Michelle Fortier

Promoting physical activity: development and testing of self-determination theory-based interventions

A growing number of studies have pulled from Deci and Ryans Self-Determination Theory to design interventions targeting health behavior change. More recently, researchers have begun using SDT to promote the adoption and maintenance of an active lifestyle. In this review, we aim to highlight how researchers and practitioners can draw from the SDT framework to develop, implement, and evaluate intervention efforts centered on increasing physical activity levels in different contexts and different populations. In the present paper, the rationale for using SDT to foster physical activity engagement is briefly reviewed before particular attention is given to three recent randomized controlled trials, the Canadian Physical Activity Counseling (PAC) Trial, the Empower trial from the UK, and the Portuguese PESO (Promotion of Health and Exercise in Obesity) trial, each of which focused on promoting physical activity behavior. The SDT-based intervention components, procedures, and participants are highlighted, and the key findings that have emanated from these three trials are presented. Lastly, we outline some of the limitations of the work conducted to date in this area and we acknowledge the challenges that arise when attempting to design, deliver, and test SDT-grounded interventions in the context of physical activity promotion.

Physical Activity Behavior Change in Middle-aged and Older Women: The Role of Barriers and of Environmental Characteristics

The majority of North American women are insufficiently active. Using an ecological approach to examine physical activity behavior in a sample of middle-aged and older women, this study aimed to (1) describe barriers to physical activity behavior change as well as environmental characteristics present in their neighborhoods, (2) examine relationships between barriers and physical activity behavior change, and (3) investigate environmental characteristics that may contribute to physical activity behavior change. Participants were 149 women ranging in age between 39 and 68. At Time 1, self-reported physical activity was assessed. Six months later (Time 2), barriers and environmental characteristics were measured, and physical activity was re-assessed. The most prevalent barriers were daily activities and fatigue. Over time, inactive women reported higher levels of barriers (e.g. fatigue, lack of interest in physical activity) than women who remained active or increased their physical activity level. Certain environmental characteristics (e.g. enjoyable scenery, seeing others exercising in their neighborhood) are suggested as potential contributors to physical activity behavior change.

Effect of Exercise Training on Physical Fitness in Type II Diabetes Mellitus

UNLABELLED Few studies have compared changes in cardiorespiratory fitness between aerobic training only or in combination with resistance training. In addition, no study to date has compared strength gains between resistance training and combined exercise training in type II diabetes mellitus (T2DM). PURPOSE We evaluated the effects of aerobic exercise training (A group), resistance exercise training (R group), combined aerobic and resistance training (A + R group), and sedentary lifestyle (C group) on cardiorespiratory fitness and muscular strength in individuals with T2DM. METHODS Two hundred and fifty-one participants in the Diabetes Aerobic and Resistance Exercise trial were randomly allocated to A, R, A + R, or C. Peak oxygen consumption (V O(2peak)), workload, and treadmill time were determined after maximal exercise testing at 0 and 6 months. Muscular strength was measured as the eight-repetition maximum on the leg press, bench press, and seated row. Responses were compared between younger (aged 39-54 yr) and older (aged 55-70 yr) adults and between sexes. RESULTS VO(2peak) improved by 1.73 and 1.93 mL O(2)*kg(-1)*min(-1) with A and A + R, respectively, compared with C (P < 0.05). Strength improvements were significant after A + R and R on the leg press (A + R: 48%, R: 65%), bench press (A + R: 38%, R: 57%), and seated row (A + R: 33%, R: 41%; P < 0.05). There was no main effect of age or sex on training performance outcomes. There was, however, a tendency for older participants to increase VO(2peak) more with A + R (+1.5 mL O(2)*kg(-1)*min(-1)) than with A only (+0.7 mL O(2)*kg(-1)*min(-1)). CONCLUSIONS Combined training did not provide additional benefits nor did it mitigate improvements in fitness in younger subjects compared with aerobic and resistance training alone. In older subjects, there was a trend to greater aerobic fitness gains with A + R versus A alone.

Improving physical activity and dietary behaviours with single or multiple health behaviour interventions? A synthesis of meta-analyses and reviews.

Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic.

Understanding physical activity in adults with type 2 diabetes after completing an exercise intervention trial: A mediation model of self-efficacy and autonomous motivation

This study was set out to test if autonomous motivation mediated the relationship between self-efficacy and 12-month physical activity (PA) in adults with type 2 diabetes involved in a randomized exercise trial. Participants (n = 234) completed questionnaires measuring barrier self-efficacy at 3 months, autonomous motivation at 6 months, and PA at 12 months. A mediational analysis of longitudinal data revealed that autonomous motivation mediated the relationship between barrier-self-efficacy and PA. High barrier self-efficacy can therefore help predict 12-month PA in adults with type 2 diabetes, although this effect is attenuated by autonomous motivation. Hence, participating in PA for autonomous reasons such as by choice and/or for fun further explains PA at 12 months in this population. Results of this study extend our understanding of the motivational constructs involved in PA in the maintenance phase. This study has important theoretical implications in that it helps to organize and consolidate well-known correlates of PA by proposing a temporal relationship between them that could be tailored in interventions.

The physical activity counselling (PAC) randomized controlled trial: rationale, methods, and interventions.

Primary care is a promising venue to build patient motivation and confidence to increase physical activity (PA). Physician PA counselling has demonstrated some success; however, maintenance of behaviour change appears to require more intensive interventions. In reality, most physicians do not have the necessary training nor the time for this type of counselling. The purpose of this paper is to outline the rationale, methods, and interventions for the ongoing physical activity counselling (PAC) randomized controlled trial (RCT), which aims to assess the impact of integrating a PA counsellor into a primary care practice. This RCT has 2 arms: (i) brief PA counselling (2-4 min) from a health care provider and (ii) brief PA counselling+intensive PA counselling from a PA counsellor (3 months). The impact of this intervention is being evaluated using the comprehensive RE-AIM framework. One hundred twenty insufficiently active adult patients, aged 18 to 69 y and recruited during regular primary care visits have been randomized. Dependent measures include psychological mediators, PA participation, quality of life, and physical and metabolic outcomes. The PAC project represents an innovative, theoretically-based approach to promoting PA in primary care, focusing on psychological mediators of change. We anticipate that key lessons from this study will be useful for shaping future public health interventions, theories, and research.

Impact of integrating a physical activity counsellor into the primary health care team: physical activity and health outcomes of the Physical Activity Counselling randomized controlled trial.

The purpose of this paper was to report the physical activity and health outcomes results from the Physical Activity Counselling (PAC) trial. Patients (n = 120, mean age 47.3 ± 11.1 years, 69.2% female) who reported less than 150 min of physical activity per week were recruited from a large community-based Canadian primary care practice. After receiving brief physical activity counselling from their provider, they were randomized to receive 6 additional patient-centered counselling sessions over 3 months from a physical activity counsellor (intensive-counselling group; n = 61), or no further intervention (brief-counselling group; n = 59). Physical activity (self-reported and accelerometer) was measured every 6 weeks up to 25 weeks (12 weeks postintervention). Quality of life was also assessed, and physical and metabolic outcomes were evaluated in a randomly selected subset of patients (33%). In the intent-to-treat analyses of covariance, the intensive-counselling group self-reported significantly higher levels of physical activity at 6 weeks (p = 0.009) and 13 weeks (p = 0.01). There were no differences in self-reported physical activity between the groups after the intervention in the follow-up period, nor was there any increase in accelerometer-measured physical activity. Finally, the intensive-counselling patients showed greater decreases in percent body fat and total fat mass from 13 weeks to 25 weeks. Results for physical activity depended on the method used, with positive short-term results with self-report and no effects with the accelerometers. Between-group differences were found for body composition in that the intensive-counselling patients decreased more. A multisite randomized controlled trial with a longer intensive intervention and follow-up is warranted.

A psychometric evaluation of the Hospital Anxiety and Depression Scale in cardiac patients: addressing factor structure and gender invariance.

OBJECTIVES The present study examined the factor structure of the Hospital Anxiety and Depression Scale (HADS) and tested measurement invariance between genders in a representative sample of cardiac patients across 2 years. DESIGN Confirmatory factor analysis and structural equational modelling were used to assess the factor structure, measurement, and structural invariance of the HADS. METHODS Eight hundred and one cardiac patients completed the HADS at baseline, 6, 12, and 24 months. RESULTS Confirmatory factor analysis consistently supported a three-factor structure of the HADS, with the best fitting model comprised of negative affect, autonomic anxiety, and depression. Structural equation modelling showed that the HADS was invariant by gender among cardiac patients. CONCLUSIONS The HADS can be appropriately used with both male and female cardiac patients to assess three domains of psychological distress. Future investigations should consider the predictive validity and relevance of the HADS subscales with respect to diagnostic distinctions and clinical outcomes among cardiac patients and other clinical populations.

Self-determination and Exercise Stages of Change: Results from the Diabetes Aerobic and Resistance Exercise Trial

Little longitudinal research exists on the relationship between exercise self-determination and stage of change. This study investigated how self-determined motivation changes in patients with type 2 diabetes (N = 175) as they moved through the stages of change over a six-month exercise trial. Hierarchical linear modelling revealed that patients who progressed through the stages of exercise change had an overall increase in self-determined motivation, while non-progressors experienced a reduction in self-determined motivation from three to six months. These results indicate that individuals engaging in regular exercise at six months maintain initial increases in self-determined motivation. Findings are discussed in light of self-determination theory.

Understanding how organized youth sport maybe harming individual players within the family unit: a literature review.

Within the United States, close to 45 million youths between the ages of 6 and 18 participate in some form of organized sports. While recent reviews have shown the positive effects of youth sport participation on youth health, there are also several negative factors surrounding the youth sport environment. To date, a comprehensive review of the negative physical and psychological effects of organized sport on youth has not been done and little thus far has documented the effect organized sport has on other players within a family, particularly on parents and siblings. Therefore the purpose of this paper is to conduct a review of studies on the negative effects of organized sport on the youth athlete and their parents and siblings. Articles were found by searching multiple databases (Physical Education Index and Sociology, Psychology databases (Proquest), SPORTDiscus and Health, History, Management databases (EBSCOhost), Science, Social Science, Arts and Humanities on Web of Science (ISI), SCOPUS and Scirus (Elsevier). Results show the darker side of organized sport for actors within the family unit. A model is proposed to explain under which circumstances sport leads to positive versus negative outcomes, ideas for future research are drawn and recommendations are made to optimize the youth sport experience and family health.