Baseline Exercise Levels Research Articles

The impact of physical activity on patient-reported outcomes following deep inferior epigastric perforator flap breast reconstruction

IntroductionWhile higher pre-operative physical activity levels have been shown to be beneficial to post-operative recovery at large, their effect on patient reported outcomes after DIEP flap breast reconstruction has yet to be investigated. This study aims to correlate patient physical activity levels with patient-reported outcome measures. MethodsA prospectively maintained database of patients who underwent DIEP flap breast reconstruction between July 2021 and June 2022 was analysed. Physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ) and patient-reported outcomes were measured using the BREAST-Q questionnaire, both pre-operatively and one year post-operatively. Patients were stratified into low (<1000 METs) and high (>1000 METs) physical activity groups. ResultsOf the 136 patients who underwent surgery, 51 completed both questionnaires, with 34 responses meeting completeness criteria for statistical analysis. The low-MET group (n=19) and high-MET group (n=15) were comparable in age and co-morbidities. Post-operatively, the low-MET group exhibited a 54% increase in physical activity levels, while the high-MET group showed a 17% decrease (p<0.01). The low-MET group experienced significant declines in psychosocial well-being (9.3%, p=0.04) and sexual well-being (14%, p=0.02), whereas the high-MET group did not show significant changes in these domains. Satisfaction with the unclothed abdomen increased significantly in the low-MET group (2.9 from 2, p=0.001), while the high-MET group showed a non-significant decrease (3.2 from 2.9, p=0.43). However, abdominal well-being significantly decreased in both groups, with a 56% decline in the high-MET group (p=0.006) and a 51% decline in the low-MET group (p=0.0002). The latter reflecting the perceived difference between aesthetic appearance and wellbeing. ConclusionsPatients with lower pre-operative physical activity levels showed improved activity post-surgery, potentially due to motivational factors from the reconstructive process. Conversely, those with higher pre-operative activity levels faced greater challenges in maintaining their activity levels post-surgery, potentially arising from disruptions in daily routines and donor site symptoms, indicating a need for targeted interventions to support this group. Concurrently, patients with higher baseline exercise levels did not show a decrease in psychosocial and sexual wellbeing, possibly reflecting a higher resilience to the operative process. These findings underscore the importance of integrating physical activity assessments into pre-operative evaluations to inform patient-centred care and optimize recovery outcomes.

Matched and moving: exploring daily social support among women partnered for exercise after a breast cancer diagnosis.

Exercise and social support are non-pharmacological strategies that improve health and wellbeing in women treated for breast cancer (WTBC). However, strategies to facilitate support and exercise in WTBC are typically resource intensive. The purpose of this study was to examine whether various forms of social support received from a matched peer were associated with increased exercise among WTBC. A daily diary study was conducted to examine naturally occurring social support as it relates to daily exercise behavior. Forty-six WTBC were matched (23 pairs) and completed pre-screening survey assessing eligibility and baseline levels of exercise. Participants were given Fitbit devices to track physical activity behavior and completed daily surveys across 3 weeks assessing perceptions of exercise-related social support at fixed times at the end of each day. Mixed models accounting for day of study, baseline support, and baseline exercise levels revealed that higher levels of daily exercise-related tangible social support were associated with more daily steps (b = 506, SE = 143) and more light physical activity (LPA) minutes (b = 7.01, SE = 3.15). Informational social support was associated with higher moderate to vigorous physical activity (MVPA) minutes (b = 3.18, SE = 1.60). Overall, peer matching programs aimed at increasing exercise-related social support among WTBC might encourage exercise behaviors, especially among women who share exercise-specific information (e.g., benefits, type, activities).

Personalized paths for physical activity: developing a person-centered quantitative function to determine a customized amount of exercise and enhancing individual commitment

BackgroundNon-Communicable Diseases (NCDs) are leading causes of mortality. These conditions are also known as chronic diseases of long duration and generally slow progression. Physical activity (PA) is a main factor to delay symptoms and consequences of NCDs. In last decades, reduced physical exercise has been observed across all ages. Despite educational campaigns aimed at modifying unhealthy habits, it is difficult to promote healthy lifestyles in general population. Poor interest, lack of motivation, as well as career and family commitments hinder people’s participation in regular PA programs. In this study we propose a theoretical person-centred approach to actively involve general population in enhancing their opportunity to perform PA based on personalized needs and targets.MethodsWe defined four profiles of baseline PA levels (inactive, moderately inactive, moderately active, and active people) by referring to Metabolic equivalents (METs) based on individual answers to General Practice Physical Activity Questionnaire (GPPAQ).ResultsBased on the answers to the GPPAQ and by computing the related METs for each profile of baseline exercise levels, we developed an innovative person-centered web-based algorithm/function for enhancing and measuring PA participation in community settings. This function can compute evidence-based standardized profiles of participants, personalized goals of PA being functional to the purpose of maintaining or gaining health benefits, as well as the type and duration of PA needed to reach these goals.ConclusionIt might be speculated that this approach would be a reliable method for increasing people’s self-efficacy and population adherence to recommended levels of PA. However, this theoretical proposal requires to be implemented in further research.

EPS1.04 Audit of virtual exercise class during COVID-19 in children with cystic fibrosis

The UK CF Trust Physiotherapy Standards of Care document (2020) advocates that physical activity & exercise should be part of the routine management for people with cystic fibrosis (pwCF) at any age for health & quality of life (QOL). During the COVID-19 pandemic we were unable to offer face to face exercise sessions in the community. Weekly virtual group exercise sessions were offered in place of this. Objectives: To implement a virtual exercise class including children with CF during COVID-19 and audit any cost & time savings. Methods: From a cohort of >150, 25 children were identified as requiring additional support to engage with exercise. 13 children accepted the offer of classes. A two-way interactive session was initiated where the physiotherapist provided specialist advice, monitoring & prompting, thereby enhancing engagement in the classes. Classes ran once weekly for 6 weeks. The regular format of the class was high intensity interval training (HIIT). The class attendees were all asked to consent to being seen on screen by the physio & the other class attendees, with parental/carer supervision within the home. General advice around pacing of activity & hydration was provided in addition to more specific advice to those where needed. Results: 100% of participants reported the classes to be beneficial. They were attended by children with a wide variety of baseline exercise levels ( 4 hours/week). Length, intensity and enjoyment of the classes were described as ‘excellent’. 100% of responding attendees would recommend the classes to other families. [Table Presented] Conclusions: Children attending the classes found them beneficial. Virtual classes were both time and cost-effective. A downward trend of attendance was noticed when schools reopened and shielding eased. Recommendations: Qualitative data on whether this platform provides some peer support to pwCF would be recommended.

Staff Self-Efficacy and Staff Outcome Expectations for Function-Focused Care: Rasch Testing.

The purpose of this study was to test the reliability and validity for two new scales. We used baseline data from a worksite health promotion project with 98 long-term care staff and Pearson correlations and Rasch analysis testing. For Staff Self-Efficacy for Function Focused Care and Staff Outcome Expectations for Function Focused Care item, reliability was .80 and .83, respectively. All items except one had acceptable INFIT and OUTFIT mean square statistics. Both new scales were significantly correlated (r = .342, p = .007), but neither of the scales were correlated with participants' baseline exercise levels (r = .014, p = .918; r = .092, p = .454, respectively). There was some evidence of validity and internal consistency for both scales. Suggestions are provided to improve the measures for future use.

Cardiac Rehabilitation in Patients With Lymphoma Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Cardio-oncology Pilot Project

BackgroundWorldwide > 50,000 hematopoietic stem cell transplants (HSCTs) are performed annually. HSCT patients receive multiple cardiotoxic therapies (chemotherapy and radiation therapy) in addition to severe physical deconditioning during hospital admission. We hypothesized that guided exercise in a cardiac rehabilitation (CR) program following autologous HSCT is a safe and feasible intervention. MethodsPilot project to assess for safety, feasibility and impact of 8 weeks of CR in HSCT patients following transplant. Consecutive patients with lymphoma underwent standard activity protocol testing before HSCT, at 6 weeks following HSCT (prior to CR), and at 14 weeks following HSCT (at completion of CR), consisting of grip strength (GS), gait speed (GtS), timed up-and-go (TUG), and 6-minute walk test (6MWT). CR consisted of 8 weekly visits for guided exercise. ResultsActivity tolerance protocol data of 30 patients (24 male, 6 female) from December 2014 to December 2016 were analyzed using repeated measures (analysis of variance [ANOVA]) to observe for changes in GS, GtS, TUG, and 6MWT. Statistically significant improvements were found in GS (P < 0.005), GtS (P = 0.02), and 6MWT (P = 0.001). These improvements show that guided CR-based exercise may assist HSCT survivors to meet or even surpass baseline exercise levels and improve physical functioning. There were no adverse events (ie, death or injury) during the study period. Fifty-seven percent of referred patients participated in CR, exceeding documented CR adherence in cardiac populations. ConclusionsThe addition of CR-based exercise programming in HSCT survivorship care of patients with lymphoma is a safe and feasible intervention to assist in recovery following transplant.

Minimal Exercise May Help Prevent Future Depression

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessMinimal Exercise May Help Prevent Future DepressionJoAnn BlakeJoAnn BlakeSearch for more papers by this authorPublished Online:30 Nov 2017https://doi.org/10.1176/appi.pn.2017.11a11AbstractResearch over the years has shown that regular physical activity can help relieve depression, but this study may be the first to recommend a specific “dose” of exercise.Even one hour per week of relatively low-level exercise can provide significant protection against future depression, according to a large population study published October 3 in AJP in Advance. iStock/PeopleImages“The majority of the protective effect of exercise against depression is realized within the first hour of exercise each week and was observed regardless of intensity,” wrote Samuel B. Harvey, Ph.D., an associate professor of psychiatry at the University of New South Wales in Sydney, Australia, and colleagues. While acknowledging that higher levels of exercise are required to achieve cardiovascular benefits, the authors assert that “informing individuals that significant mental health benefits may be achieved with small changes in their behavior may be valuable in facilitating behavioral change.” Because low levels of exercise were found protective, they suggest everyday activities, such as walking or cycling, may protect against depression. The cohort for the study consisted of more than 33,908 Norwegian adults with no symptoms of common mental disorders or limiting physical health conditions, monitored over 11 years. Participants were asked about their exercise habits and symptoms of depression and anxiety at the beginning and end of the study. Of the 22,564 individuals tracked over the study period, 1,578 (7 percent) developed case-levels symptoms of depression. “If causality is assumed and there are no other major confounders, our results suggest that at least 12% of new cases of depression could be prevented if all adults participated in at least 1 hour of exercise each week,” Harvey and colleagues wrote.The study did not find that exercise protected against anxiety. The prevalence of case-level anxiety at follow-up was similar regardless of the participants’ levels of baseline exercise; therefore, no association between baseline exercise levels and later case-level anxiety could be made.In phase 1 of the study—known as the Health Study of Nord-Trondelag County (HUNT 1)—researchers asked the residents of a rural county in Norway aged 20 years or older to complete questionnaires about their lifestyles and medical histories and undergo a physical exam. As part of the baseline exam, study participants were asked questions about symptoms of depression and anxiety, as well as how often they engaged in exercise and the intensity of their exercise. At follow-up (HUNT 2), the study participants were asked to complete the Hospital Anxiety and Depression Scale, a self-report questionnaire with 14 items covering depression and anxiety items over the previous two weeks.Participants who reported undertaking no exercise at baseline had 44 percent increased odds of developing case-level depression compared with those who exercised one to two hours per week.“Those who engaged in less exercise at baseline tended to have higher resting pulse, lower levels of perceived social support, and more subthreshold symptoms of depression and anxiety, and they were more likely to develop new-onset physical illnesses over the course of the study,” noted the researchers. The combined physical and social benefits of exercise may mediate the protective effects against depression, according to the study. The study was funded by the National Institute for Health Research Biomedical Research Centre at South London, Maudsley NHS Foundation Trust, and King’s College London. ■“Exercise and the Prevention of Depression: Results of the HUNT Cohort Study” can be accessed here. ISSUES NewArchived

Encouraging bigger-picture thinking in an intervention to target multiple obesogenic health behaviours

Research has shown that use of the third-person perspective to visualise a behaviour results in increased motivation to engage in the behaviour relative to the first-person perspective. This effect is claimed to operate in part because the third-person perspective leads the individual to “see the bigger picture”, linking the visualised behaviour to broader goals and identities. Reasoning that this effect could be harnessed to encourage engaging in multiple behaviours that serve the same broader goal, the present study manipulated the visual perspective participants used to imagine themselves exercising, and assessed effects on cognitions and behaviour related to both exercising and healthy eating. Baseline exercise levels were measured and explored as a moderation effect. As predicted, it was found that for participants who engaged in more exercise at baseline, visualising exercise using the third-person perspective resulted in them reporting stronger intentions to exercise and taking more leaflets showing local exercise classes. For those who engaged in less exercise at baseline, there was no effect of perspective. In terms of eating, there was a main effect of perspective, such that participants who imagined themselves exercising using the third-person perspective ate significantly less chocolate than those who used the first-person perspective, irrespective of baseline exercise levels. These results suggest that use of third-person perspective visualisation can be used to encourage engagement in multiple behaviours that serve the same broad goal, which may serve as an intervention technique that will be especially helpful for health outcomes with multiple contributing behaviours, such as obesity and overweight.

Anxiety Sensitivity Uniquely Predicts Exercise Behaviors in Young Adults Seeking to Increase Physical Activity.

Individuals with elevated levels of anxiety sensitivity (AS) may be motivated to avoid aversive emotional or physical states, and therefore may have greater difficulty achieving healthy behavioral change. This may be particularly true for exercise, which produces many of the somatic sensations within the domain of AS concerns. Cross-sectional studies show a negative association between AS and exercise. However, little is known about how AS may prospectively affect attempts at behavior change in individuals who are motivated to increase their exercise. We recruited 145 young adults who self-identified as having a desire to increase their exercise behavior. Participants completed a web survey assessing AS and additional variables identified as important for behavior change-impulsivity, grit, perceived behavioral control, and action planning-and set a specific goal for exercising in the next week. One week later, a second survey assessed participants' success in meeting their exercise goals. We hypothesized that individuals with higher AS would choose lower exercise goals and would complete less exercise at the second survey. AS was not significantly associated with exercise goal level, but significantly and negatively predicted exercise at Time 2 and was the only variable to offer significant prediction beyond consideration of baseline exercise levels. These results underscore the importance of considering AS in relation to health behavior intentions. This is particularly apt given the absence of prediction offered by other traditional predictors of behavior change.

Exercise facilitates smoking cessation indirectly via improvements in smoking-specific self-efficacy: Prospective cohort study among a national sample of young smokers

ObjectiveThe purpose of this study was to examine whether exercise is associated with 2-year follow-up smoking status through its influence on smoking-specific self-efficacy. MethodsLongitudinal data from the 2003–2005 National Youth Smoking Cessation Survey were used, including 1,228 participants (16–24years). A questionnaire was used to examine baseline exercise levels, baseline smoking-specific self-efficacy, follow-up smoking status, and the covariates. ResultsBaseline exercise was associated with baseline self-efficacy (β=0.04, p<0.001) after adjusting for age category, sex, race–ethnicity, education, and nicotine dependence. Baseline self-efficacy, in turn, was associated with 2-year smoking status (β=0.23, p<0.001) after adjustments. There was no adjusted direct effect of baseline exercise on 2-year smoking status (β=0.001, p=0.95); however, the adjusted indirect effect of baseline self-efficacy on the relationship between exercise and 2-year smoking status was significant (β=0.008, bootstrapped lower and upper CI: 0.002–0.02; p<0.05). The mediation ratio was 0.837, which indicates that smoking-specific self-efficacy mediates 84% of the total effect of exercise on smoking status. ConclusionsAmong daily smokers, exercise may help to facilitate smoking cessation via exercise-induced increases in smoking-specific self-efficacy.

Health impact of sport and exercise in emerging adult men: a prospective study

Health benefits of sport and exercise are well documented in children, adolescents and adults, but little is known about emerging adulthood-a period of life characterized by significant demographic and developmental changes. The present study aimed to assess the health impact of changes in sport and exercise levels during that specific period of life. The analysis used baseline and 15-month follow-up data (N=4,846) from the cohort study on substance use risk factors. Associations between baseline exercise levels or changes in exercise levels and health indicators (i.e., health-related quality of life, depression, body mass index, alcohol dependence, nicotine dependence and cannabis use disorder) were measured using chi-squared tests and ANOVA. Direction of effects was tested using cross-lagged analysis. At baseline, all health indicator scores were observed to be better for regular exercisers than for other exercise levels. At follow-up, participants who had maintained regular exercise over time had better scores than those who had remained irregular exercisers or had discontinued, but their scores for health-related quality of life and depression were close to those of participants who had adopted regular exercise after the baseline questionnaire. Cross-lagged analysis indicated that regular exercise at baseline was a significant predictor of health-related quality of life and substance use dependence at follow-up, but was itself predicted only by health-related quality of life. From a health promotion perspective, this study emphasizes how important it is for emerging adult men to maintain, or adopt, regular sport and exercise.

The tripartite efficacy framework in high school physical education: Trans-contextual generality and direct and indirect prospective relations with leisure-time exercise.

The purpose of this study was to examine the extent to which adolescents’ beliefs in their physical education (PE) teacher’s capabilities (i.e., other-efficacy), and their estimation of their teacher’s confidence in their ability (i.e., relation-inferred selfefficacy, RISE), predicted leisure-time exercise engagement, as well as the extent to which within-class and leisure-time self-efficacy beliefs mediated those relationships. At Time 1, we assessed high school students’ (N 640, Mage 13.15, SD 0.80) confidence in their own PE ability (i.e., self-efficacy), along with their other-efficacy and RISE appraisals. Two weeks later, students reported their confidence in their ability to regulate their leisure-time exercise, and then during the following three weeks, they maintained an exercise log in which they recorded their leisure-time exercise behavior. Structural equation modeling revealed that other-efficacy and RISE positively predicted students’ confidence in their own PE ability. Students’ PE self-efficacy predicted their self-efficacy for regulating their leisure-time exercise, which in turn predicted average weekly exercise participation. As well as highlighting indirect pathways through which students’ tripartite perceptions supported leisure-time exercise, direct effects were also found for self- and other-efficacy in relation to exercise levels, even when controlling for the effect of baseline exercise levels. These findings emphasize the potential significance of the tripartite framework in terms of understanding adolescent exercise behavior.

Beyond intentional processes: The role of action and coping planning in explaining exercise behaviour among adolescents

The purpose of this study was to examine the extent to which action planning, coping planning and the interaction with past behaviour explain additional variance over and above that predicted by behavioural intention in a sample of 210 Swiss high school students (160 boys, 150 girls, mean age = 17.43 years). Participants filled in a questionnaire designed to assess exercise intention, action planning coping planning, past and current exercise behaviour at baseline and after three months. The findings show that adolescents’ exercise participation was predominantly regulated by exercise intention. Stronger exercise intentions were found among adolescents with positive outcome expectancies, high self-efficacy and self-determination scores. Spontaneous implementation intentions had no substantial influence on exercise participation. No significant interactions occurred between intention × Action Planning and Intention × Coping Planning. The effects of exercise intentions were stronger among students with high baseline exercise levels. In summary, action and coping planning explained little variance in adolescents’ exercise behaviour. More research is warranted to distinguish between organized and non-organized sport participation and to find out whether implementation intentions can be manipulated experimentally in this age group.

Effects of acute leg ischemia during cycling on oxygen and carbon dioxide stores

This study estimated changes in whole body oxygen stores (O(2)s) and carbon dioxide stores (CO(2)s) during steady state exercise with leg ischemia induced by leg cuff inflation. Six physically fit subjects performed 75 W steady state exercise for 15 min on a cycle ergometer. After 5 min of exercise, cuffs on the upper and lower legs were inflated to 140 mmHg. Cuffs were deflated after 5 min and exercise continued for another 5 min. O(2 )uptake (VO(2)) and CO(2) output (VCO(2)) significantly increased during the first 30 s after inflation, significantly decreased between 60 and 90 s, and then rose linearly until deflation. VO(2) and VCO(2) significantly increased further after cuff deflation, peaking between 30 and 60 s and then returned to near baseline exercise levels. Model-estimated changes in total O(2)s and CO(2)s were compared with time-integrated store changes from VO(2) and VCO(2). During 5 min after cuff deflation, VO(2) and VCO(2) exceeded the model-estimated change in stores by 273 and 697 mL, respectively. These results reflect the O(2) cost repayment of the anaerobic component and lactate buffering to neutralize circulating metabolites caused by the preceding ischemia.

Accelerometer Feedback to Promote Physical Activity in Adults with Type 2 Diabetes: A Pilot Study

This study examined whether giving activity feedback to obese, sedentary adults with Type 2 diabetes would improve their adherence to a home-based walking program. 49 subjects were recruited. Ten failed a treadmill cardiovascular test. Another 9 dropped out before the intervention, and 4 dropped out during the intervention. The remaining 26 adults (14 women, 12 men; age M = 48.1 yr., SD = 7.1) received behavioral counseling monthly for 3 mo. regarding exercise. All subjects wore a triaxial accelerometer during these 3 months. Randomly, half of the subjects were blind to the data from the accelerometers, i.e., no feedback, and had counseling based on their self-report diaries. The other half had access to the accelerometer data, got a computerized graph of their physical activity for the period between counseling sessions, and had counseling based on these objective data, i.e., feedback. The feedback group showed an increase in exercise over the 3 mo. The nonfeedback group showed an increase in activity at 1.5 mo. but reverted to their baseline exercise levels at 3 mo. However, analysis of variance showed there was at least an 8% probability that this effect was due to chance, so the hypothesis that feedback would improve exercise adherence could not be supported. Further studies with larger sample sizes and greater control of experimental conditions are needed to determine the utility of objective activity feedback.

Predictors of Exercise Relapse in a College Population

Exercise improves physical and mental health. Nevertheless, most 20-year-olds do not exercise, and approximately 50% of the participants in exercise programs drop out in the first 3 to 6 months. In view of the health benefits of exercise, college health educators and clinicians need to be able to identify factors that predict exercise relapse in a student population. The authors administered questionnaires measuring Prochaska's 10 processes of change for exercise, self-efficacy, and decisional balance to 52 physically active undergraduate students. They assessed baseline exercise levels in October and reassessed them about 8 weeks later. At baseline, relapsers had significantly lower self-efficacy scores than those who maintained their exercise levels. The relapsers also had higher perceived negative views of exercise. These findings provide support for applying the transtheoretical model of behavioral change to a college population.