Physical Activity Behaviour In People Research Articles

Factors facilitating and hindering South Asian immigrant adults from engaging in exercise and physical activity - a qualitative systematic review.

Exercise and physical activity are key components of management in patients with rheumatic musculoskeletal diseases (RMD), but people of the South Asian communities have a lower level of engagement with these activities compared to their Caucasian counterparts. The aim of this qualitative systematic review was to determine the barriers and facilitators of exercise and physical activity in South Asian communities who have migrated and live in western countries, particularly in those who have RMD. Qualitative studies, published in English between 1999 and 2021 and including evaluation of barriers and/or facilitators to exercise or physical activity behaviour in people of South Asian adult communities who have migrated and/or lived in western countries were identified from Embase, MEDLINE, CINAHL, PsycINFO, Google Scholar and manual searches. The studies were appraised using the CASP checklist. Inductive thematic synthesis was used to identify common and global themes. A total of 32 studies that discussed barriers and facilitators of physical activity in South Asian communities who have migrated and lived in western countries were used for this review but there were no studies identified that focussed specifically on those with RMD. Following appraisal of the reporting of the studies, 30 studies were included in the pooling of the results. The facilitators and barriers to physical activities were broadly categorized into 'extrinsic' and 'intrinsic' factors. Extrinsic factors such as 'opportunity' included environmental factors such as weather and safety; socioeconomic factors such as education, language and literacy, and support in the form of social, psychological and resources. Intrinsic factors included cultural factors, such as life stages and family influence, beliefs and knowledge, which impacted attitudes and skills. This review has synthesised evidence of barriers or facilitators and identified potentially modifiable factors influencing physical activity and exercise engagement, which could form the basis of evidence-based interventions to promote participation in healthy behaviour change. Provision of a safe, comfortable and culturally acceptable environment together with culturally-aligned cognitive strategies to facilitate acquisition of exercise-efficacy skills could help engagement. The systematic review was registered on PROSPERO, registration no. 289,235.

How Perceptions of Aging Influence Physical Activity and Exercise in Older Age: Exploring the Behavior of People Aged 70+ Years Engaged in Fall Prevention Activities.

For older people, physical inactivity increases fall risk as well as other preventable health conditions. Despite the well-documented benefits of physical activity, uptake and adherence continue to challenge efforts aimed at increasing physical activity and reducing falls. Nested within a randomized controlled trial, this study reports on the factors influencing the physical activity behavior of people, aged between 70 and 90years, engaged in StandingTall, a home-based balance exercise program proven to reduce falls in the community. The perception of aging, physical activity in older age, and the delivery of exercise were identified as major themes, with the perception of aging an overarching theme influencing both preferences for physical activity in older age and exercise delivery. Findings demonstrate the importance of considering the role of aging, the influence aging has on physical activity and exercise behavior, and how aging influences the delivery and design of exercise programs including falls prevention activities for older people.

Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews.

Physical activity in people with stroke remains low despite considerable research. This overview aimed to provide high-level synthesis and aid clinical decision-making. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to classify interventions to understand which components improve physical activity behaviour in people with stroke. CINAHL, Cochrane Database, MEDLINE, PEDro, PsychINFO, SPORTDiscus. A systematic search was conducted (November 2023) to identify reviews of interventions to improve physical activity in people with stroke. Results were screened and assessed for eligibility. Participant characteristics, intervention classification using COM-B, and effect of intervention were extracted. Quality was assessed using AMSTAR2, and Corrected Cover Analysis for study overlap. Narrative synthesis was used to understand components of interventions to improve physical activity behaviour. 1801 references were screened and 29 full-text references assessed for eligibility. Twenty reviews were included. Quality ranged from critically low (n = 3) to high (n = 10). Study overlap calculated using corrected cover area indicated slight overlap (0.028) and minimal reporting bias.The majority of participants were mobile with mild stroke and community dwelling. Twenty-three interventions were classified using COM-B. Three of twelve interventions classified to one aspect of the COM-B were effective. Fourteen of sixteen effective interventions combined at least two COM-B elements, ten of these combined capability and motivation. Interventions including at least two elements of the COM-B are most likely to improve physical activity in mobile stroke survivors. Further research is needed to understand physical activity behaviour in those with moderate to severe stroke.

Understanding factors that influence physical activity behavior in people with developmental coordination disorder (DCD): a mixed-methods convergent integrated systematic review.

This systematic review synthesizes the literature on physical activity amongst people with DCD using the COM-B framework. The review questions were: (1) what is the Capability (C), Opportunity (O) and Motivation (M) for physical activity and (2) what does physical activity behavior (B) look like? A mixed-methods systematic review was conducted by searching eight databases (PubMed, APA PsycINFO, EMBASE, Scopus, Child Development and Adolescent Studies, Cochrane Library, Web of Science, CINAHL) up to July 2023. Data were extracted, thematically analyzed, and mapped to the COM-B model. The quality of studies was assessed with the Joanna Briggs Institute (JBI) critical appraisal tool. The protocol was registered with PROSPERO (CRD42022319127). Forty-three papers, 42 of which related to children, were included. Fifteen aligned with physical activity behavior, nine with physical capability, thirteen with psychological capability, one with social opportunity, one with physical opportunity, one with reflective motivation and three with automatic motivation. Pre-school-aged children with DCD engage in comparable levels of physical activity behavior, but differences emerge from 6 years of age. Characteristics of DCD result in reduced physical capability and less varied participation in physical activity. This impacts psychological capability, whereby lower self-perceptions result in a negative feedback loop and reduce the motivation to participate. Barriers relating to social opportunities may result in poor reflective and automatic motivation, although there is evidence that interventions can enhance enjoyment in the short term.

Analysis of Psychosocial Factors Affecting Physical Activity Behaviour of People with Type 2 Diabetes Mellitus in Indonesia

Physical activity exercise is an essential component in comprehensive diabetes management. Non-adherence to physical activity exercises can lead to poor metabolic control, causing increased complications, morbidity, and premature death due to diabetes. One of the factors that can determine the behavior of physical activity is the psychosocial factor of people with T2DM. The study aims to assess the effect of psychosocial factors on physical activity behavior. This study was an analytical observational with a cross-sectional approach. The sample size was 138 respondents with multistage random sampling. The dependent variable was physical activity behavior, and the independent variables were psychosocial factors (knowledge, coping, distress, perceptions of family support, and perceptions of nurse support). Data analysis used multiple linear regression (α=0.05). Psychosocial factors that influenced the physical activity behavior were distress (p=0.001 < α=0.05). Meanwhile, knowledge, coping, perceived family support, and perceived nurse support did not affect physical activity behavior (p=0.684; p=0.919; p=0.235; p=0.108 > α=0.05) with Adjusted R2=0.113 (F=4.502; p=0.001 < α=0.05). Psychosocial factors that influence physical activity behavior in T2DM patients are diabetic distress. Therefore, health workers, in providing health services as much as possible, must be able to prevent and reduce diabetes distress to increase the physical activity behavior of people with T2DM.

Psychosocial factors of physical activity among people with disabilities: Prospective cohort study.

This study aimed to (a) explore the associations between psychosocial factors and physical activity behavior in people with physical disabilities and/or chronic diseases, both between and within persons over time; and (b) examine whether these associations differ for people initiating and people maintaining physical activity behavior. Data of 1,256 adults with physical disabilities and/or chronic diseases enrolled in the prospective cohort study Rehabilitation, Sports, and Active lifestyle (ReSpAct) were analyzed. Self-reported physical activity and four main psychosocial factors (i.e., self-efficacy, attitude, motivation, social support) were measured with questionnaires 3-6 weeks before discharge (T0) and 14 (T1), 33 (T2), and 52 (T3) weeks after discharge from rehabilitation. Hybrid multilevel regression models (corrected for age, sex, education level, diagnosis, counseling support) were used. Multivariable significant between-subject associations were found for self-efficacy (std β = .094; 95% CI [0.035, 0.153]) and intrinsic motivation (std β = .114; [0.036, 0.192]). Multivariable significant within-subject associations were found for identified regulation (std β = -.038; [-0.072, -0.005]) and intrinsic motivation (std β = .049; [0.016, 0.082]). Effect modification of initiating or maintaining physical activity was found for the between-subject association of attitude (p = .035). No significant associations were found for social support, amotivation, external regulation, and introjected regulation. This study is the first that explored the between- and within-subject associations between psychosocial factors and physical activity over time in a large cohort of adults with physical disabilities and/or chronic diseases. The findings indicate the importance of intrinsic motivation, identified regulation, and self-efficacy in initiating and maintaining physical activity behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

To Act or Not to Act-a Sense of Control Is Important for People With Chronic Obstructive Pulmonary Disease to Increase Physical Activity: Grounded Theory Study.

Among people with chronic obstructive pulmonary disease (COPD), low level of daily physical activity (PA) is the main risk factors for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is complex as PA behavior itself is complex and multifaceted, including personal, physiological, and psychological elements as well as social and environmental factors. Although eHealth solutions such as web-based support or websites have shown positive effects on PA in people with COPD, the results are inconclusive, and it is still unclear how eHealth solutions might be used to support positive changes in PA behavior in people with COPD. This study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool among people with COPD. This study was part of a pragmatic randomized controlled trial with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist grounded theory. All sampling included participants from the randomized controlled trial intervention group, that is, participants who had access to the eHealth tool in question and agreed to be contacted for an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 13 (n=7, 54% women) participants aged between 49 and 84 years and living in 8 municipalities in Middle and Northern Sweden. Two interviews were conducted face-to-face, and the remaining interviews were conducted via telephone. All interviews were recorded using a Dictaphone. The analysis resulted in 3 main categories: welcoming or not welcoming action, having or lacking resources, and lowering the threshold. The first 2 categories contain barriers and facilitators, whereas the third category contains only facilitators. The categories lead to the more latent theme Perceiving enough control to enable action, meaning that it seems that perceiving the right amount of control is essential to maintain or increase the level of PA when using an eHealth tool among patients with COPD. However, the right amount of control seemed to depend on the individual (and context) in question. The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or by being too demanding on the user. Perceptions varied depending on other environmental factors. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study provides further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels. RR2-10.1136/bmjopen-2019-030788.

Objectively measured physical activity levels and adherence to physical activity guidelines in people with multimorbidity-A systematic review and meta-analysis.

To determine levels of objectively measured physical activity (PA) and the proportion of adults with multimorbidity that adheres to PA guidelines. All studies, where PA was measured at baseline using an activity monitor in an adult (≥18 years) multimorbid (≥80% of the population had ≥2 chronic conditions) population. A systematic literature search was performed in Medline, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, opengrey.eu and google.com from inception up until 18th of January 2022. Risk of bias was assessed with a modified version of the Quality Assessment Tool for Quantitative Studies. A random-effects meta-analyses was performed to estimate daily minutes of sedentary behavior (SB), light PA (LPA), moderate PA (MPA), moderate to vigorous PA (MVPA) and steps. Proportions adhering to PA guidelines was narratively synthesized. Certainty of evidence was determined using The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Fifteen studies (2,172 participants) were included. The most frequent combination of conditions were type 2 diabetes and hypertension (six studies). Participants spent a daily average of 500.5 (95% CI: 407.1 to 593.9) minutes in SB, 325.6 (95% CI: 246.4 to 404.7 minutes in LPA and 32.7 (95% CI: 20.2 to 45.3) minutes in MVPA. The mean daily number of steps was 5,145 (95% CI: 4264 to 6026) for people in free-living conditions. The proportion adhering to PA guidelines ranged widely (7.4% to 43%). All studies were rated as at high risk of bias and the certainty of evidence was very low. PA levels and adherence varied from low to above guideline recommended levels for adults with chronic conditions, depending on PA intensity. The very low certainty of evidence calls for high quality studies focusing on detailed descriptions of PA behavior in people with multimorbidity. CRD42020172456.

The role of worry in exercise and physical activity behavior of people with multiple sclerosis

ABSTRACT Purpose: This study is a secondary analysis of data from a mixed methods exploration of fatigue in people with multiple sclerosis (MS), a chronic autoimmune disease affecting the central nervous system. During initial analysis, worry emerged during discussions of the fatigue experience. The purpose of this study is to explore worry in relationship to exercise and physical activity behavior. Methods: Mixed methods were used to address the research question. 55 people with MS provided demographic and survey data (habitual physical activity, body perception, functioning). 35 participated in semi-structured interviews on the topics of fatigue, body sensations, emotions, and their effects on physical activity. Qualitative data were analyzed utilizing constructivist grounded theory. Quantitative data were analyzed utilizing multiple regression. Results: Qualitative theory described participants’ thoughts and experiences regarding the consequences of fatigue during activity, and how they appear to influence subsequent actions. Worry played a critical role in thought processes regarding physical activity. Aspects of body perception were weak quantitative predictors of physical activity behavior after control of physical functionality. Conclusions: The most significant finding of this study was the description and dialogue about worry as a factor that shapes perceptions of the benefits and value of exercise and physical activity. Physical activity practitioners could benefit from seeking to understand physical-activity-related worry when examining physical activity behavior and designing programming.

COVID-19 and Physical Activity Behaviour in People with Neurological Diseases: A Systematic Review.

The COVID-19 pandemic has led to a radical lifestyle change, which may unintendedly change physical activity levels. We aimed to perform a systematic review to investigate the physical activity changes in people with neurological diseases, and to examine the relationship between physical activity and disease symptoms, and psychosocial factors. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of the literature across five databases (PubMed, CINAHL, Web of Science, SCOPUS, and Cochrane Library) was carried out using the keywords relating to COVID-19, physical activity, sedentary behaviour, exercise, and the name of the neurological diseases. The systematic search was updated on 4 February 2021 with the same keywords. Fourteen studies (n = 7662 persons with neurological diseases, n = 1663 healthy controls) were eligible for this review. The study populations were Parkinson disease (n = 7), dementia (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 1), hereditary spastic paraplegia (n = 1), neuromuscular diseases (n = 1), Charcot-Marie-Tooth neuropathy (n = 1), and epilepsy (n = 1). Thirteen studies reported a decreased physical activity level, one study reported a high interruption rate of physiotherapy/rehabilitation. Furthermore, the physical activity reduction was associated with worse disease symptoms, depression, perceived health, and mental and physical components of quality of life. The COVID-19 pandemic has a negative impact on the physical activity levels of people with neurological diseases, and this change was related to the worsening of disease symptoms and psychosocial factors. Registration number A protocol of the review was registered with the PROSPERO database (CRD42020207676).Supplementary InformationThe online version contains supplementary material available at 10.1007/s10882-022-09836-x.

Impact of regular physical activity awareness sessions by primary care physicians in rural India

Abstract Funding Acknowledgements Type of funding sources: None. Background Regular physical activity is associated with improved physical and mental health. Studies have shown that regular physical activity reduces the risk of cardiovascular diseases, diabetes mellitus, osteoporosis, depression and obesity. Patients frequently identify their family physicians as an important source of constant encouragement for physical activity. Purpose We wanted to assess the impact of regular awareness sessions about physical activity by Primary care physicians in adults. Methods 73 participants between the age group 30 to 60 years were recruited in this single center study in rural India.70 participants completed this 6 month intervention study whereas 3 participants dropped out of study. Once in a month audio visual awareness session of one hour were conducted from August 2017 to January 2018 by primary care physicians to educate the participants about ill effects of sedentary lifestyle and benefits of regular physical activity. Pre and post intervention data were collected by using validated Godin leisure time exercise questionnaire from all 70 participants. Paired t test and Wilcoxon test were used to compare pre- and post-intervention data. Percentage increase in physical activity score was also calculated. Results In this study baseline Godin score pre intervention were 38.82 ± 12.22 (Mean ± SD) and post intervention were 65.98 ± 11.25 (Mean ± SD). Participants significantly improved Godin score post intervention which were statistically significant (p: < 0.001) . Compared to baseline pre intervention score, there was 170% increase in physical activity score post intervention. Conclusions Results of this intervention suggest that regular awareness sessions using modern technology is cost effective in changing physical activity behavior in people. Active involvement of primary care physician in this intervention will further help in establishing and continuing physical activity behavior. Physicians can play a major role in promotion of physical activity. As primary care physicians have direct regular contact with their patients and their families, their role in promotion of physical activity will have more impact and long-lasting effect on patient’s behavior. We assume that similar studies are needed to promote physical activity in the people.

Physical activity behavior in people with asthma and COPD overlap residing in Spain: a cross-sectional analysis

Objectives To identify levels of physical activity (PA) among the Spanish population with asthma and chronic obstructive pulmonary disease overlap (ACO). A further aim was to analyze differences in PA levels by sex, age, education, marital status, cohabiting, smoking habits, alcohol consumption and body mass index (BMI). Methods In this cross sectional study, data from the Spanish National Health Survey 2017 were analyzed. A total of 198 people with ACO aged 15–69 years were included in the analyses. The short version of the international physical activity questionnaire (IPAQ) was used to measure total PA (MET·min/week). PA was further classified as low, moderate and high, and analyzed according to sample characteristics. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test and chi squared test. Statistical significance was set at p < 0.05. Results People with ACO engaged in a mean volume of 2038.1 MET·min/week. Those aged 30–60 years and those with normal weight were significantly more active than those aged ≥60 and those with obesity. When classifying PA level in low, moderate and high, results showed no significant differences between sample characteristics. Overall, moderate and high levels of PA were the most and least frequent levels (48.0% and 16.2%, respectively). Conclusions More than three out of ten Spanish adults with ACO do not achieve PA recommendations. Therefore, it is recommended to implement programs that promote the importance and benefits of PA among the Spanish population with ACO, and such programs should focus on older adults and those who are obese.

Physical activity behavior in people with multiple sclerosis during the COVID-19 pandemic in Israel: Results of an online survey

Multiple sclerosis (MS) itself and first-line disease modifying therapies do not increase the risk of contracting COVID-19. However, home isolation is likely to result in a significant decrease in participation in leisure time physical activities and an increase in sedentary behavior. Therefore, using an online cross-sectional survey we examined the impact of the COVID-19 epidemic on physical activity (PA) behavior and fitness level in an Israeli cohort of people with multiple sclerosis (PwMS). The survey PA questionnaire included 10 questions. Specifically, participants reported on whether, and to what extent, the pandemic conditions had altered their PA behavior. One hundred and twenty PwMS filled out the online survey, 78 were females with a mean age of 43.0 (S.D.=12.9) years. PA behavior during the pandemic demonstrated that 17.5% who were engaged in PA before the COVID-19 pandemic, ceased PA, 33.3% reduced their PA, 20.0% continued their PA as before, 18.3% increased their PA during the pandemic, and 10.8% did not perform any PA in the past and did not so during the pandemic. As for the patient's self-reported fitness level, 31.7% reported that their fitness level had decreased during the pandemic, 60.0% felt no change, and 8.3% reported an improvement. Our findings serve as a call of action for all professionals involved in MS management to address physical activity behavior in PwMS during the COVID-19 epidemic.

Improving physical activity within diabetes care: Preliminary effects and feasibility of a national low‐intensity group‐based walking intervention among people with type 2 diabetes mellitus

AbstractIntroductionDespite the positive outcomes of physical activity (PA) interventions on health and PA behavior in people with type 2 diabetes mellitus (T2DM), it proves rather difficult to structurally implement such interventions in daily diabetes care. The National Diabetes Challenge (NDC) was designed as a low‐intensity and low‐cost annual walking intervention for people with T2DM, with the aim to overcome potential barriers in intervention delivery. The aim of the present study was to explore the feasibility and preliminary efficacy of this approach.MethodsThis feasibility study had a pre/posttest design. First, we assessed acceptability and feasibility by means of posttest process evaluations among participants and healthcare providers. Second, to examine preliminary efficacy we studied emotional well‐being and patient activation among 822 participants with T2DM, and number of daily steps and somatic health outcomes in a subgroup of 189 participants with T2DM. These data were analyzed using paired‐samples t‐tests.ResultsThe intervention was generally well‐received by both the participants and healthcare providers, people reporting satisfaction and perceived benefits. The results show improved glycemic control in participants with above target baseline HbA1c, improved patient activation in participants with lower activation at baseline, and decrease of body weight and improved emotional well‐being in all participants. Furthermore, the number of daily steps taken increased during the intervention.ConclusionsThis feasibility study did show acceptability and generally good feasibility with regard to implementation, and provides initial evidence for the effectiveness of a group‐based walking intervention with weekly group supervision, with improved behavioral, somatic and psychological outcomes in people with T2DM. Our findings highlight the potential of a low‐intensity group‐based walking intervention in increasing PA behavior in people with T2DM, while also taking into account common barriers regarding structural implementation in diabetes care. The study provides support for a more rigorous testing of the NDC program.

Pedometers, the frustrating motivators: a qualitative investigation of users’ experiences of the Yamax SW-200 among people with multiple sclerosis

Purpose Self-monitoring may represent a mechanism to enhance physical activity among people with multiple sclerosis. To optimise activity monitoring as a behavioural tool to increase physical activity, user experience must be understood. This study evaluated user experience of the Yamax SW-200 Digi-walker pedometer in a group of people with MS. Methods Semi-structured interviews were conducted with 15 adults who participated in a 12-week pedometer-supported behavioural change intervention, the iStep-MS trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the Framework Method. Results An overarching theme Pedometers, the frustrating motivators captures the complex and often contradictory experience of the pedometer. Sub-themes include: Increasing activity awareness, which describes the pedometer’s utility in raising activity consciousness; Numeric motivation provides insight into dual motivating and demotivating experiences of using an objective feedback device; (Un) usability focuses on practical concerns encountered in the day-to-day use of the monitor. Conclusion The Yamax SW-200 Digi-walker raised awareness and enhanced participant motivation to engage in physical activity. Accuracy and usability concerns highlighted warrant consideration in the selection of this pedometer within a population with multiple sclerosis. Trial registration Changing physical activity behaviour in people with MS: the iStep-MS trial; ISRCTN15343862; https://doi.org/10.1186/ISRCTN15343862 Implications for rehabilitation Use of self-monitoring tools such as pedometers can enhance physical activity awareness. Objective, numeric step count feedback is an effective motivational tool for physical activity. Accuracy and usability concerns may limit the value of the Yamax SW-200 Digiwalker for people with MS. Identification of individualised, reliable, usable and acceptable tools is important to ensure engagement with self-monitoring.

Physical Activity Behaviour in People with COPD Residing in Spain: A Cross-Sectional Analysis.

Chronic obstructive pulmonary disease (COPD) represents a major public health problem due to its high prevalence, morbidity and health cost. It has been demonstrated that physical activity (PA) is one of the most beneficial measures to prevent chronic diseases. The aim of this study was to examine PA levels of adults with COPD residing in Spain, and to analyse the differences by sex, age, education, marital status, cohabiting, tobacco consumption, alcohol consumption and body mass index. A total of 615 adults aged 15 to 69years participated in this study. Data from the Spanish National Health Survey 2017 were used. This survey included the short version of IPAQ to measure PA levels. PA was expressed in total volume (MET·min/week), classified as low, moderate and high, and analysed according to sample characteristics. Statistical significance was set at p < 0.05 (CI = 95%). Level of PA was higher in men than in women (1808.8 vs. 1575.6 MET·min/week; p = 0.016), in those aged under 30years than in those older than 60years (2129.4 vs. 1381.4 MET·min/week; p = 0.047) and in those who drank alcohol than in those who did not drink (1912.8 vs. 1248.2 MET·min/week; p = 0.004). Also, underweight and obese participants participated in lower levels of PA than normal weight participants (p= 0.001). When classifying PA level, a total of 37.9% had a low level, 47.5% had a moderate level and only 14.6% had a high level of PA (p < 0.001). It is recommendable to implement programs to raise awareness of the importance and benefits of PA in the control of COPD, and these programs should focus on those with lower levels of PA.

The association between comorbidity and physical activity levels in people with osteoarthritis: secondary analysis from two randomised controlled trials

Purpose: Osteoarthritis (OA) is highly prevalent in patients with multiple long-term chronic morbidities. Clinical guidelines recommend physical activity (PA) in the form of general aerobic and strengthening exercises for people with OA irrespective of comorbidity to improve health. However, the relationship between comorbidity and PA behaviour in adults with OA, is unknown. The objectives of this study are to investigate whether; 1) comorbidity presence is associated with PA levels 2) the number of comorbid is conditions associated with PA levels and 3) different types of comorbidity are associated with PA levels. Methods: Adults aged ≥45 with knee pain attributed to OA were recruited to the BEEP trial (ISRCTN93634563) and the MOSAICS trial (ISRCTN06984617) respectively between 2009 and 2014 from UK general practices and NHS physiotherapy services. Comorbidities including; respiratory (asthma, bronchitis, chronic obstructive pulmonary disease), cardiovascular (angina, heart failure, stroke, heart disease, heart attack), depression, type 2 diabetes and obesity (BMI ≥30) were identified from Self-report baseline questionnaire (BEEP) and medical record review (MOSAICS). Self-report PA levels were measured using the Physical Activity Scale for the Elderly (PASE - ranging from 0-400+ with higher scores indicating higher PA levels). Linear regression models were used to estimate the adjusted mean change (95% confidence interval) in PASE score in the presence of; any comorbidity; increased number of comorbidities (0 (reference), 1, 2, 3+ comorbidities), and; presence of specific comorbidity types. Results were adjusted for covariates (demographics; age, gender, relationship status and clinical measures; Western Ontario and McMaster Osteoarthritis Index (function subscale) and anxiety (Generalised Anxiety Disorder 7). Results: The BEEP and MOSAICS trials recruited 514 and 525 participants respectively. Participant mean ± standard deviation age was 62.9±9.8; 67.3±10.5, and 51%; 60% were female (BEEP; MOSAICS). Over half of the participants had at least one comorbidity (BEEP: n=324 (66%); MOSAICS: n=271 (52%)). Mean PASE scores were 176.9±83.5 (BEEP) and; 142.7±80.3 (MOSAICS). Comorbidity presence was associated with a decrease in PASE score in BEEP however, no statistically significant association was observed in MOSAICS (Table 1). In the comorbidity count model, each additional comorbidity was associated with an incrementally lower PASE score in BEEP (adjusted models displayed in Table 1). This pattern was similar in MOSAICS, but with a plateau in association from two comorbidities onward. The specific types of comorbidity had different strengths of associations with PASE within and between trials Table 1.). In BEEP and MOSAICS, respiratory and cardiovascular comorbidity were associated with the largest reduction in PASE scores respectively. A greater number of comorbidity types were found to be associated with PASE score in BEEP than in MOSAICS. Conclusions: This is the first study to investigate and describe in detail the association between comorbidity and PA in people with OA. Our findings suggest a dose-response relationship with activity levels decreasing as the number of comorbidities increase. Presence of respiratory disease, cardiovascular disease and Type II diabetes were most strongly associated with lower PA levels. A strength of this analysis was the use of two datasets and two methods for recording comorbidity. A limitation was that only self-report PA was measured within the two trials, there was no objectively measured PA. Although the directions of associations were generally consistent across the two trials there was some difference in the magnitude of associations. Since our analysis is cross-sectional, we cannot infer causation and it is possible that a reciprocal relationship exists where comorbidities may be both risk factors for, or a result of, reduced PA. Future explanatory research could help inform our understanding of the relationship between comorbidity and PA behaviour in people with OA. This information could then be used to inform future interventions aimed at increasing PA in people with OA and comorbidity.

Behaviour change interventions targeting physical activity in adults with fibromyalgia: a systematic review.

Physical activity (PA) and exercise programmes are recommended for the management of fibromyalgia. Despite positive effects on symptoms and function, PA promotion remains a significant clinical challenge. Behaviour change theories and techniques are recommended as part of complex health interventions; their integration into interventions aimed at PA behaviour in people with fibromyalgia is not known. This review explored behaviour change interventions targeting PA in adults with fibromyalgia. A systematic review was conducted; randomized and quasi-randomized controlled trials with at least one behaviour change intervention targeting PA were included. MEDLINE/OVID, EMBASE, PEDro, PsychINFO, CINAHL, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials and relevant conference abstracts were searched. Two authors independently screened studies for inclusion and performed risk of bias assessments. Articles were reviewed for their use of behaviour change theory and behaviour change techniques (BCTs). The search identified 2491 records, from which eight studies (1416 participants) were included. PA and exercise behaviours were the primary focus of four interventions and were components of broader interventions in four studies. Behaviour change theories informed four interventions. Thirty-two different BCTs were used across studies. Five studies reported improvements in PA either post-intervention or at follow-up. Two studies used objective PA measures and seven studies used self-report measures. Short-term benefits in pain, quality of life, and physical fitness were also observed. Behaviour change interventions targeting PA in people with fibromyalgia have had limited success to date. With significant variations in intervention designs, the optimal intervention remains unknown.

Physical activity behaviour in people with diabetes residing in India: A cross-sectional analysis

Summary Aim To describe and analyse physical activity behaviour and barriers and facilitators, in adults with diabetes residing in India. Methods The sample consisted of 190 (110 men and 80 women) adults with diabetes living in India. The mean age of the sample was 57 years (18 to 83 years), and the mean duration since diagnosis of diabetes was 10.38 years (SD 8.41 years). All participants completed a questionnaire about their physical activity behaviour, importance of, and barriers and facilitators. Results In all, 78.9% of participants thought that physical activity was important in the control of diabetes. In all, 54.7% of respondents did regular physical activity every week, and physical activity was more frequent in men (63.6%), and in those with an intermediate (60%) or advanced (65.2%) level of English. Barriers that discouraged participants from physical activity were lack of time (31.6%), lack of knowledge (23.2%) and health limitations (17.4%). Potential identified facilitators included more information about physical activity (39%) and group exercise with people of the same sex or speaking the same language. Conclusions Most of the sample thought that physical activity is important to control diabetes, although few participated in regular physical activity. Findings also suggest that physical activity had a higher importance for men, for those with an advanced level of English and those under 60 years of age. Men, those with intermediate or advance level of English, and people under 60 years were significantly more active.

Associations with being physically active and the achievement of WHO recommendations on physical activity in people with spinal cord injury.

Secondary data analysis from the cross-sectional survey of the Swiss Spinal Cord Injury Cohort Study. To explore associations with physical activity (PA) levels in people with spinal cord injury (SCI) with the specific aim to identify aspects that potentially explain being physically active (PHYS-ACT) and the achievement of the World Health Organization recommendations on PA. Community sample (n=485). Participants who completely answered four items of the Physical Activity Scale for Individuals with Physical Disabilities were included. Two outcome measures were defined: (1) being PHYS-ACT vs being completely inactive and (2) achieving WHO recommendations on PA (ACH-WHO-REC) (at least 2.5 h per week of at least moderate intensity) vs performing less. Independent variables were selected from the original questionnaire by applying the ICF framework. Multivariate logistic regression analyses were conducted. In the participants (aged 52.8±14.8; 73.6% male) older age decreased, but being a manual wheelchair user increased the odds of achieving both outcomes. Social support and self-efficacy increased the odds of being PHYS-ACT. Use of an intermittent catheter increased, whereas dependency in self-care mobility and coping with emotions decreased the odds for ACH-WHO-REC. Experiencing hindrances due to accessibility is associated with increased odds for ACH-WHO-REC. Being PHYS-ACT at all and achieving the WHO recommendations on PA are associated with different aspects. Applying the ICF framework contributes to a comprehensive understanding of PA behavior in people with SCI, which can tailor the development of interventions. Longitudinal studies should be initiated to test these associations for causal relationships.