Maintaining physical activity in cardiac rehabilitation

This chapter describes an intervention that has been used to encourage individuals to remain regularly physically active in exercise-based CR in phases III and IV.The principles of this intervention are also appropriate for allphases of CR.This intervention, called the exercise consultation (EC), is based on the Transtheoretical Model of behaviour change and Relapse Prevention Model (pp.197-205), and uses cognitive and behavioural strategies to increaseand maintain physical activity (Loughlan and Mutrie,1995,1997). The strategies used in this EC include: assessing stage of change, decisional balance, overcoming barriers to activity, social support, goal setting, self-monitoring and relapse prevention. It involves a client-centred, one-to-one counselling approach and encourages individuals to develop an activity plan, tailored to their needs, readiness to change and lifestyle. The EC aims to encourage accumulated physical activity accumulating at least 30 minutes ofmoderate intensity activity on five days per week (Pate, et al., 1995, stage one, as discussed in Chapter 4). In addition, this level of physical activity may be easier for cardiac patients to incorporate into their daily routine and to sustainin the long term. Thus, the exercise consultation encourages individuals to integrate moderate intensity activity into their daily lives. In addition, EC can help maintain involvement in structured exercise in phases III and IV (SIGN, 2002)

Healthy body, healthy mind?

The field of psychosomatic medicine has clearly established the idea that how we think and feel will affect the functioning of the body. What we do with our bodies may also affect how we think and feel, but this somatopsychic approach is less well established. This article aims to review what is known about the effects of physical activity on psychological function, and raise awareness of this research amongst psychologists

Alternative research strategies in the exercise - mental health relationship

From the numerous investigations available, there is cautious support for the proposition that exercise is associated with enhanced emotion and mood in mental illness, but the strength of the conclusions derived from the empirical findings available will largely depend on the strength of the designs applied. In applied research, such as the investigation of the exercise - mental health relationship, this relationship depends on population, environmental and individual characteristics and a number of difficulties will certainly hinder progress in this area of inquiry. Randomised controlled trials are important but have the disadvantage of deemphasizing the importance of the individual. Single-case designs on the other hand have considerable potential to adequately unravel the mechanisms at work in the exercise - mental health relationship. From a clinical perspective however, research findings should be viewed based on the support of earlier epidemiological evidence, suggesting that mental illness indeed might be associated with low activity/fitness and that those who maintain activity are less likely to develop mental illness

Using pedometers as motivational tools : are goals set in steps more effective than goals set in minutes for increasing walking?

Background Pedometers are popular devices that measure walking steps. There has been a recent surge in promoting the pedometer as a motivational tool to increase walking. However, little empirical evidence exists to support this suggestion. This study examined the effectiveness of a pedometer as a motivational tool to increase walking. 50 participants (7 men and 43 women, mean age (SD) 40.16 (8.81) years, range 25-61 years) were randomly assigned to either an intervention group who followed a four-week walking programme with goals set in steps (using an open pedometer for feedback) or a comparison group who followed an equivalent four-week walking programme with goals set in minutes. Participants had step-counts recorded at baseline, weeks 1, 2, 3, 4, and at weeks 16 and 52 for follow-up. Both groups significantly increased step-counts from baseline to week 4 with no significant difference between groups. However, a significantly greater number of participants in the intervention group (77%) compared with the comparison group (54%) achieved their week 4 goals (p=0.03). There was no significant change in step-counts from week 4 to week 16. There was a significant decrease from week 16 to week 52. In the short term, both goals set in minutes and goals set in steps using a pedometer may be effective at promoting walking. In the long term, additional support may be required to sustain increases in walking

Motivations and barriers to participation in sport and exercise : a review of the literature

In considering a strategy for research development at the National Centre for Prosthetics and Orthotics, the importance of making accessibility and involvement in sport to those athletically inclined has become apparent. Preparation for the 2012 Paralympic Games in London and the 2014 Commonwealth Games in Glasgow highlights a need to champion sport for people with lower limb deficiency and empower those who might never have participated to become involved (Gold & Gold, 2007). We are all athletes in our own way; each individual has the right to fulfil their exercise potential. The White Paper on Sport (2007) by the Commission of European Communities stated that 'Sport has a greater influence than any social movement as a tool for health enhancing physical activity'. Importantly, the UK population with limb deficiency is predominantly elderly and has a sedentary lifestyle (Davies and Datta, 2003). Although there has been an increase in opportunities for these people to participate in sports due to better prosthetic components, the number of sports prostheses users remain relatively low. This appears to be linked to limited skills specific to disability sport within the rehabilitation and sports professional communities. The objective was to investigate the motivations and barriers to participation in physical activity and sports in a group of people with lower limb deficiency. A review was carried out by examining literature from a number of different sources. Articles were limited to those written in, or translated into English, and which focused on established users of lower limb prostheses. In future, the review will underpin ongoing doctoral research into how exercise and sport participation can be increased for our patients and how exercise concepts and knowledge can be enhanced in the undergraduate curriculum and professional communities. The work examines the motivations and barriers to exercise within the normal population, and how these issues might be compounded within the prostheses user population. The work also examines the type of psychological benefit the user can derive from physical activity and how patients can be encouraged to implement a healthy lifestyle change. In conclusion and because of its dynamic nature, increasing physical activity in all populations is challenging. The challenges of lower limb loss can seem insurmountable when compounded by an alteration in body image. Factors such as self-efficacy, social support, and perceived health benefits are all mutable and show potential for an increase in the chance of individual behaviour change in people with lower limb amputation. Integrating an achievable, realistic exercise regime into hospital based rehabilitation and importantly continuing this into community based sports initiatives for people with limb loss would capitalise on the clear relationship between physical activity and improved health and well-being

Perceived characteristics of the environment associated with active travel: development and testing of a new scale

Background Environmental characteristics may be associated with patterns of physical activity. However, the development of instruments to measure perceived characteristics of the local environment is still at a comparatively early stage, and published instruments are not necessarily suitable for application in all settings. We therefore developed and established the test-retest reliability of a new scale for use in a study of the correlates of active travel and overall physical activity in deprived urban neighbourhoods in Glasgow, Scotland. Methods We developed and piloted a 14-item scale based on seven constructs identified from the literature (aesthetics, green space, access to amenities, convenience of routes, traffic, road safety and personal safety). We administered the scale to all participants in a random postal survey (n = 1322) and readministered the scale to a subset of original respondents (n = 125) six months later. We used principal components analysis and Varimax rotation to identify three principal components (factors) and derived summary scores for subscales based on these factors. We examined the internal consistency of these subscales using Cronbach's alpha and examined the test-retest reliability of the individual items, the subscale summary scores and an overall summary neighbourhood score using a combination of correlation coefficients and Cohen's kappa with and without weighting. Results Public transport and proximity to shops were the items most likely to be rated positively, whereas traffic volume, traffic noise and road safety for cyclists were most likely to be rated negatively. Three principal components – 'safe and pleasant surroundings', 'low traffic' and 'convenience for walking' – together explained 45% of the total variance. The test-retest reliability of individual items was comparable with that of items in other published scales (intraclass correlation coefficients (ICCs) 0.34–0.70; weighted Cohen's kappa 0.24–0.59). The overall summary neighbourhood score had acceptable internal consistency (Cronbach's alpha 0.72) and test-retest reliability (ICC 0.73). Conclusion This new scale contributes to the development of a growing set of tools for investigating the role of perceived environmental characteristics in explaining or mediating patterns of active travel and physical activity

Recruiting hard-to-reach populations to physical activity studies : evidence and experiences

Most researchers who are conducting research with a public health focus face difficulties in recruiting the segments of the population that they really want to reach. This symposium presented evidence and experiences on recruiting participants to physical activity research, including both epidemiological and intervention based studies. Results from a systematic review of recruitment strategies suggested that we know little about how best to recruit and highlighted the need for researchers to report this in more detail, including metrics of reach into the target population such as number, proportion, and representativeness of participants. Specific strategies used to optimise responses to a population-based mail survey were presented such as study promotion, survey design, multiple mailings, and personal engagement. Finally, using place based recruiting via schools or places of worship to target ethnic minority youth were discussed. Overall the symposium presenters suggested that we need to learn more about how best to recruit participants, in particular those typically under-represented, and that researchers need to apportion a similar amount of planning effort to their recruitment strategies as they do the their research design. Finally we made a plea for researchers to report their recruitment processes in detail

Do pedometers motivate people to walk more?

Physical activity confers many important health benefits. The 'active living message' recommends that adults should accumulate 30 ruin of moderate-intensity physical activity (e.g. brisk walking) on most--preferably all--days of the week, but the populations of most developed countries are not meeting this target. Walking is one mode of activity that most people can do without skills, equipment, facilities or extra expense and walking has less bias in terms of age, sex and social class than facility-based exercise. Thus we need to investigate interventions that promote walking

The impact of retirement on physical activity

Most adults do not achieve the levels of physical activity currently recommended for a healthy lifestyle. Population surveys suggest that there is a linear decline of activity levels with age, yet physical activity has many health benefits for older adults. If these are to be more widely adopted among older people, health policy and promotion require an understanding of the factors that influence decreasing activity with age. This study examined the patterns of physical activity of 699 participants in the West of Scotland Twenty-07 Study who were aged 60 years when interviewed in 1991 and followed up four to five years later. It examined the factors that influenced whether or not the subjects achieved currently recommended levels of activity, by applying random effects models with a seasonal adjustment. It was found that higher levels of physical activity associated with a healthier lifestyle, and that socio-economic factors played a minor role in determining the level of physical activity. A substantial amount of physical activity occurred at work but was lost by those who had retired, for while those who were not working were more physically active at home or at leisure than those in work, the majority of the sample did too little physical activity outside work to compensate for the loss of work-based activity. One conclusion is that health promotion initiatives that encourage people to become more physically active should be targeted at those who are about to retire

Weight management for overweight and obese men delivered through professional football clubs : a pilot randomized trial

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