the recovery process. Therefore, we used semistructured interviews to explore older adults' and allied health professionals' acceptance of a rehabilitation intervention for hip fracture, and we described perceptions of the early recovery period (<4 months). Interviews were recorded and transcribed verbatim; three authors independently read the transcripts multiple times and together developed themes guided by Interpretive Description. Older adults described the intervention as acceptable and provided valuable feedback for its future implementation. Older adults also provided reflections on their experience of fracture recovery. Themes that emerged included physical limitations and loss of independence, the long recovery time, and coping with additional complications of living with multimorbidity. To overcome challenges, older adults identified the need for social support and physical activity, balanced by their own personal outlook.
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Affiliation(s)
- Dolores Langford
- 1 Vancouver Coastal Health, Vancouver, British Columbia, Canada
- 2 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicola Edwards
- 2 The University of British Columbia, Vancouver, British Columbia, Canada
- 3 Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Samantha M Gray
- 2 The University of British Columbia, Vancouver, British Columbia, Canada
- 3 Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Lena Fleig
- 4 Freie Universität Berlin, Berlin, Germany
- 5 Medical School Berlin, Berlin, Germany
| | - Maureen C Ashe
- 2 The University of British Columbia, Vancouver, British Columbia, Canada
- 3 Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
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C. Ashe M, L. Ekegren C, M. Chudyk A, Fleig L, K. Gill T, Langford D, Martin-Martin L, Ariza-Vega P. Telerehabilitation for community-dwelling middle-aged and older adults after musculoskeletal trauma: A systematic review. AIMS Medical Science 2018. [DOI: 10.3934/medsci.2018.4.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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C. Ashe M, Merali K, Edwards N, Schiller C, M. Hanson H, Fleig L, M. Khan K, L. Cook W, A. McKay H. Integrating research into clinical practice for hip fracture rehabilitation: Implementation of a pragmatic RCT. AIMS Medical Science 2018. [DOI: 10.3934/medsci.2018.2.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Schwarzer R, Warner L, Fleig L, Gholami M, Salvatore S, Cianferotti L, Ntzani E, Roman-Viñas B, Trichopoulou A, Brandi ML. Psychological mechanisms in a digital intervention to improve physical activity: A multicentre randomized controlled trial. Br J Health Psychol 2017; 23:296-310. [PMID: 29265563 DOI: 10.1111/bjhp.12288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 11/12/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The randomized controlled trial examined factors that might be responsible for individual differences in physical activity change among men and women who participated in a lifestyle intervention. The main purpose of the analyses regarded the role of psychological mechanisms involving motivation, planning, self-monitoring, and habit strength. DESIGN A two-arm digital intervention was conducted in Italy, Spain, and Greece to improve physical activity levels, with follow-ups at 3 and 6 months after baseline assessment. METHODS Participants were 1,564 adults at baseline, n = 638 at 6-month follow-up. Linear mixed models examined the intervention effects, and a two-group longitudinal structural equation model explored which psychological constructs (motivation, planning, self-monitoring, habit strength) were associated with changes in physical activity. RESULTS In addition to an overall increase in self-reported activity, there were interactions between time and sex and between time and experimental groups, and a triple interaction between time, sex, and experimental groups, indicating that men reported an increase in activity independent of groups, whereas women in the active control group did not benefit from the intervention. Planning, self-monitoring, and habit strength mediated sequentially between initial motivation and follow-up physical activity. CONCLUSIONS Although the intervention produced overall improvements in physical activity, the time-by-treatment interaction emerged only for women. The mechanism included a sequence leading from motivation via planning, self-monitoring, and habit strength towards physical activity. Statement of contribution What is already known on this subject? Digital lifestyle interventions can be effective in terms of physical activity performance gains. Men are on average more physically active than women. Long-term adherence rates to digital interventions are usually low. What does this study add? Giving users of an online platform more interactive options did not make a difference. Women gained more than men from adaptive, dynamic online platform content. Individual characteristics (motivation, planning, self-monitoring, habit) were more important than online treatment features.
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Affiliation(s)
- Ralf Schwarzer
- Freie Universität Berlin, Germany
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | | | | | | | - Sergio Salvatore
- Euro-Mediterranean Biomedical Scientific Institute, University of Salento, Lecce, Italy
| | | | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Greece
- Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Blanca Roman-Viñas
- Nutrition Research Foundation, University of Barcelona Science Park, Spain
- CIBER Physiopathology of Overweight and Nutrition (CIBERobn), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Maria L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Italy
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Schwarzer R, Warner LM, Fleig L, Gholami M, Serra-Majem L, Ngo J, Cianferotti L, Kritikou M, Mossi P, Ntzani E, Brandi ML. Dietary planning, self-efficacy, and outcome expectancies play a role in an online intervention on fruit and vegetable consumption. Psychol Health 2017; 33:652-668. [PMID: 28990404 DOI: 10.1080/08870446.2017.1385785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment. METHOD A two-arm digital intervention with 269 men and 395 women (Mage = 41.2, SDage = 11.45; range: 19-66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform. RESULTS Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes. CONCLUSION FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan.
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Affiliation(s)
- Ralf Schwarzer
- a Department of Psychology , Freie Universität Berlin , Berlin , Germany
| | - Lisa M Warner
- a Department of Psychology , Freie Universität Berlin , Berlin , Germany
| | - Lena Fleig
- a Department of Psychology , Freie Universität Berlin , Berlin , Germany
| | - Maryam Gholami
- a Department of Psychology , Freie Universität Berlin , Berlin , Germany
| | - Lluis Serra-Majem
- b Nutrition Research Foundation , University of Barcelona Science Park , Barcelona , Spain
| | - Joy Ngo
- b Nutrition Research Foundation , University of Barcelona Science Park , Barcelona , Spain
| | - Luisella Cianferotti
- c Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
| | | | - Piergiorgio Mossi
- e Department of Psychology , Istituto Scientifico Biomedico Euro Mediterraneo , Mesagne , Italy
| | - Evangelia Ntzani
- f Department of Hygiene and Epidemiology , University of Ioannina School of Medicine , Ioannina , Greece.,g Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health , Brown University , Providence , RI , USA
| | - Maria L Brandi
- h Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
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Fleig L, Gardner B, Keller J, Lippke S, Pomp S, Wiedemann AU. What contributes to action plan enactment? Examining characteristics of physical activity plans. Br J Health Psychol 2017; 22:940-957. [PMID: 28833976 DOI: 10.1111/bjhp.12263] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Individuals with chronic conditions can benefit from formulating action plans to engage in regular physical activity. However, the content and the successful translation of plans into action, so-called plan enactment, are rarely adequately evaluated. The aim of this study was to describe the content of user-specified plans and to examine whether participants were more likely to enact their plans if these plans were highly specific, viable, and instrumental. DESIGN AND METHODS The study presents secondary analyses from a larger behavioural intervention in cardiac and orthopaedic rehabilitation. The content of 619 action plans from 229 participants was evaluated by two independent raters (i.e., qualitative analyses and ratings of specificity) and by participants themselves (i.e., instrumentality and viability). Plan enactment was also measured via self-reports. Multilevel analyses examined the relationship between these plan characteristics and subsequent plan enactment, and between plan enactment and aggregated physical activity. RESULTS Participants preferred to plan leisure-time physical activities anchored around time-based cues. Specificity of occasion cues (i.e., when to act) and highly instrumental plans were positively associated with plan enactment. Interestingly, individuals who planned less specific behavioural responses (i.e., what to do) were more likely to enact their plans. Plan enactment was positively associated with aggregated behaviour. CONCLUSIONS Interventions should not only emphasize the importance of planning, but also the benefits of formulating specific contextual cues. Planning of the behavioural response seems to require less precision. Allowing for some flexibility in executing the anticipated target behaviour seems to aid successful plan enactment. Statement of Contribution What is already known on this subject? Action planning interventions are efficacious in promoting health behaviour. Characteristics of plan content (i.e., specificity) matter for unconditional behaviour change. Plan enactment (i.e., degree to which plan is followed through) is positively linked to behaviour change. What does this study add? Specificity of occasion cues (i.e., when to act) and highly instrumental plans were positively associated with plan enactment. Individuals who planned less specific behavioural responses (i.e., what to do) were more likely to enact their plans. Planning interventions should focus on specificity of context cues but flexibility of behavioural action.
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Affiliation(s)
- Lena Fleig
- Health Psychology, Freie Universität Berlin, Germany.,Social, Organizational and Economic Psychology, Freie Universität Berlin, Germany
| | | | - Jan Keller
- Health Psychology, Freie Universität Berlin, Germany
| | - Sonia Lippke
- Health Psychology, Jacobs University, Bremen, Germany
| | | | - Amelie U Wiedemann
- Health Psychology, Freie Universität Berlin, Germany.,DearEmployee GmbH, Berlin, Germany
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Keller J, Fleig L, Hohl DH, Wiedemann AU, Burkert S, Luszczynska A, Knoll N. Which characteristics of planning matter? Individual and dyadic physical activity plans and their effects on plan enactment. Soc Sci Med 2017; 189:53-62. [PMID: 28783502 DOI: 10.1016/j.socscimed.2017.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Past research supports individual planning as an effective intervention strategy to increase physical activity in individuals. A similar strategy, dyadic planning, adds a planning partner who supports an individual's planning processes. Whether the two planning formats differ in terms of participants' entered plan content and whether and how different content characteristics are linked to plan enactment remains unknown. By investigating the content of generated plans, this study aimed at distinguishing plan characteristics of the two planning formats and examining their role as predictors of later plan enactment. METHODS Secondary analyses of a three-arm RCT with German couples (data collection between 2013 and 2015). Couples were assigned to an individual (IPC, n = 114) or dyadic planning condition (DPC, n = 111) and formulated up to 5 physical activity plans for a target person. Couples assigned to a control condition were not included as they did not generate plans. The following characteristics were distinguished and coded for each plan: number of planned opportunities, presence of a planned routine, planned cue- or activity-related specificity, activity-related intensity, and chronological plan rank. One week before (T0) and two weeks following (T2) the intervention (T1), increase vs. no increase of the planned activity was coded as a dichotomous plan enactment variable. Multilevel logistic regressions were fit. RESULTS Plan enactment was higher in dyadic than in individual planners. Findings indicated that routines (e.g., after work) were positively related to plan enactment, whereas a high specificity of when-cues (e.g., Friday at 6.30 p.m.) showed a negative relationship. None of the examined plan characteristics could explain differences in enactment between IPC and DPC. CONCLUSIONS Linking health behaviours to other behavioural routines seems beneficial for subsequent plan enactment. Dyadic planning was linked with higher enactment rates than individual planning. However, as mechanisms underlying this effect remain unclear, they should be investigated further.
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Affiliation(s)
- Jan Keller
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany.
| | - Lena Fleig
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Diana Hilda Hohl
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Amelie U Wiedemann
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
| | - Silke Burkert
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Germany
| | - Aleksandra Luszczynska
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland; Trauma, Health, & Hazards Center, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | - Nina Knoll
- Department of Education and Psychology, Division Health Psychology, Freie Universität Berlin, Germany
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Cherneski N, Burnett L, Fleig L, Milne K, Giangregorio L, Clemson L, Ashe M. REACH FOR AN ACTIVE LIFESTYLE: PROGRAM FEASIBILITY AND PARTICIPANT PERCEPTIONS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N. Cherneski
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - L. Burnett
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - L. Fleig
- Freie Universität Berlin, Berlin, Germany,
| | - K. Milne
- Cardea Health Consulting, Vancouver, British Columbia, Canada,
| | | | - L. Clemson
- University of Sydney, Sydney, New South Wales, Australia
| | - M.C. Ashe
- Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada,
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
- The University of Adelaide, Adelaide, South Australia, Australia,
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Burnett L, Cherneski N, Fleig L, Milne K, Giangregorio L, Clemson L, Ashe M. REACH LIFESTYLE INTERVENTION: FEASIBILITY OF DELIVERING AN INSTRUCTOR TRAINING COURSE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L. Burnett
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - N. Cherneski
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - L. Fleig
- Freie Universität Berlin, Berlin, Germany,
| | - K. Milne
- Cardea Health Consulting, Vancouver, British Columbia, Canada,
| | | | - L. Clemson
- University of Sydney, Sydney, New South Wales, Australia
| | - M.C. Ashe
- Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada,
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
- The University of Adelaide, Adelaide, South Australia, Australia,
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Stott-Eveneshen S, Sims-Gould J, McAllister MM, Fleig L, Hanson HM, Cook WL, Ashe MC. Reflections on Hip Fracture Recovery From Older Adults Enrolled in a Clinical Trial. Gerontol Geriatr Med 2017; 3:2333721417697663. [PMID: 28540341 PMCID: PMC5433673 DOI: 10.1177/2333721417697663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/11/2016] [Accepted: 02/01/2017] [Indexed: 11/15/2022] Open
Abstract
This study describes patients' perspectives on recovery during participation in a randomized controlled trial that tested a postoperative hip fracture management program (B4 Clinic), compared with usual care, on mobility. Semistructured qualitative interviews were conducted with 50 older adults with hip fracture (from both groups) twice over 12 months. A total of 32 women (64%) and 18 men (36%) participated in the study with a mean age at baseline of 82 (range = 65-98) years. A total of 40 participants reported recovery goals at some point during their recovery from hip fracture but only 18 participants realized their goals within 12 months. Recovering mobility, returning to prefracture activities, and obtaining stable health were the most commonly reported goals. Participants described good social support, access to physiotherapy, and positive perspective as most important to recovery. These factors were influenced by participants' knowledge, resources, and monthly contact with study staff (perceived as a form of social support). The most frequently reported barriers to participants' recovery were the onset of complications, pain, and limited access to physiotherapy. Potential implications of these findings include design and modification of new or preexisting fracture programs, prioritizing patient engagement and enhanced knowledge for future clinical research in hip fracture recovery.
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Affiliation(s)
| | | | | | | | | | - Wendy L. Cook
- The University of British Columbia, Vancouver, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Maureen C. Ashe
- The University of British Columbia, Vancouver, Canada
- Maureen C. Ashe, Department of Family Practice, Centre for Hip Health and Mobility, The University of British Columbia, 7F-2635 Laurel Street, Robert H.N. Ho Research Centre, Vancouver, British Columbia, Canada V5Z 1M9.
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Arnautovska U, Fleig L, O'Callaghan F, Hamilton K. A longitudinal investigation of older adults' physical activity: Testing an integrated dual-process model. Psychol Health 2016; 32:166-185. [PMID: 27838920 DOI: 10.1080/08870446.2016.1250273] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the effects of conscious and non-conscious processes for prediction of older adults' physical activity (PA), we tested a dual-process model that integrated motivational (behavioural intention) and volitional (action planning and coping planning) processes with non-conscious, automatic processes (habit). METHOD Participants (N = 215) comprised community-dwelling older adults (M = 73.8 years). A longitudinal design was adopted to investigate direct and indirect effects of intentions, habit strength (Time 1), and action planning and coping planning (Time 2) on PA behaviour (Time 3). Structural equation modelling was used to evaluate the model. RESULTS The model provided a good fit to the data, accounting for 44% of the variance in PA behaviour at Time 3. PA was predicted by intentions, action planning, and habit strength, with action planning mediating the intention-behaviour relationship. An effect of sex was also found where males used fewer planning strategies and engaged in more PA than females. CONCLUSIONS By investigating an integration of conscious and non-conscious processes, this study provides a novel understanding of older adults' PA. Interventions aiming to promote PA behaviour of older adults should target the combination of psychological processes.
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Affiliation(s)
- Urska Arnautovska
- a School of Applied Psychology and Menzies Health Institute Queensland, Griffith University , Brisbane , Australia
| | - Lena Fleig
- b Health Psychology , Freie Universität Berlin , Berlin , Germany
| | - Frances O'Callaghan
- a School of Applied Psychology and Menzies Health Institute Queensland, Griffith University , Brisbane , Australia
| | - Kyra Hamilton
- a School of Applied Psychology and Menzies Health Institute Queensland, Griffith University , Brisbane , Australia.,c School of Psychology and Speech Pathology and Health Psychology and Behavioural Medicine Research Group, Curtin University , Perth , Australia
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Fleig L, Ashe MC, Voss C, Therrien S, Sims-Gould J, McKay HA, Winters M. Environmental and psychosocial correlates of objectively measured physical activity among older adults. Health Psychol 2016; 35:1364-1372. [PMID: 27505192 DOI: 10.1037/hea0000403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neighborhood environments can support or hinder physical activity especially as health declines with age. This study puts psychological theories of health behavior change in context with built environment research to better understand the interplay of environmental and psychosocial characteristics impacting older adults' sedentary behavior and physical activity. METHOD The Active Streets, Active People study recruited 193 older adults living in a highly walkable neighborhood in Vancouver, British Columbia, Canada. Participants completed questionnaires on attitudes toward walking, behavioral control for walking, and perceived built environment variables. To assess behavior, participants wore an ActiGraph GT3X + accelerometer for 7 consecutive days. Regression-based path analysis was conducted to examine whether the link between the perceived environment and behavior is mediated by psychosocial variables. RESULTS In total, 174 participants had valid accelerometry data (Mage = 70.3, SD = 7.2) and demonstrated a daily average of 525.7 min of sedentary behavior (SD = 65.1) as well as high levels of total physical activity (M = 254.3, SD = 65.1 min/day). Mediation analysis revealed that perceived street connectivity and diversity of land use were negatively related to sedentary behavior, but only indirectly through behavioral control. Similarly, effects of street connectivity and diversity of land use on physical activity were mediated by behavioral control. CONCLUSIONS Results highlighted that the perceived built environment is important for physical activity and sedentary behavior, largely because these environmental perceptions are positively linked to older adults' confidence in walking. By integrating environmental and psychosocial correlates of preventive health behaviors within a theoretical structure, the psychosocial mechanisms through which the environment affects activity can be better understood. (PsycINFO Database Record
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Affiliation(s)
| | | | - Christine Voss
- Department of Pediatrics, University of British Columbia
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Lippke S, Fleig L, Wiedemann AU, Schwarzer R. A Computerized Lifestyle Application to Promote Multiple Health Behaviors at the Workplace: Testing Its Behavioral and Psychological Effects. J Med Internet Res 2015; 17:e225. [PMID: 26429115 PMCID: PMC4642394 DOI: 10.2196/jmir.4486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preventive health behaviors, such as regular physical activity and healthy nutrition, are recommended to maintain employability and to facilitate the health of employees. Theory-based workplace health promotion needs to include psychological constructs and consider the motivational readiness (so-called stages of change) of employees. According to the stages, people can be grouped as nonintenders (not motivated to change and not performing the goal behavior), intenders (decided to adopt the goal behavior but not started yet), or actors (performing the goal behavior already). The tailoring to these stages can be done computer based and should make workplace health promotion more effective. OBJECTIVE It was tested whether a parsimonious computer-based health promotion program implemented at the workplace was effective in terms of lifestyle changes and psychological outcomes as well as body weight. We hypothesized that the stage-matched intervention would outperform the one-size-fits-all active control condition (standard care intervention). METHODS In a randomized controlled trial, a total of 1269 employees were recruited by a trained research assistant at their workplace during a routine medical examination. After excluding noneligible employees, 560 completed Time 1 (T1), and 384 also completed Time 2 (T2), achieving a retention rate of 68.6%. Two fully automated computer-based treatments were adopted: (1) an active control condition with information about benefits of exercise and healthy nutrition (n=52), or (2) a stage-matched multiple-behavior intervention that provided different psychological treatments to 9 subgroups, addressing stages of change (nonintenders, intenders, and actors per behavior; n=332). Baseline assessments (T1) on behavior, psychological constructs, and body weight were repeated after 4 weeks (T2). RESULTS The stage-matched intervention outperformed the active control condition for lifestyle changes containing physical activity and nutrition (χ(2) 1=3.5; P=.04, for N=384) as well as psychological variables (physical activity intention, P=.04; nutrition intention, P=.03; nutrition planning, P=.02; and general social support to live healthily, P=.01). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR, 2.25, 95% CI 1.73-2.92; P<.01) and the intervention (OR 1.96, 95% CI 1.00-3.82; P=.05) were found to be significant predictors. Physical activity planning mediated the effect of the intervention on the adoption of an overall healthy lifestyle (consisting of activity and nutrition, R(2) adj=.08; P<.01), indicating that if the stage-matched intervention increased planning, the adoption of a healthy lifestyle was more likely. CONCLUSIONS Matching an intervention to the motivational readiness of employees can make a health promotion program effective. Employees' motivation, planning, social support, and lifestyle can be supported by a stage-matched intervention that focuses on both physical activity and healthy nutrition. Occupational settings provide a potential to implement parsimonious computer-based health promotion programs and to facilitate multiple behavior change.
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Affiliation(s)
- Sonia Lippke
- Jacobs Center for Lifelong Learning and Institutional Development (JCLL), Focus Area Diversity, Health Psychology, Jacobs University Bremen, Bremen, Germany.
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Fleig L, Ngo J, Roman B, Ntzani E, Satta P, Warner LM, Schwarzer R, Brandi ML. Beyond single behaviour theory: Adding cross-behaviour cognitions to the health action process approach. Br J Health Psychol 2015; 20:824-41. [DOI: 10.1111/bjhp.12144] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 05/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Lena Fleig
- Health Psychology; Freie Universität Berlin; Germany
- Centre for Hip Health and Mobility; Vancouver British Columbia Canada
- Department of Family Practice; University of British Columbia; Vancouver British Columbia Canada
| | - Joy Ngo
- Nutrition Research Foundation; Barcelona Science Park; Spain
| | - Blanca Roman
- Nutrition Research Foundation; Barcelona Science Park; Spain
- EUSES Sports Science; University of Girona; Spain
| | - Evangelia Ntzani
- Clinical and Molecular Epidemiology Unit; Department of Hygiene and Epidemiology; University of Ioannina School of Medicine; Greece
| | - Paolo Satta
- Department of Surgery and Translational Medicine; University of Florence; Italy
| | | | - Ralf Schwarzer
- Institute for Positive Psychology and Education; Australian Catholic University; Sydney New South Wales Australia
| | - Maria L. Brandi
- Department of Surgery and Translational Medicine; University of Florence; Italy
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Fleig L, Küper C, Lippke S, Schwarzer R, Wiedemann AU. Cross-behavior associations and multiple health behavior change: A longitudinal study on physical activity and fruit and vegetable intake. J Health Psychol 2015; 20:525-34. [DOI: 10.1177/1359105315574951] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the interrelation of physical activity and fruit and vegetable intake. The influence of stage congruence between physical activity and fruit and vegetable intake on multiple behavior change was also investigated. Health behaviors, social-cognitions, and stages of change were assessed in 2693 adults at two points in time. Physical activity and fruit and vegetable intake were assessed 4 weeks after the baseline. Social-cognitions, stages as well as stage transitions across behavior domains were positively interrelated. Stage congruence was not related to changes in physical activity and fruit and vegetable intake. Physical activity and nutrition appear to facilitate rather than hinder each other. Having intentions to change both behaviors simultaneously does not seem to overburden individuals.
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Affiliation(s)
| | | | | | - Ralf Schwarzer
- Australian Catholic University, Australia
- University of Social Sciences and Humanities, Poland
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Reyes Fernández B, Fleig L, Godinho CA, Montenegro Montenegro E, Knoll N, Schwarzer R. Action control bridges the planning-behaviour gap: a longitudinal study on physical exercise in young adults. Psychol Health 2015; 30:911-23. [PMID: 25587901 DOI: 10.1080/08870446.2015.1006222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Maintaining physical exercise levels may not only require motivation and planning but also action control which is supposed to mediate between planning and exercise. DESIGN Behavioural intention, action planning, coping planning and past behaviour were assessed at baseline, and action control and concurrent exercise were measured one month later in 497 young adults. METHOD Three nested structural models were specified to examine different mediation mechanisms. One model reflected the intention-planning-behaviour chain, the other one focused on the intention-action control-behaviour chain and the third model comprised the full sequence. RESULTS Indirect effects from intentions on exercise involved either planning or action control as mediating variables. In Model 3, all three constructs (action planning, coping planning and action control) were sequential mediators between intentions and later physical exercise levels. Action and coping planning were not directly but indirectly related to exercise via action control. CONCLUSIONS Findings support the sequential mediation for planning and action control as antecedents of physical exercise. Action control is needed for exercise, because planning in itself is not always sufficient. Maintaining exercise levels may be attributed to effective self-regulatory strategies such as action control in combination with planning.
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Langford DP, Fleig L, Brown KC, Cho NJ, Frost M, Ledoyen M, Lehn J, Panagiotopoulos K, Sharpe N, Ashe MC. Back to the future - feasibility of recruitment and retention to patient education and telephone follow-up after hip fracture: a pilot randomized controlled trial. Patient Prefer Adherence 2015; 9:1343-51. [PMID: 26491262 PMCID: PMC4599063 DOI: 10.2147/ppa.s86922] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Our primary aim of this pilot study was to test feasibility of the planned design, the interventions (education plus telephone coaching), and the outcome measures, and to facilitate a power calculation for a future randomized controlled trial to improve adherence to recovery goals following hip fracture. DESIGN This is a parallel 1:1 randomized controlled feasibility study. SETTING The study was conducted in a teaching hospital in Vancouver, BC, Canada. PARTICIPANTS Participants were community-dwelling adults over 60 years of age with a recent hip fracture. They were recruited and assessed in hospital, and then randomized after hospital discharge to the intervention or control group by a web-based randomization service. Treatment allocation was concealed to the investigators, measurement team, and data entry assistants and analysts. Participants and the research physiotherapist were aware of treatment allocation. INTERVENTION Intervention included usual care for hip fracture plus a 1-hour in-hospital educational session using a patient-centered educational manual and four videos, and up to five postdischarge telephone calls from a physiotherapist to provide recovery coaching. The control group received usual care plus a 1-hour in-hospital educational session using the educational manual and videos. MEASUREMENT Our primary outcome was feasibility, specifically recruitment and retention of participants. We also collected selected health outcomes, including health-related quality of life (EQ5D-5L), gait speed, and psychosocial factors (ICEpop CAPability measure for Older people and the Hospital Anxiety and Depression Scale). RESULTS Our pilot study results indicate that it is feasible to recruit, retain, and provide follow-up telephone coaching to older adults after hip fracture. We enrolled 30 older adults (mean age 81.5 years; range 61-97 years), representing a 42% recruitment rate. Participants excluded were those who were not community dwelling on admission, were discharged to a residential care facility, had physician-diagnosed dementia, and/or had medical contraindications to participation. There were 27 participants who completed the study: eleven in the intervention group, 15 in the control group, and one participant completed a qualitative interview only. There were no differences between groups for health measures. CONCLUSION We highlight the feasibility of telephone coaching for older adults after hip fracture to improve adherence to mobility recovery goals.
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Affiliation(s)
- Dolores P Langford
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Lena Fleig
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Hip Health and Mobility, Vancouver, BC, Canada
- Freie Universität Berlin, Health Psychology, Berlin, Germany
| | - Kristin C Brown
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Nancy J Cho
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Maeve Frost
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Monique Ledoyen
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Jayne Lehn
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Kostas Panagiotopoulos
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
- Department of Orthopaedics, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Nina Sharpe
- Vancouver Coastal Health, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Hip Health and Mobility, Vancouver, BC, Canada
- Correspondence: Maureen C Ashe, Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada, Tel +1 604 675 2574, Fax +1 604 675 2576, Email
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Tsui K, Fleig L, Langford DP, Guy P, MacDonald V, Ashe MC. Exploring older adults' perceptions of a patient-centered education manual for hip fracture recovery: "everything in one place". Patient Prefer Adherence 2015; 9:1637-45. [PMID: 26604713 PMCID: PMC4655952 DOI: 10.2147/ppa.s86148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe older adults' perspectives on a new patient education manual for the recovery process after hip fracture. MATERIALS AND METHODS The Fracture Recovery for Seniors at Home (FReSH) Start manual is an evidence-based manual for older adults with fall-related hip fracture. The manual aims to support the transition from hospital to home by facilitating self-management of the recovery process. We enrolled 31 community-dwelling older adults with previous fall-related hip fracture and one family member. We collected data using a telephone-based questionnaire with eight five-point Likert items and four semi-structured open-ended questions to explore participants' perceptions on the structure, content, and illustration of the manual. The questionnaire also asked participants to rate the overall utility (out of 10 points) and length of the manual. We used content analysis to describe main themes from responses to the open-ended interview questions. RESULTS Participants' ratings for structure, content, and illustrations ranged from 4 to 5 (agree to highly agree), and the median usefulness rating was 9 (10th percentile: 7, 90th percentile: 10). Main themes from the content analysis included: ease of use and presentation; health literacy; illustration utility; health care team delivery; general impression, information support from hospital to home; emotional and decision-making support; and the novelty of the manual. CONCLUSION The FReSH Start manual was perceived as comprehensive in content and acceptable for use with older adults post-fall-related hip fracture. Participants expressed a need for delivery and explanation of the manual by a health care team member.
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Affiliation(s)
- Karen Tsui
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, The University of British Columbia, Vancouver, BC, Canada
| | - Lena Fleig
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
- Health Psychology, Freie Universität Berlin, Berlin, Germany
| | - Dolores P Langford
- Vancouver Coastal Health, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Pierre Guy
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, The University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
| | - Valerie MacDonald
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
- Fraser Health Authority, Surrey, BC, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
- Correspondence: Maureen C Ashe, Centre for Hip Health and Mobility, 7F – 2635 Laurel St, Vancouver, BC, Canada V5Z 1M9, Tel +1 604 675 2574, Fax +1 604 675 2576, Email
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Fleig L, Kerschreiter R, Schwarzer R, Pomp S, Lippke S. ‘Sticking to a healthy diet is easier for me when I exercise regularly’: Cognitive transfer between physical exercise and healthy nutrition. Psychol Health 2014; 29:1361-72. [DOI: 10.1080/08870446.2014.930146] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parschau L, Fleig L, Warner LM, Pomp S, Barz M, Knoll N, Schwarzer R, Lippke S. Positive Exercise Experience Facilitates Behavior Change via Self-Efficacy. Health Educ Behav 2014; 41:414-22. [PMID: 24722218 DOI: 10.1177/1090198114529132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Motivational processes can be set in motion when positive consequences of physical exercise are experienced. However, relationships between positive exercise experience and determinants of the motivational and the volitional phases of exercise change have attracted only sparse attention in research. METHOD This research examines direct and indirect associations between positive experience and motivational as well as volitional self-efficacy, intention, action planning, and exercise in two distinct longitudinal samples. The first one originates from an online observational study in the general population with three measurement points in time (N = 350) and the second one from a clinical intervention study in a rehabilitation context with four measurement points (N = 275). RESULTS Structural equation modeling revealed the following: Positive experience is directly related with motivational self-efficacy as well as intentions in both samples. In the online sample only, positive experience is associated with volitional self-efficacy. In each sample, experience is indirectly associated with action planning via motivational self-efficacy and intentions. Moreover, action planning, in turn, predicts changes in physical exercise levels. CONCLUSIONS Findings suggest a more prominent role of positive experience in the motivational than in the volitional phase of physical exercise change. Thus, this research contributes to the understanding of how positive experience is involved in the behavior change process.
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Affiliation(s)
| | - Lena Fleig
- Freie Universität Berlin, Berlin, Germany
| | - Lisa Marie Warner
- Freie Universität Berlin, Berlin, Germany German Centre of Gerontology, Berlin, Germany
| | - Sarah Pomp
- Freie Universität Berlin, Berlin, Germany
| | | | - Nina Knoll
- Freie Universität Berlin, Berlin, Germany
| | - Ralf Schwarzer
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia Freie Universität Berlin, Berlin, Germany
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Fleig L, Pomp S, Schwarzer R, Lippke S. Promoting exercise maintenance: how interventions with booster sessions improve long-term rehabilitation outcomes. Rehabil Psychol 2013; 58:323-33. [PMID: 24041250 DOI: 10.1037/a0033885] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Follow-up intervention boosters are supposed to promote exercise maintenance beyond initial treatment. The current quasi-experimental study investigated the benefits of adding telephone-delivered intervention boosters to a self-management exercise intervention for rehabilitants. Psycho-social mechanisms by which the intervention boosters promote exercise maintenance were examined. RESEARCH DESIGN Between 2009 and 2011, individuals in cardiac and orthopedic rehabilitation (N = 1,166) were allocated to either a self-management exercise intervention or a control group (i.e., questionnaire only). In addition to standard rehabilitation, participants in the intervention group were offered a series of telephone-delivered intervention boosters after 6 weeks and again after 6 months. Self-efficacy, action planning, and satisfaction with previous exercise outcomes were reassessed 12 months after discharge. Habit strength and exercise were measured 18 months after rehabilitation. RESULTS The intervention with boosters promoted the maintenance of planning, self-efficacy, satisfaction, exercise, and habit strength. Changes in exercise were simultaneously mediated by changes in planning, self-efficacy, and satisfaction. Changes in habit strength were sequentially mediated by planning and exercise. CONCLUSIONS Interventions with boosters that focus on action planning, self-efficacy, and satisfaction help to maintain self-directed postrehabilitation exercise. Frequent exercise performance, in turn, can strengthen exercise habits.
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Affiliation(s)
- Lena Fleig
- Department of Social and Economic Psychology, Freie Universität Berlin
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Koring M, Parschau L, Lange D, Fleig L, Knoll N, Schwarzer R. Preparing for physical activity: pedometer acquisition as a self-regulatory strategy. Appl Psychol Health Well Being 2013; 5:136-47. [PMID: 23457088 DOI: 10.1111/aphw.12003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
When people intend and plan to perform higher levels of physical activity, they do not start on impulse without preparing. Thus, preparation is a behavioral construct positioned between planning and target behavior. This may be reflected by the acquisition of sports equipment as well as monitoring devices such as pedometers. The research questions are who takes such preparatory action, whether picking up a complimentary pedometer can be predicted by self-efficacy and outcome expectancies, and whether this kind of preparatory action facilitates subsequent physical activity. A longitudinal physical activity survey was conducted with 143 university students who were offered a complimentary pedometer. Collecting this free gift served as indicator of preparatory behavior. Outcome expectancies and self-efficacy beliefs were specified as predictors of this behavior. Two weeks later, physical activity differences between the groups were determined. Collecting the pedometer was associated with higher levels of physical activity at follow-up. Outcome expectancies failed to predict the pedometer collection, but self-efficacy did. An interaction between these two factors indicated that self-efficacy compensated for low outcome expectancies. Pedometer acquisition signifies a preparatory action that is facilitated by self-efficacy. Positioned between planning and target behavior, they constitute a proximal self-regulatory step towards health behavior change.
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Affiliation(s)
- Milena Koring
- Department of Health Psychology, Freie Universität Berlin, Berlin, Germany.
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Pomp S, Fleig L, Schwarzer R, Lippke S. Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study. Int J Clin Health Psychol 2013. [DOI: 10.1016/s1697-2600(13)70001-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Parschau L, Fleig L, Koring M, Lange D, Knoll N, Schwarzer R, Lippke S. Positive experience, self-efficacy, and action control predict physical activity changes: a moderated mediation analysis. Br J Health Psychol 2012; 18:395-406. [PMID: 23013288 DOI: 10.1111/j.2044-8287.2012.02099.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/26/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Experiencing positive consequences of one's physical activity is supposed to facilitate further activity. This motivational outcome might be generated by an increase in perceived self-efficacy. In addition to such a mediator effect, we examine whether this applies generally or only under conditions of volitional control. For this purpose, perceived action control was considered as a putative moderator. DESIGN AND METHOD N = 193 students participated in a study with three measurement points in time. At baseline, positive experience with previous physical activity was measured as a predictor of physical activity. Two weeks later, self-efficacy and action control variables were assessed as putative mediator and moderator, respectively. After another 2 weeks, physical activity was measured as the outcome. A moderated mediation model was specified with baseline physical activity and sex as covariates. RESULTS Self-efficacy was found to mediate between initial positive experience and later physical activity, and this mediation was moderated by action control. CONCLUSIONS Participants' perceptions of positive experience were associated with their subsequent self-efficacy fostering physical activity. However, persons with low levels of action control did not translate positive experience into physical activity via self-efficacy. STATEMENT OF CONTRIBUTION What is already known on this subject? Numerous studies have shown that exercise-specific self-efficacy predicts subsequent physical activity. Prior positive experience with physical activity is suggested to be associated with exercise-specific self-efficacy. Furthermore, action control was found to be beneficial for the maintenance of physical activity. What does this study add? This study unveils the mechanisms between these social-cognitive determinants: our longitudinal results suggest that the mediation of positive experience and subsequent physical activity via self-efficacy is moderated by action control. Persons with low levels of action control did not translate positive experience into physical activity via self-efficacy.
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Affiliation(s)
- Linda Parschau
- Department of Health Psychology, Freie Universität Berlin, Germany.
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Pomp S, Fleig L, Schwarzer R, Lippke S. Depressive symptoms interfere with post-rehabilitation exercise: outcome expectancies and experience as mediators. PSYCHOL HEALTH MED 2012; 17:698-708. [PMID: 22416795 DOI: 10.1080/13548506.2012.661864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of the study was to examine the relationship between depressive symptoms and physical exercise by unveiling how outcome expectancies regarding exercise and positive exercise experience could mediate between depressive symptoms and exercise. A longitudinal study included 178 cardiac and orthopedic rehabilitation patients in Germany. Patients responded to psychometric scales at two points in time with a six-week interval, assessing depressive symptoms (Time 1), outcome expectancies regarding exercise (Time 1), exercise experiences (Time 2), and exercise behavior (Times 1 and 2). Depressive symptoms were negatively related to physical exercise (r =- 0.18), to positive outcome expectancies (r =- 0.23), and to positive exercise experiences (r =- 0.26). In a multiple-step mediation model, expectancies and experiences mediated between depressive symptoms and exercise. In total, 15% of the exercise variance was accounted for. Outcome expectancies and a lack of positive experience seem to partly explain why depressed individuals are less likely to exercise.
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Affiliation(s)
- Sarah Pomp
- Freie Universität Berlin, Berlin, Germany.
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