Promoting exercise on prescription: recruitment, motivation, barriers and adherence in a Danish community intervention study to reduce type 2 diabetes, dyslipidemia and hypertension

Objective: The aim of this study is to analyse recruitment, motivation, barriers and adherence to increasing physical activity in a community-based 1-year intervention. Research design and methods: This study included a baseline investigation of 1,156 participants (67% female, 33% male), a post-intervention investigation after 4 months and a follow-up assessment after 1 year. All patients included in the study were physically inactive, had a body mass index (BMI) of less than 35 and were mobile enough to participate in physical training. The inclusion criteria are at least one of the following diagnoses: type 2 diabetes, above-normal cholesterol level (dyslipidemia) or above-normal blood pressure (hypertension). Theory-based activities to promote physical activity and nutrition counselling were implemented, and self-report questionnaires investigated attitude, experiences and barriers towards physical activity and self-reported health. Results: The findings indicated an increase in physical activity and fitness level, weight loss and lower body mass index both immediately after the training period and after 1 year. The programme led to reduced tobacco use. The recruitment of the patients is not representative of the general population. More better educated and female patients participated in the programme. Weight loss was the main motivation for participation, while weight gain was the main reason for dropping out of the programme. Patients who lived with a partner accomplished 10% more than did patients who lived alone, and patients who reported a good or very good state of health at baseline were more successful in completing the programme than were patients who reported having a “bad” state of health. The reported psychological barriers include physical barriers, emotional barriers, motivational barriers and time-related barriers. Motivation was strengthened by the training group, and especially the overweight patients experienced coherence and meaning in the group training activities. Conclusions: A theory-driven community intervention can lead to an increase in physical activity. Training with a group is beneficial for motivation and adherence

The Wildman Programme: A Nature-Based Rehabilitation Programme Enhancing Quality of Life for Men on Long-Term Sick Leave: Study Protocol for a Matched Controlled Study In Denmark

Many men have poor mental health and need help to recover. However, designing a rehabilitation intervention that appeals to men is challenging. This study protocol aims to describe the ‘Wildman Programme’, which will be a nature-based rehabilitation programme for men on long-term sick leave due to health problems such as stress, anxiety, depression, post-cancer and chronic cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, or diabetes type II. The programme will be a nature-based rehabilitation initiative combining nature experiences, attention training, body awareness training, and supporting community spirit. The aim of the study will be to examine whether the ‘Wildman Programme’ can help to increase quality of life and reduce stress among men with health problems compared to treatment as usual. The study will be a matched control study where an intervention group (number of respondents, N = 52) participating in a 12-week nature-based intervention will be compared to a control group (N = 52) receiving treatment as usual. Outcomes are measured at baseline (T1), post-treatment (T2), and at follow up 6 months post-intervention (T3). The results of this study will be important to state whether the method in the ‘Wildman Programme’ can be implemented as a rehabilitation offer in the Danish Healthcare System to help men with different health problems

Cultivating a Healthy Second Nature - Nature, Culture, and Morality in Danish Parents’ Narratives about their Children’s Overweight and Weight Loss

Professional explanations for the causes of childhood overweight vary greatly and no particular weight loss methods have proved successful. Nevertheless, parents are generally regarded as primarily to blame for overweight children and also perceived as key to successful weight loss. Based on semi-structured interviews with twelve mothers and two fathers of overweight preschool children, we use a narrative approach to focus on parents’ own aetiological explanations as well as their hopes for a resolution. In their stories of how their children became overweight, parents draw on a number of explanations that refer to both natural and cultural causes which to a large extent mirror the available professional explanations, and in their stories of future possibilities, parents hope to develop a healthy second nature in their children. We argue that the parents employ these hopes and explanations as narrative devices to position themselves as moral actors in relation to the prevalent and widespread idea of childhood overweight as caused by parental failure. The parents’ narratives offer valuable insight into the exceptionally morally charged position of parenting within the social and cultural context of childhood overweight and weight loss

Cultivating a Healthy Second Nature - Nature, Culture, and Morality in Danish Parents’ Narratives about their Children’s Overweight and Weight Loss

Professional explanations for the causes of childhood overweight vary greatly and no particular weight loss methods have proved successful. Nevertheless, parents are generally regarded as primarily to blame for overweight children and also perceived as key to successful weight loss. Based on semi-structured interviews with twelve mothers and two fathers of overweight preschool children, we use a narrative approach to focus on parents’ own aetiological explanations as well as their hopes for a resolution. In their stories of how their children became overweight, parents draw on a number of explanations that refer to both natural and cultural causes which to a large extent mirror the available professional explanations, and in their stories of future possibilities, parents hope to develop a healthy second nature in their children. We argue that the parents employ these hopes and explanations as narrative devices to position themselves as moral actors in relation to the prevalent and widespread idea of childhood overweight as caused by parental failure. The parents’ narratives offer valuable insight into the exceptionally morally charged position of parenting within the social and cultural context of childhood overweight and weight loss

How do patients actually experience and use art in hospitals?:The significance of interaction. A user-oriented experimental case study.

This article aims to understand patient wellbeing and satisfaction and to qualify the current guidelines for the application of art in hospitals. Employing anthropological methods, we focus on the interactional aspects of art in health interventions. A user-oriented study ranked 20 paintings, followed by an experiment using paintings in the dayroom of five medical wards. Fieldwork was done over a two-week period. During the first week, dayrooms were configured without the presence of art and in the second week were configured with the artworks. Semi-structured interviews, observation, participant observation and informal conversation were carried out and were informed by thermal cameras, which monitored the usage, patient occupation and flow in two of the dayrooms. The study shows that art contributes to creating an environment and atmosphere where patients can feel safe, socialize, maintain a connection to the world outside the hospital and support their identity. We conclude that the presence of visual art in hospitals contributes to health outcomes by improving patient satisfaction as an extended form of health care. The article draws attention to further research perspectives and methods associated with the development of art in hospitals

Efficacy of ‘Tailored Physical Activity’ or ‘Chronic Pain Self-Management Program’ on return to work for sick-listed citizens: design of a randomised controlled trial

BACKGROUND: Pain affects quality of life and can result in absence from work. Treatment and/or prevention strategies for musculoskeletal pain-related long-term sick leave are currently undertaken in several health sectors. Moreover, there are few evidence-based guidelines for such treatment and prevention. The aim of this study is to evaluate the efficacy of ‘Tailored Physical Activity’ or ‘Chronic Pain Self-Management Program’ for sick-listed citizens with pain in the back and/or the upper body. METHODS: This protocol describes the design of a parallel randomised controlled trial on the efficacy of ‘Tailored Physical Activity’ or a ‘Chronic Pain Self-management Program’ versus a reference group for sick-listed citizens with complaints of pain in the back or upper body. Participants will have been absent from work due to sick-listing for 3 to 9 weeks at the time of recruitment. All interventions will be performed at the ‘Health Care Center’ in the Sonderborg Municipality, and a minimum of 138 participants will be randomised into one of the three groups. All participants will receive ‘Health Guidance’, a (1.5-hour) individualised dialogue focusing on improving ways of living, based on assessments of risk behavior, motivation for change, level of self-care and personal resources. In addition, the experimental groups will receive either ‘Tailored Physical Activity’ (three 50-minute sessions/week over 10 weeks) or ‘Chronic Pain Self-Management Program’ (2.5-hours per week over 6 weeks). The reference group will receive only ‘Health Guidance’. The primary outcome is the participants’ sick-listed status at 3 and 12 months after baseline. The co-primary outcome is the time it takes to return to work. In addition, secondary outcomes include anthropometric measurements, functional capacity and self-reported number of sick days, musculoskeletal symptoms, general health, work ability, physical capacity, kinesiophobia, physical functional status, interpersonal problems and mental disorders. DISCUSSION: There are few evidence-based interventions for rehabilitation programmes assisting people with musculoskeletal pain-related work absence. This study will compare outcomes of interventions on return to work in order to increase the knowledge of evidence-based rehabilitation of sick-listed citizens to prevent long-term sick-leave and facilitate return to work. TRIAL REGISTRATION: The trial is registered in the ClinicalTrials.gov, number NCT01356784

Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

BACKGROUND: Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. METHODS: Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9). RESULTS: 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders. CONCLUSION: High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. TRIAL REGISTRATION: NCT01071980