Shane N. Sweet

Explaining physical activity levels from a self-efficacy perspective: the physical activity counseling trial.

Background: The Physical Activity Counseling (PAC) trial compared the effects of a 13-week primary care physical activity (PA) intervention that incorporated a PA counselor into a health care practice compared to a control condition on PA over a 25-week period and showed group differences in PA were present at 6 and 13 weeks.Purpose: The main purpose was to examine the mediating effect of 6-week task and barrier self-efficacy on the intervention versus control group/13-week PA relationships. A secondary purpose was to determine whether task and barrier self-efficacy were significantly related to PA throughout the trial for both groups.Method: Participants were primarily sedentary individuals who received a 2- to 4-min PA intervention from their primary care provider, after which they were randomly assigned to the intervention (n=61) or control condition (n=59). Self-reported PA and task (barrier) self-efficacy measures were obtained during (i.e., baseline, 6 and 13 weeks) and after (i.e., 19 and 25 weeks) the intervention in both groups.Results: Six-week task and barrier self-efficacy had a small mediating effect. Furthermore, barrier self-efficacy had a significant relationship with PA throughout the trial, whereas the relationship between task self-efficacy and PA became significantly weaker as the trial progressed.Conclusions: PAC interventions among primarily sedentary individuals should be partly based on barrier and task self-efficacy. However, the stability of the task self-efficacy/PA relationship needs further examination.

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.

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.

Identifying physical activity information needs and preferred methods of delivery of people with multiple sclerosis

Abstract Purpose: The purpose of this study was to examine the preferred sources and methods for acquiring physical activity information of individuals with multiple sclerosis (MS) using the Comprehensive Model of Information Seeking. A secondary objective was to explore the barriers and facilitators to physical activity information seeking. Methods: Twenty-one participants diagnosed with MS participated in focus groups or telephone interviews. Results: A direct content analysis of the transcripts revealed that individuals appeared to generally prefer receiving physical activity information during period of relapse and remission. Participants also had positive beliefs toward physical activity and a clear preference for a time when physical activity messages would be relevant. Receiving physical activity information from credible sources such as the MS Society of Canada, healthcare professionals and peers with MS was also deemed important. The Internet was a preferred source to receive information due to its accessibility, but it often was considered to lack credibility. The lack of physical activity information specific to MS is the greatest barrier for individuals with MS to learn about physical activity. Conclusions: Healthcare professionals, National MS Societies, and peers should work together to deliver specific and relevant physical activity messages the MS population. Implications for Rehabilitation People with MS want more physical activity information from credible sources. Multiple vehicles of physical activity information delivery (i.e. healthcare providers, peers, MS Society) should be utilized. Physical activity information should be tailored to the individual with MS.

Patterns of Motivation and Ongoing Exercise Activity in Cardiac Rehabilitation Settings: A 24-Month Exploration from the TEACH Study

BackgroundFew studies have explored exercise and motivational patterns of cardiac rehabilitation patients in the long term.PurposeWe explored differential patterns of exercise and motivation in cardiac rehabilitation patients over a 24-month period and examined the relationship between these emerging patterns.MethodsParticipants (n = 251) completed an exercise, barrier self-efficacy, outcome expectations and self-determined motivation questionnaire. Latent class growth modelling was used to classify patients in different exercise and motivational patterns.ResultsThree exercise patterns emerged: inactive, non-maintainers and maintainers (16%, 67% and 17% of sample per pattern, respectively). Multiple trajectories were found for barrier self-efficacy, outcome expectations and self-determined motivation (3, 5, and 4, respectively). Patients in high barrier self-efficacy, outcome expectation and self-determined groups had greater probability of being in the maintainer exercise group.ConclusionsIdentifying a patient’s exercise and motivational profile could help cardiac rehabilitation programmes tailor their intervention to optimize the potential for continued exercise activity.

Investigating intermediary variables in the physical activity and quality of life relationship in persons with spinal cord injury.

OBJECTIVE Leisure time physical activity (LTPA) has been consistently associated with quality of life (QOL) in people with spinal cord injury (SCI). However, recent research suggests that intermediary variables account for the LTPA-QOL relationship in other populations. Using a prospective design, this study examined potential intermediary constructs linking LTPA and QOL in people with SCI. Drawing from previous literature, a longitudinal structural equation model was developed and tested to determine if depression, functional independence, social integration/participation, and self-efficacy mediate the LTPA-QOL relationship. METHOD Participants (n = 395) were adults with SCI who reported engaging in at least some LTPA over an 18-month period. LTPA was assessed at baseline, the intermediary variables of depression, functional independence, social integration/participation and self-efficacy were measured at 6-months, and QOL was evaluated at 18-months. RESULTS The structural model had minimally acceptable fit [χ²(395) = 803.16, p > .05; CFI = .90, RMSEA = .05 and SRMR = .06]. Baseline LTPA was related to functional independence (β = .20, p > .05), depression (β = -.32, p > .05) and self-efficacy (β = .60, p > .05) at 6 months. Six-month functional independence (β = .15, p > .05), social participation (β = .21, p > .05) and depression (β = -.34, p > .05) significantly predicted 18-month QOL. Only functional independence and depression were significant mediators. CONCLUSIONS These results suggest that LTPA may improve QOL in adults with SCI through its influence on functional independence and depression.

Exercise Facilitators and Barriers from Adoption to Maintenance in the Diabetes Aerobic and Resistance Exercise Trial

OBJECTIVE We conducted a qualitative investigation of patients with type 2 diabetes to determine their perceived facilitators and barriers to exercise at multiple time points while enrolled in a randomized exercise trial including aerobic, resistance or combined exercise. We explored differences in these themes over time, between intervention groups and by adherence level after intervention. METHODS Interviews were conducted by telephone at 3 weeks (run-in period), and at 3 (midintervention), 6 (end of intervention) and 9 months (maintenance) after enrollment to assess factors that facilitated and hampered adherence to the exercise program. Audiotapes were transcribed verbatim and subjected to content analysis. RESULTS Participants (n=28) with type 2 diabetes engaged in the interviews. Social support from family and the trainer, future health benefits, a sense of well-being and perceived fitness improvements were exercise facilitators. Experiencing illness or injury, work commitments and inclement weather were highlighted barriers. A sense of well-being, fitness improvements and enjoyment frequently were expressed by participants assigned to the combined and resistance exercise conditions. Participants who maintained prescribed exercise levels tended to be engaged in resistance exercise, and spoke of support from their personal trainers, the importance of strategies and enjoyment more frequently than those who did not maintain their exercise level. Exercise maintainers also cited more facilitators; no differences were found for barriers. CONCLUSIONS Patients with type 2 diabetes require social support, including continued contact with exercise specialists. Patients need assistance with motivational enhancement and strategies to increase facilitators to maintain exercise behaviour. Incorporating resistance exercise improves well-being and enjoyment-2 important factors linked to exercise maintenance.

Perceived variety, psychological needs satisfaction and exercise-related well-being

Objective: Perceived variety represents a psychosocial experience that gives rise to, and supports the maintenance of, an individual’s well-being. In this study, we developed an instrument to measure perceived variety in exercise (PVE), and examined whether ratings of PVE predict unique variance in indices of exercise-related well-being in addition to that explained by satisfaction of the three basic psychological needs (for competence, relatedness and autonomy) embedded within self-determination theory (SDT). We also examined the extent to which variance in perceived variety is empirically distinct from (or subsumed by) competence, relatedness and autonomy in the context of exercise. Methods: A convenience sample of community adults (N = 507) completed online surveys twice over a six-week period (n = 367). Results: PVE was found to prospectively predict unique variance in indices of exercise-related well-being, in addition to that explained by perceived competence, relatedness and autonomy. Using exploratory and confirmatory factor analytic procedures, perceived variety was found to be empirically distinct from perceived competence, relatedness and autonomy. Conclusion: Results from this work suggest that perceived variety holds potential for theoretical and applied advancements in understanding and predicting well-being in exercise settings.

Peer support need fulfillment among adults with spinal cord injury: relationships with participation, life satisfaction and individual characteristics

Abstract Purpose: To test the hypothesis among people with spinal cord injury (SCI) that greater fulfillment of peer support needs to be associated with greater participation and life satisfaction. A secondary objective was to identify characteristics of people in great need of SCI peer support. Method: The participants consisted of a population-based sample of 1549 adults with SCI. The participants completed a survey with questions on peer support, participation, life satisfaction and provided demographic and SCI-related information. A secondary analysis of cross-sectional survey data was conducted. A set of regression analyses tested the primary purpose and a partition analysis was conducted to examine the secondary objective. Results: In regression analyses, peer support need fulfillment was positively associated with autonomous-outdoors participation (p < 0.05), health participation (p < 0.05), and work/education participation (p < 0.05), as well as life satisfaction (p < 0.001) after controlling demographic and SCI-related variables. However, peer support need fulfillment was not related with overall participation or other subdomains of participation: autonomy indoors, social relationships and family role. The number of unmet SCI-related needs, injury characteristics and education were associated with fulfillment of SCI peer support needs. Conclusions: The results provide some evidence that SCI peer support plays an important role in promoting participation and life satisfaction. Individuals with many SCI-related unmet needs are most likely to report a need for peer support. Implications for Rehabilitation The receipt of peer support after a spinal cord injury (SCI) is positively related to aspects of social participation and life satisfaction. Provision of peer support can play an important role in the SCI rehabilitation process. Education, injury-related characteristics, and the number of other unmet needs are factors that rehabilitation professionals can use to identify those in particular need of peer support. Rehabilitation professionals should encourage patients who have sustained an SCI, to participate in peer support programs.