Fiona Gillison

The effects of exercise interventions on quality of life in clinical and healthy populations; a meta-analysis.

The aim of the study was to provide an overview of the effect of exercise interventions on subjective quality of life (QoL) across adult clinical populations and well people, and to systematically investigate the impact of the exercise setting, intensity and type on these outcomes. From a systematic search of six electronic databases, 56 original studies were extracted, reporting on 7937 sick and well people. A meta-analysis was conducted on change in QoL from pre- to post-intervention compared with outcomes from a no-exercise control group, using weighted (by the studys sample size) pooled mean effect sizes and a fixed-effects model. Significant differences in outcome were found when treatment purpose was compared; prevention/promotion (well populations), rehabilitation, or disease management. Three to 6 months post-baseline, a moderate positive effect of exercise interventions was found for overall QoL in rehabilitation patients, but no significant effect for well or disease management groups. However, physical and psychological QoL domains improved significantly relative to controls in well participants. Psychological QoL was significantly poorer relative to controls in the disease management group. This pattern of results persisted over 1 year. With some exceptions, better overall QoL was reported for light intensity exercise undertaken in group settings, with greater improvement in physical QoL following moderate intensity exercise. The implications for future health care practice and research are discussed.

Sex Differences in Exercise Behavior During Adolescence: Is Biological Maturation a Confounding Factor?

PURPOSE To test the hypothesis that sex-related differences in exercise behavior during adolescence are confounded by biological age. METHODS Biological age and leisure-time exercise activity were assessed in 103 male and 83 female British Year 9 students (mean = 14.04 years, SD = 0.31). To assess exercise behavior, participants completed the Leisure-Time Exercise Questionnaire (LTEQ). Percentage of predicted adult height attained at measurement was used as an estimate of biological maturity status. Males reported more frequent engagement in strenuous forms of exercise and total exercise activity than females. RESULTS Sex differences in exercise behavior were attenuated and nonsignificant when biological maturity was controlled for. CONCLUSIONS Sex-related differences in biological maturity contribute to sex-related differences in exercise behavior during adolescence.

Changes in quality of life and psychological need satisfaction following the transition to secondary school

BACKGROUND Quality of life (QoL) is an important area for research during adolescence, due to its associations with (1) physical and mental health and (2) the emergence of health risk behaviours. A time that poses a particular threat to QoL is the transition from primary to secondary school. AIMS This study aimed to investigate changes in QoL immediately following the transition to secondary school. Using Self-Determination Theory (SDT) as a conceptual foundation, the relationship between QoL and satisfaction of the three basic psychological needs advanced by SDT (autonomy, competence and relatedness) was explored. SAMPLE The sample comprised 63 Year 7 students (age 11-12 years) attending a UK coeducational secondary school. METHOD Data were collected using self-report questionnaires on three occasions over 10 weeks, starting on the second week of term. Change in need satisfaction was used to predict change in QoL, and the possible reciprocal relationship explored using regression analysis. RESULTS A meaningful improvement in QoL was recorded for 21% of students. Improvements in QoL were predicted by satisfaction of the needs for autonomy and relatedness, but not by competence, explaining 36% of the variance. QoL showed a weaker, but reciprocal effect on need satisfaction. CONCLUSIONS The findings suggest that support for the needs for autonomy and relatedness would provide the most likely route to the enhancement of student QoL over the transition to senior school.

A prospective trial of the effects of isotretinoin on quality of life and depressive symptoms

Background  Isotretinoin is an efficacious treatment for acne, but has been controversially linked with depression.

The relationship between smoking cessation and mouth ulcers.

Patients who stop smoking often complain of aphthous (mouth) ulcers. This symptom is sometimes attributed to the use of smoking cessation medications, but little is known about it. We investigated the incidence, severity, and time course of mouth ulcers in abstaining smokers and the effect of different smoking cessation medications on the symptom. The sample consisted of 1234 smokers who sought treatment at a large smoking cessation clinic, maintained at least 1 week of continuous biochemically validated abstinence, and provided usable data. Participants assessed their mouth ulcers by rating a mouth ulcer item added to the Mood and Physical Symptoms Scale. Subjects made ratings weekly on three occasions while still smoking and over 4 weeks following smoking cessation. After stopping smoking, some 40% of patients developed mouth ulcers, mostly in the first 2 weeks. The problem was generally mild, but 8% reported severe ulceration. The ulcers resolved within 4 weeks in 60% of patients affected. The ulcer ratings in patients using oral nicotine replacement products were higher than in those using patch, nasal spray or bupropion in the first week of abstinence but not afterward. Mouth ulcers were more prevalent in more dependent smokers, and the occurrence of ulcers correlated with other tobacco withdrawal symptoms. Our results confirm that mouth ulcers are a common result of stopping smoking, affecting two in five quitters. Patients should be reassured that the lesions are a result of stopping smoking and not a side-effect of smoking cessation medication.

A theoretical investigation of the development of physical activity habits in retirement

OBJECTIVES This study examined the impact of retirement on physical activity (PA) patterns. More specifically, the process of initiating and maintaining behaviour changes in PA were explored using a self-determination theory perspective. DESIGN Semi-structured interviews were conducted to explore the formation of lifestyle habits post-retirement, and the role of PA within these. Interviews were analysed using thematic analysis and an informal comparison made between physically active and inactive retired adults. METHODS A total of 11 participants (7 female, 4 male; 6 physically active, 5 physically inactive) were recruited from churches and a local newspaper advertisement in South West England. On average, participants (M age=62.91 years; SD=2.3) had been retired 2 years and 8 months (SD=20.03). RESULTS Three main themes emerged from the interviews specific to retired adults; social factors, lifelong tendencies, and sense of purpose. All retired adults searched for purpose in their lives, and for physically active adults having an exercise schedule contributed to this on a daily basis. PA also represented a source of personal challenge, whereas physically inactive retirees sought meaning and challenge from non-exercise domains. All participants were acutely aware of their mortality, but active participants felt that PA would increase their chances of enjoying a healthy retirement, rather than accepting a decline in physical function. CONCLUSIONS The results highlighted how global aspirations for life after retirement can influence ones post-retirement lifestyle. The implications for future research and potential health promotion approaches are discussed.

Biological maturity status, body size, and exercise behaviour in British youth: A pilot study

Abstract The main purpose of this pilot study was to examine the relations between estimated biological maturity status, body size, and leisure-time exercise behaviour in British Year 9 students. Estimated biological maturity status and body size were assessed in 103 male and 82 female students aged 13–15 years (mean 14.04 years, s = 0.31) in physical education classes. To assess exercise behaviour, participants completed the Leisure-Time Exercise Questionnaire (Godin & Shephard, 1985). One year later, 127 of the participants were reassessed for maturity status and body size. Maturity status was positively correlated with involvement in mild forms of reported exercise behaviour and total reported exercise activity in males, and negatively associated with involvement in strenuous forms of reported exercise in females. Hierarchical regression models, with main and interactive effects of body size and maturity status as predictor variables, failed to predict a significant proportion of variance in total reported exercise activity in both males and females.

Health-related quality of life and lifestyle behavior clusters in school-aged children from 12 countries

Objective To evaluate the relationship between childrens lifestyles and health‐related quality of life and to explore whether this relationship varies among children from different world regions. Study design This study used cross‐sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9‐11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24‐hour accelerometry and self‐reported diet and screen time. Health‐related quality of life was self‐reported with KIDSCREEN‐10. Cluster analyses (using compositional analysis techniques) were performed on a site‐wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health‐related quality of life was assessed with the use of linear models. Results Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary behavior (sitters); (3) high screen time/unhealthy eating pattern (junk‐food screenies); and (4) low screen time/healthy eating pattern and moderate physical activity/sedentary behavior (all‐rounders). Health‐related quality of life was greatest in the all‐rounders cluster. Conclusions Children from different world regions clustered into groups of similar lifestyle behaviors. Cluster membership was related to differing health‐related quality of life, with children from the all‐rounders cluster consistently reporting greatest health‐related quality of life at sites around the world. Findings support the importance of a healthy combination of lifestyle behaviors in childhood: low screen time, healthy eating pattern, and balanced daily activity behaviors (physical activity and sedentary behavior). Trial registration ClinicalTrials.gov: NCT01722500.

What motivates girls to take up exercise during adolescence? Learning from those who succeed.

OBJECTIVES  The present study explored factors that underpin increased internalization (i.e., perceived autonomy) in motivation towards exercise over a 1-year period in adolescent girls. DESIGN  A mixed methods prospective study. METHODS  A total of 107 girls (mean age = 13.28 years) reported their exercise behaviour, exercise goals, and a multidimensional measure of motivation towards exercise on two occasions, 1 year apart. Ten girls reporting increased autonomous motivation were then interviewed. RESULTS  Two themes were extracted; growing up and seeking challenge. Most participants reported being more interested in exercising for their health as a result of growing up, through having greater understanding of the health-behaviour link and willingness to act now for future health gain. However, their motivation appeared to be only partially internalized, as health was still viewed primarily as a value promoted by respected others (parents, teachers, media). Furthermore, as many girls conflated being healthy with being thin, health for appearance-related weight control was experienced as an extrinsic (controlling) goal. The second theme was more suggestive of autonomous motivation; girls reported valuing exercise for the opportunity it provides to set and achieve personally meaningful challenges, facilitating a sense of competence and achievement. CONCLUSIONS  The findings may have a useful application in suggesting how exercise settings could be manipulated to increase enjoyment and participation during adolescence. In particular, the findings suggest that means of increasing the salience of the rewarding nature of setting and reaching personal challenges in an exercise setting are investigated.

Multiple lifestyle behaviours and overweight and obesity among children aged 9–11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment

Objectives The purpose of this study was to explore the independent associations between multiple lifestyle behaviours (physical activity, sleep, screen time (ST) and diet) and overweight and obesity in UK children. The second objective was to compare body mass index (BMI) z-score between children who meet health guidelines for each lifestyle behaviour and those who do not and to explore the impact of interactions between lifestyle behaviours on BMI z-score. Design, setting and participants Cross-sectional study on children aged 9–11 years in the UK (n=374). Outcome measures Participants were classified as overweight or obese using the WHO BMI cut-points. Moderate-to-vigorous intensity physical activity (MVPA) and sleep duration were measured using an ActiGraph GT3X+ accelerometer, whereas ST and dietary habits were assessed using questionnaires. Multilevel multiple logistic regression was employed to analyse associations between lifestyle behaviours and overweight/obesity. Participants were then categorised according to whether or not they met specific health criteria for MVPA, ST, sleep and diet. Multilevel multiple linear regression was used to compare these groupings on the outcome of BMI z-score and interactions were explored. Results MVPA and longer sleep duration were associated with lower odds of overweight or obesity, whereas ST and a healthy diet score were associated with increased odds of overweight/obesity. No association was found for an unhealthy diet score. Meeting MVPA guidelines was significantly associated with a lower BMI z-score in all models, and significant two-way interactions were observed for physical activity and sleep, ST and sleep, and physical activity and diet. Conclusions MVPA, sleep and ST are important lifestyle behaviours associated with overweight/obesity among children. More research is required to confirm the role of diet on adiposity and such work would benefit from objective assessment. Overall, this work suggests that strategies aimed at improving compliance with health guidelines are needed. Trial registration number: NCT01722500.