Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review.

Lifestyle intervention programmes are efficacious in the management of obesity but often report poor attendance and adherence rates that hinder treatment effectiveness and health outcomes. The aim of this systematic review is to identify (i) barriers to behaviour change and (ii) predictors of adherence to lifestyle intervention programmes in adults with obesity. Studies were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from inception to August 2016. Barriers to behaviour change include poor motivation; environmental, societal and social pressures; lack of time; health and physical limitations; negative thoughts/moods; socioeconomic constraints; gaps in knowledge/awareness; and lack of enjoyment of exercise. The most prominent predictors of adherence include early weight loss success, lower baseline body mass index (BMI), better baseline mood, being male and older age. The findings within this review provide novel insight to clinicians working in obesity and have important implications for lifestyle intervention programme design. Barriers to behaviour change need to be addressed early in treatment, with lifestyle intervention individualized accordingly. Predictors of adherence should also be taken into careful consideration, with negative moods and unrealistic weight loss expectations discussed at the outset. If adherence is improved, treatment effectiveness, health outcomes and the ultimate burden of chronic diseases could also be improved.

Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: a systematic review and meta-analysis.

Poor adherence to lifestyle intervention remains a key factor hindering treatment effectiveness and health outcomes for adults with obesity. The aim of this systematic review and meta-analysis is to determine if behavioural treatment strategies (e.g. goal setting, motivational interviewing, relapse prevention, cognitive restructuring etc.) improve adherence to lifestyle intervention programmes in adults with obesity. Randomized controlled trials that investigated the use of behavioural treatment strategies in obesity management were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from their inception to August 2016. This meta-analysis shows that behavioural treatment interventions have a significant positive effect on session attendance (percentage) and physical activity (total min/week) in adults with obesity (M = 17.63 (95% confidence interval (CI) = 10.77, 24.50), z =5.0337, P < 0.0001 and M = 105.98 (95% CI = 58.64, 153.32), z =4.3878, P < 0.0001, respectively). This meta-analysis of randomized controlled trials provides evidence that behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity. These strategies should be routinely incorporated into lifestyle intervention, obesity management and weight loss programmes with the aim of improving engagement and adherence. If adherence were improved, treatment effectiveness, health outcomes and the ultimate burden of chronic disease could also be improved.

Training practices and overtraining syndrome in Swedish age-group athletes.

Heavy training in combination with inadequate recovery actions can result in the overtraining/staleness syndrome and burnout. Even young and aspiring elite athletes develop staleness. The aim was therefore to determine the incidence and nature of staleness, and its association with training behavior and psychosocial stressors in young elite athletes. A sample of 272 individuals from 16 sports completed questionnaires on training, staleness, and psychosocial stress and 37% reported being stale at least once. The incidence rate was higher for individual sports (48%) compared with team (30%) and less physically demanding sports (18%). Stale athletes reported greater perceptual changes and negatively elevated mood scores in comparison to healthy athletes. Staleness was distinguished from burnout on the basis of motivational consequences; 41 % of the athletes lost their motivation for training, which in turn indicates a state of burnout. Further, 35 % of the athletes reported low satisfaction with time spent on important relationships, 29% rated the relationship with their coach as ranging from very, very bad to only moderately good. The results indicate that staleness is a widespread problem among young athletes in a variety of sports, and is not solely related to physical training, but also to non-training stressors.

Cardiac deceleration in elite golfers as modified by noise and anxiety during putting.

The relationship between attention and performance in sports has been investigated in numerous studies, often by using indirect measurements such as self reports. Alternatives for studying attentional processes during an event are pro vided by psychophysiological methods. In the present study, cardiac patterns of highly skilled golfers were monitored during the performance of a putting task in both the presence and absence of noise. As a group, the golfers putted as well when noise was present as when it was absent. However, those who scored high on a trait anxiety test showed greater intraindividual variation between putts when noise occurred. More importantly, the players with higher trait anxiety did not show, as expected, pronounced cardiac deceleration prior to putting, as did the players with low trait anxiety scores. Consequently, the present result calls into question the view that cardiac deceleration is associated with superior athletic performance. Furthermore, cardiac deceleration cannot be used as a general measure of attentional processes because interindividual differences in traits, such as anxiety. are probably also important factors to consider.

Stress fractures of the tibia: can personality traits help us detect the injury-prone athlete?

One of the few serious drawbacks associated with running is overuse injuries such as stress fractures of the tibia, which cause local pain and swelling, often resulting in a temporary cessation of training. Whereas some runners rarely become injured, others experience recurrent injuries even during fairly short periods of time. The aim of the present study was to compare selected personality traits in a group of runners who had sustained a previous tibial stress fracture (n=17), with a matched group of runners (n=17) who had never experienced stress fractures. The results indicated that the injured runners, especially the women, scored higher than the non-injured runners did on inventories measuring both the Type A behavior pattern and exercise dependency. Since motivation, ambitiousness, and competitiveness are integral parts of these inventories, high scoring individuals might be part of a high-risk population for running injuries, the more so if the individual also feels dependent on regular running for managing stress related mood states, which was the case particularly for the injured women in the present study. However, the somewhat limited number of runners who had had a confirmatory scintigram, which was a criterion for inclusion in the study, warrants a cautious interpretation of the results. The findings nevertheless suggest that in order to prevent recurrent injuries, health education professionals and clinicians ought to focus on conveying the importance of detecting precursors of injury, and the subsequent steps which should be taken to avoid developing a serious injury.

Physical exercise and psychological well-being: a population study in Finland.

BACKGROUND: Regular physical exercise has been characterized as a positive health behavior having physiological benefits. It may also yield psychological benefits. The purpose of the present study was therefore to explore the association between physical exercise frequency and a number of measures of psychological well-being in a large population-based sample. METHODS: A total of 3403 participants (1856 women and 1547 men) of the Finnish cardiovascular risk factor survey, ranging in age between 25 and 64, completed questionnaires. Besides answering questions concerning their exercise habits and perceived health and fitness, the participants also completed the Beck Depression Inventory, the State-Trait Anger Scale, the Cynical Distrust Scale, and the Sense of Coherence inventory. RESULTS: The results of this cross-sectional study suggest that individuals who exercised at least two to three times a week experienced significantly less depression, anger, cynical distrust, and stress than those exercising less frequently or not at all. Furthermore, regular exercisers perceived their health and fitness to be better than less frequent exercisers did. Finally, those who exercised at least twice a week reported higher levels of sense of coherence and a stronger feeling of social integration than their less frequently exercising counterparts. CONCLUSIONS: The results indicate a consistent association between enhanced psychological well-being, as measured using a variety of psychological inventories, and regular physical exercise.

Precompetitive mood states and performance of elite male golfers: do trait characteristics make a difference?

The relationship between preperformance mood, measured by the Profile of Mood States inventory, and subsequent athletic performance has been the focus of considerable research. Presumably, athletes with less positive mood profiles should be outperformed by those with more favorable profiles. The results presented so far in the literature are equivocal. One possible explanation is that more stable trait characteristics might medicate mood states prior to competitive situations. In the present study, 8 male golf players, all members of the Swedish National Team, completed a number of trait inventories (Eysenck's Personality Inventory, Locus of Control, Sport Competition Anxiety Test, Self-consciousness Scale) prior to the competitive season. Subsequently, they completed the Profile of Mood States before each game played. Analysis showed that the players' preperformance mood states differed significantly and that these differences were associated with their scores on the trait inventories. Furthermore, preperformance mood states were significantly related to athletic performance for some individuals but not for others. Further research should also include trait measurements to understand better the relationship between mood states and the athletic performance of individual athletes.

Overtraining and recovery. A conceptual model.

Fiercer competition between athletes and a wider knowledge of optimal training regimens dramatically influence current training methods. A single training bout per day was previously considered sufficient, whereas today athletes regularly train twice a day or more. Consequently, the number of athletes who are overtraining and have insufficient rest is increasing. Positive overtraining can be regarded as a natural process when the end result is adaptation and improved performance: the supercompensation principle--which includes the breakdown process (training) followed by the recovery process (rest)--is well known in sports. However, negative overtraining, causing maladaptation and other negative consequences such as staleness, can occur. Physiological, psychological, biochemical and immunological symptoms must be considered, both independently and together, to fully understand the 'staleness' syndrome. However, psychological testing may reveal early-warning signs more readily than the various physiological or immunological markers. The time frame of training and recovery is also important since the consequences of negative overtraining comprise an overtraining-response continuum from short to long term effects. An athlete failing to recover within 72 hours has presumably negatively overtrained and is in an overreached state. For an elite athlete to refrain from training for > 72 hours is extremely undesirable, highlighting the importance of a carefully monitored recovery process. There are many methods used to measure the training process but few with which to match the recovery process against it. One such framework for this is referred to as the total quality recovery (TQR) process. By using a TQR scale, structured around the scale developed for ratings of perceived exertion (RPE), the recovery process can be monitored and matched against the breakdown (training) process (TQR versus RPE). The TQR scale emphasises both the athlete's perception of recovery and the importance of active measures to improve the recovery process. Furthermore, directing attention to psychophysiological cues serves the same purpose as in RPE, i.e. increasing self-awareness. This article reviews and conceptualises the whole overtraining process. In doing so, it (i) aims to differentiate between the types of stress affecting an athlete's performance: (ii) identifies factors influencing an athlete's ability to adapt to physical training: (iii) structures the recovery process. The TQR method to facilitate monitoring of the recovery process is then suggested and a conceptual model that incorporates all of the important parameters for performance gain (adaptation) and loss (maladaptation).

Central, local, and overall ratings of perceived exertion during cycling and running by women with an external or internal locus of control.

Much research has been directed toward finding the most prominent psychological factors affecting ratings of perceived exertion during physical exercise. The one most frequently mentioned, although rarely investigated empirically, is locus of control. Findings from non-sport-related research indicate that individuals with an internal locus of control (internals) are better at using the available information than individuals with an external locus of control (externals). That finding has been attributed to the inferior information-processing capacity of the latter group, a deficit that might also affect the processing of exertional cues during physical exercise. In the present study, a group of women categorized as internals were compared with a similar group of externals during both ergometer cycling and treadmill running. The results indicated significantly different ratings between the groups not only for overall perceived exertion but also for local (muscles and joints) and central (cardiopulmonary) exertion. The observed differences were greater during ergometer cycling than during treadmill running. It is possible that the more distinct cues available during cycling, stemming mainly from the working muscles (local factors), presented more information to process, a task that the internals were better at than the externals.

Mood, physical working capacity and cognitive performance in the elderly as related to physical activity.

The age-related decline in physical working capacity, cognitive performance, and psychological well-being can presumably be modified by regular physical exercise. The present study comprises 20 men and 20 women with a mean age of 66 years. Half of the participants were randomly assigned to an exercise group, the remaining half to a control group. The members of the exercise group exercised individually through regular walking (three times a week) during a period of three months. The control group performed instead a series of mental tasks with the same regularity. Results showed significant differences in favor of the exercise group on complex tasks at the post-test, whereas only minor differences were found on simple tasks. Mood improvements were uniform, regardless of exercise involvement. The latter can be taken to indicate that exercise is not the most important factor, instead social context and regular contacts with other people may be equally important for elderly individuals.

Influence of ingesting a solution of branched-chain amino acids on perceived exertion during exercise.

On two occasions, seven male endurance-trained cyclists performed exhaustive exercise on a cycle ergometer in the morning after they had performed a bout of exercise the preceding evening in an attempt to lower the muscle glycogen stores. The subjects exercised at a work rate corresponding to approximately 70% of their maximal oxygen uptake for 60 min, followed by another 20 min of maximal exercise. During exercise the subjects were given either a solution of branched-chain amino acids (BCAAs) or flavoured water (placebo). Every 10 min during exercise the subjects rated their perceived exertion and mental fatigue on two different Borg scales. During the 60 min exercise at a given work rate the subjects ratings of perceived exertion when they were given BCAAs were 7% lower, and their ratings of mental fatigue were 15% lower than when they were given placebo. In addition, the performance in the colour task of Stroops Colour Word Test performed after exercise was improved when BCAAs had been ingested during exercise, compared with the results from the placebo trial. There was no difference in the physical performance between the two trials measured as the amount of work done during the last 20 min of exercise when the subjects performed at their maximum. The plasma concentration ratio of free tryptophan/BCAAs, which increased by 45% during exercise and by 150% 5 min after exercise in the placebo trial, remained unchanged or even decreased when BCAAs were ingested.

Ratings of perceived exertion by a group of women: does Type A behavior act a modifier?

It has previously been suggested that individuals displaying the Type A behavior pattern underestimate their perceived exertion during physical exercise. Most research pertaining to these results has been performed with male participants. In the present study, 70 women (mean age 26.8 yr.) varying in scores on the Bortner scale participated in a standardized cycle ergometer test performed individually in a laboratory setting. Analysis showed small but nonsignificant differences in ratings by participants. This held over the whole range from light to heavy exercise intensity. Less than 1% of the explained variance in ratings of perceived exertion (RPE) could be traced back to the scores for behavior of the individuals. Thus, contrary to some prior reports of RPE suppression associated with the Type A behavior pattern, the results present instead a null finding. Possible causes for the equivocal results are the environment (laboratory vs field), the question whether a laboratory test performed individually is perceived as challenging enough to trigger the competitive urge, type of exercise, the individual's sex, the measure used for assessing Type A behavior pattern, and whether gender-based schematic/aschematic processing is involved.

Ratings of perceived exertion by women with internal or external locus of control.

Ratings of perceived exertion are frequently used to estimate the strain and effort experienced subjectively by individuals during various forms of physical activity. A number of factors, both physiological and psychological in origin, have been suggested to work as modifiers of the exertion perceived by the individual. It has been reported in nonsport-related research that individuals with an internal locus of control seem to pay more attention to relevant information and use the available information more adequately than individuals with an external locus of control. The reputed inferior information-processing abilities of externals compared with internals could possibly also influence the ratings of perceived exertion, with externals being less accurate in their ratings. Whether locus of control might be such a factor was investigated. Fifty women worked on an ergometer cycle at four different work loads. The results showed statistically significant differences in subjective ratings of perceived exertion between externals and internals, especially at heavier work loads. Such differences might be because of unequal information-processing abilities, as the observed discrepancies occurred at higher work intensities, when more cues are available for processing.

Sources and effects of low-frequency noise.

The sources of human exposure to low-frequency noise and its effects are reviewed. Low-frequency noise is common as background noise in urban environments, and as an emission from many artificial sources: road vehicles, aircraft, industrial machinery, artillery and mining explosions, and air movement machinery including wind turbines, compressors, and ventilation or air-conditioning units. The effects of low-frequency noise are of particular concern because of its pervasiveness due to numerous sources, efficient propagation, and reduced efficacy of many structures (dwellings, walls, and hearing protection) in attenuating low-frequency noise compared with other noise. Intense low-frequency noise appears to produce clear symptoms including respiratory impairment and aural pain. Although the effects of lower intensities of low-frequency noise are difficult to establish for methodological reasons, evidence suggests that a number of adverse effects of noise in general arise from exposure to low-frequency noise: Loudness judgments and annoyance reactions are sometimes reported to be greater for low-frequency noise than other noises for equal sound-pressure level; annoyance is exacerbated by rattle or vibration induced by low-frequency noise; speech intelligibility may be reduced more by low-frequency noise than other noises except those in the frequency range of speech itself, because of the upward spread of masking. On the other hand, it is also possible that low-frequency noise provides some protection against the effects of simultaneous higher frequency noise on hearing. Research needs and policy decisions, based on what is currently known, are considered.

Simple indicators of physical working capacity.

Traditional methods used to estimate an individual's physical working capacity have at least one disadvantage in common, namely, the demand for expensive equipment such as cycle ergometers or treadmills. Consequently, the search for suitable tests performed in the field has been extensive. Most field tests do, however, require a maximal performance from the subject. The present investigation compared two special field tests, walking and running, both of a submaximal character, with (a) a treadmill run test and (b) a standardized cycle ergometer test. The comparisons were made to judge whether these field tests have the potential to replace or complement laboratory tests in certain situations, for example, when the purpose is to monitor training progress over time. Correlations were generally high and statistically significant within as well as between tests. Higher values were observed between field running and the laboratory tests than with field walking. This was true especially for the higher reference levels. Despite this, field walking may still be the best alternative for elderly persons or subjects recovering from injury, since the results indicate that walking, when performed intensely enough, gives a fairly good estimate of an individual's physical working capacity.

Effect of branched-chain amino acid and carbohydrate supplementation on the exercise-induced change in plasma and muscle concentration of amino acids in human subjects.

Five male endurance-trained subjects performed exhaustive exercise on a cycle ergometer at a work rate corresponding to 75% of their VO2max after reduction of their muscle glycogen stores. During exercise the subjects were given in random order a 6% carbohydrate solution continuing 7 g L-1 of branched-chain amino acids (BCAA), a 6% CHO solution and flavoured water. The physical performance was lowered in four of the five subjects when they were given flavoured water during exercise as compared with the two conditions when CHO was supplied. No difference in performance was found when the subjects were given CHO + BCAA or only CHO during exercise. When CHO + BCAA was supplied the plasma and muscle (vastus lateralis) concentrations of BCAA increased during exercise by 120 and 35%, respectively. In the other conditions there was no change or a slight decrease in the plasma concentrations of BCAA, but the muscle concentrations of BCAA were decreased after exercise. The plasma concentration of glutamine over the whole exercise period and 5 min after exercise was higher when CHO + BCAA were supplied during exercise compared with a supply of CHO alone or water. However, exercise caused no change in the muscle concentration of glutamine, whereas that of glutamate decreased in all three conditions. A supply of CHO + BCAA or CHO alone did not affect the exercise-induced increase in the plasma and muscle concentration of aromatic amino acids, indicating that neither BCAA nor CHO influenced the net protein degradation during exercise.

Note on the relationship between loudness and annoyance.

Contradictory results are often encountered when different groups are asked to rate loudness using the method of magnitude estimation, especially when scaling complex auditory stimuli. This can be explained by subjects' inability to separate perceived loudness accurately from perceived annoyance. In addition, subjects are not uniformly influenced by these two perceptual attributes; the individual's preference for or against the stimulus in question also affects the scaling behavior.

Branched-chain amino acid supplementation during 30-km competitive run: mood and cognitive performance.

It has been suggested that an elevated concentration of the neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) in specific areas of the brain may contribute to the development of central/mental fatigue during and after sustained exercise. Supplementation with branched-chain amino acids (BCAAs) should prevent the exercise-induced increase in the plasma concentration ratio of free tryptophan to other large neutral amino acids (including BCAAs) and thereby prevent an elevation in the level of 5-HT in the brain. In this study, subjects were given either a mixture of BCAAs in a carbohydrate solution or a placebo drink that contained only carbohydrates during a 30-km cross-country race. Several tasks to measure cognitive performance were performed before and after the race. When subjects were supplied with BCAAs, their performance in the different parts of the color-word test (words, colors and color words) was improved by an average of 3-7% (p < 0.05) after exercise, whereas there was no difference in performance before and after exercise in the subjects who were given the placebo. Furthermore, the experimental group, supplied with BCAAs, maintained their performance in the shape-rotation and figure-identification tasks, whereas an impairment in performance in these tests by 25% (p < 0.05) and 15% (p < 0.05), respectively, was found in the subjects who received the placebo. Thus, BCAA supplementation seemed to have an effect on the more complex tasks, whereas no effect could be detected on the less demanding tasks. However, an intake of BCAAs during exercise modified only slightly the exercise-induced changes in mood.

Psychophysiological stress and EMG activity of the trapezius muscle.

Although it is generally assumed that mental stress induces muscular tension, the experimental data have, so far, been inconclusive. Likely explanations for these inconsistent findings are (a) too small subject samples in some experiments, (b) the use of only one type of stress stimulation, and (c) the lack of objective (physiological) measurements documenting the stress-inducing properties of the experimental treatment. Furthermore. the effect of mental stress and physical load separately, versus the combined influence of physical and mental load on muscular tension, has not been investigated earlier. Therefore, the aim o f the present experiment was lo examine the effects of mental stress as well as of physical load, separately and in combination, on perceived stress, physiological stress responses, and on muscular tension as reflected in electromyographical (EMG) activity of the trapezius muscle. Sixty two female subjects were individually exposed to mental arithmetic, the Stroop color word test (CWT), the cold pressor test, standardized test contractions (TCs), and the CWT combined with a TC. Compared to baseline, the stress session induced significant increases in systolic and diastolic blood pressure, heart rate, urinary catecholamines, salivary cortisol, and self-reported stress. Each of the two mental stress tests induced a significant increase in EMG activity. The CWT caused a rise in EMG activity also during the TC, which was significantly more pronounced than the increase induced by the CWT alone. Blood pressure responses and self-reported stress followed the same pattern as the EMG activity. The results are consistent with the assumption that psychological stress plays a role in musculoskeletal disorders by increasing muscular tension both in low-load work situations and in the absence of physical load. It is also indicated that the stress-induced increase in muscular tension is accentuated on top of a physical load.

Psychophysiological responses to exercise in type A/B men.

Previous research concerning physical exercise has yielded mixed results with regard to the possible influence of the Type A behavior pattern (TABP) on ratings of perceived exertion. However, almost all studies have been performed in the confined space of a laboratory. Few have studied the influence of an individual's behavior pattern outdoors in the field where most everyday exercise takes place. Hence, the present study compared three groups of subjects: one group with pronounced TABP, one showing very little TABP, and finally one intermediate group exhibiting an average level of Type A behavior. The results indicate that there are distinct and statistically significant differences between the groups. Type A individuals underestimate their degree of perceived exertion at comparable levels of heart rate. Thus, an individual's behavior pattern ought to be considered when ratings of perceived exertion are used to quantify exercise intensity.