Marit Sørensen

Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies

There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty-four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal-setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.

Motivation for physical activity and exercise in severe mental illness: A systematic review of cross-sectional studies: Motivation, Physical Activity, and Mental Illness

Individuals with severe mental illness (SMI) are less physically active than the general population. One important barrier contributing to this inactivity is lack of motivation. The aim of this paper is to systematically review all cross-sectional literature on motivation for physical activity among people with SMI and to use the results as basis for guidance on how mental health nurses can facilitate motivation for physical activity. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they included participants with SMI and reported data on motivation for physical activity. In total, 21 articles were included and over half them were published in 2011 or later. The present results indicate preliminary evidence of how the motivational processes do not differ between individuals with SMI and the general population, and that they are independent of diagnosis, medication, age, gender, and body mass index. Results from the current systematic review can give some tentative guidance on how to facilitate motivation for physical activity within mental health-care. However, there is still a great need for developing and examining practical strategies that can enhance adoption and adherence of physical activity among people with SMI.

The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation

BackgroundEuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs’ community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30–65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes.MethodsThis mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club.DiscussionThe process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program’s conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs.Trial RegistrationISRCTN81935608. Registered on 16 June 2015.

Inclusion of Children With Disabilities in Physical Education: A Systematic Review of Literature From 2009 to 2015

This systematic review examines research published from 2009 to 2015 on inclusion of children with disabilities in physical education according to the PRISMA guidelines. We have used a stakeholder approach as a framework for organizing and discussing the results. The searches yielded 535 studies, of which 112 were included. The systematic review outlines which stakeholder perspectives received the most attention, the main themes and findings, the methodological trends that governed the research contribution, and the country of data collection. The main findings indicated that perspectives of pre- and in-service teachers and studies of attitudes still dominate the research contributions. The strengths and limitations of the research conducted to date highlight that several other perspectives need to be discussed. Especially important is seeking information from children with disabilities themselves. Other barriers and facilitators perceived by those actively involved in the inclusion process need to be sought.

HIV/AIDS education in Tanzania: The experience of at-risk children in poorer communities

This study has investigated human immunodeficiency virus (HIV) knowledge, attitudes and sexual at-risk behaviours of youths from disadvantaged communities of Dar es Salaam, Tanzania. Participants were 800 youths aged 12–15 years within three youth subgroups in these poorer communities: those children attending school; children who were not attending school but who were still residing within their communities; and children who were street children (more than 50% of them being orphans). Participants responded to questionnaires. In general, all youths showed low levels of HIV knowledge, experience with condom use and intention to use condoms. They exhibited moderate perceived behaviour control in using condom and positive subjective norms about the use of condoms, the value of sexual abstinence and having an exclusive sexual partner. Contrary to expectations, there were no significant differences between those in-school and those out-of-school with regard to HIV knowledge, intended condom use, subjective norms about condom use and abstinence. Indeed, the in-school children were more at risk for HIV infection, in that they reported the lowest condom experience and perceived behavioural control in condom use. There were systematic gender differences, in that girls scored lower than boys on all variables. The policy of basing HIV/acquired immunodeficiency syndrome (AIDS) education within the schools of Tanzania has not been as effective as desired. To be effective in “kicking AIDS out of Africa”, we need to re-evaluate the educational strategies being used.

Motivational factors associated with physical activity and quality of life in people with severe mental illness

BACKGROUND There has been increasing interest for investigating the role of motivation in physical activity among people with severe mental illness (SMI). Autonomous motivation has been suggested to have a potentially important role in adoption and maintenance of physical activity. However, the knowledge about factors that facilitate autonomous motivation among people with SMI is scarce. AIM The aim of this study was to examine factors associated with motivation for physical activity as well as the relationships between motivation, physical activity and health-related quality of life in individuals with SMI that were currently physically active. METHODS A cross-sectional design was used, and 88 participants were recruited from a public health network promoting physical activity for people with SMI. They answered a questionnaire package consisting of scales measuring psychological need support - psychological need satisfaction - and motivation for physical activity, physical activity and health-related quality of life. RESULTS The majority of participants reported to be in regular physical activity. Associations between variables were tested according to the self-determination theory process model. Structural equation modelling yielded good fit of the process model to the data. Specifically, a need-supportive environment was positively associated with psychological need satisfaction, while psychological need satisfaction was positively associated with autonomous motivation and mental health-related quality of life, and negatively associated with controlled motivation and amotivation. Physical activity was positively associated with autonomous motivation and physical health-related quality of life, and negatively associated with amotivation. CONCLUSION This study indicates that individuals with SMI can be regularly physically active when provided with suitable opportunities. Furthermore, the present results suggest that it is vital for health-care practitioners to emphasise creating a need-supportive environment when organising physical activity because such an environment is associated with both increased autonomous motivation for physical activity and mental health-related quality of life.

‘I would not be satisfied if I had not given it a try’: the expectations and experiences of students in a high school skiing program

Abstract The article presents results from a panel study among students who attended a high school program dedicated to the development of athletes in various skiing disciplines. Using the conceptual framework of Bourdieu, the study examined the students’ social backgrounds, their expectations of succeeding in the field of skiing as well as in the field of education (secondary school), and the extent to which their expectations were fulfilled. Integral to the latter, were the students’ negotiation of uncertainty and realities related to fulfilment of expectations. The investigation was conducted at the first and the third year at school, employing quantitative and qualitative methods. In general, the students came from families with well-educated parents having a distinct sport habitus. During the school period, the students’ expectations as to both skiing achievements and good school grades were reduced. Many had experienced challenges. About one-fifth of the sample had quit during the three years and almost one-third had considered quitting at one point. The qualitative interviews revealed how the students managed to adjust and re-evaluate their ambitions, particularly with respect to skiing.

Associations between physical activity and motivation, competence, functioning, and apathy in inhabitants with mental illness from a rural municipality: a cross-sectional study

BackgroundThere is increasing evidence for physical activity (PA) having a positive impact on physical and mental health as well as illness symptoms in individuals with severe mental illness (SMI). However, individuals with SMI experience several barriers that makes it difficult to take advantage of the benefits associated with PA. One barrier consistently reported to impede PA is motivational issues. Thus, the main aim of the present study was to examine associations between PA and motivation for PA, perceived competence for PA, functioning, apathy, and demographic variables among individuals with SMI. This was conducted within a larger study aiming at including all inhabitants with SMI in one particular small, rural municipality.MethodA total of 106 participants were recruited to the study. Questionnaire-based interviews conducted by two mental health nurses assessed self-reported PA, motivation and competence for PA, functioning, and apathy. Additionally, 71 participants accepted to wear an accelerometer-equipped wristwatch yielding an objective assessment of PA.ResultsThe participants engaged in little PA. However, they did not lack motivation, as over 90% stated that they would like to be more active, and participants across PA level displayed high scores of a motivation reflecting that they valued the benefits of PA. Results showed that higher self-reported PA level was associated with higher levels of integrated regulated motivation and perceived competence for PA while it was unrelated to functioning and apathy. In the subpopulation with objectively measured PA, integrated regulated motivation for PA remained significantly associated with PA level, whereas poor scores on functioning lowered the odds ratio for higher PA level.ConclusionThe results show that PA specific motivation is associated with PA even when controlling for functioning and apathy. This highlight the importance of facilitating context specific motivation (i.e., motivation for PA) and that health care practitioners should emphasise helping people with SMI develop more intrinsic forms of motivation.

Gender differences in HIV related psychological variables in a Tanzanian intervention using sport

Despite the encouraging reduction in new HIV infections in most parts of the world, Sub-Saharan Africa accounted for 72% of all new infections worldwide in 2011 [UNAIDS (2012). World AIDS day report. Geneva: Author]. Young women are more likely to be infected than young men. However, the possibilities for doing research on development of strategies and interventions for HIV prevention are not well supported in most Sub-Saharan universities. It is therefore important that we in the developed world support our colleagues in finding ways to develop research environments: In this case, on preventive strategies for HIV in the local culture in Dar es Salaam in Tanzania. Sport is gaining recognition as an effective means to increase HIV/AIDS awareness and reduce vulnerability. We used an HIV/AIDS education intervention through soccer, using peer coaches, to investigate the efficacy of the intervention and in particular to examine gender differences in changes in HIV-related psychological variables of at-risk youth subgroups participating in the intervention. Participants were at-risk children within a community sport programme. Children attending local schools, and a group of street children from the same communities acted as control groups. The intervention lasted eight weeks. The intervention was successful in that both boys and girls improved their scores on the behavioural intention variables. However, gender differences at pre-test were maintained post-test in that girls continued to score lower than boys. The sport intervention was successful, but girls scored reliably lower on most of the variables under study, especially the variables involving the use of a condom.