Exploring beliefs around physical activity among older adults in rural Canada.

OBJECTIVE: As physical activity can improve health and reduce the risk of chronic disease, it is important to understand the contributing factors to physical activity engagement among older adults, particularly those living in rural communities to assist in remaining active and healthy as long as possible. The purpose of this study was to gain a deeper understanding of the socio-ecological factors that influence or contribute to physical activity among rural-dwelling older adults in rural Saskatchewan, Canada. METHODS: This qualitative description explored the perceptions of physical activity among older adults living in two rural communities in the Canadian province of Saskatchewan. Semi-structured interviews were conducted with 10 adults aged 69-94. Using content analysis techniques, transcribed interview data were coded and categorized. RESULTS: Participants identified socio-ecological elements facilitating physical activity such as improved health, independence, and mobility as well as social cohesion and having opportunities for physical activity. The most common perceived environmental barrier to engaging in physical activity was the fear of falling, particularly on the ice during the winter months. Participants also cited adverse weather conditions, aging (e.g., arthritis), and family members (e.g., encouraged to "take it easy") as barriers to physical activity. CONCLUSION: Hearing directly from older adults who reside in rural Saskatchewan was determined to have the potential to improve awareness of physical activity in rural communities to support the implementation of programs and practices that will facilitate active lifestyles for older adults.

Examining the Promotion of Healthy Eating among Exercise Specialists: A Cross-sectional Study.

The aim of this cross-sectional study was to survey exercise specialists about nutrition counselling practices, their own dietary practices, and to identify potential relationships. An electronic survey was used to examine characteristics and strategies used for assessing and promoting healthy eating to clients. Exercise specialists (n = 94) were recruited through a public registry and through targeted advertising on 2 professional websites in Alberta, Canada. Eighty-five percent of respondents promoted healthy eating to clients. Confidence in assessing and promoting healthy eating was moderate to low. Those with more than 6 years of professional experience reported higher confidence compared with those with less than 1 year of experience in assessing healthy eating (P < 0.05) and promoting healthy eating (P < 0.01). Confidence was higher among those with more professional experience but who did not meet Canada's Food Guide recommendations (P < 0.05). Professional experience, personal dietary practices, and confidence are important characteristics when considering the assessment and promotion of healthy eating by exercise specialists. Promoting collaborative relationships between registered dietitians and exercise specialists would likely benefit exercise specialists when they are assessing and promoting healthy eating among their clients.

Distinguishing perceived competence and self-efficacy: an example from exercise.

UNLABELLED: This article examined the conceptual and statistical distinction between perceived competence and self-efficacy. Although they are frequently used interchangeably, it is possible that distinguishing them might assist researchers in better understanding their roles in developing enduring adaptive behavior patterns. Perceived competence is conceived in the theoretical framework of self-determination theory and self-efficacy is conceived in the theoretical framework of social-cognitive theory. PURPOSE: The purpose of this study was to empirically distinguish perceived competence from self-efficacy for exercise. METHOD: Two studies evaluated the independence of perceived competence and self-efficacy in the context of exercise. Using 2 extant instruments with validity and reliability evidence in exercise contexts, the distinctiveness of the 2 constructs was assessed in 2 separate samples (n = 357 middle-aged sedentary adults; n = 247 undergraduate students). RESULTS: Confirmatory factor analysis supported the conceptual and empirical distinction of the 2 constructs. CONCLUSIONS: This study supports the conceptual and statistical distinction of perceived competence from perceived self-efficacy. Applications of these results provide a rationale for more precise future theorizing regarding their respective roles in supporting initiation and maintenance of health behaviors.

Development and impact of exercise self-efficacy types during and after cardiac rehabilitation.

OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death in the developed world. Cardiac rehabilitation (CR) is a comprehensive treatment program centered on structured exercise that has been demonstrated to achieve significant decreases in mortality and morbidity in cardiac patients, yet few patients adhere to exercise post-CR and so fail to maintain any health benefits accrued during rehabilitation. One reason for the lack of adherence might be that CR fails to address the challenges to adherence faced by patients when they no longer have the resources and structure of CR to support them. Self-efficacy (SE) is a robust predictor of behavioral persistence. This study therefore focuses on changes in different types of SE during CR and the relationship of SE to subsequent levels of physical activity. METHOD: A sample of 63 CR patients completed assessments of task, scheduling and coping SE at baseline and the end of CR, as well as self-reported exercise behavior at the end of CR and 1-month post-CR. RESULTS: Task SE (for performing elemental aspects of the behavior) was found to be most changed type of SE during CR and was strongly related to self-reported exercise at the end of CR. However, scheduling SE (for performing the behavior regularly) was most strongly related to self-reported exercise post-CR. CONCLUSIONS: These results are theoretically consistent and suggest that scheduling SE should be targeted during CR to improve post-CR exercise adherence.

Exploring the relationship between socioeconomic status, control beliefs and exercise behavior: a multiple mediator model.

The purpose of this study was to examine the relationship between control beliefs, socioeconomic status and exercise intentions and behavior. Specifically, we examined whether distal and proximal control beliefs mediated the association between socioeconomic status and exercise intentions and behavior. A one time, cross sectional mail out survey (N = 350) was conducted in a large urban Canadian city. Distal (i.e., personal constraints) and proximal (i.e., scheduling self-efficacy) control beliefs mediated the association between socioeconomic status and exercise, explaining approximately 30% of the variance. Proximal control beliefs (i.e., scheduling self-efficacy) partially mediated the association between socioeconomic status and intentions, with the models explaining approximately 50% of the variance. Compared to individuals with lower socioeconomic status, individuals with higher socioeconomic status reported more exercise and stronger intentions to exercise. This was at least partly because higher socioeconomic status respondents reported fewer barriers in their lives, and were more confident to cope with the scheduling demands of exercise.

The Role of Socioeconomic Status and Control Beliefs on Frequency of Exercise During and After Cardiac Rehabilitation.

BACKGROUND: Exercise is considered a key component of rehabilitation for heart patients, yet adherence to exercise remains problematic. This study examined the role of socioeconomic status, patients' perception of control over their heart problem and self-efficacy beliefs on exercise during and after cardiac rehabilitation. METHODS: A prospective design was used. Measures were assessed prior to beginning rehabilitation, at the end of rehabilitation, and 1 month post rehabilitation. RESULTS: There were 107 participants (Mean age = 59 years; 85% men) enrolled in the rehabilitation program who completed the study. Regression analysis showed that initial exercise capacity and patients' perception of control over their heart problem prior to starting rehabilitation predicted exercise during the rehabilitation period. Patients scheduling self-efficacy beliefs at the end of the rehabilitation was the key predictor of exercise 1 month post rehabilitation. CONCLUSIONS: Findings support the role of multiple kinds of control beliefs, including conceptualising self-efficacy in terms of multiple dimensions. Further, there may be different motivational influences on exercise performed during rehabilitation than exercise performed after rehabilitation.

Understanding physical activity intentions and behavior in postmenopausal women: an application of the theory of planned behavior.

BACKGROUND: In the present paper, we report the social cognitive correlates of physical activity (PA) intentions in postmenopausal women using the two-component theory of planned behavior (TPB) framework. PURPOSE: The primary objective of the present study was to investigate the utility of the TPB in understanding PA behavior in postmenopausal women. METHOD: Postmenopausal women (N = 297) residing in Southern Alberta, Canada completed a mailed questionnaire that assessed self-reported PA and TPB constructs. RESULTS: Data indicated that 67% of postmenopausal women intended to engage in PA behavior consistent with the public health PA guidelines. Multiple regression analysis suggested that the TPB model explained 44% of the variance in PA intentions with instrumental attitude (ß = 0.33), affective attitude (ß = 0.29), descriptive norm (ß = 0.19), and self-efficacy (ß = 0.24) making significant contributions to PA intentions. Postmenopausal women meeting PA guidelines reported higher scores across all TPB variables when compared to women not meeting PA guidelines. Unique behavioral, normative, and control beliefs were also elicited. CONCLUSION: The two-component TPB framework appears to be a useful model for understanding PA intentions and behavior in postmenopausal women. These data can be used in the development and establishment of PA behavior intervention and health promotion materials designed to facilitate PA intentions and behavior in postmenopausal women.

Perceived control: a construct to guide patient education.

BACKGROUND: Educational needs for patients who are hospitalized with cardiovascular health issues are often underestimated by those caring for them. Perceived control is a construct that has been employed to guide understanding these needs. PURPOSE: The purpose of this exploratory study was to expose cardiac nurses to the construct of perceived control during an annual cardiac education day in February 2009, and evaluated whether the nurses find perceived control constructive in their current practice. The exploratory study also evaluated whether the nurses planned to alter their approach to patient teaching to incorporate perceived control based on the information contained in the presentation. METHOD: Data were collected from registered nurses (n=16) employed in a tertiary cardiac intervention unit, who attended an annual cardiac education day in February 2009. The nurses completed a one-time cross-sectional survey, created de novo, which explored their beliefs around perceived control and patient education. FINDINGS: The survey revealed that the nurses generally agreed that perceived control had the potential to positively impact patient teaching. This was despite the nurses' lack of previous knowledge about perceived control. Younger nurses tended to find that perceived control had an impact on patient adherence more than older nurses, although this result was not statistically significant. Younger and less experienced nurses were also more open to theory and research underpinning patient education. CONCLUSION: Further study is required with a larger sample size and validated measurement tool.

A comparison of fitness training to a pedometer-based walking program matched for total energy cost.

BACKGROUND: Fitness and health variables were measured in 128 sedentary men and women randomly assigned to 6 months of fitness training (F), a walking program (W), or a control (C) group. METHODS: The F program gradually increased volume and intensity until 4 d/wk of training, at 70% of peak VO2 for 43 min/session was prescribed while the W group performed daily walking monitored with pedometers and increased until 10,000 steps x d-1 were prescribed. Total weekly energy expenditure was matched between the activity groups. The control group was asked to maintain their usual activity. RESULTS: Body mass, waist circumference, waist/hip ratio, resting HR were reduced in all groups after 6 months (P < .05). Fasting glucose, glucose tolerance, and total cholesterol were similarly improved in all groups (P < .05). Blood pressure and HR decreased during submaximal exercise in all groups (P < .05) but rating of perceived exertion (RPE) was decreased only in the F group (P < .05). Only the F participants showed a significant increase in ventilatory threshold (VT; ~15%) and peak VO2 (~9%) after 6 months. CONCLUSIONS: Supervised fitness training in previously sedentary adults produced greater improvements in submaximal RPE, BP(sys), VT, and peak VO2 but not other fitness and health-related variables compared with a pedometer-based walking program matched for total energy cost.

Quality of life and psychosocial health in postmenopausal women achieving public health guidelines for physical activity.

OBJECTIVE: The aim of this study was to determine if there are differences in health-related quality of life (HRQoL) and psychosocial health between postmenopausal women who meet public health physical activity (PA) guidelines versus those who do not (ie, self-report) and those women who achieve at least 7,500 steps . day versus those who do not (ie, via objective monitor). METHODS: Postmenopausal women (n = 297) residing in Southern Alberta, Canada, completed a mailed questionnaire that assessed self-reported PA, HRQoL, and psychosocial health outcomes. Total daily steps were assessed with a pedometer via a 3-day step monitoring period. RESULTS: Of the postmenopausal women, 43.1% were meeting public health PA guidelines. A significant multivariate model (Wilks lambda = 0.968, F2,294 = 4.918, P = 0.008) indicated that women achieving public health PA guidelines reported higher HRQoL on both the physical (mean difference [Mdiff] = 2.4, P = 0.008, d [effect size] = 0.31) and mental (Mdiff = 2.3, P = 0.011, d = 0.30) component scales of the RAND-12 compared with women not achieving PA guidelines. Furthermore, women achieving at least 7,500 steps . day-1 indicated significantly higher scores on the physical component scale (Mdiff = 4.33, P < 0.001, d = 0.56) than did women achieving fewer than 7,500 pedometer steps . day-1. CONCLUSIONS: These findings lend support for the health benefits of achieving public health PA guidelines in postmenopause and further the rationale for developing, evaluating, and implementing strategically designed PA behavior change programs for postmenopausal women.

Effect of pretesting on intentions and behaviour: a pedometer and walking intervention.

This study addressed the influence of pedometers and a pretest on walking intentions and behaviour. Using a Solomon four-group design, 63 female university students were randomly assigned to one of four conditions: pedometer and pretest (n = 16), pedometer and no pretest (n = 16), no pedometer and pretest (n = 15), no pedometer and no pretest (n = 16). The pretest conditions included questions on walking, intentions to walk 12,500 steps per day, and self-efficacy for walking 12,500 steps per day. In the pedometer conditions a Yamax Digi-Walker SW-650 pedometer was worn for one week. All participants completed posttest questions. While significant pretest x pedometer interactions would have indicated the presence of pretest sensitisation, no such interactions were observed for either intention or self-reported walking. Wearing pedometers reduced intentions for future walking and coping self-efficacy. However, after controlling for pretest self-reported walking, pedometer use resulted in more self-reported walking. We conclude that wearing a pedometer increased self-reported walking behaviour but that a pretest did not differentially influence walking intentions, behaviour, or self-efficacy.

Conscientiousness and the intention-behavior relationship: predicting exercise behavior.

The present study examined the moderating role of conscientiousness within the theory of planned behavior (TPB) for exercise behavior during usual vs. unusual context. Affective and cognitive attitude, subjective and descriptive norm, perceived behavioral control, behavioral intention, past behavior, conscientiousness, and self-reported behavior were assessed in relation to exercising in a sample of university students (n = 146). Conscientiousness was found to significantly moderate the intention-behavior relationship when the behavior was performed in unusual context (exercising during a reading week of term), but not when behavior was performed in usual context (exercising during a normal week of term). The findings indicate a role for conscientiousness in understanding intention-behavior relationships when the context of behavior is changing or unknown.

The enduring impact of social factors on exercise tolerance in men attending cardiac rehabilitation.

PURPOSE: This study explored the influence of social support on a prognostic indicator among cardiac patients, exercise tolerance. The relationship of sociodemographic factors to social support was examined, as well as the role of social support as a potential mediator between sociodemographic factors and exercise tolerance. METHODS: Archival data were collected from a sample of 254 men referred to cardiac rehabilitation. An exercise tolerance test was completed upon entry into cardiac rehabilitation, after 14 weeks, and after 9 months. RESULTS: Sociodemographic factors and social support reported upon entry into the cardiac rehabilitation program were related to initial and post-cardiac rehabilitation exercise tolerance, after controlling for admitting diagnoses, medical history, smoking, and perceived severity of illness. Overall, 28% of the variance in exercise tolerance was explained at baseline, 19% at 14 weeks, and 20% at 9 months. Specifically, older individuals had poorer exercise tolerance, whereas those with more income had better exercise tolerance. Social support was positively related to exercise tolerance at all 3 times. Older men reported less social support than younger men did, and those with more income reported more social support. However, social support did not mediate the relationship between sociodemographic factors and exercise tolerance. CONCLUSIONS: Results support the potential use of broad social factors in examining the determinants of prognostic factors for heart patients.

Relationships between exercise regulations and motivational consequences in university students.

The aim of this study was to examine propositions stemming from Self-Determination Theory (SDT) that contend motivational consequences vary as a function of different regulations in the exercise domain. Participants (N = 276; n = 98 men; n = 178 women) completed inventories assessing exercise regulations, current exercise behavior, and behavioral intentions to continue exercising for the next 4 months and the effort and importance associated with exercise participation. Bivariate analyses indicated autonomous exercise regulations (identified and intrinsic) were the strongest correlates of each motivational consequence across both sexes, and introjected regulation was positively associated with exercise consequences in women. Simultaneous multiple regression analyses indicated that exercise regulations accounted for a sizeable portion of the variance across each motivational consequence in both sexes (R2adj values ranged from .20 to .53). Both regression and structure coefficients revealed that introjected regulation was a stronger motivational force in women than men, and identified regulation was the most important predictor of all three motivational consequences in both sexes. Collectively, these findings suggest that exercise regulations differentially predict motivational consequences across sexes, and future research using this theoretical framework for examining motivational issues pertinent to the exercise domain appears warranted.

Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation?

PURPOSE: This study evaluated the theory of planned behavior (TPB) as a framework for understanding exercise adherence during phase II cardiac rehabilitation (CR). METHODS: A total of 215 patients completed a baseline questionnaire that included the TPB constructs and past exercise. Exercise adherence was measured via program attendance during phase II CR. RESULTS: Hierarchic regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 30% of the variance in exercise intention, with attitude, subjective norm, and PBC each making significant unique contributions to intention. Furthermore, exercise intention explained 12% of the variance in exercise adherence. Finally, the behavioral, normative, and control beliefs provided novel information concerning why patients in phase II CR hold certain attitudes, subjective norms, PBC, and exercise intentions. CONCLUSION: Results of the present study provide evidence that the TPB is a useful framework for understanding exercise intentions and adherence during phase II CR.

An experimental investigation of the relation between catastrophizing and activity intolerance.

The present study examined the value of a measure of catastrophizing as a predictor of activity intolerance in response to delayed onset muscle soreness (DOMS). A sample of 50 (17 men, 33 women) sedentary undergraduates participated in an exercise protocol designed to induce muscle soreness and were asked to return 2 days later to perform the same physical maneuvers. Participants performed five strength exercises that emphasized the eccentric component of the muscle contraction in order to induce DOMS. Dependent variables of interest were the proportion reduction in total weight lifted, and the number of repetitions. Analyses revealed that catastrophizing, assessed prior to the first exercise bout, was significantly correlated with negative mood, pain and with reduction in weight lifted. Regression analyses revealed that catastrophizing predicted reductions in weight lifted even after controlling for pain and negative mood. These findings extend previous research in demonstrating that catastrophizing is associated with objective indices of activity intolerance associated with pain. Implications of these findings for understanding pain-related disability are addressed.