Participant perceptions of physical activity-enhancing interventions for adults with disability: A meta-synthesis of qualitative research

The United Nations Convention on the Rights of Persons with Disabilities enshrines the rights of disabled people to access services in all areas of citizenship including participation in recreational, leisure and sport activities. Despite this protection, people with disabilities face multiple personal, environmental and social barriers to participation in physical activity (PA). As a result, disabled people are more likely to be inactive compared to the able bodied population and are at a greater risk of inactivity-related diseases. Thus, there is an urgent need for behaviour change interventions to increase PA by specifically addressing the situations of people with disabilities and their barriers to participation. This original meta-synthesis of qualitative research was undertaken to explore participants’ perceptions of PA-enhancing interventions for adults with physical disability. To identify published articles relevant to the meta-synthesis, a rigorous systematic search of electronic databases and hand search of relevant journals was undertaken. In total, 76 papers were read in full, and based on the inclusion criteria, 10 papers were included for review. Following a critical appraisal of the papers, methods of thematic synthesis were drawn upon to generate analytical themes through interpretation and conceptual synthesis. Seven interrelated analytical themes were constructed representing both components and outcomes of the interventions. These were: (i) social support; (ii) diversity; (iii) communication; (iv) behavioural strategies; (v) changing thoughts; (vi) knowledge; (vii) health and well-being. The results of this meta-synthesis provide significant new information that will help interventionists design more effective PA-enhancing interventions, and researchers to better identify and measure key mechanisms and outcomes associated with successful PA-enhancing interventions for people with disabilities

Effects of a single aerobic exercise session on body image

Background and Objectives Most research on the effects of exercise on body image has concentrated on the benefits of regular exercise. However, some research has indicated that exercise has an immediate impact on body image. The aims of this study were to investigate the immediate effects of aerobic exercise in a fitness class and the at-home environment on body image, and to examine the impact of nutritional status (i.e., normal weight vs. overweight/obesity) and exercise addiction on these changes. Method 322 Hungarian women participated in the study with two different environmental conditions, fitness class condition (N = 155) and at-home video condition (N = 167). They completed the Body Appreciation Scale and Exercise Addiction Inventory before and after a one-hour aerobic exercise session. Self-report data on weight, height and exercise frequency were also collected. Results There were no significant differences between the fitness class and video groups in terms of age, educational level, BMI, body appreciation, exercise frequency and exercise addiction. We found that 7.5% (N = 24) of the participants were at risk for exercise addiction. Aerobic exercise had a significant positive effect on body appreciation (t(321) = 7.564, p < .001) independently from environment and nutritional status. Exercise addiction moderated the relationship between exercise and body image, the at risk for exercise addiction group showed the greatest improvement (F(1) = 3.252, p = .040). Conclusion The results indicate that even a one-hour aerobic exercise session has a positive effect on body image; this has important practical implications for intervention strategies and weight-loss treatments. | Elméleti háttér és célkitűzés Bár a legtöbb kutatás a rendszeres testedzés testképre gyakorolt pozitív hatására fókuszál, néhány vizsgálat eredménye a testedzés testképre tett azonnali hatására hívja fel a figyelmet. Jelen tanulmány célja az aerobik edzés testképre gyakorolt azonnali hatásának vizsgálata fitnesztermi és otthoni edzési körülmények között, továbbá a tápláltsági állapot (normális testsúly vs. túlsúly/elhízás) és a testedzésfüggőség potenciális moderátor szerepének vizsgálata az edzés és a testkép alakulása közötti kapcsolatban. Módszer A vizsgálatba aerobikedzést folytató nőket vontunk be (n = 322). A résztvevők egyik része edzőteremben folytatta a testgyakorlást (n = 155), másik része otthon végzett aerobik testedzést, video vagy DVD segítségével (n = 167). Mérőeszközök önbeszámolóval nyert testtömeg és testmagasság, a testedzés gyakoriságára vonatkozó kérdés, Testértékelési Skála, Testedzés Addikció Kérdőív. Az adatfelvétel az egyórás testgyakorlást megelőzően és azt követően történt. Eredmények Nem találtunk szignifikáns különbséget az edzőteremben és az otthonukban aerobik edzést folytató nők között az életkor, az iskolai végzettség, a BMI, a testértékelés, a testedzés gyakorisága és a testedzésfüggőség tekintetében. A válaszadók 7,5%-a (n = 24) esetében jelenik meg a testedzésfüggőség kockázata. Az egyórás testedzés szignifikáns, kedvező hatást gyakorolt a testképre (t(321) = 7,564; p < 0,001), amely hatás a testgyakorlás helyszínétől (edzőterem vs. otthon) és a tápláltsági állapottól függetlennek bizonyult. A testedzésfüggőség azonban moderálta a testgyakorlás és a testkép változásának kapcsolatát: a testedzést követően a testedzésfüggőség szempontjából veszélyeztetett csoportban mutatkozott meg a legnagyobb mértékű, pozitív irányú változás a testkép tekintetében (F(1) = 3,252; p = 0,040). Következtetés Eredményeink arra utalnak, hogy akár egy egyórás testgyakorlásnak is pozitív hatása lehet a testképre, amelynek jelentős gyakorlati implikációi vannak a testsúlycsökkentő kezelések szempontjából

Assessing the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI physical activity counseling intervention among physiotherapists and SCI peer coaches during the transition from rehabilitation to community

IntroductionPhysical Activity (PA) levels for individuals with spinal cord injury (SCI) peak during rehabilitation and sharply decline post-discharge. The ProACTIVE SCI intervention has previously demonstrated very large-sized effects on PA; however, it has not been adapted for use at this critically understudied timepoint. The objective is to evaluate the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI intervention delivered by physiotherapists and SCI peer coaches during the transition from rehabilitation to community.MethodsA single-group, within-subjects, repeated measures design was employed. The implementation intervention consisted of PA counseling training, champion support, prompts and cues, and follow-up training/community of practice sessions. Physiotherapists conducted counseling sessions in hospital, then referred patients to SCI peer coaches to continue counseling for 1-year post-discharge in the community. The RE-AIM Framework was used to guide intervention evaluation.ResultsReach: 82.3% of patients at the rehabilitation hospital were reached by the intervention. Effectiveness: Interventionists (physiotherapists and SCI peer coaches) perceived that PA counseling was beneficial for patients. Adoption: 100% of eligible interventionists attended at least one training session. Implementation: Interventionists demonstrated high fidelity to the intervention. Intervention strategy highlights included a feasible physiotherapist to SCI peer coach referral process, flexibility in timepoint for intervening, and time efficiency. Maintenance: Ongoing training, PA counseling tracking forms, and the ability to refer to SCI peer coaches at discharge are core components needed to sustain this intervention.DiscussionThe ProACTIVE SCI intervention was successfully adapted for use by physiotherapists and SCI peer coaches during the transition from rehabilitation to community. Findings are important for informing intervention sustainability and scale-up

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury

This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI). Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members’ own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices. The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client’s physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate. We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.</p

The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling:a randomized controlled trial

Background: Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. Methods: Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n &gt; 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. Results: Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p &lt;.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course. Conclusion: We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.</p

The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study

Introduction: Persons with spinal cord injury (SCI) often report high levels of neuropathic pain (NP) and poor well-being, which may result from increased inflammation. This study examined the impact of sub-maximal aerobic exercise on NP, inflammation and psychological affect among adults with SCI. Methods: Eight active adults with tetraplegia (n-4, AIS A-C) and paraplegia (n = 4, AIS A-C) performed 30-min of arm-crank aerobic exercise and reported their ratings of perceived exertion (RPE) each minute. Measures of NP, affect, and inflammatory cytokines (IL-6, IL-10, IL-1ra, TNF-α) were taken pre-(T0), immediately post-(T1), and 90-min post-exercise (T2). Results: NP decreased between T0 and T1 for tetraplegics (−60%, d = 0.47; CI = −0.32, 2.02) and paraplegics (−16%, d = 0.15; CI = −0.30, 0.90). Correlations between change in cytokines and change in NP were medium-to large for tetraplegics (rs ranged from −0.820 to 0.965) and paraplegics (rs ranged from −0.598 to 0.833). However, the pattern of correlations between change in cytokines and affect was inconsistent between groups. Lower baseline levels of IL-1ra predicted greater decreases in NP immediately post-exercise (r = 0.83, p = 0.01). Conclusion: Sub-maximal exercise can positively impact NP for some persons with SCI. Further experimental research should identify the optimal exercise intensity to reduce NP for persons with SCI, in addition to understanding biomarkers which may predict changes in NP. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03955523

Perceived barriers and enablers of physical activity in postpartum women: A qualitative approach

© 2016 Saligheh et al.Background: Postpartum women's recovery from birth can be assisted through increased physical activity (PA). However, women face substantial barriers to participating in exercise and require support to enable them to benefit from increased PA. Methods: This study sought to explore women's beliefs about and experiences of PA and exercise during the 6 weeks to 12 months postpartum period. A cohort of 14 postpartum women from a survey study of the barriers and enablers to exercise participation agreed to take part in interview sessions to provide an in-depth understanding of the women's perceptions of the postpartum period and their physical activity during this time. Results: Findings are presented with reference to the social ecological framework and indicate postpartum women face substantial personal and environmental barriers to PA and exercise participation: fatigue, a lack of motivation and confidence, substantial time constraints, lack of access to affordable and appropriate activities and poor access to public transport. In contrast, enablers such as possessing greater social support, in particular partner support, improved PA and exercise participation. Conclusions: The findings encourage facilitation of exercise through mothers' groups, mothers' exercise clubs or postnatal classes suggesting behavioral and social change is needed. Interaction between individuals, community, organizations and policy makers is required. In addition, the provision of specifically tailored and appropriate exercise programs could potentially enable increased PA in postpartum women, thereby improving their health

Chronic inhibition, self-control and eating behavior: test of a 'resource depletion' model

The current research tested the hypothesis that individuals engaged in long-term efforts to limit food intake (e.g., individuals with high eating restraint) would have reduced capacity to regulate eating when self-control resources are limited. In the current research, body mass index (BMI) was used as a proxy for eating restraint based on the assumption that individuals with high BMI would have elevated levels of chronic eating restraint. A preliminary study (Study 1) aimed to provide evidence for the assumed relationship between eating restraint and BMI. Participants (N = 72) categorized into high or normal-range BMI groups completed the eating restraint scale. Consistent with the hypothesis, results revealed significantly higher scores on the weight fluctuation and concern for dieting subscales of the restraint scale among participants in the high BMI group compared to the normal-range BMI group. The main study (Study 2) aimed to test the hypothesized interactive effect of BMI and diminished self-control resources on eating behavior. Participants (N = 83) classified as having high or normal-range BMI were randomly allocated to receive a challenging counting task that depleted self-control resources (ego-depletion condition) or a non-depleting control task (no depletion condition). Participants then engaged in a second task in which required tasting and rating tempting cookies and candies. Amount of food consumed during the taste-and-rate task constituted the behavioral dependent measure. Regression analyses revealed a significant interaction effect of these variables on amount of food eaten in the taste-and-rate task. Individuals with high BMI had reduced capacity to regulate eating under conditions of self-control resource depletion as predicted. The interactive effects of BMI and self-control resource depletion on eating behavior were independent of trait self-control. Results extend knowledge of the role of self-control in regulating eating behavior and provide support for a limited-resource model of self-control. © 2013 Hagger et al

A meta-analytic review of stand-alone interventions to improve body image

Objective Numerous stand-alone interventions to improve body image have been developed. The present review used meta-analysis to estimate the effectiveness of such interventions, and to identify the specific change techniques that lead to improvement in body image. Methods The inclusion criteria were that (a) the intervention was stand-alone (i.e., solely focused on improving body image), (b) a control group was used, (c) participants were randomly assigned to conditions, and (d) at least one pretest and one posttest measure of body image was taken. Effect sizes were meta-analysed and moderator analyses were conducted. A taxonomy of 48 change techniques used in interventions targeted at body image was developed; all interventions were coded using this taxonomy. Results The literature search identified 62 tests of interventions (N = 3,846). Interventions produced a small-to-medium improvement in body image (d+ = 0.38), a small-to-medium reduction in beauty ideal internalisation (d+ = -0.37), and a large reduction in social comparison tendencies (d+ = -0.72). However, the effect size for body image was inflated by bias both within and across studies, and was reliable but of small magnitude once corrections for bias were applied. Effect sizes for the other outcomes were no longer reliable once corrections for bias were applied. Several features of the sample, intervention, and methodology moderated intervention effects. Twelve change techniques were associated with improvements in body image, and three techniques were contra-indicated. Conclusions The findings show that interventions engender only small improvements in body image, and underline the need for large-scale, high-quality trials in this area. The review identifies effective techniques that could be deployed in future interventions

Viability of high intensity interval training in persons with spinal cord injury-a perspective review

Spinal cord injury (SCI) leads to loss of sensory and motor function below the level of injury leading to paralysis and limitations to locomotion. Therefore, persons with SCI face various challenges in engaging in regular physical activity, which leads to a reduction in physical fitness, increases in body fat mass, and reduced physical and mental health status. Moderate intensity continuous training (MICT) is recommended to enhance physical fitness and overall health status in this population, but it is not always effective in promoting these benefits. High intensity interval training (HIIT) has been promoted as an alternative to MICT in individuals with SCI due to its documented efficacy in healthy able-bodied individuals as well as those with chronic disease. However, the body of knowledge concerning its application in this population is limited and mostly composed of studies with small and homogeneous samples. The aim of this review was to summarize the existing literature regarding the efficacy of HIIT on changes in health- and fitness-related outcomes in this population, denote potential adverse responses to HIIT, describe how participants perceive this modality of exercise training, and identify the overall feasibility of interval training in persons with SCI.</p