Relationships Among Self-Efficacy, Implicit Associations, Motives and Exercise Behaviour

The general purpose of this dissertation was to examine how self-efficacy, explicit exercise motives and implicit automatic associations with exercise influence exercise behaviour of sedentary adults. This dissertation is divided into three manuscripts. The first manuscript examined how self-selection influences the decision to enrol in an exercise program as well as in self-efficacy, explicit motives and implicit associations. Additionally, manuscript one sought to understand the role of self-selection bias in the adoption and maintenance of exercise over six months. A total of 290 inactive adults aged 35-65 completed the Multidimensional Self-Efficacy for Exercise Scale (MSES; Rodgers, Wilson, Hall, Fraser, & Murray, 2008), two Go/No Go Association Tasks (GNATs; Nosek & Banaji, 2001) to measure automatically activated associations of exercise, and the Exercise Motivations Inventory-2 (EMI-2; Markland & Ingledew, 1997) at baseline, three months and six months of an exercise program. Analysis of variance was used to test study hypotheses. At baseline, participants were grouped into three self-selection profiles: self-selection (n =126), self-selection with previous knowledge of the exercise program (n = 111), and those who did not enrol in the exercise program (n =53). Those in the self-selection groups had higher task, coping and scheduling SE, as well positive health exercise motives. No differences in implicit automatic associations with exercise were found. The influence of self-selection bias did not influence adherence or drop outs at three and six months across the three dependent variables. Manuscript two investigated the role that self-efficacy, explicit motives and implicit automatic associations with exercise influence the intention behaviour gap. Those participants who enrolled in the exercise program and had no previous knowledge of the exercise program were included in this study resulting in a total of 141 participants (107 inclined actors and 35 inclined abstainers) aged 35-65. Analysis of variance, logistic regression, and moderation models were used to examine hypotheses. SE beliefs, explicit motives or implicit automatic associations with exercise did not differentiate inclined actors and abstainers. Coping SE was a significant predictor of being an inclined actor. Explicit weight management and appearance motives moderated the relationship between SE and becoming an inclined actor. The purpose of Manuscript 3 was to examine how self-efficacy, explicit exercise motives and implicit automatic associations change over the course of a six-month exercise program as a function of exercise type (weight training or aerobic training). A total of 141 (aged 35-65) began the exercise program and were included in this manuscript. Repeated measures analysis of variance was used to assess change over time. Implicit associations did not change over time. Explicit motives, except weight management motives significantly decreased from baseline to six months and from three months to six months. The change in appearance motives was stronger for those in the strength-training group. Task, coping and scheduling SE increased from baseline and remained stable except for task SE, which, decreased from three to six months

EXAMINING THE RELATIONSHIP BETWEEN TEAM COHESION AND SELF-PRESENTATION

Within team sport, cohesion is not only associated with group level outcomes such as performance but also with individual outcomes, which may include a sense of protection and security. These benefits of group membership are related to reduced levels of anxiety associated with self-presentational concerns (Carron, Estabrooks, Horton, Prapavessis, & Hausenblas, 1999), which are inherent in sport competition (Leary, 1992). The purpose of this study was to examine how self-presentational concerns are predicted by perceptions of cohesion. It was hypothesized that high cohesion would be associated with low self-presentational concerns. A total of 163 competitive team sport athletes completed the Group Environment Questionnaire (GEQ: Carron, Widmeyer, & Brawley, 1985), Self-presentation in Sport Questionnaire (SPSQ; Wilson & Eklund, 1998), and the Sport Anxiety Scale (SAS; Smith, Smoll, & Shutz, 1990). Structural Equation Modeling determined that perceptions of cohesion (R= -.20) significantly predicted 4% of the variance of self-presentation in sport

The experiences of people with Alzheimer’s dementia and their caregivers in acquiring and using a mobility aid_ a qualitative study

Purpose: Cognitive deficits and gait and balance problems are progressive in people with Alzheimer’s dementia. Yet, mobility aids are associated with an increased falls risk in people with dementia. Our objectives were to identify the perceptions of people living with mild-to-moderate Alzheimer’s dementia, and their caregivers, on the use of mobility aids. Methods: A qualitative study using semi-structured, face-to-face interviews was conducted. Community-dwelling older adults with dementia attending a day hospital program were recruited. Thematic analysis was conducted and the text was coded into broad themes aligned with the research questions. The coded text was examined for patterns and similarities, and grouped to form inductive themes. Results: Twenty-four people (12 living with dementia and their 12 caregivers) participated. Five themes were identified: (1) acknowledgement of need; (2) protecting a sense of self; (3) caregiver oversight and relief of burden; (4) healthcare professional involvement; (5) environment and design of aids. Conclusions: The findings suggest that people with Alzheimer’s dementia and their caregivers regard mobility aid use as increasing independence. There is a role for healthcare professionals to be involved in the prescription, provision and training for use of mobility aids among people living with dementia to ensure uptake and safety.IMPLICATIONS FOR REHABILITATION Mobility aid use is regarded as increasing independence by people with Alzheimer’s disease and their caregivers. Falls risk associated with mobility aid use was not well known and caregivers perceived mobility aids as a means to reduce falls. Most people do not see a healthcare professional when they acquire a mobility aid and there is a role for healthcare professionals to be involved in the prescription, provision and training of people living with dementia in the use of mobility aids in order to increase the uptake of aids and their safe use

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer\u27s Disease: Part I - Cane

BACKGROUND: People with Alzheimer\u27s disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD. OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking. METHODS: Seventeen participants with AD (age 82.1±5.6 years) and 25 healthy controls (age 70.8±14.1 years) walked using a single-point cane in a straight (6 meter) and a complex (Figure of 8) path under three conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). Velocity and stride time variability were recorded with accelerometers. RESULTS: Gait velocity significantly slowed for both groups in all conditions and stride time variability was greater in the AD group. Overall, multi-tasking produced a decrease in gait and cognitive demands for both groups, with more people with AD self-prioritizing the cognitive task over the gait task. CONCLUSION: Learning to use a cane demands cognitive resources that lead to detrimental changes in velocity and stride time variability. This was most pronounced in people with mild to moderate AD. Future research needs to investigate the effects of mobility aid training on gait performance

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer\u27s Disease: Part II - 4-Wheeled Walker.

BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer\u27s disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk. OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults. METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). RESULTS: Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values CONCLUSION: Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance

Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review

Background: People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. Objective: To review gait parameters and characteristics associated with falls in people with dementia. Methods: Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. Results: Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson’s Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. Conclusion: This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population

A framework for secondary cognitive and motor tasks in dual-task gait testing in people with mild cognitive impairment

Background: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI). Methods: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined tasks of motor and cognitive activities. The cognitive cost was the difference between the single gait task and each of the concurrent motor and cognitive challenges. A repeated two-way measure ANOVA assessed the effect of cognitive group and walking test condition for each gait task test. Results: Gait velocity was significantly slower in the MCI group under all tasks. For both groups, the concurrent motor task of carrying a glass of water conferred a challenge not different from the cognitive task of counting backwards by ones. Performance of the complex cognitive task of serial seven subtractions reduced gait velocity in both groups, but produced a greater change in the MCI group (31.8%). Conclusions: Not all concurrent tasks challenge cognition-motor interaction equivalently. This study has created a framework of task difficulty which allows for the translation of dual-task test conditions to future research and clinical practice to ensure the accuracy of assessing patient deficits and risk

The differential effect of first time single-point cane use between healthy young and older adults

Introduction Walking aids are often introduced to older adults to enable independent mobility. Single‐point canes are the most common device used. Benefits are tempered by research suggesting that walking aids increase falls risk. A better understanding of the effect of walking aid use on gait performance is required. Objective To evaluate differences in the effect of initial single‐point cane use on gait between younger (YA) and older adults (OA). Design Cross‐sectional. Setting Community‐dwelling. Participants Twenty‐six YA (aged: 23.7 ± 2.8 years) and 25 OA (aged: 70.8 ± 14.1 years) participated. Inclusion criteria were: age 18‐35 for YA or ≥ 50 for OA, able to ambulate unassisted, and without any condition affecting mobility. Interventions Not applicable. Main Outcome Measure(s) Gait velocity and stride time variability under different walking path configurations (straight path, Groningen Meander Walking Test, Figure of Eight Test) and conditions (unassisted walking, walking with a single‐point cane, and walking with a single‐point cane while completing a cognitive task) was recorded in a laboratory. The arithmetic task of subtracting ones from 100 was used as the secondary cognitive task. Data analysis included separate three‐way mixed ANOVAs (path/condition/group). Results There was a statistically significant two‐way interaction between walking path and condition for velocity (P < 0.001, ω2 = 0.03) and stride time variability (P = 0.032, ω2 = 0.02). Additionally, a significant main effect of group was also observed (velocity: P = 0.004, ω2 = 0.07; stride time variability: P = 0.001, ω2 = 0.09). Conclusions Using a single‐point cane decreased velocity and increased stride time variability in both younger and older adults. However, the cognitive load and effect on gait of initial cane use was not different between age groups. Standardized guidelines aimed at facilitating a client's transition towards the safe use of a walking aid are needed. Future research should evaluate if training can mitigate some of the adverse changes to gait stability observed with initial walking aid use