H. Mills

Factors associated with physical activity referral completion and health outcomes

Abstract Participant socio-demographic characteristics and referral reason were investigated in relation to completion and health outcomes in a Primary Care Physical Activity Referral Scheme using a prospective population-based longitudinal design. Participants (n = 1735) were recruited over a 2-year period. A three-stage binary logistic regression analysis identified the factors associated with the outcomes of completion (model 1), body mass reduction (model 2) and blood pressure reduction (model 3). Participants age, gender, ethnicity, occupation and referral reason were the independent variables for model 1, with the variables of completion added in model 2 and completion and body mass reduction added in model 3. Logistic regression analysis revealed that increasing age is associated with the likelihood of completion (Odds Ratio, OR = 1.019; Confidence Interval, CI = 1.008–1.030; P = 0.001). Participants with a pulmonary condition are less likely to complete (OR = 0.546; CI = 0.346–0.860; P < 0.01) compared to those referred for cardiovascular conditions. For ethnicity, in comparison to the white category, patients in the mixed category are significantly more likely to achieve a reduction in body mass (OR = 3.991; CI = 1.191–13.373; P < 0.05). Those who complete are more likely to achieve a reduction in body mass (OR = 3.541; CI = 2.721–4.608; P < 0.001). When compared to the unemployed category, the skilled manual category had an increased likelihood of achieving a reduction in blood pressure (OR = 1.875; CI = 1.044–3.227; P < 0.05). Participants who completed also demonstrated an increased likelihood of a reduction in blood pressure (OR = 1.680; CI = 1.250–2.003; P < 0.001). Furthermore, those participants who achieved a reduction in body mass had an increased likelihood of achieving a reduction in blood pressure (OR = 1.292; CI = 1.008–1.641; P < 0.05). Completion is associated with health outcomes of reduced body mass and blood pressure.

Public Attitudes Toward People with Intellectual Disabilities after Viewing Olympic or Paralympic Performance

Despite some changes to the way that people with intellectual disabilities (ID) are viewed in society, negative attitudes prevail. One of the aspirations of the 2012 Paralympic games was to influence the publics attitudes toward people with disabilities. The aim of this study was to investigate whether stimuli depicting people with ID performing at Paralympic level of competition change attitudes toward ID. A mixed randomized comparison design was employed comparing 2 groups: those who viewed Paralympic-level ID sport footage and information and those who viewed Olympic footage and information. One hundred fourteen students, mean age 25 yr, were administered measures of implicit (subconscious) attitudes toward disability and explicit (belief-based) attitudes toward ID. Implicit attitudes significantly changed in a positive direction for both groups. The findings provide evidence that both Paralympic (ID) and Olympic media coverage may have at least a short-term effect on attitudes toward people with disabilities.

Exploring the Perceptions of Success in an Exercise Referral Scheme: A Mixed Method Investigation

Background: Exercise referral schemes feature as one of the prevalent primary care physical activity interventions in the United Kingdom, without extensive understanding of how those involved in providing and participating view success. The present research explores and reveals the constituents of “success,” through comparison, contradiction, and integration of qualitative and quantitative research findings. Method: A population-based cohort design formed the basis for a mixed method approach to the research. The quantitative component used a three-stage binary logistic regression to identify patient sociodemographic characteristics and referral reasons associated with three outcomes (n = 1,315). The qualitative component (n = 28) comprised four focus groups with patients (n = 17), individual interviews with exercise providers (n = 4), and referring health professionals (n = 7). The research components were compared at discussion stage to offer insights into the concept of “success.” Results: The integrated findings highlighted the multidimensional nature of the concept of success, containing a wide range of concepts such as empowerment, inclusion, and confidence. The traditional notions of success such as, attendance, weight loss, and blood pressure reduction featured amid a more holistic view which incorporated psychological and social aspects as both influences and outcomes. Conclusion: These findings can enable future development of more representative evaluations of the benefits of exercise referral. This mixed methods research approach can facilitate the development of sophisticated, tailored, evidence-based interventions in the future.

Examining exercise intention and behaviour during pregnancy using the Theory of Planned Behaviour: a meta-analysis

Abstract Background: The efficacy and predictive utility of the Theory of Planned Behaviour (TPB) in explaining a variety of behaviours including physical activity (PA) is well documented. However, the relative contribution of the theory’s components in describing intention and behaviour may differ depending on the context, time and population being studied. Such evidence is necessary to inform PA advice and interventions aimed at special populations including pregnant women. Objective: The purpose of this study was to review the existing literature surrounding the application of the TPB in explaining exercise intentions and behaviour during pregnancy and to evaluate the magnitude of relationships between TPB constructs within this context. Method: Multiple search strategies yielded 99 potentially relevant studies of which 47 were assessed against the inclusion criteria. Finally, eight studies were subjected to a random-effects meta-analysis. Result: Results confirmed the existence of a strong relationship between intention and behaviour while perceived behavioural control (PBC) revealed a weaker correlation with behaviour. Women’s attitude towards exercise had the strongest association with their intention to be physically active while expecting. However, both PBC and subjective norm showed strong relationships with intention. Conclusion: The study supports the TPB as a relevant conceptual framework for the investigation of PA intentions and behaviours during pregnancy. Furthermore, this study supported subjective norm as a pertinent construct to investigate exercise intentions and behaviour in a pregnant population. These findings present both researchers and practitioners with an opportunity for intervention and further research.Background: Several studies have supported the efficacy and predictive utility of the Theory of Planned Behaviour (TPB; Ajzen 1991) in explaining a variety of behaviours including physical activity. However, the relative contribution of the theory’s components in describing intention and behaviour may differ depending on the context, time and population being studied. Such evidence is necessary to inform exercise advice and interventions aimed at pregnant women. Purpose: The purpose of this study was therefore to review the existing literature surrounding the application of the TPB in explaining exercise intentions and behaviour during pregnancy and to evaluate the magnitude of relationships between TPB constructs within this context. Method: Multiple search strategies yielded 99 potentially relevant studies of which 47 were assessed against the inclusion criteria. Finally, 7 studies, involving 777 pregnant women, were included in the analysis. Relationships identified among TPB constructs were subjected to a random-effects meta-analytic review using the Comprehensive Meta-Analysis (version 3.0) computer software package. Results: Results confirmed the existence of a medium to strong relationship between intention and behaviour (r = 0.44, P < 0.05, R2 = 19.36) and also supported the existence of a direct relationship between behaviour and perceived behavioural control (PBC; r = 0.45, P < 0.05, R2 = 20.25). Pregnant women’s attitude (r = 0.48, P < 0.05, R2 = 23.04) had the strongest association with their intention to be physically active. However, both PBC (r = 0.47, P < 0.05, R2 = 22.09) and subjective norm (r = 0.42, P < 0.05, R2 = 17.64) revealed similar relationships with intention. Conclusion: The study supports the TPB as a relevant conceptual framework for the investigation of exercise intentions and behaviours during pregnancy. PBC carried slightly more weight in explaining behaviour than did intention thereby suggesting that exercise during pregnancy is not a behaviour that is under women’s complete volitional control. Intention to exercise was influenced primarily by expectant mothers’ beliefs about the positive and negative consequences of doing so. Contrary to previous meta-analytic reports in the exercise domain, this study supported the relevance of subjective norm as a construct to investigate exercise intentions and behaviour in a pregnant population. The perceived social pressure to conform to other people’s opinion about physical activity during pregnancy may well be an important consideration for pregnant women. These findings present both researchers and practitioners with an opportunity for intervention and further research.

A mixed methods approach to advance the understanding of physical activity behaviour during pregnancy

An active pregnancy encompasses benefits that apply to both mother and baby. However, before investing resources in interventions aimed at changing or supporting expectant mothers’ physical activity behaviours, it is necessary to have a greater fundamental understanding of the modifiable factors influencing women’s decisions during this time. Therefore, the main purpose of this study was to investigate the socio-cognitive determinants of physical activity during pregnancy. A mixed methods research approach using a multiphase design framed by the Theory of Planned Behaviour (TPB; Ajzen, 1991, Organizational Behavior and Human Decision Processes, 50, 179-211) guided the investigation. Following ethical approval and permission to carry out the study, participants were recruited from randomly selected antenatal clinics in the East Kent region of England. Application of the TPB required both qualitative and quantitative cross-sectional data to be collected. Study One (n = 18) involved the elicitation of pregnant women’s beliefs towards being physically active. The modal salient behavioural, normative and control beliefs were used to inform the development of a TPB questionnaire which was implemented during the next phase of the investigation. Study Two (n = 78) examined the predictive utility of the TPB in explaining pregnant women’s physical activity intentions and behaviour and scrutinised the role of past behaviour within this context. Finally, Study Three (n = 10) comprised semi-structured interviews involving community midwives. Meta-inferences maintained the function of improving the validity of the study and advancing the overall aim of the research project. Specifically, triangulation was used to ascertain convergence, corroboration, and correspondence of findings between studies. Whilst results of the individual studies hold merit, meta-inferences point towards the development of three main themes: (1) pregnant women lack access to the necessary information that would allow them to make informed decisions regarding their engagement in physical activities; (2) a co-ordinated effort involving interprofessional collaboration is required to support pregnant women in overcoming barriers associated with regular physical activity participation; and (3) profiling pregnant women according to motivation and behaviour status could serve as a useful and manageable starting point for intervening to produce positive changes in pregnant women’s physical activity behaviour. In normalising physical activity during pregnancy and achieving better health outcomes for mothers and babies, it is necessary to consider the modifiable factors involved in behaviour change, identify opportune moments to intervene, and involve a network of professionals in facilitating and supporting pregnant women’s engagement with physical activities.Life skills are defined as a range of transferrable skills needed for everyday life (Jones and Lavallee, 2009, Psychology of Sport and Exercise, 10, 159-167). According to Benson and Saito’s (2001, In P.L. Benson & K.J. Pittman (Eds.), Trends in youth development: Visions, realities and challenges (pp. 135-154). London, UK: Kluwer Academic Publishers) framework for youth development theory and research, life skills impact upon young people’s academic performance, health and well-being. Thus, the aim of this study was to explore the relationships between university sports degree students’ life skills (teamwork, goal setting, time management, emotional skills, interpersonal communication, social skills, leadership, and problem solving & decision making) and their academic self-efficacy, predicted academic performance, health-related quality of life (physical, emotional, social, and work/school functioning), and flourishing. With institutional ethics approval, 423 sports degree students (male = 236, female = 187, mean age = 20.42 ± 2.56 years) completed a survey assessing the main study variables. Standard multiple regression analyses revealed that time management (B = .51, P < .001), problem solving & decision making (B = .23, P < .01), and goal setting (B = .15, P < .05) contributed significantly to students’ academic self-efficacy. Time management was the only significant contributor to students’ predicted academic performance (B = 2.23, P < .001). In terms of health-related quality of life, emotional skills (B = .23, P < .001) were the only significant contributor to students’ emotional functioning, social skills (B = .18, P < .001) were the only contributor to students’ social functioning, and both time management (B = .25, P < .001) and problem solving & decision making (B = .14, P < .05) contributed significantly to students’ work/school functioning. Finally, five life skills contributed significantly to students’ flourishing: social skills (B = .27, P < .001), leadership (B = .26, P < .01), emotional skills (B = .20, P < .001), goal setting (B = .14, P < .01), and time management (B = .13, P < .01). Interpretation of the results suggest that university degree programmes and staff (e.g., lecturers or learning services) should help sports degree students develop these life skills which contribute to their academic performance, health-related quality of life, and flourishing. In practice, staff could provide specific learning sessions during the degree programme, that target the development of key life skills at what is a critical developmental period of young adulthood.This abstract was published in Journal of Sports Sciences : BASES Conference 2017 – Programme and Abstracts on 24 November 2017 (online) available at http://dx.doi.org/10.1080/02640414.2017.1378421Reactive strength index (RSI) has been described as an individual’s ability to change quickly from an eccentric to a concentric contraction (Young, 1995, New Studies in Athletics, 10, 825-833). RSI has been used in the practical strength and conditioning setting and exercise science literature as a means of quantifying stretch-shortening cycle performance (Flanagan and Comyns, 2008, Strength and Conditioning Journal, 30, 32-38). A drop jump test has been used extensively to assess an athlete’s RSI capabilities. Recently, RSI has been derived from the average of the best 5 jumps obtained from a series of 10 maximal repeated bilateral hops (10/5 repeated jump test (RJT)) (Harper, Hobbs and Moore, 2011, BASES Student Conference). Limited research exists on the interday reliability and usefulness (ability to detect the smallest worthwhile change) of the 10/5 RJT with no reported research for a female population. This study aimed to assess the reliability and usefulness of RSI derived from the 10/5 RJT for an amateur female field sport population. With institutional ethical approval, 15 female participants (mean age: 21.1 ± 0.9 years; stature: 1.65 ± 0.73 m; body mass: 62.0 ± 5.1 kg) (mean ± s) completed 2 trials of the 10/5 RJT with 60 s rest after a specific warm-up protocol on two testing sessions separated by a minimum of 48 hours. A 10/5 RJT technique familiarisation session preceded the two testing sessions. For all 10/5 RJT trials the participants were instructed to minimise ground contact time and maximise jump height. The best trial from each testing day was used for the interday reliability and usefulness analysis. Acceptable reliability was determined at an ICC ≥ 0.8 and a CV ≤ 10% (Hopkins, 2000, Sports Medicine, 30, 1-15). The reported ICC for RSI was 0.91 (95% CI; 0.76 to 0.97) and the CV was 7.3%. In order to assess the usefulness of the test the typical error (TE) was compared to the smallest worthwhile change (SWC). The SWC for RSI in the 10/5 RJT test was 0.09 units (SWC%: 7.0%), while the TE was 0.14 units. Therefore the usefulness of this test for this female population is rated as ‘marginal’ (Hopkins, 2004, Sportscience, 8, 1-7). The results suggest that the 10/5 RJT is a reliable test for RSI as both criteria for acceptable reliability were satisfied but the ability of the test to detect the SWC is marginal.Metacognition refers to our ability to control, modify, and interpret cognitive activity (Wells & Cartwright-Hatton, 2004, Behaviour Research and Therapy, 42, 385–396). Research suggests dysfunctional metacognitive beliefs can be an important factor in the development and maintenance of mental health problems (Cotter, Yung, Carney, & Drake, 2017, Behaviour Research and Therapy, 90, 25–31). Mental toughness represents a collection of personal resources that may act as a positive indicator of mental health (Gucciardi et al., 2016, Journal of Science and Medicine in Sport, 20, 307–311). Therefore the purpose of our study was to assess whether an inverse relationship existed between mental toughness and metacognitive factors associated with psychopathology. Following institutional ethical approval 60 undergraduate university students (mean age: 21.07 ± 4.19 years) studying various sport science related degree programmes voluntarily consented to participate in the current study. Participants completed the Metacognitions Questionnaire-30 (Wells & Cartwright-Hatton, 2004, Behaviour Research and Therapy, 42, 385–396) and Mental Toughness Index (Gucciardi et al., 2015, Journal of Personality, 83, 26–44). Questionnaires were counterbalanced to reduce order effects with participants on average taking nine minutes to complete both questionnaires. A Pearson bivariate correlation recorded significant negative relationships between the mental toughness index, total MCQ-30 (r = –.334, P < 0.01, BCa 95% CI: –.639–.084) scores, positive beliefs about worry (r = –.329, P = < 0.01, BCa 95% CI: –.652–.010), and negative beliefs about thoughts concerning uncontrollability and danger (r = –.330, P = <0.05, BCa 95% CI: –.652–.109) subscale scores. Our investigation suggests that mental toughness is a state-like psychological resource that may contribute to people being less likely to adopt metacognitive beliefs, judgements, and monitoring tendencies associated with the development and maintenance of psychological disorders. More specifically, mental toughness scores were negatively associated with positive beliefs about worry suggesting that participants were unlikely to consider worrying as a means to cope and avoid problems in the future. In addition, responses to items indicative of persistent worrying thoughts that can be accompanied with unpleasant somatic effects were also inversely associated with mental toughness scores. Practitioners may wish to consider developing higher levels of mental toughness as a means of mitigating against the adoption of negative metacognitive processing and in doing so minimise the emergence of negative mental health symptoms (e.g., depression, anxiety).Despite extensive research exploring the psychological phenomenon of flow in performance contexts for individuals, there is a paucity in literature with regards to the experience of group flow in team sports. Whilst group flow has received attention in predominantly non-sporting domains, only a limited amount of research has explicitly explored group flow experiences of athletes (Bakker et al., 2011, Psychology of Sport and Exercise, 12, 442–450). As such, the aim of this study was to investigate perceptions of group flow experience of athletes that competed in team sports, applying a qualitative framework. A particular emphasis was placed on exploring the characteristics involved in group flow and the factors that facilitate or disrupt this experience. With institutional ethical approval, semi-structured interviews were conducted with eight (N = 8) athletes (mean age: 24.0 ± 3.96, years’ experience playing their sport 9.9 ± 2.17) from a variety of standards (ranging from national to recreational), and sports (including soccer, rugby, tennis doubles, camogie, and handball). The trustworthiness of the data was established through peer debriefs, critical peer review, and member checking. Subsequent data analysis included both inductive and deductive analysis, based on Sparkes and Smith’s (2013, Qualitative research methods in sport, exercise and health: From process to product. London: Routledge) recommendations. Inductive analysis created higher order themes from the raw data, and these themes were deductively coded into Csikszentmihalyi’s (2002, Flow: The classic work on how to achieve happiness. 2nd ed. London. Rider Books) model of flow, producing eight characteristics describing the experience of group flow. When athletes experienced group flow they also perceived an enhancement in team performance, and shared understanding with teammates. In particular, a perceived shared understanding between teammates was associated with heightened automaticity of movement and decisions. Group flow was reported to be facilitated by high levels of confidence within the team at both an individual and collective level, and by positive team play and interactions. Group flow disruptors included negative interactions from team-mates, such as criticism. The current study provides a detailed understanding of athletes’ perceptions of group flow in relation to current flow theories, with considerations outlined for theoretical development and practical application of developing group flow.It is hypothesised that the human unconscious consists of two layers: the personal unconscious and collective unconscious (Jung, 1959, The archetypes and the collective unconscious. London: Routledge). Personal experience is theorised to define the former while inherent behavioural patterns, dubbed archetypes, form the latter, these being universal to all human minds. Previous studies reveal that individuals exhibiting mature archetypes, specifically the warrior archetype, can enhance development and performance in sport. (Moore & Gillete, 1990, King, warrior, magician, lover: rediscovering the archetypes of the mature masculine. San Francisco: Harper Collins Publishers). The psychosocial journey from immature hero to mature warrior is conceptualised as a complex interweaving between an individual’s collective unconscious, inherited self, and environment that is yet to be contextualised. Therefore, the aims of this study on talent development and performance in English football academies are to explore the implications of the immature and mature archetypes called the hero and the warrior, and their bipolar counterparts the bully and the coward, and the sadist and the masochist. This is with a view to exploring the impact of various talent development environments and coaching methods on the psychosocial development of football players. Following ethical approval, a two stage ethnographic study was conducted using an interpretist approach. Stage one was comprised of eight field observations (four per team) of an under nine and under ten team in a category three English football academy. In stage two semi-structured interviews with key academy staff members concerning their experiences with and perceptions of the participants and the club’s talent pathway to establish major and minor themes. Results indicate that although they are considered psychosocially immature, participants were accessing the warrior/hero and their bipolar archetypes numerous times during one session/ game. Participants who displayed behaviours of the warrior and hero archetypes regularly were perceived by academy staff to be developing and performing more effectively in comparison to participants habitually accessing the bipolar archetypes. Results also show a potential link between the use of planned traumas in a situational based approach underpinned by a warrior/hero-based culture and effective development of these archetypes. Further research is required to fully comprehend the psychosocial maturation process from the immature to the mature warrior archetype and the mediators to psychosocial growth before stronger conclusions are made. Correspondingly, the researcher recommends that practitioners in English football academies identify the archetypes that an athlete is displaying and facilitate appropriate experiences to enhance development and performance.This abstract was published in Journal of Sports Sciences : BASES Conference 2017 – Programme and Abstracts on 24 November 2017 (online) available at http://dx.doi.org/10.1080/02640414.2017.1378421

Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis

Abstract Objective: To explore the qualitative experiences and decision-making processes surrounding physical activity (PA) for women who have undergone IVF treatment. Background: PA during pregnancy is safe for both mother and fetus in the majority of cases, including for women who have undergone in vitro fertilisation (IVF) treatment; however, there is a paucity of research into decision-making and PA in this population. Methods: Eight women, who had undergone successful IVF treatment and were currently pregnant or had given birth within the last two years, participated in semi-structured interviews about their experiences of infertility and PA during pregnancy. Interview transcripts were analysed using interpretative phenomenological analysis. Results: Three superordinate themes emerged from the data: ‘navigating away from childlessness and towards motherhood’, ‘negotiating a safe passage’ and ‘balancing the challenges of pregnancy with the needs of the self’. Ten subthemes indicated the processes adopted to navigate experiences of infertility, the IVF process, and subsequent decision-making about PA during pregnancy. Conclusion: PA during pregnancy was experienced as a way to soothe the self and control the experience of pregnancy; however, this was mediated by concerns about safety and physical limitations on PA. Limitations of the study are considered, as well as implications for clinical practice and directions for future research.