Exercise Self-efficacy Research Articles

Understanding regular exercise behavior in frail older adults: a structural equation model based on social-cognitive variables.

Regularly engaging in exercise has been recognized as the only therapy found to consistently manage frailty. This study applies structural equation modeling (SEM) to integrate the theoretical perspective of Social cognitive theory (SCT) to better understand and promote regular exercise behavior among frail older adults, providing a foundation for enhancing exercise engagement in this vulnerable population. A total of 306 frail older adults in Chengdu, China, were selected in this cross-sectional study. Participants completed the the FRAIL scale, the Self-Efficacy for Exercise (SEE) Scale, the behavioral regulation in exercise questionnaire (BREQ-2), the Outcome Expectations for Exercise (OEE), the Exercise Social Support (ESS) Scale. Structural equation modeling (SEM) was used to specify hypothesis between components of social-cognitive theory on regular exercise behavior among frail seniors. The percentage of regular exercise behavior was 29.1% among participants. There were statistically significant differences in the regular exercise behavior for demographic characters of occupation, disposable monthly income, frail phenotype of fatigue, resistance and weight loss (p < 0.05). SEM showed that the exercise self-efficacy (β = 0.52, p < 0.001) and exercise outcome expectation (β = 0.45, p < 0.011) are the strongest determinants of regular exercise behavior, while social support (β = 0.092, p > 0.05) and self-regulation (β = 0.05, p > 0.05) are non-determinant. Our study underscores that adherence to regular and structured exercise regimens remains low among frail older adults, suggesting that this population may not be fully benefiting from scientifically guided exercise programs. Integrating self-efficacy and outcome expectations into further exercise promotion is critical. Patient-centered approach is essential for developing more effective and sustainable exercise interventions.

Interactive 3D visualisation technique used in pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled study evaluating quality of life, compliance and use of health care.

A pulmonary rehabilitation (PR) programme, including exercise training, education, and behaviour change, is highly recommended in treatment guidelines for chronic obstructive pulmonary disease (COPD). A new PR educational material for PR using an interactive three-dimensional (3D) visualisation technique was developed. There is little known regarding using 3D in this setting. The aim was to evaluate, within a PR programme setting, differences between outcomes of education through interactive 3D compared with education by means of 2D visualisation in patients with COPD regarding health-related quality of life (HRQL), physical capacity, exercise self-efficacy, compliance to exercise training, compliance to medication, and the use of health care and to describe learning styles. Patients were cluster randomised to PR at the University Hospital clinic, including exercise training, for 10 weeks with education by 3D (n = 27) or education by traditional 2D technique (n = 17). At follow-ups, HRQL, physical capacity, self-efficacy, handgrip strength, compliance to exercise training, compliance to medication and health care utilisation were assessed. No significant differences were observed in HRQL in relation to COPD between the groups after 10 weeks. Differences were found in handgrip strength at baseline and at 10 weeks (p < 0.01). The 3D group had improved scores in HRQL assessed with the Leicester Cough Questionnaire (LCQ-S) psychological domain (p = 0.022). In the 2D group, the LCQ-S social domain (p = 0.028), psychological domain (p = 0.021) and the St George's Respiratory Questionnaire total (p = 0.050) were increased. The most common learning mode and learning style in both groups was reflective observation and divergent style. An interactive education in 3D technique used in a PR programme for patients with COPD yielded no significant differences compared to conventional techniques. Three-dimensional techniques can be used in PR for COPD as an alternative to conventional techniques. ClinicalTrials.gov (identifier:NCT02802618).

Feasibility and preliminary efficacy of a physical activity intervention in adults with lymphoma undergoing treatment

BackgroundTo determine the feasibility, acceptability, and preliminary efficacy of a 6-month tailored non-linear progressive physical activity intervention (PAI) for lymphoma patients undergoing chemotherapy.MethodsPatients newly diagnosed with lymphoma (non-Hodgkin (NHL) or Hodgkin (HL)) were randomized into the PAI or healthy living intervention (HLI) control (2:1). Feasibility was assessed by examining accrual, adherence, and retention rates. Participants completed assessments of exercise capacity (VO2 peak and 6-min walk distance (6MWD)), objective and self-reported levels of physical activity, MRI-derived cardiovascular functioning (Left Ventricular Ejection Fraction [LVEF], stroke volume, and cardiac output), and self-reported health-related and disease-specific quality of life and self-efficacy for exercise at baseline, 3, and 6 months.ResultsOne hundred and forty-five individuals were screened with 23 of 84 eligible patients agreeing to participate (27%). Three participants withdrew before baseline testing. Out of the 20 participants randomized to the PAI (n = 13) and HLI groups (n = 7), 18 completed the intervention resulting in an overall retention rate of 78%. The adherence rates to the PAI and HLI were 85% and 87%, respectively. One non-serious adverse event was registered. VO2 peak ranged from 15.5–28.0 ml/kg/min at baseline and participants in both groups improved by 6 months. Physical activity levels and cardiovascular function were reduced prior to treatment but did not deteriorate further.ConclusionsImplementing a tailored PAI in adults with lymphoma during active treatment is feasible, was well received by participants and shows preliminary efficacy for limiting a decline in function during treatment. Potential Implications for Cancer Survivors: Physical activity may be beneficial for improving exercise capacity and health-related quality of life in patients undergoing chemotherapy.Trial registration#NCT01719562 ClinicalTrials.gov. Registered July 2, 2019—retrospectively registered.

Feasibility and preliminary effects of the mindful healthy family project among rural families

ABSTRACT Background/purpose: Rural adults and children are at higher risk for overweight and obesity. However, there are relatively few lifestyle modification programs available for these high-risk families, mainly because of the difficulty in reaching them. This mindfulness-based motivational interviewing (MM-based-MI) pilot aimed to improve parents’ healthy eating index (HEI), collective family efficacy, family satisfaction, perceived stress, and depressive symptoms as well as parent–child dyads’ eating patterns, physical activity (PA), and body mass index (BMI). Methods: This randomized controlled trial (RCT) was conducted in the Midwestern US to examine the feasibility (enrollment, attendance, and attrition), acceptability, and preliminary effects of an MM-based-MI intervention that contained nine sessions of health coaching (1-on-1), while the active-control included nine emailed health handouts sent over an 18-week period. Results: A total of 46 parents (29 intervention, 17 control; Mage = 38.5 years, 85% female) participated. The enrollment rate, intervention attendance rate, and attrition rate were 12.6%, 79.8%, and 23.9% respectively. Although not statistically significant, compared to the control, the MM-based-MI intervention showed positive effects on improving parents’ HEI in terms of increasing total HEI score (Cohen’s d = 0.43), vegetable intake (d = 0.41), greens/beans (d = 0.59), protein food (d = 0.82), and self-efficacy in exercise (d = 0.21), as well as decreasing total calories (Kcal, d = −0.58), added sugar (d = −0.50), and depressive symptoms (d = −0.42), while controlling for marital status. Controlling for age, sex, and marital status, intervention children had greater improvement in increasing fiber (d = 0.75) and protein (d = 0.72) intake compared to the active-control group. Moreover, parents in both groups reported improvement (small to large effects) in ↑mindful eating, ↑collective family efficacy, ↑family satisfaction, and ↓perceived stress over time. Conclusions: Despite some limitations (small sample size, virtual at home measurement), our results support the feasibility, acceptability, and preliminary effects of this Mindful Healthy Family program on potentially mitigating some obesogenic behaviors among rural parent–child dyads. Trial registration: ClinicalTrials.gov identifier: NCT05324969.

Formative evaluation of a mobile chat-based intervention (ChatEx) for promoting exercise behaviour in older cancer survivors.

To conduct a formative evaluation of ChatEx to increase and maintain exercise among older cancer survivors. ChatEx is a blended intervention involving 12 weeks of theory-based instant messages and two in-person training sessions. This pilot study comprises three phases: (1)intervention development: developing a message library reviewed by experts; (2)message library pretesting: exploring the views of older cancer survivors toward the message library and making modifications (n=20); and (3)intervention pilot testing: piloting the ChatEx using a non-randomized quasi-experimental design using quantitative and qualitative methods among cancer survivors aged 65+ who do not meet current exercise guidelines and have completed treatment (n=40). Feasibility, Acceptability, aerobic and resistance exercise, exercise capacity, grip strength, frailty, quality of life, exercise self-efficacy were assessed as the main outcomes. ChatEx had a retention rate of 80%, with most participants having moderate/high levels of engagement with messaging, and 100% attendance at in-person sessions. Compared to wait-list control, the intervention group significantly increased the time spent in aerobic exercise at 24 weeks, as well as resistance exercise at both 12 weeks and 24 weeks. The intervention group also had significantly greater improvement in exercise capacity and exercise self-efficacy than control at 24 weeks. Participant interviews revealed five major themes: positive feedback, facilitators of exercise adherence, barriers to exercise adherence, negative feedback, and suggestions for improvement. The findings support the feasibility, acceptability, and potential efficacy of ChatEx in increasing exercise behaviour among older cancer survivors. A full-scale trial with a larger and more diverse sample is now warranted.

Effects of a goal attainment theory-based intervention on physical activity, body composition, and motivation in emerging adults with physical inactivity: A randomized controlled trial.

This study aims to assess the effectiveness of an intervention based on the goal attainment theory to levels of physical activity, body composition, and motivational variables of emerging adults with physical inactivity. A randomized, controlled trial. A total of 157 emerging adults with physical inactivity were randomized into the control group (n=77) or the intervention group (n=80). The control group received routine health education for a period of 3 months, and the intervention group used a physical activity promotion intervention model based on King's attainment theory on the basis of the control group. The primary outcome was the body composition. Secondary outcomes were examined included levels of physical activity, motivation, and self-efficacy. The results indicate that the visceral fat area was significantly lower in the intervention group (Z = -6.79, P < 0.001), along with reductions in body fat mass (Z = -2.85, P < 0.05) and body fat percentage (F = -2.78, P < 0.05). The intervention group also demonstrated higher introjected motivation (Z = 2.70, P < 0.05) and self-efficacy (Z = 4.06, P < 0.001) than the control group. Physical activity levels were significantly higher in the intervention group, with increases observed in vigorous activity (Z = 60.51, P < 0.001), moderate activity (Z = 104.90, P < 0.001), walking activity (Z = 7.37, P < 0.001), and total physical activity (Z = 91.40, P < 0.001) compared to the control group. Physical activity interventions based on King's Attainment Theory can improve body composition, increase physical activity levels, improve exercise self-efficacy, and promote maintenance of healthy behaviours in emerging adults. This study was registered on ClinicalTrials (NCT05697679).

The impact of electronic health literacy on emotional management ability among college students: the mediating roles of peer relationships and exercise self-efficacy

ObjectiveThis study aims to explore electronic health literacy’s impact on college students’ emotional management ability and analyze the chained mediating effects of peer relationships and exercise self-efficacy.MethodsThe study used stratified, cluster, and staged sampling methods to collect demographic information. Electronic health literacy, peer relationships, exercise self-efficacy, and emotional management ability data were collected among college students using the Questionnaire Star software. A total of 30,105 valid questionnaires were obtained, with a valid response rate of 98.7%. Using Process Model 6, investigated how electronic health literacy sequentially influences emotional management ability through mediators such as peer relationships and exercise self-efficacy.ResultsThere was a significant positive correlation between electronic health literacy and emotional management ability (r = 0.496, P < 0.01), between electronic health literacy and peer relationships (r = 0.226, P < 0.01), and between electronic health literacy and exercise self-efficacy (r = 0.180, P < 0.01). Peer relationships were significantly positively correlated with exercise self-efficacy (r = 0.142, P < 0.01) and emotional management ability (r = 0.396, P < 0.01). Exercise self-efficacy was significantly positively correlated with emotional management ability (r = 0.339, P < 0.01). Electronic health literacy significantly and positively predicted emotional management ability (β = 0.254, P < 0.001). There was a mediating effect of peer relationships between electronic health literacy and emotional management ability, accounting for 58.2% of the impact, 95%CI: [0.036,0.042]. Exercise self-efficacy also mediated the relationship between electronic health literacy and emotional management ability, accounting for 61.5% of the effect, 95%CI: [0.022,0.027]. Moreover, a chained mediating effect of peer relationships and exercise self-efficacy was observed between electronic health literacy and emotional management ability, accounting for 17.1% of the effect, 95%CI: [0.004,0.005].ConclusionElectronic health literacy among college students can positively predict emotional management ability. Both peer relationships and exercise self-efficacy play a chained mediating role between electronic health literacy and emotional management ability.

A pilot study of a gratitude journaling intervention to enhance spiritual well-being and exercise self-efficacy in Black breast cancer survivors

BackgroundBreast cancer (BC) survivorship presents significant health disparities, particularly affecting Black women, who experience a 40% higher BC death rate compared to White women. These disparities are exacerbated by comorbidities, which contribute to poorer overall health outcomes. Additionally, Black BC survivors often face psychosocial challenges, including increased stress and lower well-being, which can lead to adverse physical health effects. This pilot study aims to assess the feasibility and efficacy of a culturally sensitive gratitude journaling intervention designed to enhance spiritual well-being, exercise self-efficacy, and reduce inflammation among Black BC survivors.MethodsThis pilot study employed a two-group, parallel random-assignment experimental design to compare a gratitude journaling intervention with a general memory journaling control group. Twenty-six Black women aged 40 to 70 years with a history of BC were randomly assigned to either the gratitude journaling intervention group (n = 13) or the control group (n = 13). The gratitude intervention group engaged in gratitude journaling twice weekly for eight weeks, while the control group documented daily memories. Outcomes measured included Gratitude Questionnaire-6, FACIT-Spiritual Well-Being 12 Item Scale, Perceived Stress Scale, Giscombe Superwoman Schema Questionnaire, and the Stage of Motivational Readiness for Physical Activity questionnaire and inflammatory biomarkers. Statistical analyses included the Wilcoxon rank sum test and Fisher’s exact test.ResultsTwenty-six participants were enrolled, with 73% completing baseline and post-intervention assessments. The intervention group showed a significant improvement in spiritual well-being (p = 0.014) with a large effect size (ES = 0.57). Marginal improvements in exercise self-efficacy were also observed (ES = 0.39). Although there were no significant differences in dispositional gratitude and perceived stress between groups, the intervention group exhibited trends toward increased gratitude and reduced stress. Inflammatory biomarker analysis indicated non-significant changes, though IL-6 levels increased in the intervention group.ConclusionThis study demonstrates the feasibility and acceptability of a gratitude journaling intervention among Black BC survivors. The intervention significantly enhanced spiritual well-being and showed promise in improving exercise self-efficacy, suggesting its potential for promoting holistic wellness in this population. These findings provide a foundation for future larger-scale randomized controlled trials to further evaluate the efficacy of gratitude-based interventions for Black BC survivors.Trial registrationThis study was registered prospectively at ClinicalTrials.gov (NCT05473026) on 07-13-2022.

Steps to Avoid Falls in the Elderly – a TECHnology Enhanced Intervention (SAFE-TECH) study: randomized controlled trial protocol for a community-based, multi-component fall prevention program

BackgroundFalls and fall-related injuries among older adults in Singapore are a serious health problem that require early intervention. In previous research, exercise interventions have been effective in improving functional outcomes and reducing falls for a broad group of older adults. However, results from multi-domain, multi-component falls prevention programs for high fall risk older adults in the community remain equivocal. One reason for these results is that there is significant heterogeneity in falls risk factors amongst high falls risk older adults which makes tailoring multicomponent interventions complex. The objective of the trial is to evaluate the effectiveness of an enhanced version of the predecessor program, SAFE. The Steps to Avoid Falls in the Elderly—a TECHnology enhanced intervention (SAFE-TECH) is designed for older adults in the community who are at high risk of falls, with candidate selection and program tailoring based on gait variables derived from wearable sensors and various questionnaire-based features.MethodsSAFE-TECH is a 12-month randomized controlled trial involving 400 older adults at high risk of falling, who are randomly allocated to an intervention or control group in a 1:1 ratio. Participants will be assessed at baseline, 3rd-month and 12th-month for functional status, physical performance, cognitive status, quality of life, and medical history. Monthly phone calls will assess fall status, healthcare utilization, physical activity, and exercise self-efficacy. Participants in the intervention group will undergo a tailored, multi-domain, multi-component falls prevention program. The active intervention phase will last for 12-weeks with exercises focusing on strength, balance, coordination, flexibility, and aerobic endurance; and weekly educational sessions on falls risk with personalized feedback based on participant’s falls risk assessments and environmental checklist.DiscussionsSAFE-TECH seeks to evaluate enhanced existing falls prevention programs by addressing the heterogeneity of falls risk through rapid assessments and personalisation of exercise and education components while maintaining the efficiency of the group setting. Our findings will inform practical efforts to reduce falls and falls-related injuries among community-dwelling older adults.Trial registrationClinicalTrials.gov. Clinical Trial Number: NCT06102954|| 22–10-2023.

Validity and Reliability of the Turkish Version of the Low Back Activity Confidence Scale (LoBACS).

The Low Back Activity Confidence Scale (LoBACS) is a 15-item scale designed to assess low back pain (LBP) through self-efficacy, a key predictor of functional recovery. This study aimed to culturally adapt and evaluate the validity and reliability of the Turkish version of LoBACS in patients with LBP. The translation and adaptation followed Beaton et al.'s protocol. Content and face validity were assessed with a pre-patient group. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to evaluate construct validity. Internal consistency, as well as test-retest reliability, were evaluated in a sample of 150 patients aged 18-70years. Concurrent validity was measured alongside the Oswestry Back Pain Disability Questionnaire (ODQ) and Quebec Back Pain Disability Scale (QBPDS). Two factors emerged from factor analysis, with item loadings for Functional Self-efficacy (FnSE) ranging from 0.745 to 0.896 and for Self-Regulatory and Exercise Self-efficacy (Self-Reg&ExSE) from 0.817 to 0.940. Cronbach's alpha was high for FnSE, Self-Reg&ExSE, and the total scale (α = 0.941). Total correlation for each item ranged between 0.770 and 0.925. Test-retest reliability was also high (r = 0.941, p < .01). LoBACS showed moderate agreement with ODQ and QBPDS, demonstrating concurrent validity. In conclusion, the Turkish version of LoBACS is a valid and reliable tool for measuring LBP-related self-efficacy.

A160: Effects of Social Support on College Students' Exercise Behavior

Background/Purpose: Improving college students’ physical fitness and health has been a critical concern for the state and society. Existing studies have shown that exercise self-efficacy and social support are essential intrinsic and extrinsic factors influencing college students’ exercise behavior. This study is based on the theory of social support. It replaced positive psychology with exercise self-efficacy, analyzed the influence of social support on college students’ exercise behavior, and explored the mediating role of exercise self-efficacy between social support and exercise behavior. Methods: 807 college students were randomly selected for the survey using the Perceived Social Support Scale, Physical Exercise Behavior Scale, and Exercise Self-Efficacy Scale. Data were analyzed on SPSS 26.0 using descriptive statistics, Pearson’s correlation method for variable correlation, the PROCESS plug-in (version 3.1) Model 4 for mediation analysis, and the Bootstrap test. Results: (1) There was a significant positive correlation between social support, exercise behavior, and exercise self-efficacy (r = 0.114–0.193, P &lt; 0.01); (2) Social support was able to negatively and significantly positively predict exercise behavior (β = 2.680, P &lt; 0.01); (3) Exercise self-efficacy played a partial mediating role in the influence of social support on physical exercise behavior (β = 0.327, t = 5.200, 95% CI = [0.183, 1.122], interval does not include 0), and the mediating effect was 21.29%. Conclusion/Discussion: Exercise self-efficacy had a mediating role in the influence of social support on college students’ exercise behavior. It also suggested that school sports departments can enhance exercise self-efficacy by improving college students’ social support to further promote their participation in exercise activities. Unlike previous studies, this study replaced positive psychology with exercise self-efficacy and analyzed the partial mediating effect of exercise self-efficacy between social support and exercise behavior, suggesting that we may also have other psychological variables, such as exercise motivation. In the mediation model, this study only analyzed the overall social support. The follow-up study can divide social support into three dimensions: family support, friend support, and teacher support, and explore the specific impact path and differences. In summary, this study examined social support as an independent variable, exercise behavior as a dependent variable, and exercise self-efficacy as an intermediary variable to construct an intermediary model. Combined with the perspective of sports science and psychology, it provided a theoretical basis for guiding college students to participate in physical exercise and actively improve their physical health.

A quasi-experimental study on couple-based exercise program improving cardiac rehabilitation exercise compliance in post-PCI patients

BackgroundPercutaneous coronary intervention (PCI) helps treat coronary artery disease but only provides short-term relief and doesn’t stop disease progression. Exercise rehabilitation can improve outcomes for patients after PCI and lower the risk of death and new heart problems, but many patients struggle to stick with their exercise routines. Spouses play a crucial role in supporting patients and helping them stay committed to their rehabilitation. This study aims to evaluate the effectiveness of a couple-based exercise program in improving exercise adherence among post-PCI patients.MethodsThis study used a quasi-experimental design, 70 dyads were recruited for a 12-week investigation. Participants were divided into an intervention group to receive the Couple-Based exercise program and a control ensemble for conventional exercise-based cardiac rehabilitation. The primary parameter under examination was exercise adherence. Secondary endpoints encompass exercise self-efficacy, the 6-minute walk test, the 9-item Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Data were harvested at baseline and post-intervention (12 weeks).ResultFollowing a three-month monitoring period, noticeable differences were observed in the Couples exercise group compared to the control group in the realms of exercise adherence, exercise self-efficacy, the 6-minute walk test, and anxiety-depression indices (P < 0.05).ConclusionA couple-based exercise program developed based on a developmental-contextual framework improves exercise adherence and exercise self-efficacy, enhances cardiac function and exercise capacity, and improves anxiety and depression in post-coronary arteriography patients. This approach is likely to be an effective way to improve rehabilitation outcomes, leading to the broader goal of improving patient prognosis and reducing adverse cardiovascular events.Trial registrationThe study’s registration was recorded with the Chinese Clinical Trials Registry (12/04/2022, registration number ChiCTR2200058600).

Relationship between exercise habits and social isolation in older patients with predialysis CKD: a cross-sectional study

BackgroundMaintaining exercise habits in older patients with predialysis chronic kidney disease (CKD) is important to prevent conversion to renal replacement therapy and improve prognosis. This study identified factors influencing exercise habits in older patients with predialysis CKD.MethodsThis cross-sectional study included 113 patients aged ≥ 65 years with stages 3–5 predialysis CKD who were admitted for CKD education purposes. Exercise habits were assessed using the transtheoretical model. Social isolation was assessed using the Lubben Social Network Scale (LSNS-6). Furthermore, the short physical performance battery (SPPB) and grip strength, exercise self-efficacy (SE), hemoglobin, and estimated glomerular filtration rate of the participants were assessed.ResultsAmong the 55 patients who maintained exercise habits, 20 (57.1%) were at CKD stage 3, 19 (43.2%) were at CKD stage 4, and 16 (47.1%) were at CKD stage 5. The LSNS-6, SPPB, grip strength, and exercise SE scores significantly differed between the with exercise habits group and without exercise habits group (p < 0.05). The multivariate logistic regression analysis results indicated that the LSNS-6 (OR:1.10; 95%CI:1.022–1.210) and exercise SE (OR:1.10; 95%CI:1.009–1.199) were significantly associated with exercise habits (p < 0.05). Conversely, no significant associations were found between exercise habits and SPPB, grip strength, renal function, or anemia.ConclusionsSocial isolation and SE may be an important factor influencing exercise habits in older patients with predialysis CKD.

Cardiorespiratory exercise and self-management early after stroke to increase daily physical activity: results from a stepped-wedge cluster randomised trial

Purpose This study aimed to determine if the Promoting Optimal Physical Exercise for Life (PROPEL) program increases participation in physical activity up to six months post-discharge from stroke rehabilitation, compared to participation in group cardiorespiratory exercise (GCE) alone. Methods This was a stepped-wedge cluster superiority randomised controlled trial. People with sub-acute stroke participated in the PROPEL (n = 107) or GCE (n = 65) intervention phases. The primary outcome was adherence to physical activity guidelines over seven days at six months post-discharge from rehabilitation. Secondary outcomes were exercise self-efficacy (Short Self-Efficacy for Exercise scale), exercise-related beliefs and attitudes (Short Outcome Expectation for Exercise scale), and perceived barriers to physical activity (Barriers to Being Active Quiz). Results Fifty-seven participants (PROPEL, n = 29; GCE, n = 28) were included in the analysis. At six months post-discharge, 6/17 PROPEL participants and 9/22 GCE participants met the guidelines for intensity and duration of physical activity; the odds of meeting physical activity guidelines did not differ between phases (p > 0.84). PROPEL participants reported higher self-efficacy for exercise than GCE participants (p = 0.0047). Conclusions While PROPEL participants reported higher self-efficacy for exercise than those who completed GCE alone, we were unable to find evidence that this translated to increased odds of meeting physical activity guidelines. Trial registration NCT02951338 IMPLICATIONS FOR REHABILITATION Integration of cardiorespiratory exercise with behaviour modification strategies to improve physical activity participation after discharge from stroke rehabilitation increases self-efficacy for exercise when compared to cardiorespiratory exercise alone. Increased self-efficacy for exercise may not increase the odds of meeting physical activity guidelines post-stroke. Improving self-efficacy for exercise during stroke rehabilitation may encourage participation in moderate to vigorous physical activity up to 6-months post-discharge from rehabilitation.

Perceived social support impacts on exercise adherence in patients with chronic low back pain.

Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP). This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise). This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis. A positive relationship was found between participants' perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: -258.08 to 746.01). Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People's self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.

Causal mediation analysis of factors influencing physical activity and community access among people with mild to moderate Parkinson's disease

ObjectiveTo examine how known causal factors (exercise self-efficacy, balance, walking capacity) affect outcomes (moderate intensity physical activity, community access) in people with Parkinson's disease (PD): through a direct pathway, indirectly through potential mediators (non-motor impairments), or through combined direct and mediated paths. DesignCausal mediation analyses using baseline and three-month data from pooled treatment groups in a randomized controlled trial. SettingData were collected at two university clinical research centers. ParticipantsOne hundred thirty-eight people with PD. InterventionsHome and community-based walking and strength exercise program. Main Outcome Measure(s)Exposures were exercise self-efficacy, walking ability, and balance. Potential mediators included pain, fatigue, mood (anxiety, depression, affect, apathy), stigma, and cognition (executive function and cognitive flexibility). Outcomes were physical activity and community access behaviour at three-month follow-up. Separate models were developed for each causal factor-mediator-outcome combination. To minimise bias, all models were adjusted for known confounders (comorbidities, freezing of gait, severity of motor impairments, and/or age) and baseline values of the outcomes. ResultsSelf-efficacy of walking duration had a causal relationship with moderate intensity physical activity through direct and combined paths (p<.001). Walking capacity had a causal relationship with community access through direct (p=.03-.04) and combined (p=.02-.03) paths. Balance did not affect community access (p>.05). There were no significant mediation effects through indirect pathways for either outcome. ConclusionsThe effect of known causal factors on physical activity and community access was not mediated by non-motor impairments. Walking self-efficacy and walking capacity remain the primary intervention targets for improving physical activity and community access, respectively, in people with PD.

The WE-RISE™ multi-domain intervention: a feasibility study for the potential reversal of cognitive frailty in Malaysian older persons of lower socioeconomic status

BackgroundCognitive frailty (CF) is an emerging concern among older persons, particularly within lower socioeconomic statuses (SES) populations. Currently, there is limited evidence on the potential reversibility of CF through multi-domain interventions within this demographic. This study aimed to investigate the effectiveness of the WE-RISE™ multi-domain intervention in addressing the potential reversibility of CF among community-dwelling older persons of lower SES, the intervention effects on multiple health dimensions, and to determine if WE-RISE™ is of low cost.MethodsThis 24-week randomised controlled trial included 55 community-dwelling older persons of lower SES with CF, who were randomised into either the WE-RISE™ intervention group (n = 27), or the control group receiving usual care (n = 28). The WE-RISE™ intervention comprised of 12 weeks of instructor led, community-based intervention, followed by 12 weeks of WE-RISE™@Home. CF status, cognitive and physical function, nutrition, disability, health-related quality of life, exercise self-efficacy and depression were assessed at baseline, 12th and 24th weeks. Changes in CF status was analysed descriptively, while intervention effects were analyzed with split plot ANOVA. The cost of the WE-RISE™ intervention was calculated using activity-based costing.ResultsAt baseline, all participants in both the intervention and control groups (100%) were classified as CF. Following 12 weeks of the WE-RISE™ intervention, 74.1% of participants in the experimental group no longer met the criteria for cognitive frailty, with 63% maintaining this improvement at 24 weeks. In contrast, the CF status of participants in the control group remained largely unchanged, with only 10.7% showing improvement at 12 weeks and falling to 3.6% at 24 weeks. Significant intervention effects were observed for cognition, physical function, body composition, disability, health-related quality of life and self-perceived exercise self-efficacy (p < 0.05) following participation in WE-RISE™. The cost per intervention session was RM4.06 (≈ USD 0.90), and the cost per subject for 48 sessions was RM194.74 (≈ USD 43.39).ConclusionThe WE-RISE™ multi-domain intervention has demonstrated potential in reversing CF among older persons of lower SES, leading to significant improvements across multiple health dimensions at a low cost. WE-RISE™ shows promise to enrich the well-being of ageing societies, contribute to societal health, and ensure equitable access to healthcare, supporting broader implementation by enhancing equitable access to health programs and addressing the needs of older persons, WE-RISE™.Trial registrationThis trial was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619001055190) on the 29th of July 2019 – retrospectively registered.

The impact of exercise self-efficacy on college students' emotion management ability: an analysis of the mediating effects based on exercise behavior and screen media use.

To explore the impact of exercise self-efficacy on college students' emotion management ability and to analyze the mediating effects of exercise behavior and screen media use between exercise self-efficacy and emotion management ability. This study adopted stratified, whole-cluster, and staged sampling methods, using an online questionnaire that included demographic information, exercise self-efficacy, exercise behavior, screen media use, and other relevant aspects, obtaining a total of 12,687 valid questionnaires. The study indicated a significant positive correlation between exercise self-efficacy and emotion management ability (r = 0.349, p < 0.01). There was also a positive correlation between physical exercise and emotion management ability (r = 0.128, p < 0.01). In contrast, smartphone use showed a significant negative correlation with emotion management ability (r = -0.102, p < 0.01). Additionally, exercise persistence and electronic health literacy presented significant positive correlations with emotion management ability (r = 0.370, p < 0.01; r = 0.502, p < 0.01). Chain-mediated effect analysis revealed that exercise self-efficacy positively affected emotion management ability by enhancing physical exercise and reducing smartphone use (95% CI: [0.001, 0.002]). Furthermore, exercise self-efficacy positively influenced emotion management ability by enhancing exercise persistence and e-health literacy (95% CI: [0.029, 0.042]). These two variables acted as chain mediators, demonstrating the pathways through which exercise self-efficacy affects emotion management ability. This study deepened the understanding of the interplay between exercise behavior, screen media use, and emotion management ability. It suggested that emotion management ability could be enhanced through strategies of improving exercise persistence, physical exercise, electronic health literacy, and reducing smartphone use while considering differences in gender, academic year, and regional factors in intervention programs.

Combining motivational and exercise intervention components to reverse pre-frailty and promote self-efficacy among community-dwelling pre-frail older adults: a randomized controlled trial

BackgroundExercise is effective in preventing frailty status in older adults, but the effect of an exercise program based on Wellness Motivation Theory (WMT) on the frailty status, self-efficacy for exercise, and quality of life for older adults with pre-frailty remains unclear. Our objective was to examine the efficacy of a multicomponent exercise program based on WMT on frailty status, self-efficacy, and quality of life among pre-frail older adults.MethodsThis was a randomized controlled trial of pre-frail older adults aged from 60 years to 85 years. Participants in the intervention group performed exercise three times a week for 24 weeks, once at a community health service station instructed by two researchers and two times at home. Participants in the control group were given one-time advice on physical activity. The assessor was the only one blinded. The primary outcome was the reversal rate of pre-frailty. The secondary outcomes included self-efficacy and quality of life.ResultsOne hundred and forty-four participants were randomized into two groups (n = 72 in the intervention group and n = 72 in the control group) and analyzed. After 24 weeks, the proportion of pre-frailty was significantly lower in the intervention group than in control (31.8% versus 74.6%, P < 0.001). The absolute risk reduction was 42.8% [95% CI, 25.1–57.1]. In the 8th week and the 24th week, the frailty score of the intervention group was significantly lower than that of the control group. There were significant improvements in self-efficacy at week 2, week 8, and week 24. In weeks 8 and 24, participants in the intervention group reported a higher quality of life than the control group. There were no exercise-related injuries or falls among the participants.ConclusionsThe exercise intervention based on WMT for pre-frail older adults could reverse pre-frailty, increase self-efficacy for exercise, and improve the quality of life in older Chinese.Study registration detailsThis study was registered in www.ClinicalTrials.gov on the 25th of July, 2024, with the identifier NCT06519695.Reporting methodThe Consolidated Standards of Reporting Trials (CONSORT) checklist was used in this study for properly reporting how the randomized trial was conducted.

Construction of nomogram for wound recurrence in elderly patients with venous leg ulcers.

Venous Leg Ulcers (VLUs) are one of the most serious and intractable complications of chronic venous insufficiency. This study aims to develop a nomogram based on a theoretical model to predict the probability of wound recurrence in older patients with VLUs. The elderly patients with VLUs attending the five hospitals between September 2021 and October 2022 were enrolled in this research, and randomized to the training and validation cohorts based on the corresponding ratio (7:3). Recurrent events were recorded during a six-month follow-up after the baseline data collection. The univariate analysis, the least absolute shrinkage and selection operator (LASSO) regression method were used to screen variables, and multiple logistic regression was used to establish a risk prediction model, which was presented by nomogram. Receiver operating curves (ROC), Hosmer-Lemeshow test, as well as calibration curves, were adopted to assess the effectiveness of the nomogram. The prognostic value of the nomogram was also examined. A total of 608 elderly patients with VLUs were included in the study. They were randomly divided into the training cohort (N = 421) and the validation cohort (N = 187). In the training cohort, Lasso regression and multivariate logistic regression analysis indicated that previous recurrence number, last ulcer duration, lower extremity DVT history, and frailty were independent risk factors for wound recurrence in elderly patients with VLUs, while daily exercise time and self-efficacy were protective factors. A nomogram was established with a good discrimination capacity and predictive efficiency with and the area under the curve (AUC) of 0.869 (95%CI: 0.831-0.908) in the training set and 0.890 (95%CI: 0.841-0.938) in the validation set. The p values of the Hosmer-Lemeshow test for both sets were 0.887 and 0.772, respectively, both greater than 0.05. The calibration degree charts showed that the data point connection was similar to the diagonal, indicating that the model's prediction probability of wound recurrence in elderly VLUs patients is close to the actual probability. This study constructed a new nomogram to predict the risk of wound recurrence in elderly patients with VLUs. The nomogram has excellent accuracy and reliability, which can help healthcare workers and patients actively monitor and follow up with patients to prevent the recurrence of ulcers and make clinical decisions.