Evaluation of a one year long, non-dieting, physical activity based lifestyle intervention programme for clinically obese women

Obesity is a heterogeneous, complex, and chronic condition with large individual differences. Lifestyle modification has been widely acknowledged as the primary treatment for obesity. Objective – This PhD examined the effects of a non-dieting exercise-based lifestyle intervention programme (e.g. no calorie-restriction) using the tenets of the self-determination theory (SDT; Deci & Ryan, 1985b) to inform intervention decisions and identify individual differences (e.g. SDT was used to identify self-regulatory profiles), on physical and metabolic fitness, and psychological well-being among premenopausal, clinically obese women. The programme titled WHEEL focused on health outcomes rather than weight loss. Design – A randomised, delayed start RCT feasibility study. This longitudinal study ran for one year in two phases: a) 12 weeks of intensive intervention and b) a 40-week maintenance phase. Setting – Free living, general community setting. Participants – 62 predominantly white Caucasian (97%), clinically obese (BMI ≥30kg/m2), pre-menopausal women with a mean age of 40.2 years, free of obesity-related diseases and fit to for exercise were randomly assigned to a non-dieting lifestyle intervention group (n = 31) or waiting list control (n = 31). Intervention – Exercise: four hours of exercise per week chosen from the following options: Tai Chi, Circuit classes x 2; and Aqua aerobics. Participants were required to complete two sessions in a WHEEL class, but were encouraged to do all four. If this was not possible they had to agree the exercise of their choice with EB who checked their plan against the FITT principle of exercise. The tenets of SDT, namely autonomy, competence building, and relatedness were used to inform the design of exercise sessions. Autonomy: participants chose their own exercise programme structure. Flexibility within exercise sessions allowed for matching activities to participants’ current state of fitness. Those with high functional limitations were given alternative, seated exercises. Relatedness was fostered in different ways: 1) Outside of WHEEL:participants were encouraged to share their weight related experiences with each other. Routes to exercise venues were planned and they were encouraged to have a car-sharing scheme; and participants organised various charity walks for the group on their own accord. 2) Within WHEEL: participants generally worked in pairs whilst exercising in a group setting. After the initial 12-week intervention phase they were also allowed to invite a female friend or family member to join them in the classes. Competence building: participants were taught exercise skills; including naming and executing each exercise routine correctly, with a view of them joining ‘regular’ classes in the future. Furthermore, they were taught to take their own pulse and monitor their heart rate throughout sessions. The psycho-educational classes targeting dieting behaviours and eating regulation using Brief Cognitive Behavioural Therapy (CBT) techniques: a two one-hour session per week for three weeks, delivered in the 12-week intervention phase, challenging maladaptive eating behaviours, whilst educating participants about food labels and food choices. Educational Sessions: one per week for 12 weeks on physiological and psychological mechanisms of exercise and dieting (e.g. dangers of weight cycling due to dieting). Social Support: follow-up phone calls if two weeks of exercise sessions were missed. Adherence: attrition and attendance were monitored. Data Analysis – Mixed Method: sequential QUAN-QUAL data analyses. QUAN: intention to treat analysis, repeated measures analysis of variance, regression, and correlations. QUAL: analytic induction analysis using the QSR*NVivo qualitative data analysis software. Outcome measures at baseline, 12 weeks, and 52 weeks. QUAN Psychological Instruments: General Causality Orientation Scale (GCOS; Deci & Ryan, 1985b), General Well-Being Schedule (GWB; Dupuy, 1977 & 1978), Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983), Self-Perception Profile (SPP; Messer & Harter, 1986), State Self-Esteem Scale (SSES; Heatherton & Polivy, 1991), Multidimensional Health Locus of Control Scales (Form C) (MHLC; Wallston,Wallston, & DeVellis, 1978), and Social Support for Exercise Scale (SSSE; Fox & Dirkin, 1992). QUAN Physiology measures: metabolic and cardio-respiratory fitness. QUAL: 62 weight history interviews at baseline with 36 follow-up interviews, including 12 drop-outs. The semi-structured interviews explored participants’ history and prevalence of self-reported dieting and eating behaviours, assessed weight cycling prevalence and development of weight status up to baseline, investigated previous exercise history and skills, perceived health status and difficulties with physical activity including barriers, and examined motivation, goals, and expectation for WHEEL from the personal point of view and from the programme’s. The follow-up interviews at 52 weeks explored difficulties with exercise behaviour change, and quality of life. Results – Baseline: participants showed high levels of psychopathology indexed by high levels of stress, low levels of general well-being (81.8% in severely distressed category of the General Well-Being Schedule) and self-perceptions (e.g. self-esteem, body image), low autonomy and high impersonal orientation, and problems with emotional eating (78%) and dieting (86%). Also, participants had poor fitness levels (< 10% percentile for women) and metabolic profile with 50% of the participants meeting the metabolic syndrome criteria. Participants had unrealistic expectations (35% expected weight loss) and low exercise self-efficacy, low confidence in their ability to achieve, and a number of problems associated with their excess body weight. Finally, participants experienced societal prejudice in various aspects of their lives (e.g. healthcare, work). RCT phase: significant improvements in psychological functioning indexed by significant improvement in well-being (29.9% improvement in total score of GWB Schedule and all its subscales), self-perceptions (athletic, appearance, global self-worth scales of the SPP), and perceived received social support (reducing significantly the discrepancy between need for support and received support). In addition, cardiorespiratory fitness improved significantly in the intervention group (9.3% increase adjusted VO2, ml-kg- 1 min-1; 7.8% absoluteVO2, ml-min-1) as compared to controls (4% reduction adjusted VO2, ml-kg-1 min-1 & 3.2% absoluteVO2, ml-min-1). All these changes took place despite the absence of significant weight loss. Maintenance: those who continued the programme showed improved psychological functioning at 12. The participants showed significant improvements in general well-being: the average value at this stage was 74.4 (±16.6) bringing the group as a whole into the positive well-being category. Most subscales of the SPP showed significant improvements from baseline to 12 months and the discrepancy between needed and perceived provided social support for listening, information, and challenge support for exercise narrowed significantly. In support of SDT, participants felt more autonomous and more in control of their own destiny. Conclusion - Although there was a significant dropout in the study (60%) the present intervention was successful in bringing about behavioural change in those who stayed in the programme. Both the QUAN and QUAL results provided strong support for the improved psychological profile of participants in the absence of significant weight changes. Reasons for dropout included: research design, facilities, and personal. Although the study was not without limitations the underlying philosophy adopted was rarely questioned and would provide a basis for definitive RCT trail

Relationship between physical self-perceptions and body composition following a 10 week exercise program for previously sedentary participants.

The aim of the present study was to investigate whether body composition and engagement in an exercise program influenced participants’ physical self-perceptions. The study consisted of 92 participants, 40 males and 52 females; with an average age of 31.9± 9.37 years. The Physical Self-Perception Profile was used to assess physical self-perceptions(PSPP; Fox & Corbin, 1989). Body fat percentage was measured using a bioelectrical impedance analyser (RJL systems,Detroit). In addition, height,weight, BMI and WHR was assessed. The study consisted of an exercise intervention group (N = 72) and a control group (N = 20). Participants in the intervention group attended public gyms in North-west London.Measurements were taken at the induction session and after a 10 week intervention period. All participants were provided with an individual training program which followed the ACSM guidelines. Adherence was assessed by means of an electronic entry card to the gym facilities and a self-report measure. For statistical analysis the participants in the exercise group were categorised as either adherers (> 30 sessions; N = 35), and non-adherers (< 30 sessions; N= 26). Repeated measures analysis of variance [3 (adherers, non-adherers, control) x 2 (pre-, post-test)] and follow-up post-hoc comparisons showed that the adherers had a significant decrease in % body fat and BMI and a significant increase on the body, condition and strength subscales of the PSPP from pre- to the post-test.Additionally, correlational analysis for the change in the dependent variables from pre- to post-test showed only significant correlations for the adherers. The participants who adhered to the exercise program showed significant changes in their body composition in terms of a decrease in % body fat and BMI and this change was associated with perceiving oneself in better physical condition, and stronger. They were also more satisfied with their physique. These findings partially support Fox’s (1997) intervention hypothesis in that engaging in regular physical exercise and its associated physical changes can positively alter participants’ physical self-perceptions

The effect of an 8 week prescribed exercise and low-carbohydrate diet on cardiorespiratory fitness, body composition and cardiometabolic risk factors in obese individuals: a randomised controlled trial

Background: Low-carbohydrate (LC) diets are an effective method for treating obesity and reducing cardiometabolic risk. However, exposure to LC diets is associated with reductions in muscle mass and increased osteoporosis risk in obese individuals. The combination of exercise with a LC diet appears to attenuate muscle mass loss induced by LC diets alone, and to further improve cardiometabolic profile. However, evidence to date in obese individuals is limited. We assessed the effect of LC diet in combination with supervised exercise on cardiorespiratory fitness, body composition and cardiometabolic risk factors in obese individuals. Methods: Male and female participants in the experimental (EX-LC; structured supervised exercise program + low-carbohydrate meals; n = 33; 35.3 years) and control (EX-CO; structured supervised exercise program + standard dietary advice; n = 31; 34.2 years) conditions underwent measurements of cardiorespiratory fitness (VO2peak), body fat, lean muscle mass (LMM), and cardiometabolic biomarkers before and after an 8 week intervention. Results: Participants in the EX-LC condition demonstrated greater improvements in VO2peak (p = 0.002) and fat mass index (FMI, p = 0.001) compared to the EX-CO condition. Achieving a ketogenic state (β-hydroxybutyrate, βHB ≥0.3 mmol/L) was associated with greater reductions in total body fat (p = 0.011), visceral adipose tissue (p = 0.025), FMI (p = 0.002) and C-reactive protein (CRP, p = 0.041) but also with greater reductions in LMM (p = 0.042). Conclusion: Short-term LC diet combined with prescribed exercise enhanced cardiorespiratory fitness and the cardiometabolic profile of obese individuals but was also associated with greater muscle mass loss compared to similar exercise training and standard dietary advice. The long-term effects of the LC diet should be further explored in future studies.</p

Modelling of diabetes knowledge, attitudes, self-management, and quality of life: a cross-sectional study with an Australian sample.

Background: Quality of life (QoL) is an important aspect of wellbeing for people with chronic conditions like type 2 diabetes, making it a noteworthy outcome. Knowledge about diabetes, attitudes, and self-management of diabetes are key factors that might directly or indirectly impact QoL. However, little is known about the inter-relationships between diabetes knowledge, attitudes, self-management and QoL among people with type 2 diabetes mellitus (T2DM). The aim of this study was to examine a model describing the relationship between diabetes knowledge, attitudes, self-management, and QoL of people with T2DM that is based on previous research linking pairs of these variables. Methods: A cross-sectional study design was employed in this research. A total of 291 participants, 192 males and 99 females, with T2DM, whose mean age was 55.8 (standard deviation = 11.09) completed questionnaires measuring diabetes knowledge (Diabetes Knowledge Scale), attitudes (Diabetes Integration Scale -19), self-management (Summary of Diabetes Self-care Activities Scale), including the aspects of diet, exercise, blood glucose testing, and foot care, and QoL (Diabetes Quality of Life Scale), comprising the aspects of satisfaction and impact on QoL respectively. To examine the model we proposed relating these variables, data were analysed using the path analysis. Results: In the final model, diabetes knowledge was a significant predictor for attitudes and self-management in terms of blood glucose testing. Attitudes was a significant predictor for self-management in terms of diet. In addition, self-management in terms of blood glucose testing was a significant predictor of impact of QoL, and self-management in terms of diet was a significant predictor of satisfaction and impact of QoL. Self-management in terms of exercise was a significant predictor of satisfaction in QoL. The final model reflected a good fit (χ2 (14) = 22.52, p = 0.069; CFI = 0.983; GFI = 0.983; RMSEA = 0.046). Conclusions: Diabetes knowledge, attitudes, and self-management are important factors that can impact the QoL among people with type 2 diabetes

Video game addiction, engagement and symptoms of stress, depression and anxiety: The mediating role of coping.

A number of studies have reported a co-occurrence between video game addiction and poorer mental health, but few have contextualised this relationship by identifying mediating variables. Further, there remains uncertainty in how to differentiate high engagement from what may be termed addiction in the context of video gaming. This study examined the mediating role of coping between one measure of video game addiction and engagement, and mental health. An international sample of 552 adult participants (M age 24.9 years, 52.3% Australian) completed an online survey including the Computer Addiction-Engagement Scale (CAES), Depression, Anxiety Stress Scale (DASS-21) and Approach/Avoidance Coping Questionnaire (BACQ). Multiple mediation analysis showed that coping explained a significant portion of the relationship between video game addiction and symptoms of depression, anxiety and stress. However, even after accounting for coping, a direct relationship remained. Video game engagement, on the other hand, indicated full mediation with no direct connection to declined mental health, except in the case of anxiety. Less use of approach coping strategies and particularly more use of resignation and withdrawal coping strategies were related to poorer mental health. Gaming for distraction was unrelated to mental health. This study identified maladaptive coping as a partial explanation of the relationship between video game addiction and poorer mental health. Also, the findings provide validity for making a distinction between video gaming engagement and addiction. Highly engaged gamers with maladaptive coping styles may be more vulnerable to developing video game addiction

Inter sport transfer: experiences of high performing Australian adolescent athletes

A recent strategy by national sport governing bodies to maximize success at global levels has been through talent transfer (TT) programs. TT occurs when a high performing athlete’s involvement in a sport—in which they have invested substantial time, effort, and resources—comes to an end, and they transfer this experience to a new sport. Research exploring the facilitators and barriers to successful TT in elite sport is surprisingly limited. This is particularly the case for high performing adolescent athletes. Little is known about when, why, and at what stages of their careers they choose to transfer from one sport to another and their consequent experiences of doing so. Through semi-structured interviews, this study explored motives for why eight, high performing Australian adolescent athletes transferred sports and identified factors which facilitated or hindered the ensuing successful inter sport transfer. Based on our findings, we propose the Adolescent Sport Talent Transfer Stage model (ASTT- four stage model): (1) Primary Sport Rejection Stage; (2) Transfer Sport Susceptibility Stage; (3) Transfer Sport Acknowledgement Stage; (4) Internalization and Acceptance of Transfer Sport Stage. The model conceptualizes how talent transfer may occur and focuses on explaining the process of how to become a successful youth and adult elite athlete in another sport. Practical implications, further research avenues and limitations are presented

Erratum: Corrigendum to “Development and initial validation of the Role Strain Questionnaire for Junior Athletes (RSQ-JA)” (Psychology of Sport and Exercise (2016) 24 (168–178)(S146902921630022X)(10.1016/j.psychsport.2016.02.004))

The authors regret to let us know that there is an authorship change in the article. The authors would like add another author to the article namely Fiona Chun Man Ling, as they believe that she has made a substantial intellectual contribution to this work and is deserving authorship. As such, they would like to change the reference of the article to: Fleur E.C.A. van Rens a, *, Erika Borkoles b, Damian Farrow a, c, Thomas Curran d, Fiona Chun Man Ling a, Remco C.J. Polman e The authors would like to apologise for any inconvenience caused

From Pre-Elite to Elite: The Pathway Travelled by Adolescent Golfers

This study employed interpretative phenomenological analysis (IPA) to explore the lived experiences of eight high performing adolescent golfers who had all successfully travelled the path from novice to elite level status. By means of semi-structured qualitative interviews, participants answered questions centred on four key areas which explored their journey from preelite to elite adolescent status: initial involvement and continued participation in golf, the meaning of golf, golf environment and social support. Two super-ordinate themes emerged from participants accounts: Early Pre-elite Sporting Experiences and Strategic Approaches to Develop Adolescent Golfing Excellence. The study provides key insights into individual, social and environmental factors that enabled pre-elite adolescent golfers to make a successful transition to the elite pathway, and highlights plausible factors that may make a difference whether an athlete becomes elite or not. The findings will help coaches, policy makers and sport psychologists more effectively support emerging talent in golf

Role strain theory: applicability in understanding developmental experiences of international junior acrobatic gymnasts

It is well established that elite sports performers encounter multiple stressors during their careers. However, limited research has specifically investigated developmental, organisational, and competitive transitional experiences of international junior elite athletes. Through the application of Role Strain Theory (RST), this study extended the sport talent development literature by providing key insights into the experiences of five highly successful Great Britain (GB) junior international acrobat gymnasts, aged 14-17. It explored how they simultaneously combined multiple sport, family and educational role demands during their pre-elite to elite transition and coped with these complex demands. Derived themes from semi-structured retrospective interviews identified a presence of chronic, but low level and manageable role strain during all transitional stages, which enabled positive acrobatic development, life satisfaction, physical and mental well-being and educational progress. All reported how severity and regularity of role strain, specifically overload and conflict, at times fluctuated intermittently during the early teenage years. It was at this point when increased role strain was reported to meet family commitments due to increased training and competition schedules. Challenges faced in maintaining healthy and compatible friendships, particularly with peers outside of acrobatics and school settings, were further sources of role strain during this time. Three key factors which regulated role strain were present in all participant narratives: early internalised acrobatic identity, acrobatic specialisation by very young age and social and tangible guidance from teachers and coaches in support of the athletes’ holistic development. Potential further research and limitations are discussed