Autonomy support in an exercise intervention with colorectal cancer patients during chemotherapy: a qualitative perspective.

OBJECTIVE: Physical activity (PA) has emerged as an important element of supportive care for cancer patients, but few patients engage with exercise. Considering that autonomy support is associated with healthy lifestyles, it would be useful to know the specific autonomy-supportive techniques that can help to encourage PA in colorectal cancer (CRC) patients. This study aims to qualitatively explore autonomy support perceptions through a self-determination-theory-based exercise program (FIT-CANCER) with CRC patients during chemotherapy treatment. METHODS AND MEASURES: A total of 27 participants were included, 16 CRC patients, six relatives, and five healthcare professionals. Qualitative data from semi-structured interviews and observational field notes were analyzed with thematic analysis. RESULTS: Three main themes were identified: Healthcare professionals encouraging enrollment in the exercise program, Relatives supporting attendance to the exercise sessions, Exercise instructor favoring adherence to the exercise program. The different subthemes showed autonomy-supportive techniques from these social agents to promote CRC patients' participation in the exercise program. CONCLUSION: The present research showed the importance of autonomy support from healthcare professionals, relatives and the exercise instructor to promote the initiation and maintenance of CRC patients' PA behavior and improve their quality of life, health and well-being.

International Physical Activity Questionnaire Short Form and accelerometer-assessed physical activity: concurrent validity using six cut-points in HF patients.

AIMS: Physical activity (PA) is an important target for improving clinical outcomes in heart failure (HF) patients. Nonetheless, assessing the daily PA profile in this population is a challenging task, traditionally performed using self-report questionnaires such as the International PA Questionnaire Short Form (IPAQ-SF). This study aimed to evaluate the concurrent validity of the IPAQ-SF and accelerometer-assessed PA using six published cut-points in patients with HF and reduced or mildly reduced ejection fraction. METHODS AND RESULTS: The concordance between the IPAQ-SF and a hip-worn accelerometer regarding daily time spent performing moderate to vigorous PA in bouts of at least 10 min was assessed in 53 participants for seven consecutive days using six different cut-points (Barnett, Dibben, Mark, Sanders, Troiano, and Vaha-Ypya). Spearman's correlation and Bland-Altman plots were used to evaluate concurrent validity between methods. Regressions were used to study the association between patient variables, wear protocol (waking hour or 24 h), and absolute bias. The kappa index was used to evaluate the concordance between IPAQ-SF and accelerometry for classifying patients as active or non-active. All analyses were re-run using non-bouted metrics to investigate the effect of bouted versus non-bouted analysis. The IPAQ-SF and accelerometry showed low to negligible correlation (ρ = 0.12 to 0.37), depending on the cut-point used. The regression analysis showed that the absolute bias was higher in participants following the waking-hour protocol at all cut-points except Dibben's (P ≤ 0.007). The concordance between the two methods to classify patients as active and non-active was low when using Mark (κ = 0.23) and Barnett (κ = 0.34) cut-points and poor for the remaining cut-points (κ = 0.03 to 0.18). The results of the sensitivity analysis showed negligible to low correlation using non-bouted metrics (ρ = 0.27 to 0.33). CONCLUSIONS: Moderate to vigorous PA measures using IPAQ-SF and accelerometers are not equivalent, and we do not encourage researchers to use IPAQ-SF alone when assessing PA in HF patients. Moreover, applying personalized collection and processing criteria is important when assessing PA in HF patients. We recommend following the 24 h protocol and selecting cut-points calibrated in patients with cardiovascular diseases. Finally, it is necessary to develop a new tailored questionnaire that considers walking intensity and is adjusted to the current World Health Organisation recommendations, which use non-bouted metrics.

"To be myself again": Perceived benefits of group-based exercise for colorectal cancer patients.

PURPOSE: To explore the perceived benefits of a group-based exercise program for patients with colorectal cancer (CRC) undergoing chemotherapy treatment. METHODS: In-depth semi-structured interviews were conducted with all participants (n = 27) at the end of the exercise program (patients, relatives and healthcare professionals). The exercise instructor in charge of the exercise program with CRC patients also collected observational field notes throughout a research diary. RESULTS: Three main themes related to exercise as a coping strategy were obtained: (a) physical recovery; (b) psychosocial well-being, and (c) reconnection with their embodied selves and normal lives. Physical recovery included a perceived increase in fitness and a reduction in physical side-effects. Psychosocial well-being included perceived benefits in self-confidence, sense of control, reduced fear, feeling of being useful, sense of achievement, positive thinking and avoiding depression. All the physical and psychosocial benefits helped patients reconnect with their embodied selves, engage in activities practised before the diagnoses, improve their body image, avoid stigma, and increase their social life beyond cancer diagnoses. In this sense, some patients held on to their past selves, trying to keep or recover normality in their lives, while others acknowledged that they might not be the same person anymore, with exercise being part of this new identity. CONCLUSIONS: This study shows that exercise is a coping strategy that benefitted CRC patients in several ways related to their physical and psychosocial quality of life.

"You Measure Us and You Depress Us": Healthism and the Subjective Impact of Body Measurements on Secondary School Students.

This study explores adolescents' subjective experiences when facing body measurements at school, performed to evaluate the effects of a school-based intervention to promote physical activity. Three semi-structured interviews (n = 3) and two focus groups (n = 7 and 3) were conducted with adolescents after measuring some variables related to their weight and adiposity. Observational data (n = 88) collected by the two researchers in charge of the measurements were also obtained. Findings derived from our thematic analysis question the suitability of body measurements as social contexts where the core ideas of healthism emerge. Some adolescents lived body measurements as negative social experiences, promoting body dissatisfaction, social comparison, embarrassment, and simplistic associations between health and body shape, which could hinder their adherence to healthy habits. We emphasize the role of qualitative research when evaluating pre/posttests of school-based intervention studies, not just the interventions themselves, to generate knowledge to improve research protocols and prevent unwanted psychological outcomes in participants.

Elements behind sedentary lifestyles and unhealthy eating habits in individuals with severe obesity.

PURPOSE: This study examines elements behind sedentary lifestyles and unhealthy eating habits in individuals who lived with severe obesity during many years of their lives. METHODS: Ten post-bariatric surgery patients participated in semi-structured interviews 7 months after surgery. A year later, a second round of interviews was also conducted to address some knowledge gaps related to the study purpose. The qualitative data collected were analysed through content analysis. RESULTS: Embarrassment about showing their body publicly, pain and poor physical condition, and bad experiences in non-inclusive physical activity contexts were found as potential elements that contributed to their adherence to sedentary lifestyles. Poor family food education, loss of a loved one, family problems, arguments or disputes, and past traumatic events (e.g., childhood sexual abuses) could be related to their development of unhealthy eating behaviours. Findings also pointed out that participants' failed attempts to lose weight provoked them anxiety, feelings of failure and rebellion, and influenced their return to an unhealthy diet and a sedentary lifestyle. CONCLUSIONS: This study may be helpful to reveal some elements which could be related to the origin and perpetuation of severe obesity, and to design prevention/treatment strategies from a more holistic, sensitive, and respectful perspective.

Barriers to physical activity participation in colorectal cancer patients during chemotherapy treatment: A qualitative study.

PURPOSE: To explore the barriers that colorectal cancer patients (stage II and III) perceive to participate in physical activity (PA) when involved in adjuvant chemotherapy. Views of relatives and physicians concerning this issue were also included. METHOD: Qualitative data from ten patients, ten relatives, and ten health professionals were obtained through semi-structured interviews (n = 30). RESULTS: Two main themes were identified after data analysis: (a) barriers to PA related to ostomy and adjuvant chemotherapy and (b) barriers related to perceived lack of support for PA. In regard to the first theme, participants reported difficulties associated with the ostomy, limitations of the intravenous chemotherapy device, fatigue and reduced physical fitness, and focusing on cancer and restructuring priorities. Concerning the perceived lack of support for PA, participants referred to their families' overprotection, the health professionals' lack of knowledge and time to prescribe PA, and the lack of PA services in health centres. CONCLUSIONS: Further information from health professionals about the recommendations of PA and its benefits during adjuvant chemotherapy could palliate these PA barriers. The offer of specific PA programmes for these patients is also recommended.

Changes in Bariatric Patients' Physical Activity Levels and Health-Related Quality of Life Following a Postoperative Motivational Physical Activity Intervention.

PURPOSE: Self-determination theory (SDT) has been widely used as a useful motivational framework for improving long-term adherence to physical activity (PA) and health-related quality of life (HRQoL). The aim of this study was to examine the effects of a 6-month motivational PA intervention (MPAI) on bariatric patients' PA levels and HRQoL from pre-surgery to the end of the MPAI (7 months post-surgery). Additionally, a re-test was performed 13 months post-surgery. METHODS: A total of 40 participants undergoing sleeve gastrectomy were assigned to a 6-month MPAI or to a control group. The MPAI was based on techniques and messages from SDT. At baseline and post-intervention measures, both groups wore accelerometers for one week and completed the SF-36 questionnaire. RESULTS: A total of 32 participants (78.1% female) completed all measures and were included in the final analyses. PA levels did not significantly differ between groups as a consequence of the intervention. Clinically significant differences (d ≥ 0.5) favoring the MPAI group were found for SF-36 domains of bodily pain (at pre-surgery, increasing at 7 and 13 months post-surgery), general health and vitality (7 months post-surgery), and physical functioning and physical component score (both 7 and 13 months post-surgery). Social functioning also showed clinically significant differences favoring the MPAI group at pre-surgery, increasing at 7 months post-surgery. These differences disappeared at 13 months post-surgery. CONCLUSIONS: SDT-based PA interventions could enhance several dimensions of bariatric patients' HRQoL after surgery. Further research is needed to understand what motivational processes are key aspects to promote PA participation in these patients.

Effects of a physical activity program on post-bariatric patients: A qualitative study from a self-determination theory perspective.

This study provides an in-depth analysis of the psychosocial benefits that 10 post-bariatric patients (nine female, 31-59 years) perceived from their participation in an exercise program grounded in self-determination theory. Qualitative data were collected through observations and interviews. Participants reported many factors which facilitated basic psychological need satisfaction such as the instructors caring about their opinion, affection, fitness improvement, pain reduction, and knowledge acquisition. These factors were associated with autonomous motivation, enjoyment, intention to be physically active, happiness, and self-confidence. The results suggest that self-determination theory-based exercise programs could be designed to achieve positive outcomes in this population.

Exploring the socio-ecological factors behind the (in)active lifestyles of Spanish post-bariatric surgery patients.

Purpose: Physical activity (PA) is considered essential for the treatment of morbid obesity and the optimization of bariatric surgery outcomes. The objective of this article was to identify the facilitators and barriers that bariatric patients perceived to do PA one year after finishing a PA programme for the promotion of a long-term active lifestyle. This objective was addressed from a socio-ecological and qualitative perspective. Methods: Nine patients (eight women and one man), aged between 31 and 59 years, participated in semi-structured interviews directly following the PA programme and one year after it. A content analysis was carried out to analyze the qualitative data. Results: Weight loss, improvement of physical fitness, perceived competence, and enjoyment were the main facilitators of PA. Complexes related to skin folds, osteoarthritis, perceived unfavourable weather conditions, lack of social support and economic resources, long workdays, lack of specific PA programmes, and other passive leisure preferences were the main barriers to participate in PA. Conclusions: Results highlight the important interplay between personal, social environmental, and physical environmental factors to explain (in)active behaviours of bariatric patients. The findings of this article could be useful for future research and interventions aimed at promoting PA in bariatric patients.

Validity of the "Samsung Health" application to measure steps: A study with two different samsung smartphones.

The purpose of this study was to examine the validity of a highly popular pedometer application (Samsung Health). Sixteen adults (28.8 ± 8.9 years of age) wore two Samsung smartphone models, Samsung Galaxy Core Prime (SGCP) and Samsung Galaxy S4 (SGS4), at three body locations (waist, arm, and hand) while walking and running over a 50-m test. All trials were recorded using a video as a gold standard measure of step counts. Results indicated that the validity of Samsung Health varied depending on the smartphone model, its body location, and the type of gait (walking and running). Samsung Health showed acceptable validity when the SGCP was located on the hand (Bias = -8.3%; RMSE = 5.6), and especially on the arm (Bias = -7.2%; RMSE = 4.9) while running, and when the SGS4 was located on the arm (Bias = -7.5%; RMSE = 5.4), and especially on the waist (Bias = 5.4%; RMSE = 3.7) while walking. Samsung Health only showed good validity when the SGS4 was located on the arm (Bias = 2.9%; RMSE = 3.6), and especially on the hand (Bias = 0.5%; RMSE = 2.5) while running. This application showed unacceptable validity in the remaining options.

The impact of living with morbid obesity on psychological need frustration: A study with bariatric patients.

Guided by self-determination theory, the purpose of this study was to gain an understanding of the previous experiences of living with morbid obesity of 10 postbariatric patients enrolled in a physical activity programme. Qualitative data were collected through interviews and diarized observations. A thematic analysis revealed that participants suffered from health and mobility troubles in their daily life and experienced stigmatization and discrimination in most areas of their social functioning. Participants described how these experiences resulted in the thwarting of their basic psychological needs for autonomy, competence and relatedness. In turn, psychological need frustration contributed to negative consequences such as body image concerns, low self-esteem, anxiety and depression; controlled regulation of their eating behaviour and extrinsic goals; rigid behaviours such as avoiding social situations; and compensatory and self-defeating behaviours such as giving up diet and physical activity regimens and binge eating (i.e., oppositional defiance). This study highlights how living with morbid obesity can impair optimal functioning and well-being via experiences of psychological need frustration.

Variabilidad de la actividad física en adolescentes españoles de 17-18 años en función del tipo de jornada y época del año / Vabiability of physical activity in 17-18 year-old spanish adolescents by type of day and season

The aim of this study was to analyze the variability of physical activity levels, according to the season (winter, autumn) and type of day (weekend, school day), in a sample of 395 Spanish adolescents aged 17-18 years old. Physical activity was measured with the Four by one-day physical activity questionnaire. Adolescents showed more energy expenditure in winter (M = 39.97 Kcal/kg/day) than in autumn (M = 37.31 Kcal/kg/day), and during the weekend (M = 39.29 Kcal/kg/day) than the school day (M = 37.99 Kcal/kg/day). Chi-square tests showed that more teens were 'active' and 'moderately active' in these periods in which there were also more energy expenditure. Nevertheless, in autumn adolescents showed more energy expenditure during the school day (M = 38.56 Kcal/kg/day) than the weekend (M = 36.06 Kcal/kg/day), while the opposite happened in winter (M = 42.52 Kcal/kg/day during weekend and M = 37.41 Kcal/kg/day during school day). Results from this study indicate season and type of day may influence adolescents’ physical activity levels, but differently compared to other countries or geographical areas. According to this specific variability, several strategies for the promotion of physical activity in the most inactive periods of the week and the year are suggested (AU)

El objetivo de este estudio fue analizar la variabilidad de los niveles de actividad física de una muestra de 395 adolescentes españoles de 17-18 años, según la estación del año (otoño, invierno) y el tipo de jornada (entre semana, fin de semana). La medida de la actividad física se llevó a cabo a través del cuestionario de recuerdo Four by one-day physical activity questionnaire. Los adolescentes presentaron mayor gasto energético en invierno (M = 39.97 Kcal/kg/día) que en otoño (M = 37.31 Kcal/kg/día), y en fin de semana (M = 39.29 Kcal/kg/día) que en jornada escolar (M = 37.99 Kcal/kg/día). Las pruebas Chi-cuadrado muestran que hay más adolescentes ‘activos’ y ‘moderadamente activos’ en estos periodos en los que también hay mayor gasto energético. No obstante, en otoño los jóvenes presentaron mayor gasto energético durante la jornada escolar (M = 38.56 Kcal/kg/día) que en fin de semana (M = 36.06 Kcal/kg/día), mientras que en invierno ocurrió lo contrario (M = 42.52 Kcal/kg/día en fin de semana y M = 37.41 Kcal/kg/día durante la jornada escolar). Los resultados de este estudio indican que la estación del año y el tipo de jornada pueden afectar a los niveles de actividad física de los adolescentes, pero de modo distinto en comparación con otros países o zonas geográficas. En función de esta variabilidad particular, se plantean diversas estrategias para la promoción de la actividad física en los periodos más inactivos de la semana y el año (AU)

Contributions of a group-based exercise program for coping with fibromyalgia: a qualitative study giving voice to female patients.

Numerous quantitative studies have illustrated the potential usefulness of exercise programs for women with fibromyalgia. However, a deeper understanding of the physical and especially psychosocial benefits of exercise therapy from the subjective perspective of this population is still needed. This study was conducted with 25 women who had fibromyalgia and were participating in a nine-month, group-based exercise program. The aim was to provide an in-depth description and analysis of the perceived physical and psychosocial benefits of participation. Qualitative data were collected through observation, interviews, and focus groups. The exercise program not only alleviated the physical symptoms of fibromyalgia, but social interactions within the group helped to counteract the isolation, frustration, and depression often associated with this chronic condition. The data from this study may contribute to a deeper understanding of the benefits of exercise for women with fibromyalgia and might be useful for the improvement of future exercise programs for this population.

Brief report: Association between socio-demographic factors, screen media usage and physical activity by type of day in Spanish adolescents.

This study examined the relationship between socio-demographic factors, screen media time usage, and light, moderate and vigorous activities on weekdays and weekends. Cross-sectional data was collected from 323 Spanish adolescents (mean age 13.59 years) who completed an interview administered recall questionnaire. Structural equation models indicated that male and younger adolescents spent more time on vigorous activities at the weekend, while females and older adolescents showed a greater involvement in light activities both on weekdays and weekends. State school students reported engaging in light and vigorous activities for longer periods than private school students on weekends. TV viewing was negatively linked to vigorous activities during weekdays and to light and moderate activities on weekends. The amount of mobile phone usage, however, was positively linked to light activities during weekdays, but negatively on weekends. The negative relationship between adolescents' use of screen media (TV and mobile phone) and physical activity and its possible displacement, depending on the type of day, added useful comparable knowledge for policies promoting an active lifestyle. Further research is required to provide evidence of the causality in the observed relationships.

Screen media time usage of 12-16 year-old Spanish school adolescents: Effects of personal and socioeconomic factors, season and type of day.

This study examined screen media time usage (SMTU) and its association with personal and socioeconomic factors, as well as the effect of season and type of day, in a Spanish sample of 12-16 year-old school adolescents (N=323). The research design was a cross-sectional survey, in which an interviewer-administered recall questionnaire was used. Statistical analyses included repeated measures analyses of variance, analysis of covariance and structural equation models. Results showed an average of 2.52h per day of total SMTU and partial times of 1.73h per day in TV viewing, 0.27h per day in computer/videogames, and 0.52h per day in mobile use. Four significant predictors of SMTU emerged. Firstly, the type of school was associated with the three media of our study, particularly students from state/public school spent more time on them than their private schools counterparts. Secondly, older adolescents (14-16 years old) were more likely to use computer/videogame and mobile phone than younger adolescents. Thirdly, the more accessibility to household technology the more probable computer/videogames and mobile phone were used. Finally, boys spent significantly more time in mobile phone than girls. Additionally, results revealed that adolescents seemed to consume more TV and computer/videogames in autumn than in winter, and more TV and mobile phones on weekends than on weekdays, especially among state school students. Findings from this study contribute to the existing knowledge on adolescents' SMTU patterns that can be transferred to families and policies.