Gorden Sudeck

Bewegungstherapie in der medizinischen Rehabilitation - Wirkungen, Qualität und Perspektiven

Exercise therapy constitutes the better part of rehabilitative treatment. However, in rehabilitation research the scientific analysis of exercise therapy only plays a minor role. Taking the theoretical model of rehabilitation and the International Classification of Functioning, Disability and Health (ICF) into account, we propose a heuristic model of aims and effects of exercise therapy and define a system of methodological target setting. This system offers a background for an expanded scientific discussion about biopsychosocial determinants and effects of exercise therapy as well as quality development and the evaluation of exercise treatment concepts within and across indications in the context of multimodal medical rehabilitation.

Subjective well-being and exercise in the second half of life: a critical review of theoretical approaches

Research has shown repeatedly that the “feeling better” effect of exercise is far more moderate than generally claimed. Examinations of subgroups in secondary analyses also indicate that numerous further variables influence this relationship. One reason for inconsistencies in this research field is the lack of adequate theoretical analyses. Well-being output variables frequently possess no construct definition, and little attention is paid to moderating and mediating variables. This article integrates the main models in an overview and analyzes how secondary analyses define well-being and which areas of the construct they focus on. It then applies a moderator and/or mediator framework to examine which person and environmental variables can be found in the existing explanatory approaches in sport science and how they specify the influence of these moderating and mediating variables. Results show that the broad understanding of well-being in many secondary analyses makes findings difficult to interpret. Moreover, physiological explanatory approaches focus more on affective changes in well-being, whereas psychological approaches also include cognitive changes. The approaches focus mostly on either physical or psychological person variables and rarely combine the two, as in, for example, the dual-mode model. Whereas environmental variables specifying the treatment more closely (e.g., its intensity) are comparatively frequent, only the social support model formulates variables such as the framework in which exercise is presented. The majority of explanatory approaches use simple moderator and/or mediator models such as the basic mediated (e.g., distraction hypothesis) or multiple mediated (e.g., monoamine hypotheses) model. The discussion draws conclusions for future research.

Self-control strength and physical exercise: An ecological momentary assessment study

Objective: We tested predictions made by the self‐control strength model on a day level using ecological momentary assessment methodology. The study examined the relationship between self‐control strength and physical exercise in participants who intended to exercise on a regular basis. We hypothesized that individuals would exercise more on days when their self‐control strength was high than on days when their self‐control strength was low and that trait self‐control would moderate this relationship. Methods: N = 63 students aged between 19 and 32 years participated in the study. Self‐control strength and physical exercise were assessed daily over a period of 20 days with an electronic diary. Results: Multilevel analyses revealed that the level of self‐control strength was positively associated with physical exercise (p = 0.01), and this relationship was stronger in individuals with low trait self‐control than in those with high trait self‐control (interaction effect: p = 0.03). Conclusion: These findings highlight the interplay between momentarily fluctuating variables such as self‐control strength and dispositional variables such as trait self‐control in the prediction of physical exercise. HighlightsIndividuals exercise more on days when their self‐control strength is high than on days when self‐control strength is low.This relationship is stronger in individuals with low trait self‐control compared to individuals with high trait self‐control.The practical importance of the self‐control strength model is emphasized.

Exercise Experiences and Changes in Affective Attitude: Direct and Indirect Effects of In Situ Measurements of Experiences

Objectives: The purpose of this study was to examine the relationship between exercise experiences (perceptions of competence, perceived exertion, acute affective responses to exercise) and affective attitudes toward exercise. This relationship was analyzed in a non-laboratory setting during a 13-weeks exercise program. Materials and Methods: 56 women and 49 men (aged 35–65 years; Mage = 50.0 years; SD = 8.2 years) took part in the longitudinal study. Affective responses to exercise (affective valence, positive activation, calmness) as well as perceptions of competence and perceived exertion were measured at the beginning, during, and end of three exercise sessions within the 13-weeks exercise program. Affective attitude toward exercise were measured before and at the end of the exercise program. A two-level path analysis was conducted. The direct and indirect effects of exercise experiences on changes in affective attitude were analyzed on the between-person level: firstly, it was tested whether perceptions of competence and perceived exertion directly relate to changes in affective attitude. Secondly, it was assessed whether perceptions of competence and perceived exertion indirectly relate to changes in affective attitudes—imparted via the affective response during exercise. Results and Conclusion: At the between-person level, a direct effect on changes in affective attitude was found for perceptions of competence (β = 0.24, p < 0.05). The model revealed one significant indirect pathway between perceived exertion and changes in affective attitude via positive activation: on average, the less strenuous people perceive physical exercise to be, the more awake they will feel during exercise (β = -0.57, p < 0.05). Those people with higher average levels of positive activation during exercise exhibit more improvements in affective attitudes toward exercise from the beginning to the end of the 13-weeks exercise program (β = 0.24, p < 0.05). Main study results have revealed that in situ experiences predicted changes in affective attitude during multi-week exercise programs. These relevant in situ experiences encompass cognitive factors, the sensation of interoceptive cues, and affective responses to exercise. Considering the predictive role of affective attitudes for exercise behavior, these findings suggest that exercise interventions should put greater emphasis on specific exercise experiences.

Instrumentelle Bewegungsaktivitäten von Herzinfarktpatienten

Zusammenfassung. Die Initiierung regelmasiger Sportaktivitaten von Herzinfarktpatienten nach ihrer Anschlussheilbehandlung (AHB) bildet eine wesentliche Voraussetzung zur Sicherung eines langfristigen Rehabilitationserfolges. Im Sinne einer theoretischen Rekonstruktion solcher instrumenteller Bewegungsaktivitaten wird ein integratives Modell vorgestellt. Darin werden mit der Rubikontheorie der Handlungsphasen (Heckhausen, 1989; Gollwitzer, 1996) eine handlungspsychologische Perspektive und mit sozial-kognitiven Determinanten aus Modellen zum Gesundheitsverhalten (z.B. Fuchs, 1997) eine gesundheitsspezifische Perspektive miteinander verknupft. Zur empirischen Anwendung des Modells werden in einer Feldstudie 135 Herzinfarktpatienten wahrend ihrer stationaren AHB schriftlich und drei Monate poststationar telefonisch hinsichtlich der Initiierung regelmasiger Sportaktivitaten im Alltag befragt. Ein zentrales Ergebnis der Studie deutet auf die besondere Rolle volitionaler Merkmale (z.B. Realisierungsintentionen...

Exercise therapy in medical rehabilitation: Study protocol of a national survey at facility and practitioner level with a mixed method design

Background The importance of physical activity and the orientation of exercise therapy in rehabilitation has changed for many chronic health conditions. Exercise therapy is the most applied therapy form within multidisciplinary rehabilitation programs for almost all chronic health conditions. Despite the scientifically discussed need to refine exercise therapy, there is relatively little knowledge of how exercise therapy is actually conducted. This study protocol describes the methodological procedure used in the project “Exercise therapy in medical rehabilitation: a survey at facility and practitioner level”, which aims to take a national survey of exercise therapy in rehabilitation practice in Germany. Methods The project was implemented using an explanatory sequential mixed method design. Quantitative and qualitative methods were integrated in two consecutive project phases. Phase 1 used a standardized, quantitative written survey of the heads of exercise therapy departments to compile a national overview of concepts and process features of exercise therapy of individual rehabilitation facilities. Phase 2 recorded individual perspectives and opinions concerning exercise therapy goals, content and methods and current developments in the rehabilitation context (e.g., physical activity promotion, interdisciplinarity, standardization) of exercise therapy practitioners. Over the course of two one-and-a-half day workshops, central themes were introduced and prepared with standardized written individual surveys from Phase 1 and combined with qualitative surveys using facilitated group discussions (focus groups in mixed methods design). Discussion The project generates a comprehensive picture of exercise therapy in medical rehabilitation at facility level and inserts further information at the practitioner level into this context. The chosen methodology of a mixed method design combines the perspective of the facility with that of the practitioner, thus allowing for a complex and multifaceted description of the status quo in exercise therapy practice and makes it possible to identify facilitators and barriers for the refinement of exercise therapy in specific everyday rehabilitation. These findings form the basis for the systematic development of quality exercise therapy in rehabilitation, in particular in terms of the refinement, implementation and dissemination of biopsychosocial concepts of exercise therapy.

Bernese motive and goal inventory in exercise and sport: Validation of an updated version of the questionnaire

Target group-specific intervention strategies are often called for in order to effectively promote exercise and sport. Currently, motives and goals are rarely included systematically in the design of interventions, despite the key role they play in well-being and adherence to exercise. The Bernese motive and goal inventory (BMZI) allows an individual diagnosis of motives and goals in exercise and sport in people in middle adulthood. The purpose of the present study was to elaborate on the original BMZI and to modify the questionnaire in order to improve its psychometric properties. The study is based on data from two samples (sample A: 448 employees of companies and authorities; sample B: 853 patients of a medical rehabilitation programme). We applied confirmatory factor analysis and exploratory structural equation modelling. Overall, both the original and the updated BMZI had an acceptable to good validity and a good reliability. However, the revised questionnaire had slightly better reliability. The updated BMZI consists of 23 items and covers the following motives and goals: Body/Appearance, Contact, Competition/Performance, Aesthetics, Distraction/Catharsis, Fitness and Health. It is recommended as an economical inventory for the individual diagnosis of important psychological conditions for exercise and sport.

Individual Differences in the Competence for Physical-Activity-Related Affect Regulation Moderate the Activity–Affect Association in Real-Life Situations

Physical activity (PA) is positively associated with affective well-being in adults. This study investigated the moderating role of the competence for PA-related affect regulation in the PA-affect association in real-life situations. A total of 37 women and 27 men completed an ecological momentary assessment study in which the authors used accelerometers to record PA and e-diaries to collect data on affective well-being on 4 study days. They applied multilevel analyses to estimate the within-person effects of PA on affective well-being and cross-level interactions between PA (within person) and PA-related affect regulation (between persons). Results revealed cross-level interaction effects between within-person PA variations and competence for PA-related affect regulation on the affect dimensions of calmness (p < .01) and valence (p = .04). Thus, the competence for PA-related affect regulation moderates the PA-affect association in real-life situations. Therefore, individual-based PA promotion should consider these individual differences to develop tailored interventions.

Bernese Motive and Goal Inventory in leisure and health sports (BMZI): Further validation and an updated version

Klusmann, V., Musculus, L., Sproesser, G., & Renner, B. (2016). Fulfilled emotional outcome expectancies enable successful adoption and maintenance of physical activity. Frontiers in Psychology, 6, 1990. Lehnert, K., Sudeck, G., & Conzelmann, A. (2011). BMZI – Berner Motiv‐ und Zielinventar im Freizeit‐ und Gesundheitssport. Diagnostica, 57, 146‐159. Sudeck, G., & Conzelmann, A. (2011). Motivbasierte Passung von Sportprogrammen. Explizite Motive und Ziele als Moderatoren von Befindlichkeitsveränderungen durch sportliche Aktivität. Sportwissenschaft, 41, 175‐189.

Warum treiben wir Sport?: Revision of the Bernese Motive and Goal Inventory in leisure and health sports (BMZI)

Introduction Tailored interventions are called for in order to promote physical activity efficiently. Sport-related motives and goals are presently rarely included systematically in the design of interventions, despite the key role they play in wellbeing and adherence to sport activities. The Bernese Motive and Goal Inventory (BMZI) allows an individual diagnosis of the motives and goals in leisure and health sports in people in middle adulthood (35-year to 64-year-old). The questionnaire was developed in 2011 (Lehnert, Sudeck & Conzelmann, 2011) and since then it have been applied in resarch and practice several times. Thereby, we have revealed certain indications, that the questionnaire should be modified. Thus, the present paper aims to examine the validity of an updated version of the BMZI. Methods We adapted the original BMZI on the basis of empirical results and theoretical considerations. We tested the updated questionnaire in two samples: One sample constist of employees of Swiss companies and authorities. The other sample consists of patients of a medical rehabilitation program in Germany. We used Exploratory Structural Equation Modeling (ESEM; Marsh et al., 2014) to examine the validity of the revised version of the BMZI. Results and Discussion The revised BMZI covering the following motives and goals: Body/Appearance, Contact, Competition/Performance, Fitness, Health, Positive Exercise Experiences, Distraction/Catharsis. The global model fit of the updated version of the BMZI can be described as satisfactory to good. These results suggest good factorial validity of the revised BMZI. The inventory can be recommended as an economical instrument for the individual diagnosis of the psychological conditions for sport commitment in middle adulthood.