Exercise Behavior Change Research Articles

Trends in exercise initiation and participation among employed breast cancer survivors undergoing curative treatment.

This study aimed to explore exercise behavior changes among employed breast cancer survivors, focusing on those who did not engage in physical activity prior to their diagnosis, and to identify factors associated with exercise initiation post-treatment in an ethnically and socioeconomically diverse population. A prospective, longitudinal study was conducted involving 497 employed women aged 18-64 with stage I-III breast cancer. Participants completed surveys about their exercise habits before diagnosis and four months post-treatment. Statistical analyses, including chi-squared tests and multivariable logistic regression, were used to identify factors associated with exercise initiation. Among the 130 participants who did not exercise before diagnosis, 64% initiated exercise post-treatment. Key factors influencing exercise initiation included not having employer-provided health insurance and receiving radiotherapy. No significant associations were found with age, income, or comorbidities. The study highlights that a substantial proportion of employed breast cancer survivors who did not exercise before their diagnosis began exercising after treatment. Factors such as insurance type and treatment modality play a role in this behavior change. Understanding these factors can inform interventions aimed at increasing exercise participation among breast cancer survivors, which is crucial for improving physical function, symptom management, and potentially survival outcomes.

The Association Between the Perception of Exercise Benefits and Barriers and Exercise Self-Efficacy During the Induction Phase of Dialysis in Patients with End-Stage Kidney Disease: A Cross-Sectional Study.

Background/Objectives: The physical function of patients with chronic kidney disease gradually declines as kidney function deteriorates, and this decline becomes more pronounced after the initiation of dialysis. Encouraging the development of exercise habits from the initiation phase of dialysis is crucial. Increased exercise self-efficacy is essential for establishing these habits. However, the related factors at this stage are unclear. This study hypothesized that perceptions of exercise benefits and barriers are related to exercise self-efficacy and aimed to investigate this association. Methods: This single-center, cross-sectional study included 72 patients and assessed the stages of exercise behavior change, perceptions of exercise benefits and barriers, and exercise self-efficacy. Multiple regression analysis was used to examine the association between exercise self-efficacy and perceptions of the benefits and barriers of exercise. Results: Perceptions of exercise benefits were still significantly associated with self-efficacy for exercise after adjustment for age, gender, history of cardiovascular disease, diabetic kidney disease, living alone, employment, and physical function (β = 0.474, p < 0.001). Similarly, perceptions of exercise barriers were also significantly associated with self-efficacy for exercise (β = -0.410, p = 0.001). A subgroup analysis that only examined participants without exercise habits revealed a similar association. Conclusions: Perceptions of exercise benefits and barriers may be associated with exercise self-efficacy in patients with end-stage kidney disease during the initiation phase of dialysis. As patients are temporarily hospitalized during this phase, it provides an opportunity for intervention. Exercise education and supportive environments during hospitalization may enhance perceptions of exercise benefits, reduce perceptions of exercise barriers, and improve exercise self-efficacy.

Implementing changing behaviour towards aerobic and strength exercise: Results of a randomised, phase I study determining the safety, feasibility, and consumer-evaluation of an online exercise program in persons with multiple sclerosis

BackgroundMany people with MS do not meet the recommended exercise regime to elicit health benefits. This study aimed to determine the feasibility, safety, acceptability, and appropriateness of an exercise intervention delivered online to persons with MS that meets current exercise recommendations and behaviour change principles. MethodsSeventy-two participants (age: 43.3 ± 13.3 years) with mild to moderate MS were stratified according to previous exercise behaviour and block-randomised into one of three groups: Control (CON; n = 24), General Exercise (GE; n = 24) who at screening did not meet current exercise recommendations, and Advanced Exercise, (AE; n = 24) who at screening met the current exercise recommendations. GE and AE groups received a four-month online-supervised, behaviour change theory-based exercise program and were assessed at baseline, four-months, five-months, and eleven-months for physical activity participation. The feasibility of process, resources, management, and scientific outcomes was assessed. ResultsOf 198 potential participants, 143 met the eligibility criteria (72 %), and 72 were randomised. Fifty-three participants completed the intervention (74 % immediate retention), and 44 were retained at the six-month follow-up (61 %). Personnel time was 369 h, and total per-participant cost was Au$1036.20. Adherence rate to ≥70 % of exercise sessions was 73 % (GE) and 38 % (AE). The GE group observed a small magnitude of improvement in physical activity (d = −0.23). ConclusionsAn online exercise program embedded with behaviour interventions for either GE or AE appears feasible, acceptable, appropriate and safe and may show long-term efficacy in increased exercise behaviours for persons with mild to moderate MS.Trial registration: ANZCRT number ACTRN12619000228189p.

The sustainability of exercise following colorectal surgery: A qualitative study of participants in the PREPARE-ABC trial

Objective This study aimed to explore perceptions regarding the sustainability of exercise following participation in a pre- and post-colorectal surgery exercise intervention trial (PREPARE-ABC). Design Qualitative interview study. Data were analysed using framework analysis and independently coded by two researchers. Setting Six United Kingdom National Health Service Trusts. Participants Eighteen interviews (hospital-based exercise n = 9, home-based exercise n = 3, standard care n = 6) were conducted with patients 12–15 months after being randomised in the trial, after their 12 month appointment. Intervention Individuals who participated in one of two exercise intervention groups (hospital-supervised or home-supported exercise) or a standard care control group of the PREPARE-ABC trial were invited to interview. Results The exercise interventions were reported to influence participants’ recovery and future sustainability of exercise behaviour change. Several participants continued to engage in exercise over a year after their surgery. Reasons for this included being engaged with exercise prior to diagnosis, psychological benefits of exercise and wanting to be engaged with something to help recovery. Perceptions about the sustainability of active lifestyles were influenced by confidence to engage in structured exercise or physical activity and beliefs about its potential to promote future wellness. Conclusions Sustainability varies among individuals and early assessment of physical activity engagement could be beneficial. Physical activity interventions immediately following surgery may be important for future engagement.

Perceived barriers and criteria for referral to pulmonary rehabilitation used in primary health care by general practitioners

Introduction: Chronic obstructive pulmonary disease encompasses both pharmacological and non-pharmacological components. The most cost-effective non-pharmacological component is pulmonary rehabilitation, an individualised, comprehensive intervention, including exercise training, education, and behavior change, to improve the physical and psychological condition and promote adherence to long-term healthy behaviors. The aim was to understand the habits and barriers perceived by Portuguese general practitioners when referring people with chronic obstructive pulmonary disease to pulmonary rehabilitation and the criteria valued in decision-making. Methodology: We conducted a cross-sectional study to assess general practitioners' knowledge, referral practices, and perceived barriers regarding pulmonary rehabilitation using an online questionnaire. The questionnaire evaluated knowledge of PR benefits, referral criteria, and existing barriers. Results: Sixty-one responses were obtained, of which 31.1% (n=19) never referred to PR. Of those who were referred, the most used criterion for referral, 78.5% (n=33), was functional limitation. This criterion was considered extremely important for referral by 64% (n=39) of the participants in this study. Discussion: To increase referrals to pulmonary rehabilitation, doctors must raise awareness of the advantages of these programmes. Publicising existing programmes is essential to ensure that general practitioners know these responses. Information from the assessment of the impact of pulmonary rehabilitation programmes on a person's condition should be shared. Conclusion: Insufficient available PR programmes, Lack of patient adherence and feedback of programme outcomes and lack of knowledge of referencing criteria are the most perceived barriers by general practitioners to referring patients to pulmonary rehabilitation programmes.

Individualized pleasure-oriented exercise sessions, exercise frequency, and affective outcomes: a pragmatic randomized controlled trial

BackgroundAffective responses are increasingly recognized as potentially effective intervention targets that may facilitate exercise and physical activity behavior change. While emerging correlational evidence suggests that more pleasant affective responses are associated with higher participation and adherence, experimental evidence remains scarce. In light of this, we conducted a preregistered, pragmatic, single-blinded, superiority randomized controlled trial with two parallel groups, with the goal of determining the impact of an individualized exercise-intensity prescription targeting pleasure on exercise frequency.MethodsForty-seven non-regular exercisers were randomized into two groups. For both groups, the intervention consisted of three exercise sessions based on the Frequency-Intensity-Time-Type (FITT) principle. However, the experimental group also received an individualized intensity prescription based on prior assessment of preference for and tolerance of exercise intensity, as well as instructions emphasizing the promotion of pleasure as a basis for self-regulating exercise intensity. The primary outcome was gymnasium attendance over an eight-week follow-up period. Secondary outcomes were affective valence and arousal, post-exercise enjoyment, core affective exercise experiences, and anticipated and remembered affect.ResultsForty-six participants were retained for analysis (Mage = 32.00; SD = 8.62 years; 56.5% female). Compared to the control group, the experimental group exhibited 77% higher session attendance (14.35 vs. 8.13 sessions) over the eight-week follow-up period (group main effect p = 0.018, η2p = 0.120; Cohen’s d ranged from 0.28 to 0.91 during follow-up). Also, the experimental group reported higher levels of pleasure during the intervention sessions (for all group main effects, p < 0.001, η2p from 0.33 to 0.37) and higher levels of remembered pleasure (group main effect p = 0.021, η2p = 0.116) and anticipated pleasure (group main effect p = 0.022, η2p = 0.114). No harm was detected.ConclusionsThese results demonstrate the practicality and effectiveness of an intervention aimed at enhancing affective responses to exercise in improving short-term session attendance.Trial registrationClinicalTrial.gov NCT05416593.

"I have to get up and exercise because that's how I'm going to get over this": a qualitative exploration of exercise identity and behavior in early cancer survivorship.

Exercise is beneficial for people living with and beyond cancer (LWBC); however, many people LWBC fail to meet the exercise guidelines. Having an identity related to exercise, a component of one's self-concept, correlates with exercising more frequently in general adult populations. Understanding how exercise identity influences exercise behaviors in people LWBC is warranted due to the many barriers people LWBC face in relation to physical activity.The purpose of this study was to explore the perceived impact of an exercise identity of the exercise behaviors and motivations among people LWBC. Thirteen participants of mixed diagnoses (Mage = 60.8 ± 10.8years) in the early survivorship period (i.e., within five years of primary treatment completion or diagnosis) participated in semi-structured interviews to identify influences of exercise identity on exercise behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. Findings demonstrated that people LWBC with a strong exercise identity engage in high and varied exercise behaviors. Despite barriers such as changes in motivations and ability to engage in exercise, participants maintained exercise throughout cancer by constant adaptation of their outlook and behaviors related to exercise. These results demonstrate a maintenance of physical activity in relation to a strong exercise identity. Results of this study have implications for the design and implementation of exercise behavior change programs for people LWBC as it provides insights into predictors of sustained exercise behavior during and following cancer treatment.

The relationship between exercise-related expectancies and exercise behaviour in adolescent athletes

ABSTRACT Background In recent years, a decline in sports behaviour among adolescents was observed, even though it is generally known that sports contribute to healthy development. According to the social cognitive theory of Bandura, outcome expectancies play an important role in the practice of health behaviour. Methods This study analysed the relationship between exercise-related outcome expectancies (EOEs) and exercise behaviour among adolescent athletes, and the differences of EOEs according to age, gender and type of sport played. In an online survey N = 223 (female = 140, male = 83) athletes between the age of 10–19 (Mage = 14.27, SD = 3.21) completed the Exercise-related Outcome Expectancies Questionnaire for Adolescents (EOEQ-A), as well as questions about their sociodemographic background and training behaviour. Results A small positive correlation of psychological EOEs with the overall amount of training was discovered while expectancies about negative consequences of sports were associated with lower training efforts. Athletes between 14 and 16 years reported significantly stronger negative EOEs than younger or older participants. Regarding gender, no significant differences were found. Furthermore, a positive correlation between social EOEs and participation in team sports, as well as training in a group was found. Conclusion These results could help with adapting exercise-related interventions so that the positive expectancies of the athletes can be fulfilled and exercise behaviour among adolescents can be promoted. Future studies should investigate the relationship between changes in expectancies and changes in exercise behaviour.

Attitudes of cardiac rehabilitation and stroke teams towards integration of stroke survivors into adapted cardiac rehabilitation: A focus group study

Objective To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery. Design Qualitative focus group-based study. Setting Acute and community national health service trusts. Participants Stroke and cardiac rehabilitation team members. Intervention Adapted cardiac rehabilitation. Main measures Focus groups. Thematic analysis was applied to the transcribed data. Results Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles. Conclusions Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed. Registration ISRCTN65957980.

DELIVERING GROUP-BASED TELE-EXERCISE SESSIONS FOR PEOPLE WITH TYPE 2 DIABETES: RESULTS AND EXPERIENTIAL INSIGHTS OF A PILOT STUDY

INTRODUCTION &amp; AIMS Delivery of group-based tele-exercise is an emerging treatment option for people with type 2 diabetes (T2D), but best practice is not yet understood. We evaluated the results and experiential insights of a pilot study investigating this model of care. METHODS Sixteen people with T2D (age 58.7±12.6, 63% male, duration of T2D 10.0±8.4years) underwent an 8-week tele-exercise intervention. Participants were assessed at baseline (in-person and via telehealth; results compared using intra-class correlations coefficients) and post-intervention (in-person only). The program was delivered in groups of 3-5, by an Accredited Exercise Physiologist using Zoom. Sessions were held once weekly and incorporated whole-body aerobic and resistance exercise (45min) and health behaviour change education (15min), reflecting the structure of Medicare-subsidised group exercise physiology sessions. Semi-structured interviews were conducted to gain participant and clinician feedback. Adverse events were monitored throughout. RESULTS The intervention demonstrated efficacy, with improvements in HbA1c (mean change -0.3±0.5%), fasting glucose (-0.8±0.8mmol/L), systolic blood pressure (-6.4±8.4mmHg), waist circumference (-0.8±4.2cm), muscular strength (30sec sit-to-stand score 1.6±2.9; 30sec bicep curl score 5.6±3.0) and fitness (2min step test score 24.5±11.9). Clients could reliably self-assess outcomes such as waist circumference (ICC 0.98, 95%CI 0.95-0.99), 30sec sit-to-stand (0.94, 0.82-0.98), and 2min step test (0.96, 0.87-0.99) when supervised by the clinician via telehealth, negating the need for in-person consults. No serious adverse events were reported. Key experiential insights include 1) Technological issues were minimised by providing clients with a guide for using Zoom, and conducting individual Zoom familiarisation sessions, prior to program start. 2) Client confidentiality could be managed by using breakout rooms for private conversations. 3) Creative exercise selection (e.g., TheraBand anchor points, non-traditional equipment) allowed participants to envision exercising in their home, which assisted in self-management. CONCLUSION This study contributes practical insights to optimise the delivery of group-based tele-exercise interventions to people with T2

Changes in Exercise Behaviors with Exercise Counseling

PURPOSE This study aimed to understand the changes in the exercise behavior of participants in the exercise-psychological counseling program.METHODS This study sampled adult female participants of C diet camp in Seoul, who were in stages 2~3 of the “Stages of Change Model.” A total of 60 participants were randomly assigned to the counseling group (n=30) and control group (n=30). During the 12 weeks of study, all subjects participated in the diet camp program C. The counseling group participated in the exercise psychological counseling program once a week, while the control group participated in recreational activities instead. Exercise adherence, outcome-expectancy, and satisfaction were measured once every four weeks. Latent growth models were used to analyze the measured data.RESULTS Exercise adherence, outcome-expectancy, and satisfaction in the counseling group exerted a statistically significant positive effect. A statistically significant positive effect on the change of exercise adherence variable was observed in the control group, but the trend was only 1/4 of that of the counseling group. In the control group, exercise outcome-expectancy and exercise satisfaction did not have a statistically significant outcome.CONCLUSIONS The exercise counseling program is an essential intervention strategy that enhances participants’ exercise adherence, outcome-expectancy, and satisfaction. Therefore, a positive change in exercise behaviors occurs.

Do abnormal screening results for chronic diseases motivate inactive people to start exercising? A community-based prospective cohort study in Changhua, Taiwan

ObjectiveExercise improves health, but illnesses can cause changes in exercise behavior, including starting or stopping. This study investigated the effects of chronic disease screening on inactive individuals' exercise behavior and analyzed the impact of age and chronic disease history on this relationship using stratified analysis. MethodsUsing a community-based prospective observational cohort design and data from the Changhua Community-Based Integrated Screening (CHCIS) dataset from 2005 to 2020, we examined 12,038 people who were screened at least twice and self-reported having never exercised at their first screening. Changes in exercise behavior were classified as “initiating exercise” and “remaining inactive.” We obtained chronic disease screening results from CHCIS records, which included measurements of waist circumference, blood glucose, blood pressure, triglycerides, and high-density lipoproteins. SAS version 9.4 was used for COX proportional hazards regression. ResultsThe findings indicated that abnormal waist circumference and blood pressure increased the likelihood of initiating exercise compared to normal results. Age stratification showed that those aged 40–49 with abnormal results were more likely to start exercising than normal participants, but not those under 40 or over 65. When stratified by chronic disease history, abnormal screening results correlated with exercise initiation only in groups without chronic disease history, except for those with a history of hyperlipidemia. ConclusionsThis is the first study to demonstrate that abnormal screening results may influence exercise initiation in individuals who have never exercised, and this association varies by screening item, age, and disease history.

Self-determined motivation and physical activity in patients with rheumatoid arthritis: a cross-sectional study

Objective To identify factors associated with two self-reported measures of physical activity (PA) in patients with rheumatoid arthritis (RA). Method Hospital outpatients with RA from central Norway filled in questionnaires about symptoms, psychological factors, and PA. Outcomes were two alternative self-reported measures of PA: (i) fulfilling the aerobic PA recommendations of ≥ 150 min/week at moderate intensity or ≥ 75 min/week at vigorous intensity; or (ii) being in the PA maintenance stage of the Stages of Exercise Behaviour Change framework. Logistic regression was applied to identify factors associated with PA. Step 1 included the independent variables sex, age, and smoking habits. Step 2a added self-reported function, joint pain during the past 6 months, and fatigue to Step 1. Step 2b added Exercise Self-Efficacy and the Relative Autonomy Index (RAI), calculated from the Behavioural Regulation in Exercise Questionnaire-2, to Step 1. Step 3 included all the mentioned independent variables. Steps 1–3 were analysed for each PA measure. Results In total, 227 patients participated. The RAI had a statistically significant positive association with being physically active according to both PA definitions. Joint pain had a significant negative association with meeting the aerobic PA recommendations but was not associated with being in the PA maintenance stage. Conclusion The degree of self-determined motivation was the most consistent variable associated with self-reported PA behaviour. Joint pain was associated with one of the two PA measures. Motivation and joint pain may be useful targets for intervention in clinical practice to improve PA engagement among patients with RA.

An Exercise and Wellness Behavior Change Program for Solid Organ Transplant: A Clinical Research Protocol for the Transplant Wellness Program.

Exercise prehabilitation is an evidence-based, safe, and effective method to increase quality of life, physical fitness and function, and post-surgical outcomes in solid organ transplant (SOT) patients. However, few prehabilitation programs for SOT patients exist in practice. Furthermore, there is a lack of multimodal prehabilitation programs that include behavior change support. To address this need, the Transplant Wellness Program (TWP) was designed. The objective of the TWP is to assess both the effectiveness and implementation of a comprehensive and multimodal exercise and wellness behavior change intervention for patients undergoing kidney or liver transplant. The TWP is a hybrid effectiveness-implementation trial consisting of exercise and wellness behavior change support. Individuals who are in evaluation or listed for kidney or liver transplant in Southern Alberta, Canada. The primary outcomes of self-reported exercise and quality of life are assessed at intake, post-exercise intervention, 6 months post-intake, 12 weeks post-transplant, and annually for 5 years after program completion. Functional fitness measures will be assessed at intake, post-exercise intervention, 12 weeks post-transplant, 6 months post-intake, and 1-year post-intake. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework is used to determine the impact of TWP at the individual and health care system level. Recruitment began in November 2023 and will continue until November 2028. Participants take part in a 12-week exercise intervention and are offered individualized and group behavior change support. Continued exercise support is offered through maintenance classes after the completion of the 12-week intervention. The design of the hybrid effectiveness-implementation trial with a single experimental group will not allow for comparisons to a control or usual care group, potentially impacting internal validity. Differences in number of participants between organ groups (kidney vs liver) and cohorts (pre-transplant vs post-transplant) will likely be uneven, requiring consideration when running and interpreting analyses. The TWP aims to support patients throughout the transplant journey through a multimodal and comprehensive exercise and wellness behavior change program. Results from this study will determine the effectiveness of the program and inform future scale-up and sustainability. NCT06367244.

Motivating Physical Activity with a Walking Exercise Behaviour Intervention and Pain Management Remotely in Intermittent Claudication (MAvERIC): protocol for a randomised controlled feasibility trial

Background: Physical activity (PA) through walking exercise improves functional capacity and quality of life and provides secondary prevention benefits in individuals with peripheral arterial disease (PAD) and intermittent claudication (IC). However, there are many barriers to uptake and maintenance of PA in this population including pain and limited motivation. The aim of this study is to test the feasibility and acceptability of delivering a clinical trial to evaluate the effect of using a walking exercise behaviour change intervention, modified to include the use of a transcutaneous electrical nerve stimulation (TENS) device for non-invasive pain management, to increase walking-based PA in individuals with PAD and IC in comparison with usual care. Methods: This is a randomised controlled analysis-blinded feasibility study with two parallel groups. We will recruit 48 adults with PAD and IC from NHS Lanarkshire vascular service. Inclusion criteria are: PAD (ankle brachial pressure index &lt;0.90) and stable IC for &gt;3 months, being able and willing to participate, and to provide informed consent. Participants will be randomly assigned 1:1 to intervention plus usual care or usual care alone. Usual care includes best medical therapy, information on PAD, walking advice or home exercise programme, and managing risk factors. The intervention consists of a home-based, walking exercise behaviour change intervention (MOSAIC), adapted for remote delivery, and includes non-pharmacological pain management through a TENS device. Feasibility and exploratory outcomes will be assessed at baseline, after 6 and 12 weeks of intervention, and at 6 and 12 months follow-up. The primary outcomes are trial process and intervention feasibility, as well as intervention acceptability measured using rates of participant recruitment and retention, intervention adherence, and the Theoretical framework of Acceptability questionnaire. Exploratory outcomes include daily PA and patient-reported outcomes including quality of life, pain self-efficacy and catastrophising, and walking impairment pain intensity and quality. Conclusion: This trial will evaluate the feasibility and acceptability of a remotely delivered walking exercise behaviour change intervention adapted to include the use of a TENS device to improve PA in individuals with PAD and IC. Trial Registration Number: ClinicalTrials.gov Identifier: NCT06114732

The Impact of COVID-19 Health and Safety Measures on the Self-Reported Exercise Behaviors and Mental Health of College Students.

The public-health restrictions (e.g., remote learning, restricted access to facilities and dining halls) put in place by colleges to reduce the spread of COVID-19 resulted in forced isolation and modifications to health-related behaviors. The restrictions and uncertainty associated with COVID-19 may have exacerbated the challenges of meeting exercise recommendations and mental-health concerns. The purpose of this study was to assess the impact of restrictions on students' exercise habits and their levels of anxiety, stress, and depression. Five-hundred and forty students completed a 29-question survey on individual demographics, living arrangements, exercise, sleep, diet, and mental health. Significant changes in weekly days of exercise and intensity were reported. Increases in anxiety, stress, and depression were reported. The two most frequently reported changes in exercise behavior were an increase in minutes of aerobic training (5%) and a combination of reduced minutes of aerobic and resistance training (3.9%), which could be reflective of an individual's ability and/or desire to maintain exercise behavior during the restrictions. Alternatively, for those students who reduced their exercise habits, aerobic training (11%) was the mode that suffered the most. Demographic factors such as ethnicity, regional residence, and gender were found to have significant effects on stress, anxiety, and depression. Amidst pandemics and future health emergencies, colleges should prioritize establishing opportunities for students to exercise, helping them meet physical activity recommendations and combat mental-health issues.

Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users

ABSTRACT The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18–83 percent) and cognitive/psychological (77–78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.

Effects of a Forest Therapy Program on Physical Health, Mental Health, and Health Behaviors

(1) Background: Although interest in the health-promoting effects of forest therapy is increasing, few researchers have investigated the mid-long-term impact of such therapy on health indicators or exercise behaviors. We explored changes in physical health, mental health, and exercise behaviors 1, 2, and 4 weeks after a forest therapy program concluded. We sought to establish a solid foundation for such programs and a standardized evaluation system. (2) Method: We measured the blood pressure and heart rate variability of 99 adults before and after participation in a forest therapy program. We used the State-Trait Anxiety Inventory to assess anxiety, the Beck Depression Inventory to evaluate both anxiety and depression, the Profile of Mood States to explore mood, the Euro-Quality of Life-5 Dimension scale to assess the overall quality of life, and the Positive and Negative Effect Schedule to measure positive and negative mood. We employed the Global Physical Activity Questionnaire to determine exercise time, intensity, and changes in exercise type before the program and 1–4 weeks after program completion. (3) Results: Anxiety, depression, mood, quality of life, heart rate, and blood pressure control improved significantly after the program. The reduced depression and increased medium-intensity exercise time persisted for 1, 2, and 4 weeks after the end of the program. (4) Conclusions: We tracked various health indicators and clearly distinguished those that were useful in the short term from those more appropriate for evaluation in the long term. This is the first report to show that a forest therapy program affects exercise behavior; this suggests that health behaviors should be continuously tracked.

The MoXFo initiative – adherence: Exercise adherence, compliance and sustainability among people with multiple sclerosis: An overview and roadmap for research

We know very little about exercise adherence, compliance and sustainability in multiple sclerosis (MS), yet adherence is seemingly important for yielding immediate and sustained health benefits. This paper is focused on exercise adherence, compliance and sustainability in the context of informing research and practice involving MS. This focus is critical for clarifying terminology for future research and providing a roadmap guiding clinical research and practice. Our objective was accomplished through a narrative summary of the literature by a panel of experts on exercise adherence from the Moving Exercise Research in Multiple Sclerosis Forward (MoXFo) initiative and a concluding summary of the state of the literature and future research directions. The panel of experts identified three overall themes (Background and Importance; Understanding and Promoting Exercise Adherence, Compliance and Sustainability and Challenges to Exercise Adherence, Compliance and Sustainability) that represented a categorization of nine subthemes. These overall themes and subthemes formed the basis of our recommendations regarding future research broadly involving exercise adherence in MS. Overall, there is limited evidence on rates and determinants of exercise adherence and compliance in MS, and little is known about techniques and interventions for immediate and long-term exercise behaviour change.

Effects of Social Support and Self-regulation on Changes in Exercise Behavior Among Infertile Women: A Cross-sectional Study for Comparison of External and Internal Factors

Background: Exercise behavior (EB) has a significant impact on infertility, but the magnitude of the effect is not easily determined. This study aimed to assess the effect of social support and self-regulation, as external and internal factors, on changes in EB among infertile women. Methods: This cross-sectional study was conducted on 483 infertile women in Sanandaj (Iran) in 2020. Samples were recruited from 35 comprehensive healthcare centers by convenience sampling. Standardized face-to-face interviews were conducted using valid and reliable instruments for the assessment of EB, social support, and self-regulation. The association between EB, social support, and self-regulation was evaluated by logistic regression models. Results: The majority of the participants (56.7%) had secondary infertility, while 70.8% of them did not perform any exercise. Self-regulation and social support were significantly higher in women with secondary infertility than in those with primary infertility (P&lt;0.01). Self-regulation was significantly lower in women whose height was below 160 centimeters (P&lt;0.05). Social support was significantly higher among participants aged≥35 years and weighing≥60 kg (P&lt;0.01). The odds of EB adoption increased with self-regulation and social support (odds ratio [OR]=1.05, 95% CI=1.02-1.09, P&lt;0.01; OR=1.06, 95% CI=1.02-1.11, P&lt;0.01). Conclusion: Social support and self-regulation almost equally influenced EB in infertile women. In future research, designing support and consultation programs can be considered to encourage infertile women to exercise.