Quantifying uptake and completion of pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease known to tertiary care

Background: People with symptomatic chronic obstructive pulmonary disease (COPD) benefit from pulmonary rehabilitation programs (PRPs), but program attrition is common. Methods: For people with COPD who presented to tertiary care and appeared appropriate for a PRP, we prospectively mapped their PRP journey, explored factors influencing attendance to pre-program assessment and captured program attrition. Results: Of the 391 participants, 31% (95% CI 27 to 36) were referred to a PRP (n = 123; age 68 ± 10years, 62 males [50%], FEV1 45 ± 19%predicted). Of those referred, 94 (76% [69 to 84]) attended a pre-program assessment. Ex-smokers and those who had a healthcare professional (HCP) explain they would be referred were more likely to attend a pre-program assessment (odds ratio [95%CI]; 2.6 [1.1 to 6.1]; and 4.7 [1.9 to 11.7], respectively). Of the 94 who attended, 63 (67% [58 to 77]) commenced; and of those who commenced, 35 (56% [43 to 68]) completed a PRP. All who completed (n = 35, 100%) were provided at least one strategy to maintain training-related gains. Conclusion: Attrition occurs throughout the PRP journey. Interactions with HCPs about PRPs positively influenced attendance. Understanding how HCPs can best contextualise PRPs to encourage referral acceptance and uptake is an important area for further work

Quantifying the effect of monitor wear time and monitor type on the estimate of sedentary time in people with COPD: Systematic review and meta-analysis

In studies that have reported device-based measures of sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD), we explored if the monitor type and monitor wear time moderated the estimate of this measure. Five electronic databases were searched in January 2021. Studies were included if \u3e70% of participants had stable COPD, and measures of ST (min/day) were collected using wearable technology. Meta-regression was used to examine the influence of moderators on ST, monitor type, and wear time. The studies identified were a total of 1153, and 36 had usable data for meta-analyses. The overall pooled estimate of ST (mean [95% CI]) was 524 min/day [482 to 566] with moderate heterogeneity among effect sizes (I2 = 42%). Monitor wear time, as well as the interaction of monitor wear time and monitor type, were moderators of ST (p \u3c 0.001). The largest difference (−318 min; 95% CI [−212 to −424]) was seen between studies where participants wore a device without a thigh inclinometer for 24 h (and removed sleep during analysis) (675 min, 95% CI [589 to 752]) and studies where participants wore a device with a thigh inclinometer for 12 h only (356 min; 95% CI [284 to 430]). In people with COPD, the monitor wear time and the interaction of the monitor wear time and the monitor type moderated the estimate of ST

Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review

Questions: In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains? Design: Systematic review, meta-analysis and meta-regression of randomised controlled trials. Participants: People with stable COPD. Intervention: Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component. Outcome measures: Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living. Data sources: EMBASE, PEDro, PubMed and the Cochrane Library. Results: Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program. Conclusion: At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains. Registration: CRD42020193833

The motivational antecedents of the development of mental toughness: a self-determination theory perspective

Mental toughness is a topic that has received growing attention in psychological literature over the past decade. Although some researchers have attempted to understand how mental toughness is developed, little effort has been made to integrate an understanding of mental toughness development with established psychological theory and research. The aim of our review is to demonstrate the utility of theory and research on motivation for understanding mental toughness and its development. In particular, we propose that self-determination theory provides a sound basis for understanding the motivational antecedents of mental toughness. To achieve our aim, we consider concepts that bridge mental toughness and self-determination theory literature, namely striving, surviving, and thriving. We conclude our review with suggestions for future lines of empirical enquiry that could be pursued to further test our propositions

Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis

Objective: To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings. Design: Systematic review and meta-analysis. Data sources: Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey. Eligibility criteria: Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables. Results: We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=−0.21, 95% CI (−0.31 to –0.12)) and doping use (g=−0.08, 95% CI (−0.14 to –0.03), but not inadvertent doping (g=−0.70, 95% CI (−1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=−0.28, 95% CI −0.31 to –0.24), doping use (z=−0.09, 95% CI −0.13 to to –0.05) and inadvertent doping (z=−0.19, 95% CI −0.32 to –0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI −0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality. Conclusion: This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions

Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis

Objective: To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings. Design: Systematic review and meta-analysis. Data sources: Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey. Eligibility criteria: Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables. Results: We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=−0.21, 95% CI (−0.31 to –0.12)) and doping use (g=−0.08, 95% CI (−0.14 to –0.03), but not inadvertent doping (g=−0.70, 95% CI (−1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=−0.28, 95% CI −0.31 to –0.24), doping use (z=−0.09, 95% CI −0.13 to to –0.05) and inadvertent doping (z=−0.19, 95% CI −0.32 to –0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI −0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality. Conclusion: This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions

Are mental toughness and mental health contradictory concepts in elite sport? A narrative review of theory and evidence

Objective: Athlete development and management encompass a complex interaction of biological, psychological, and social factors. Within elite sport, multidisciplinary sport science and medicine teams play an important role in achieving an optimal balance between preventing athlete ill-health and optimizing health and performance. The psychological aspects of athlete health and performance have gained increased attention over the past two decades, with much of this research concerned with the mental health of athletes and the concept of mental toughness. Recently, it was proposed that mental health and mental toughness are contradictory concepts in the world of elite sport. Although an interesting proposition, this claim was not substantiated. Thus, the purpose of this narrative review was to evaluate theory and evidence regarding the thesis that mental health and mental toughness are contradictory concepts in the world of elite sport, with the view to advance scholarly knowledge and inform professional practice. Design: Narrative review. Results: A critical evaluation of this literature suggests that mental toughness may represent a positive indicator of mental health, or facilitate its attainment, rather than be at odds with it. Conclusion: When implemented alongside multilayered approaches to organizational change (e.g., group structures, policies), mental toughness could be used as a 'hook' to attract athletes into settings that can open dialogue on the importance of mental health and improve knowledge of key issues (e.g., stigma, symptoms)

Health behaviour profiles in young Australian adults in relation to physical and mental health: The Raine study

Issues Addressed: We aimed to identify latent health behaviour profiles of young adults and examine their associations with physical and mental health outcomes. We also characterised the profiles by socio-demographic characteristics. Methods: Data were collected between 2012 and 2014. Participants (N = 476) were young adults (M age [SD] = 22.1 [.57] years) from Generation 2 of the Raine Study longitudinal cohort. Health behaviours were measured via ActiGraph GT3X waist monitors (physical activity, sedentary behaviour) and questionnaires (diet quality, alcohol, smoking and sleep). Physical and mental health were measured using clinical health assessments, blood biomarkers, and questionnaires. Latent Profile Analysis using Mplus (8.2) was employed to identify profiles. Results: Four latent profiles were identified: ‘heavy drinkers with moderately unhealthy eating habits’ (high takeaway foods; n = 135), ‘unhealthy food abstainers’ (low takeaway foods; n = 138), ‘moderately sedentary alcohol abstainers’ (n = 139) and ‘physically active drinkers with unhealthy eating habits’ (high takeaway foods and sugary drinks; n = 64). ‘Physically active drinkers with unhealthy eating habits’ had the poorest (physical and mental) health outcomes, yet the lowest insulin resistance. ‘Unhealthy food abstainers’ had the most favourable health outcomes (adiposity, health perceptions, blood pressure). Sex differed among the profiles. Conclusions: The profiles identified among young adults are different to profiles with general adult populations. A novel finding was that ‘physically active drinkers with unhealthy eating habits’ had low insulin resistance. The findings also suggest that future interventions may need to be sex specific. So What: Our findings suggest that health behaviour interventions for young adults should be targeted to distinct profile characteristics

A Multi-Study Exploration of Factors that Optimise Hardiness in Sport Coaches and the Role of Reflective Practice in Facilitating Hardy Attitudes

Hardiness has been identified as a key personal characteristic that may moderate the ill-effects of stress on health and performance. However, little is known about how hardiness might be developed, particularly in sport coaches. To systematically address this gap, we present two linked studies. First, interviews were conducted with pre-determined high-hardy, elite coaches (n = 13) to explore how they had developed their hardy dispositions through the associated attitudinal sub-components of control, commitment, and challenge. Utilizing thematic analysis, we identified that hardiness was developed through: experiential learning; external support; and the use of specific coping mechanisms. Key to all of these themes was the concept of reflective practice, which was thought to facilitate more meaningful learning from the participants’ experiences and, subsequently, enhance the self-awareness and insight required to augment hardiness and its sub-components. To investigate further the potential relationship between coaches’ reflective practices and their level of hardiness, we conducted a follow-up study. Specifically, a sample of 402 sports coaches completed the Dispositional Resilience Scale-15, the Self-Reflection and Insight Scale, and the Questionnaire for Reflective Thinking. Using latent profile analysis, we clustered participants into groups based on their reflective profiles (e.g., type of engagement, level of reflective thinking). We then examined differences in hardiness between the five latent sub-groups using multinomial regression. Findings revealed that the sub-group of highly engaged, intentionally critical reflective thinkers reported significantly higher levels of all three hardiness sub-components than all other sub-groups; these effect sizes were typically moderate-to-large in magnitude (standardized mean differences = -1.50 to -.10). Conversely, the profile of highly disengaged, non-reflective, habitual actors reported the lowest level of all three dimensions. Collectively, our findings offer novel insights into the potential factors that may influence a coaches’ level of hardiness. We provide particular support for the importance of reflective practice as a meta-cognitive strategy that helps coaches to develop hardy dispositions through augmenting its attitudinal sub-components. Consequently, our research makes a significant contribution by providing a comprehensive insight into how we might better train and support coaches to demonstrate the adaptive qualities required to thrive in demanding situations

Conceptualizing and testing a new tripartite measure of coach interpersonal behaviors

Objectives: Various self-report measures based on Self-Determination Theory (Deci & Ryan, 1985; Ryan & Deci, 2017) have been developed to assess athletes’ perceptions of their coaches’ need supportive and thwarting behaviors. We propose that it is also conceptually important to distinguish between coaching behaviors that thwart and those that are indifferent to athletes’ psychological needs. This distinction is useful, as we contend that athletes’ degree of need frustration, and concomitant negative outcomes, are likely to be more pronounced in a coaching environment that actively thwarts (vs. is indifferent to) athletes’ needs. In this three-study paper, we outline the conceptual rationale for, the development of, and initial validity evidence for a tripartite (need supportive, thwarting, and indifferent) measure of interpersonal behaviors of coaches (TMIB-C). Method: In Study 1, we developed 54 candidate items and gathered evidence for their face and content validity with athletes and an expert panel. Competing factor models were tested in Study 2 to determine the best representation of the measure’s factor structure. In Study 3, we tested the replication of such models and the nomological network surrounding the identified factors. Results: In Study 2, a 22-item, three-factor structure (supportive, thwarting, and indifferent behaviors) using exploratory structural equation modeling, demonstrated acceptable fit, good standardized factor loadings, factor correlations in the expected directions, and acceptable estimates of internal consistency. This model was replicated in Study 3. Tests of nomological networks showed that as expected, need indifference was a weaker predictor of autonomy and competence need frustration as compared to need thwarting, and the only significant predictor of irrelevant thoughts. Unexpectedly however, need indifference, when compared to need thwarting, was as good a predictor of exhaustion and a better predictor of relatedness frustration. Conclusions: Evidence supports the TMIB-C as a parsimonious and promising measure of athletes’ perceptions of coach interpersonal behaviors. Our tripartite conceptualization and measure should be further tested in terms of its predictive utility in order to advance conceptual understanding and intervention efforts targeting interpersonal behaviors in sport, and potentially other life domain