The origins of exercise adherence in the Canadian seniors population

This research identified and examined the responses of 19 physically active seniors to determine why they were physically active. The participants were physically active seniors, from the Niagara region who participated in physical activity 2, or more times per week. The purpose to this research was to determine what specific experiences or characteristics those seniors' possessed which motivated them to follow an exercise regime in later life. Three focus group interviews were conducted and participants responded to a set of predetermined questions. Responses to the interview questions were transcribed and analysed by comparing words and participant responses. This method of analysis is known as ethnographic summary. Themes, concepts, and experiences that emerged from the focus group interviews were also recorded according to systematic coding by way of content analysis. From this study, factors that predispose, enable, reinforce and prevent seniors from participating in exercise have been identified. Nine recommendations for improving seniors quality of life have also emerged from the study. Additionally, the findings from the study illustrate that those responsible for planning programs for seniors need to consider senior's wants and needs. Finally, the study also has educational implications. All participants in the study experienced a positive introduction to daily phyiscal activity through their school setting. Participants of the study believed, that their positive experiences at school, directly influenced their lifelong involvement in exercise.

Regular exercise participation mediates the affective response to acute bouts of vigorous exercise

Physical inactivity is a leading factor associated with cardiovascular disease and a major contributor to the global burden of disease in developed countries. Subjective mood states associated with acute exercise are likely to influence future exercise adherence and warrant further investigation. The present study examined the effects of a single bout of vigorous exercise on mood and anxiety between individuals with substantially different exercise participation histories. Mood and anxiety were assessed one day before an exercise test (baseline), 5 minutes before (pre-test) and again 10 and 25 minutes post-exercise. Participants were 31 university students (16 males, 15 females; Age M = 20), with 16 participants reporting a history of regular exercise with the remaining 15 reporting to not exercise regularly. Each participant completed an incremental exercise test on a Monark cycle ergometer to volitional exhaustion. Regular exercisers reported significant post-exercise improvements in mood and reductions in state anxiety. By contrast, non-regular exercisers reported an initial decline in post-exercise mood and increased anxiety, followed by an improvement in mood and reduction in anxiety back to pre-exercise levels. Our findings suggest that previous exercise participation mediates affective responses to acute bouts of vigorous exercise. We suggest that to maximise positive mood changes following exercise, practitioners should carefully consider the individual’s exercise participation history before prescribing new regimes.

Exercise barriers self-efficacy : development and validation of a subcale for individuals with cancer-related lymphedema

Background No tool exists to measure self-efficacy for overcoming lymphedema-related exercise barriers in individuals with cancer-related lymphedema. However, an existing scale measures confidence to overcome general exercise barriers in cancer survivors. Therefore, the purpose of this study was to develop, validate and assess the reliability of a subscale, to be used in conjunction with the general barriers scale, for determining exercise barriers self-efficacy in individuals facing lymphedema-related exercise barriers. Methods A lymphedema-specific exercise barriers self-efficacy subscale was developed and validated using a cohort of 106 cancer survivors with cancer-related lymphedema, from Brisbane, Australia. An initial ten-item lymphedema-specific barrier subscale was developed and tested, with participant feedback and principal components analysis results used to guide development of the final version. Validity and test-retest reliability analyses were conducted on the final subscale. Results The final lymphedema-specific subscale contained five items. Principal components analysis revealed these items loaded highly (> 0.75) on a separate factor when tested with a well-established nine-item general barriers scale. The final five-item subscale demonstrated good construct and criterion validity, high internal consistency (Cronbach’s alpha=0.93) and test-retest reliability (ICC=0.67, p< 0.01). Conclusions A valid and reliable lymphedema-specific subscale has been developed to assess exercise barriers self-efficacy in individuals with cancer-related lymphedema. This scale can be used in conjunction with an existing general exercise barriers scale to enhance exercise adherence in this understudied patient group.

Sedentariness and physical inactivity in diabetes: a case for home-based exercise prescription

Increasing proportions of the global population are being diagnosed with diabetes. It is anticipated that by 2030, 10% of the adult population worldwide will be living with this condition. Lifestyle factors can impact on the development, management and progression of diabetes. Obesity and sedentary living are contributory factors to the increased volume of diabetes. Physical activity offers those living with diabetes the opportunities to keep well and attain potentially more stable blood glucose control reducing the level of medical intervention required and delaying or preventing some of the life-changing complications that can derive from a diabetes diagnosis. Exercise interventions are effective in preventing and treating type-II diabetes. However, maintaining regular exercise routines, especially home-based exercises may provide a key for sustaining the health benefits.

Characteristics of preferred gait patterns: considerations for exercise prescription

Gait patterns have been widely studied in different fields of science for their particular characteristics. A dynamic approach of human locomotion considers walking and running as two stable behaviors adopted spontaneously under certain levels and natures of constraints. When no constraints are imposed, people naturally prefer to walk at the typical speed (i.e., around 4.5 km.h-1) that minimizes metabolic energy cost. The preferred walking speed (PWS) is also known to be an indicator of mobility and an important clinical factor in tracking impairements in motor behaviors. When constrained to move at higher speeds (e.g., being late), people naturally switch their preference to running for similar optimization reasons (e.g., physiological, biomechanical, perceptual, attentionnal costs). Indeed, the preferred transition speed (PTS) marks the natural seperation between walking and running and consistently falls within a speed range around 7.5 km.h-1. This chapter describes the constraint-dependant spontaneous organisation of the locomotor system, specifically on the walk-to-run speed continuum. We provide examples of the possibility of long-term adaptations of preferred behaviors to specific constraints such as factors related to traditional clothing or practice. We use knowledge from studies on preferred behaviors and on the relationship between affect and exercise adherence as a backdrop to prescribing a walk exercise program with an emphasis on populations with overweight or obesity.

The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design.

BACKGROUND: The Lung Cancer Exercise Training Study (LUNGEVITY) is a randomized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness (VO2peak), patient-reported outcomes, and the organ components that govern VO2peak in post-operative non-small cell lung cancer (NSCLC) patients. METHODS/DESIGN: Using a single-center, randomized design, 160 subjects (40 patients/study arm) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center (DUMC) will be potentially eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of four conditions: (1) aerobic training alone, (2) resistance training alone, (3) the combination of aerobic and resistance training, or (4) attention-control (progressive stretching). The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70% of the individually determined VO2peak for aerobic training and an intensity between 60 and 80% of one-repetition maximum for resistance training, for 30-45 minutes/session. Progressive stretching will be matched to the exercise groups in terms of program length (i.e., 16 weeks), social interaction (participants will receive one-on-one instruction), and duration (30-45 mins/session). The primary study endpoint is VO2peak. Secondary endpoints include: patient-reported outcomes (PROs) (e.g., quality of life, fatigue, depression, etc.) and organ components of the oxygen cascade (i.e., pulmonary function, cardiac function, skeletal muscle function). All endpoints will be assessed at baseline and postintervention (16 weeks). Substudies will include genetic studies regarding individual responses to an exercise stimulus, theoretical determinants of exercise adherence, examination of the psychological mediators of the exercise - PRO relationship, and exercise-induced changes in gene expression. DISCUSSION: VO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC. LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect. Overall, this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum. TRIAL REGISTRATION: NCT00018255.

Can a Manipulated Mind Alter Matter? : The Effects of Verbal Feedback on Self-Efficacy, Exercise Intention, and Exercise Behaviour among Low-Active College-Aged Women

Self-efficacy (SE), a person’s confidence in the ability to perform a task, is an important predictor of the adoption and maintenance of physical activity. The present study examined the effects of SE manipulated through verbal persuasion on exercise intentions and behaviour during a 4-week follow-up period and investigated the role of social physique anxiety (SPA) as a moderator. Female college infrequent exercisers (n = 66) were randomly assigned into one of three groups (high-efficacy [HE], low-efficacy [LE], or control) and asked to complete several questionnaires at baseline. The HE and LE groups were provided with positive and negative exercise adherence feedback, respectively. The HE group reported higher SE from pre- to post-feedback. Both the HE and LE groups reported increases in exercise behaviour at the 4-week follow-up. Pre- to post-feedback changes in SE, exercise intention, and exercise behaviour did not depend on level of SPA reported.

Regular exercise participation mediates the affective response to acute bouts of vigorous exercise

Physical inactivity is a leading factor associated with cardiovascular disease and a major contributor to the global burden of disease in developed countries. Subjective mood states associated with acute exercise are likely to influence future exercise adherence and warrant further investigation. The present study examined the effects of a single bout of vigorous exercise on mood and anxiety between individuals with substantially different exercise participation histories. Mood and anxiety were assessed one day before an exercise test (baseline), 5 minutes before (pre-test) and again 10 and 25 minutes post-exercise. Participants were 31 university students (16 males, 15 females; Age M = 20), with 16 participants reporting a history of regular exercise with the remaining 15 reporting to not exercise regularly. Each participant completed an incremental exercise test on a Monark cycle ergometer to volitional exhaustion. Regular exercisers reported significant post-exercise improvements in mood and reductions in state anxiety. By contrast, non-regular exercisers reported an initial decline in post-exercise mood and increased anxiety, followed by an improvement in mood and reduction in anxiety back to pre-exercise levels. Our findings suggest that previous exercise participation mediates affective responses to acute bouts of vigorous exercise. We suggest that to maximise positive mood changes following exercise, practitioners should carefully consider the individual's exercise participation history before prescribing new regimes.

MCT1 T1470A polymorphism influences adherence to strength training in overweight and obese men following a weight loss program

The monocarboxylate transporter (MCT) family member MCT1 transports lactate into and out of myocytes. Oxidative cells import lactate through MCT1 as a substrate, being the role of MCT1 in glycolysis-derived lactate efflux less clear. MCT1 T1470A polymorphism (rs1049434), which has been related with lactate metabolism and sports specialty 1, 2, could be an influencing factor for exercise adherence. Therefore the aim of this study was to relate the adherence to different training modalities with the T1470A MCT1 polymorphism in overweight and obese men following a weight loss program (WLP).

The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol

BACKGROUND: Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease. Despite the benefits associated with regular exercise, adherence with supervised exercise-based cardiac rehabilitation remains low. Increasingly powerful mobile technologies, such as smartphones and wireless physiological sensors, may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease. This study compares the effectiveness of technology-assisted, home-based, remote monitored exercise-based cardiac rehabilitation (REMOTE) to standard supervised exercise-based cardiac rehabilitation in New Zealand adults with a diagnosis of coronary heart disease. METHODS/DESIGN: A two-arm, parallel, non-inferiority, randomised controlled trial will be conducted at two sites in New Zealand. One hundred and sixty two participants will be randomised at a 1:1 ratio to receive a 12-week program of technology-assisted, home-based, remote monitored exercise-based cardiac rehabilitation (intervention), or an 8-12 program of standard supervised exercise-based cardiac rehabilitation (control).The primary outcome is post-treatment maximal oxygen uptake (V̇O2max). Secondary outcomes include cardiovascular risk factors (blood lipid and glucose concentrations, blood pressure, anthropometry), self-efficacy, intentions and motivation to be active, objectively measured physical activity, self-reported leisure time exercise and health-related quality of life. Cost information will also be collected to compare the two modes of delivery. All outcomes are assessed at baseline, post-treatment, and 6 months, except for V̇O2max, blood lipid and glucose concentrations, which are assessed at baseline and post-treatment only. DISCUSSION: This novel study will compare the effectiveness of technology-supported exercise-based cardiac rehabilitation to a traditional supervised approach. If the REMOTE program proves to be as effective as traditional cardiac rehabilitation, it has potential to augment current practice by increasing access for those who cannot utilise existing services. TRIAL REGISTRATION: Australian New Zealand Clinical Trials RegistryStudy ID number: ACTRN12614000843651. Registered 7 August 2014.

Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis

OBJECTIVE: Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD). METHODS: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence. RESULTS: 11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors. CONCLUSIONS: Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions.

Correlates of adults' participation in physical activity : review and update

Purpose To review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults. Methods Systematic review of the peer-reviewed literature to identify papers published between 1998 and 2000 with PA (and including exercise and exercise adherence). Qualitative reports or case studies were not included. Results Thirty-eight new studies were located. Most confirmed the existence of factors already known to be correlates of PA. Changes in status were noted in relation to the influence of marital status, obesity, smoking, lack of time, past exercise behavior, and eight environmental variables. New studies were located which focused on previously understudied population groups such as minorities, middle and older aged adults, and the disabled. Conclusion The newly reported studies tend to take a broader “ecological” approach to understanding the correlates of PA and are more focused on environmental factors. There remains a need to better understand environmental influences and the factors that influence different types of PA. As most of the work in this field still relies on cross-sectional studies, longitudinal and intervention studies will be required if causal relationships are to be inferred.

Comparação das variáveis fisiológicas e psicológicas em diferentes configurações de exercícios aeróbios

Existem diversas recomendações de treinamento aeróbio. Contudo, exercícios auto-ajustados têm sido indicados sob a premissa de gerar melhor resposta afetiva (ex.: prazer) gerando possivelmente maior chance de adesão. Diante da baixa adesão ao exercício e considerando seus benefícios, é necessário verificar que atividade gera melhor resposta afetiva. Esta dissertação investiga esta questão e é composta por dois estudos. Comparar as respostas fisiológicas e afetivas geradas por duas recomendações de treinamento aeróbio. Vinte e quatro participantes realizaram 3 sessões em esteira rolante. Foram determinados o nível de atividade física (questionário IPAQ) e o VO2Max. Nas visitas 2 e 3 foram aplicadas as recomendações aeróbias, uma baseada no nível de atividade física (PBPA) e outra baseada no VO2Max (PBVO2Max). Os dados foram divididos em quartis (Q). A PBPA gerou risco 150% maior de abandono da sessão de treino. O tamanho do efeito (TE) mostrou maior resposta afetiva (escala de sensações) para a PBVO2Max no Q4 (TE 0,41) e menor FC na PBVO2Max (TE médio dos quartis -0,85). Comparar as respostas fisiológicas e afetivas de atividades impostas e auto-ajustadas. Catorze participantes realizaram 3 sessões em cicloergômetro. O VO2Max foi determinado na visita 1. Na visita 2 foi realizada uma atividade AA e na visita 3 uma atividade imposta. Não foram encontradas diferenças significativas entre as atividades AA e imposta nas variáveis fisiológicas (FC, VO2, e lactato; p>0,05), na potência (p>0,05) e nas variáveis perceptivas (esforço percebido, escala de sensações e escala de ativação; p>0,05). Prescrições baseadas no VO2Max parecem proporcionar melhor resposta afetiva. O tipo de prescrição realizada (auto-ajustada ou imposta) parece não influenciar a resposta afetiva dos indivíduos. Os achados sugerem que um ajuste adequado do treino pode gerar melhores respostas afetivas

A physical activity intervention in a workplace setting

Physical inactivity poses a huge burden on Canada's health care system and is detrimental to the health of Canadians (Katzmarzyk & Janssen, 2004). Walking is a viable option for individuals to become physically active on a daily basis and is in fact the most commonly reported leisure time physical activity. It has been associated with many health benefits including weight loss/weight control, reduced risk of coronary artery disease and diabetes, lowered blood pressure, and improved psychological wellbeing (Brisson & Tudor-Locke, 2004). Specifically, individuals' stage of change, selfefficacy and health related quality of life (HRQL) are three psychological constructs that can be greatly improved with increased physical activity (Dishman, 1991; Penedo & Dahn, 2005; Poag & McAuley, 1992). Public health physical activity recommendations exist but many individuals find these difficult to meet due to overly busy lifestyles (Public Health Agency of Canada, 2003). Pedometers are inexpensive devices that can monitor individual bouts of walking so that the incorporation of physical activity into one's daily life is more plausible. They are also excellent tools for motivation, goalsetting, and immediate feedback (Brisson & Tudor-Locke, 2004). Since many people spend a large proportion of their time at their places of employment, workplaces have begun to be a common site for the development of physical activity interventions. These programs have been growing in popUlarity and have shown numerous benefits for both employees and employers (Voit, 2001). The purpose of the current study was to implement and evaluate the use of a pedometer-based physical activity intervention incorporating goal-setting and physical activity logs in a workplace setting, and to examine the relationship between different types of self-efficacy (task, barrier, and scheduling) and different phases of the intervention. Twenty male participants from a local steel manufacturing plant who exhibited health risk factors (e.g. hypertension, diabetes, etc.) were assigned to one of two groups (group A or group B). All participants were asked to wear pedometers on their waists, record their daily steps, set goals that were outlined on a step-tracking sheet (detennined by their baseline number of steps), and keep track of their work days, wakelbed time, sedentary time, and time spent doing other physical activity. Group A began the intervention immediately following the baseline measures, whereas group B continued with their regular routine for 4 weeks before beginning. Physiological measures (height, weight, blood pressure, relative body fat, waist and hip circumference, and body mass index) were taken and a battery of questionnaires that assessed barrier, task and scheduling self-efficacy, HRQL, and stage of change administered at baseline, week 5 (end of intervention for group A), week 9 (end of intervention for group B; follow-up for group A) and week 13 (follow-up for both groups). Results showed that this workplace physical activity intervention was successful at increasing the participants' daily steps, that task self-efficacy is a significant predictor of participants' exercise adherence during the initial stages of participation (intervention phase), and that the participants felt that this intervention was effective. Finally, further exploratory analyses showed that this intervention was effective for all participants, but most valuable for participants most in need of improvement - that is, those who were most sedentary prior to the intervention. This intervention is an inexpensive use of simple and effective tools (e.g. pedometers), has the potential to attract a wide variety of participants and become a pennanent part of any health promotion initiative.

Étude des réponses physiologiques aiguës à l’exercice intermittent de haute intensité chez le patient insuffisant cardiaque

L’optimisation de l’exercice par intervalles de haute intensité (EIHI) chez les patients insuffisants cardiaques (IC) n’a jamais été étudiée auparavant. Nous avons comparé les réponses cardio-pulmonaires aiguës lors de 4 différents EIHI dans le but de trouver le protocole optimisé chez les patients IC. Les patients IC étaient aléatoirement alloués à 4 sessions d’EIHI. Chaque phase d’exercice était à une intensité de 100% de la puissance aérobie maximale (PAM), mais de différentes durées (30s ou 90s) et de type de récupération (passive ou active). Chaque protocole d’EIHI durait un maximum de 30 minutes ou jusqu’à épuisement. Considérant le temps total d’exercice, l’adhérence, une perception d’effort moins élevée, le confort du patient ainsi que des temps similaires passés à un haut pourcentage du VO2pic, le mode avec intervalles courts (30s) et récupération passive s’est avéré être le protocole d’EIHI optimisé chez ces patients. Suite à cette étude, nous avons voulu comparer les réponses cardio-pulmonaires aiguës d’un exercice continu d’intensité modéré (ECIM) par rapport à celles de l’EIHI optimisé de dépense énergétique équivalente chez les patients IC. L’objectif de cette étude était de comparer les réponses cardio-pulmonaires, l’adhérence, la perception de l’effort, l’inflammation et les biomarqueurs cardiaques. Comparativement à l’ECIM, l’adhérence, l’efficience et la tolérance étaient plus élevées lors de l’EIHI optimisé chez les patients IC tout en produisant un stimulus physiologique important. L’EIHI n’a causé aucune arythmie significative ou d’effets délétères sur l’inflammation (CRP), le BNP et la nécrose myocardique (C-TnT) chez les patients IC. L’EIHI semble être un mode d’exercice prometteur et devrait être considéré lors de la réadaptation cardiaque chez les patients IC.