A.-J. Romain

Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: what is the optimal dose needed?

BACKGROUND Several meta-analyses have examined the role of exercise interventions in improving psychological outcomes in cancer survivors but most did not focus on adjuvant therapy period and did not investigate the optimal dose of exercise needed. The present meta-analysis examines the impact of exercise interventions delivered at this particular period on fatigue, anxiety, depression, and quality of life (QoL) as well as dose-response relationships between volume of prescribed exercise and these psychological outcomes. MATERIALS AND METHODS Randomized, controlled trials that proposed an exercise intervention to patients with breast cancer undergoing chemotherapy and/or radiotherapy were systematically identified and coded. Psychological outcomes effect sizes were calculated and analyzed for trends using linear and quadratic regressions. RESULTS Pooled effects of the 17 included studies revealed improvement for all outcomes, significant for fatigue, depression, and QoL with pooled estimates ranging from 0.2 to 0.5 favoring intervention. Significant inverse associations of the volume of prescribed exercise with fatigue and QoL were observed. CONCLUSIONS Exercise intervention improved fatigue, depression, and QoL in patients with breast cancer receiving adjuvant therapy. Prescription of relatively low doses of exercise (<12 MET h/week) consisting in ∼90-120 min of weekly moderate physical exercise seems more efficacious in improving fatigue and QoL than higher doses.BACKGROUND Several meta-analyses have examined the role of exercise interventions in improving psychological outcomes in cancer survivors but most did not focus on adjuvant therapy period and did not investigate the optimal dose of exercise needed. The present meta-analysis examines the impact of exercise interventions delivered at this particular period on fatigue, anxiety, depression, and quality of life (QoL) as well as dose-response relationships between volume of prescribed exercise and these psychological outcomes. MATERIALS AND METHODS Randomized, controlled trials that proposed an exercise intervention to patients with breast cancer undergoing chemotherapy and/or radiotherapy were systematically identified and coded. Psychological outcomes effect sizes were calculated and analyzed for trends using linear and quadratic regressions. RESULTS Pooled effects of the 17 included studies revealed improvement for all outcomes, significant for fatigue, depression, and QoL with pooled estimates ranging from 0.2 to 0.5 favoring intervention. Significant inverse associations of the volume of prescribed exercise with fatigue and QoL were observed. CONCLUSIONS Exercise intervention improved fatigue, depression, and QoL in patients with breast cancer receiving adjuvant therapy. Prescription of relatively low doses of exercise (<12 MET h/week) consisting in ∼90-120 min of weekly moderate physical exercise seems more efficacious in improving fatigue and QoL than higher doses.

Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials

Implementing theory-based interventions is an effective way to influence physical activity (PA) behaviour in the population. This meta-analysis aimed to (1) determine the global effect of theory-based randomised controlled trials dedicated to the promotion of PA among adults, (2) measure the actual efficacy of interventions against their theoretical objectives and (3) compare the efficacy of single- versus combined-theory interventions. A systematic search through databases and review articles was carried out. Our results show that theory-based interventions (k = 82) significantly impact the PA behaviour of participants (d = 0.31, 95% CI [0.24, 0.37]). While moderation analyses revealed no efficacy difference between theories, interventions based on a single theory (d = 0.35; 95% CI [0.26, 0.43]) reported a higher impact on PA behaviour than those based on a combination of theories (d = 0.21; 95% CI [0.11, 0.32]). In spite of the global positive effect of theory-based interventions on PA behaviour, further research is required to better identify the specificities, overlaps or complementarities of the components of interventions based on relevant theories.

Six minutes walk test for individuals with schizophrenia.

Abstract Purpose: The six-minute walk test (6MWT) is a sub-maximal exercise test measuring the distance that a patient can walk quickly in a period of 6 minutes (6MWD). The objectives of this systematic review are to evaluate the 6MWTs suitability for measuring the impact of an intervention, to compare the 6MWD walked by patients with schizophrenia with data for the general population or matched controls, to identify the determinants of 6MWD and to examine the measurement properties and quality procedures of the 6MWT. Methods: Using five databases, we performed a systematic review of full-text articles published through August 2013. Results: Sixteen studies met our selection criteria. The assessment of the 6MWTs suitability for measuring the impact of interventions was not made because none of the interventional studies reported a significant increase in 6MWD. The distance walked by adults with schizophrenia seemed generally shorter than that walked by healthy adults. Mean 6MWDs ranged from 421 m to 648 m in the included studies. The 6MWD is usually negatively associated with a higher Body Mass Index, increased cigarette consumption, higher doses of antipsychotic medication and lower physical self-worth in individuals with schizophrenia. The 6MWT demonstrates high reliability. To date, however, its criterion validity has not been investigated. In spite of existing guidelines, the test procedures used in the studies reviewed varied significantly. Conclusions: Future physical health monitoring recommendations for patients with schizophrenia should include the 6MWT. Future studies should investigate its predictive role and continue to assess its measurement properties. Implications for Rehabilitation The Six-Minute Walk Test reliably assesses the functional exercise capacity in patients with schizophrenia. The impact of therapeutic interventions on patients, as measured by the 6MWT, cannot be confirmed. Clinicians should take into account overweight, antipsychotic medication use and the physical self-perception when considering the functional exercise capacity in schizophrenia. Clinicians should follow International standards such as these of the American Thoracic Society when using the Six-Minute Walk Test in patients with severe mental illnesses.

Health-related quality of life and stages of behavioural change for exercise in overweight/obese individuals.

BACKGROUND Stages of change in exercise behaviour have been shown to be associated with health-related quality of life (HRQoL) in overweight/obese adults. However, studies examining this relationship have not used questionnaires specifically designed for such a population. The present study assessed the impact of stages of change (SOC) for exercise, using the transtheoretical model, on the HRQoL, using the quality of life, obesity and dietetics (QOLOD) scale, an obesity-specific QoL questionnaire. Our hypothesis was that the more people are in the advanced stages of behavioural change, the better their HRQoL. METHODS A total of 214 consecutive obese individuals (148 women/66 men, mean age 47.4 ± 14.0 years, BMI 37.2 ± 8.4 kg/m2) were included in the cross-sectional study, and all completed SOC and QOLOD questionnaires. RESULTS Multivariate analysis of covariance (MANCOVA) established significant effects on the overall composite of the five dimensions of the QOLOD (P < 0.001). Analysis of covariance (ANCOVA) further determined the significant effect of SOC in terms of physical impact (P < 0.001) and psychosocial impact (P < 0.01), with marginally significant effects on sex life (P = 0.07), but no impact on comfort with food (P = 0.13) or on the dieting experience (P = 0.13), two dimensions evaluating attitudes toward food. CONCLUSION In obese/overweight individuals, the HRQoL varies with the SOC, with those in the more advanced behavioural stages reporting better HRQoL. However, dimensions related to food showed no differences according to SOC, confirming the complexity of the relationship between exercise and nutrition, and the need for further studies to acquire a more complete understanding of their underlying mechanisms.

Experiential or behavioral processes: which one is prominent in physical activity? Examining the processes of change 1 year after an intervention of therapeutic education among adults with obesity.

OBJECTIVE Although physical activity (PA) is essential, most obese people will not engage in its practice. The transtheoretical model (TTM) and its processes of change (POC) contribute to the understanding of behavior change regarding PA. The present study aimed to test how POC are associated with a progression through the stages of change (SOC) and whether they predict BMI change. METHODS Interventional study. A total of 134 subjects participated in an education program, were called at 1 year and 62 of them provided follow-up data. Participants completed the SOC and POC questionnaires at baseline, at 1 year and were classified according to their SOC progression. RESULTS Participants who progressed through SOC lost more weight (p<0.001). Significant interactions were found for three out of five POC (p<0.05). Progression through SOC was associated with an increased use of POC. Weight loss was predicted by two behavioral POC. CONCLUSION Results support the previous cross-sectional studies showing that physically active people use more frequently POC. PRACTICE IMPLICATIONS The present findings support the development of TTM-grounded behavioral interventions targeted to obese patients. Identifying methods to promote POC use to improve adherence to weight guidelines may lead to improved clinical outcomes and quality of life.

Validation of the TTM Processes of Change Measure for Physical Activity in an Adult French Sample

BackgroundProcesses of change (POC) are constructs from the transtheoretical model that propose to examine how people engage in a behavior. However, there is no consensus about a leading model explaining POC and there is no validated French POC scale in physical activityPurposeThis study aimed to compare the different existing models to validate a French POC scale.MethodThree studies, with 748 subjects included, were carried out to translate the items and evaluate their clarity (study 1, n = 77), to assess the factorial validity (n = 200) and invariance/equivalence (study 2, n = 471), and to analyze the concurrent validity by stage × process analyses (study 3, n = 671).ResultsTwo models displayed adequate fit to the data; however, based on the Akaike information criterion, the fully correlated five-factor model appeared as the most appropriate to measure POC in physical activity. The invariance/equivalence was also confirmed across genders and student status. Four of the five existing factors discriminated pre-action and post-action stages.ConclusionThese data support the validation of the POC questionnaire in physical activity among a French sample. More research is needed to explore the longitudinal properties of this scale.

We need reproducible health behaviour change interventions to help adults with severe mental illness

It is with great pleasure we read the health behaviour change intervention developed by Bonfioli et al. (2017) that aimed to increase the time improve physical activity and dietary fiber consumption in adults with severe mental illness. In their trials, the authors found that seven one-hour health education group sessions combined with weekly group of walking sessions significantly increased the number of participants with health behaviours (HB) corresponding to theWorld Health Organization recommendations. It is an encouraging result. The authors efforts to help patients from psychiatric community services to improve their HBs are praiseworthy and should be commended. The current letter highlights several crucial conceptual andmethodological issues of HB change interventions in peoplewith schizophrenia. Four central points about these interventions are presented: a need of theoretical rationale to design HB change intervention, an intervention content presented with behaviour change techniques (BCTs) targeting determinants of change, a need of fidelity checking to improve the external validity of intervention, and the use of validated health behaviour measures. We used the Bonfioli et al. investigation to illustrate the future research challenges in HB change, with respect for their work. Indeed, HB change in psychiatry is a currentmajor challenge for clinicians and researchers. However, we need to improve the designing of HB change interventions in mental health research. Bonfioli et al. provided a succinct description of their intervention limiting a possible replication of their investigation. Having a short description of the HB change intervention constitutes a barrier for future evidence synthesis as for the translation towards in clinical contexts (Michie and Abraham, 2004). Also, readers cannot clearly understand the potential mechanisms explaining the intervention effectiveness. Over the last decade, HB experts highlighted the need for theoretical rationale to design HB change intervention (Michie et al., 2013a; Michie and Abraham, 2004). Indeed, the lack of theorywhen developing the intervention limits the potential understanding of the mechanisms involved in the intervention effectiveness and might omit the central psychological processes involved in HB modification (Michie and Abraham, 2004).Moreover, using a theory-based intervention also facilitates the identification of the possible underlying psychological determinants resulting in effective HB change (Gourlan et al., 2016). To modify these determinants, BCTs have been defined. BCTs are the “observable, replicable, and irreducible components of an intervention designed to alter or redirect causal processes that regulate behaviour; that is, a technique is proposed to be an active ingredient (e.g., feedback, self-monitoring)” (Michie et al., 2013b). BCTs are

Dose response association of objective physical activity with mental health in a representative national sample of adults: A cross-sectional study

Although higher physical activity (PA) levels are associated with better mental health, previous findings about the shape of the dose–response relationship between PA and mental health are inconsistent. Furthermore, this association may differ according to sedentary levels. We investigated the cross-sectional dose-response associations between objectively measured PA and mental health in a representative national sample of adults. We also examined whether sedentary time modified the PA—mental health associations. Based on 2007–2013 Canadian Health Measures Survey data, PA and sedentary time were measured using accelerometry among 8150 participants, aged 20 to 79 years. Generalized additive models with a smooth function were fitted to examine associations between minutes per day of moderate and vigorous PA (MVPA), light PA (LPA), daily steps (combined or not with sedentary time) and self-rated mental health. A significant curvilinear relationship between average daily minutes of MVPA and mental health was observed, with increasing benefits up to 50 minutes/day. For LPA, a more complex shape (monotonic and curvilinear) was found. For daily steps, inverted U-shaped curve suggested increasing benefits until a plateau between 5 000 and 16 000 steps. The MVPA-LPA combination was significantly associated with mental health but with a complex pattern (p < 0.0005E-06). The tested PA-sedentary time combinations showed that increasing sedentary time decreased the positive PA-mental health associations. Non-linear dose-response patterns between the PA modalities and self-reported mental health were observed. Optimal doses of daily minutes of MVPA, LPA, MVPA combined with LPA and daily steps are independently associated with better mental health in adults. The results also suggest that PA-mental health associations could be hampered by daily sedentary time.

Cognitive Behavior Therapy combined with Exercise for Adults with Chronic Diseases: Systematic Review and Meta-Analysis

Objective: The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise). Method: Relevant randomized clinical trials, published before July 2017, were identified through database searches in PubMed, PsycArticles, CINAHL, SportDiscus, and the Cochrane Central Register for Controlled Trials. Results: A total of 30 studies were identified. CBTEx interventions yielded small to large effect sizes for depression (standardized mean change [SMC] = −0.34, 95% CI [−0.53, −0.14]), anxiety (SMC = −0.18, 95% CI [−0.34, −0.03]), and fatigue (SMC = −0.96, 95% CI [−1.43, −0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes. Conclusion: The current literature suggests that CBTEx interventions are effective for decreasing depression, anxiety, and fatigue symptoms but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the 4 outcomes compared to each condition alone.

Pour des interventions de changement de comportement factuelles

1 Département des Sciences de l’activité Physique, Université du Québec à Montréal, Montréal, Québec, Canada 2 Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada 3 Centre de Recherche du CHU de Montréal, Montréal, Québec, Canada 4 Laboratoire Epsylon, Dynamique des capacités humaines et des conduites de santé, EA 4556, Université de Montpellier, Montpellier, France 5 Les Cliniques du Souffle, Groupe 5 Santé, France Mots-clés activité physique, motivation, promotion, médecine comportementale