Structured Exercise Classes Research Articles

218 Understanding Recruitment into Structured Exercise Classes for Individuals with Chronic Conditions

218 Understanding Recruitment into Structured Exercise Classes for Individuals with Chronic Conditions

Augmented Rehabilitation Program for Patients 60 Years and Younger Following Total Hip Arthroplasty-Feasibility Study.

The purpose of this study is to examine the feasibility, safety and outcomes of a study comparing a 6-week post-operative rehabilitation program to usual care in patients ≤60 years undergoing elective unilateral total hip arthroplasty (THA). Methods: A cohort of 24 THA patients were recruited during their 6-week postoperative visit to their surgeons. The community-based rehabilitation program, which was designed to improve function and increase activity, consisted of 12 structured exercise classes on land and water over 6 weeks. Physical activity was assessed using a Sense Wear Pro Armband (SWA). Participants completed the Hip Osteoarthritis Outcome Score (HOOS) and THA satisfaction questionnaire before and immediately after the intervention. Results: 14 participants received the augmented rehabilitation, and 10 participants were in the control group. All except one in the intervention group completed at least 80% of the sessions. The intervention group took significantly more steps/day (mean difference = 2440 steps/day, 95% CI = 1678, 4712) (p < 0.05), at the follow-up compared to baseline. The intervention group had a higher mean change of number of weekly PA bouts than the control group. Within the intervention group, all HOOS subscales were significantly higher at the follow-up compared to baseline. Conclusion: Findings provided pragmatic insight regarding the intervention and assessments of implementing an augmented rehabilitation program for elective THA.

Interventions to improve health literacy among Aboriginal and Torres Strait Islander Peoples: a systematic review

BackgroundAboriginal and Torres Strait Islander peoples continue to experience poorer health outcomes than other population groups. While data specific to Indigenous Australians are scarce, a known social health literacy gradient exists linking low health literacy and poor health outcomes within many minority populations. Improving health literacy among Indigenous Australians is an important way to support self-determination and autonomy in both individuals and communities, by enhancing knowledge and improving health outcomes. This review aims to rigorously examine the effectiveness of health literacy interventions targeting Aboriginal and Torres Strait Islander peoples.MethodsA systematic review across six databases (The Cochrane Library, PubMed, Embase, SCOPUS, ProQuest Dissertation and Thesis and Web of Science) was performed for publications evaluating interventions to improve health literacy among Indigenous Australian adults using search terms identifying a range of related outcomes.ResultsOf 824 articles retrieved, a total of five studies met the eligibility criteria and were included in this review. The included studies evaluated the implementation of workshops, structured exercise classes and the provision of discounted fruit and vegetables to improve nutrition, modify risk factors for chronic diseases, and improve oral health literacy. All interventions reported statistically significant improvement in at least one measured outcome. However, there was limited involvement of the Aboriginal and Torres Strait Islander community members in the research process and participant retention rates were sub-optimal.ConclusionThere is limited evidence on interventions to improve health literacy in Indigenous Australian adults. Participation in interventions was often suboptimal and loss to follow-up was high. Future studies co-designed with Aboriginal and Torres Strait Islander community members are needed to improve health literacy in this population.

Attitudes and Beliefs of Older Female Breast Cancer Survivors and Providers About Exercise in Cancer Care.

To understand breast cancer survivors' and providers' attitudes and beliefs regarding exercise counseling and structured exercise programs within cancer care. 61 female breast cancer survivors and 11 breast cancer providers from a university cancer center in the Pacific Northwest. Survivors completed anonymous self-report surveys, and providers participated in semistructured interviews. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using qualitative content analysis. Breast cancer survivors and providers believed that including exercise counseling within cancer care was important. More than half of the survivors reported that they would attend structured exercise classes; a majority of providers thought cancer centers should offer exercise programs. Nurses could facilitate exercise counseling within cancer care and advocate for clinic-based exercise programs.

A Qualitative Exploration of Womens’ Experiences Who Belong to a “Fitness Community”

ABSTRACTBackground: A promising method for improving physical inactivity among women is to increase their engagement in group-based exercise programs. Fitness communities are exercise groups that practice the principles of group dynamics and promote a lifestyle of physical activity by engaging members through social media and hosting social event/hangouts outside of the gym or “fitness” setting. Purpose: The purpose of this study was to examine the role of “fitness communities” as a mechanism for increasing engagement in physical activity. Methods: In-depth, semi-structured interviews (N = 15) from women who were members of an established fitness community (i.e. Titan Fitness; the original name has been changed for purposes of anonymity) in Southern California. Results: Results suggested that the women’s experiences in Titan Fitness were encompassed by six sub-themes which were the following: Structured Exercise Classes with Group Dynamics: (1) personal and group accountability and (2) minimizing intimidation; Social Media Engagement: (3) empowerment and (4) accountability via online engagement; and Engagement Outside of the Physical Gym Setting: (5) in-group engagement and (6) out-group (extended) engagement. Discussion: Our findings illustrated that community members that were engaged in all three components of a fitness community described improved physical activity adherence. Translation to Health Practice: These findings may benefit fitness professionals, researchers, and Health Education practitioners who desire to develop innovative theoretically-based interventions for women having difficulty with physical activity adherence.

Structured Exercise Classes And Non-structured Exercise Increase Functionality In Older Adults

Advancing age is typically associated with decreases in aerobic capacity and strength and loss of muscle mass and bone density. Evidence-based community exercise programs that emphasize strength, flexibility, and balance have been shown to improve functionality and increase independence. Pre-and-post assessment is critical to measuring program success and individual improvement. PURPOSE: To provide a summary of five collaborative teams that used standardized tests to measure changes in functional fitness scores among adults. METHODS: Adults ranged in age from 39-90+ years. Six tests for strength, aerobic fitness, flexibility, and dynamic balance were administered: CHAIR stand, ARM curls, 2-min STEP, sit-and-REACH, BACK scratch, and 8-FOOT up-and-go. Paired t-tests were used to analyze pre-and-post scores. Test sessions were arranged with the 5-6 collaborators and conducted in fall/spring: (1) F2008, (2) F2010, (3) F2014, (4) Spr2015, and (5) Spr2016. At the completion of the pre-tests, collaborators provided individual feedback and exercise recommendations to the adults and encouraged enrollment in a fitness class. RESULTS: Significant pre-and post-results, Mean (SD), were found for the following tests. Fall2008 CHAIR M = 14.29 (2.27), M = 21.21 (5.19), p < 0.001; ARM: M = 16.79 (2.36), M = 21.57 (3.80), p < 0.005; EIGHT-FOOT: M = 5.44 (1.33), M = 4.81 (1.05), p <0.01; Fall2010 CHAIR: M = 18.14 (2.67), M = 22.00 (2.52), p <0.005; ARM: M = 24.86(3.49), M = 27.86 (3.63), p < 0.01; STEP: M = 144 (9.60), M = 131 (7.63), p < 0.005; Fall2014-to-Spr2015 CHAIR: M = 14.73 (3.26), M = 18.07 (3.10), p < 0.001; ARM: M = 16.20 (2.65), M = 20.73 (3.31), p < 0.0001; STEP: M = 90 (15.15), M = 108 (18.63), p < 0.001; REACH: M = 1.55 (2.58), M = 3.57 (3.52), p < 0.05; Spring2016 ARM: M = 17.32 (4.66), M = 196.04 (5.47), p < 0.05; EIGHT-FOOT: M = 5.67 (1.40), M = 5.16 (1.03), p < 0.05. CONCLUSIONS: Significant results indicating improved functionality were found for each testing session. Greater improvements were reported with longer time periods between pre-to-post assessment (e.g., F2014-to-Spr2015) and for 2 sets of test results administered only to adults enrolled in two evidence-based prevention/intervention programs (F2008 & F2010).

Real World Evidence: A Quantitative and Qualitative Glance at Participant Feedback from a Free-Response Survey Investigating Experiences of a Structured Exercise Intervention for Men with Prostate Cancer.

Aim To explore patient experiences of a structured exercise intervention for men with prostate cancer (PCa). Sample 41 men with either localised or advanced PCa who had been referred for a structured exercise programme by their physician and then subsequently consented to a telephone survey. Method Participants underwent a 10-week supervised exercise programme within a large cancer centre hospital consisting of 8 sessions. They then completed a short multiple choice telephone survey, elaborating on their responses where appropriate. Views expressed by participants were analysed using an affinity diagram and common themes were identified. Results Feedback from our telephone surveys was consistently positive and suggests that the structured exercise intervention provides exercise confidence, motivation to exercise, and social support and promotes positive health behaviour change in the context of exercise. Individual differences arose amongst participants in their perceived utility of the intervention, with 73.3% expressing a preference for structured exercise classes and 19.5% expressing a preference for exercising independently. Conclusion Design of a structured exercise intervention for patients with PCa should embrace the positive aspects outlined here but consider patients' individual differences. Ongoing feedback from patients should be utilised alongside traditional study designs to inform intervention design in this area.

The influence of motivation and attentional style on affective, cognitive, and behavioral outcomes of an exercise class.

Exercise classes are a popular form of physical activity. A greater understanding of the individual difference factors that might influence the outcomes of such classes could help to minimize the high dropout rates associated with exercise. The study explored the effects of dominant attentional style and degree of self-determination on affective, cognitive, and behavioral outcomes following structured exercise classes. Data from 417 female participants revealed that those with a dominant attentional style for association (Associators) reported significantly (P < 0.05) more positive affective, cognitive, and behavioral outcomes than did Dissociators, and were more self-determined. Highly self-determined individuals reported the most positive outcomes. Almost 29% of the variance in participants' affective valence could be explained by Dissociators' behavioral regulations. Results lend support to the notion that attentional style is associated with motivation. The combination of attentional style and degree of self-determination appear to be noteworthy individual difference factors that influence responses to exercise classes and could thus have a bearing on long-term exercise adherence.

Physical self-concept and basic psychological needs in exercise: Are there reciprocal effects?

This study investigated a reciprocal effects model of physical self-concept and basic psychological need satisfaction in a sample of undergraduate students engaged in structured exercise classes. A total of 329(N = 329) exercisers completed surveys at the beginning and end of the semester. Hierarchical linear modelling analyses revealed that physical self-concept at the start of the semester predicted exercisers’ feelings of autonomy, competence, and relatedness at the end of the semester after controlling for individual and class-related variables. Surprisingly, autonomy, competence, and relatedness at the start of the semester did not predict physical self-concept at the end of the semester. Thus, the self-enhancing effects of physical self-concept on future exercise need satisfaction were supported while reciprocal effects were not. Findings suggest that physical self-concept may be best situated as an antecedent rather than an outcome of exercise need satisfaction.

Exercise for postnatal psychological outcomes: a systematic review and meta-analysis

BackgroundPostnatal psychological morbidity is an important and prevalent issue. Postnatal anxiety affects 3–43% of mothers and postnatal depression (PND) 10–15% of women in the year after giving birth. Both can affect the social and cognitive development of the child. In 2007, the UK National Institute for Health and Clinical Excellence recommended exercise as part of the treatment for women with a new mild or moderate episode of PND. These guidelines were based on two very small methodologically flawed randomised controlled trials (RCTs). A systematic review by Daley and colleagues (2009) assessed the effectiveness of exercise as an adjunctive treatment for PND. Their findings gave some support for the use of exercise. However, only 238 patients were included from five trials, most of which contained important methodological flaws. MethodsWe undertook a systematic review and meta-analysis of RCTs and quasirandomised controlled trials with interventions designed to increase aerobic physical activity. Studies with populations of mothers up to 1 year postpartum measuring any of the following outcomes were included: depression, anxiety, self-efficacy for exercise, quality of life, mother and infant bonding, and child social development. Trials of co-interventions such as physical activity and social support were included; however, trials comparing two types of physical activity were excluded. Medline, Embase, Cochrane Library, Psych Lit, and SportDiscus were searched from inception to March 13, 2012, with the search terms “exercise”, “physical activity”, “postnatal”, “postpartum”, “mother”, “birth”, “perinatal”, “depression”, “anxiety”, “self-efficacy”, “quality of life”, “mother and infant bonding”, and “child development”. No language restrictions were used. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched for trials in progress. OpenGrey and OAIster were searched for grey literature. Study selection, data abstraction, and quality assessment were done independently and in duplicate. The Cochrane Collaboration's method for assessing risk of bias was used to establish study quality. Weighted mean differences (WMD), standardised mean difference (SMD), and 95% CIs were calculated for individual studies and pooled. Findings5771 articles were identified from initial searches, 61 full text articles were obtained, and eight trials were eligible, with a total of 1354 participants. Four studies involved exercise classes or a set exercise routine; four consisted of tailored exercise advice sessions. Two studies had an unclear risk of bias and six a high risk. A previous review by Daley (2009) assessed quality using a quantitative measure; included trials had a mean risk of bias of 4·6 of a maximum score of 7, suggesting a moderate overall risk. Both reviews showed moderate to high risk of bias, mainly due to incomplete reporting of bias criteria. Women receiving exercise interventions in the postnatal period had a significantly reduced Edinburgh postnatal depression score (six trials included): WMD 2·22 (95% CI 0·48–3·96; χ2 =20·27, p=0·001, I2=75%). SMD for depression score for all trials was 0·39 (0·14–0·64; χ2 =17·93, p=0·01, I2=61%). SMD for trials with set exercise classes or routines was 0·73 (95% CI 0·35–1·11) and for trials with tailored exercise advice was 0·18 (95% CI 0·01–0·35). There were insufficient data for other outcomes to allow meta-analyses. InterpretationThe results suggest a moderate effect of exercise in reducing the symptoms of PND. However, the mean difference of 2·22 was less than the clinically significant difference of 4 units. Substantial heterogeneity was present, suggesting that caution should be used in interpretation of this result. We used a random effects model to address the heterogeneity. Subgroup analysis suggested that structured exercise classes or routines were more effective than tailored advice. These results will inform the development of more effective exercise interventions for postnatal depression and inform policy. FundingNational School of Primary Care Research.

The Effect of Structured Exercise Classes and a Lifestyle Intervention on Cardiovascular Risk Factors in Primary Schoolchildren: An Exploratory Trial (The A-CLASS Project)

This exploratory trial evaluates the effect of a structured exercise (STEX) or lifestyle intervention (PASS) program upon cardiovascular (CV) disease risk factors in children. Sixty-one schoolchildren were randomly assigned by school to an intervention or control (CON) condition. The effect of the STEX (compared with CON) was a mean benefit of -0.018 mm for average maximum carotid intimamedia thickness. The PASS intervention did not result in clinically important effects, and no other substantial changes were observed. Relatively high probability of clinically beneficial effects of the STEX intervention suggests that a larger, definitive randomized trial with longer follow-up is warranted.

Unassisted pelvic floor exercises for postnatal women: a systematic review

This paper is a report of a systematic review on unassisted pelvic floor exercises for postnatal stress incontinence to identify effective interventions and highlight areas for further research. Stress incontinence is a common and embarrassing problem. Childbirth is a major cause and problems can be persistent for some. However women are often reluctant to seek help. We conducted a systematic literature search in December 2006 using the CINAHL, Medline and Cochrane Library databases, hand-searching of selected textbooks, checking reference lists and contacting experts. There were no date restrictions. The review included randomized controlled trials, published in English, of unassisted pelvic floor exercises in postnatal women. Two reviewers independently extracted data and assessed study quality. Main outcomes were reduction in symptoms of incontinence, patient satisfaction and quality of life. Four randomized controlled trials met the inclusion criteria. Interventions ranged from written information to structured exercise classes, while usual care varied from a leaflet to group sessions with a midwife. Three out of four studies demonstrated short-term improvement in incontinence symptoms, which was statistically significant in two. However, at later follow-up there was no longer a statistically significant effect on continence. All trials found that women in the intervention group were more likely to do the exercises. We found few trials, quality was variable, and comparisons were difficult because of variations in interventions and outcomes measured. Further high quality evaluations are needed, using standardized interventions and outcome measures, patient-relevant outcomes such as quality of life, and follow-up periods that enable evaluation of long-term effectiveness.

Quantifying the Exercise Dosage in Phase 3 Cardiac Rehabilitation

BACKGROUND: Exercise-based phase 3 cardiac rehabilitation represents the transition from a medically supervised, ECG-monitored phase 2 treatment plan to a more independent exercise program. Few data, however, are available regarding the long-term adherence to the prescribed exercise dosage, especially as it relates to current national recommendations. PURPOSE: The present study was designed to assess the amount of time/session spent in the prescribed exercise heart rate range, average weekly attendance, transit time to and from the rehabilitation facility, and time spent each day in selected sedentary activities (i.e., television viewing, computer interactions, reading). METHODS: Ninety-two phase 3 coronary patients (68 men, 24 women; mean ± SD age = 68.9 ± 10.4 years; mean ± SD body mass index = 27.1 ± 4.8 kg/m2) agreed to participate in the study. All had been enrolled in our phase 3 exercise-based cardiac rehabilitation program for a minimum of 6 months. Adherence to the prescribed exercise heart rate, corresponding to moderate-to-vigorous intensities, was unobtrusively obtained by staff surveillance (e.g., pulse palpation, heart rate/ECG monitoring) during a designated exercise class. Transit time and sedentary activities each day were assessed by questionnaire; attendance records were reviewed to establish the average weekly attendance. RESULTS: During a typical phase 3 exercise class, the mean ± SD time in the prescribed heart rate range was 31.0 ± 12.6 minutes (range, 2–68 minutes), with no difference between men and women. Transit time (via automobile) to and from the rehabilitation facility averaged 18 ± 11 minutes each way. The average patient attended ∼ 2 of 3 structured exercise classes each week. Daily television, computer, and reading time averaged 142 ± 72, 56 ± 76, and 100 ± 66 minutes, respectively. CONCLUSIONS: Phase 3 patients commonly spend more time in transit to/from a rehabilitation facility than in their prescribed heart rate range, at a suboptimal exercise frequency. Sedentary activities approximated 5 hours/day. These data suggest that increasing lifestyle physical activity should be a high priority for phase 3 patients.

Self‐Efficacy as a Mediator of the Relationship Between Causal Attributions and Exercise Behavior

The primary purposes of this study were to examine whether the attribution–intention link was mediated by self‐efficacy and whether the attribution–behavior link was mediated by self‐efficacy. As a secondary purpose, we examined whether the attribution–behavior link was mediated by exercise intentions. These relationships were tested prospectively at multiple time points. Participants were 260 adult exercisers (M age=32 years) enrolled in 12 weeks of structured exercise classes. Social cognitive measures were assessed at early and midprogram; attendance was tracked for the first and second half of the program. Hierarchical multiple regression procedures indicated support for self‐efficacy as a mediator of the relationship between attributions and behavior. Secondary analyses revealed support for intention as a mediator of the attribution–behavior relationship. Finally, additive relationships in support of social cognitive theory also were detected. The attribution/self‐efficacy/behavior link is important for adherence interventions and should be investigated further in both asymptomatic and symptomatic populations.

Acute and chronic ischaemia of the limb

Limb ischaemia is an important clinical problem due to the high prevalence of atherosclerosis in the UK population. The main risk factors for limb ischaemia are smoking and diabetes mellitus. In young patients, alternative diagnoses of emboli and thrombosis, arteritis, congenital anomalies, fibrosis and traumatic arterial injury must be considered. Intermittent claudication, critical limb ischaemia and the acute or ‘threatened’ limb are clinical diagnoses. Non-invasive arterial assessment by colour duplex, MRI and CT have an increasing role alongside angiography in confirming the diagnosis and planning intervention. Patients with intermittent claudication require aggressive modification of risk factors, interventions to stop smoking, an anti-platelet agent, a statin, and structured exercise classes. In patients who are severely incapacitated or who have aorto-iliac disease, intervention (usually by percutaneous angioplasty) is considered. Patients with critical limb ischaemia require intervention if limb loss is to be avoided; arterial reconstruction is preferable to primary amputation as preserving mobility is an important determinant of quality of life. The acute ‘threatened’ limb is a surgical emergency and requires immediate intervention, best performed in a specialized unit.

Differences in Balance Related Measures Among Older Adults Participating in Tai Chi, Structured Exercise, or No Exercise

ABSTRACTPurpose:This study compared balance-related measures for elderly individuals participating in Tai Chi, structured exercise classes, or no exercise program.Methods:We conducted a cross-sectional study of 94 healthy, older adults (>60 years) categorized according to their current participation

Does the Theory of Planned Behavior Mediate the Relation Between Personality and Exercise Behavior?

Ajzen's (1991) theory of planned behavior (TPB) proposes that the relation between personality and behavior is mediated by the social-cognitive constructs contained within the TPB. The purpose of the present studies was to examine the mediational role of the TPB in the exercise domain using the Five Factor Model (FFM; Costa & McCrae, 1992) as the personality framework. Two studies provided data to answer this question. Study 1 used a cross-sectional design with self-reported exercise behavior from 300 female undergraduate students. Study 2 used a prospective design with objective attendance records from 67 female participants enrolled in structured exercise classes. As expected, extraversion (E), conscientiousness (C), and neuroticism (N) were significantly related to exercise behavior. Contrary to our hypothesis, however, the relation between personality and exercise behavior was only partially mediated by the TPB. Specifically, hierarchical regression analysis of both data sets indicated that E had a direct relation with exercise behavior even after controlling for the TPB. We concluded that personality as operationalized by the FFM may need to be integrated into social-cognitive models applied to exercise behavior. To this end, we suggested that a more sophisticated theoretical description of the relations among personality, the TPB, and exercise behavior is needed.

Does the Theory of Planned Behavior Mediate the Relation Between Personality and Exercise Behavior?

Ajzen's (1991) theory of planned behavior (TPB) proposes that the relation between personality and behavior is mediated by the social-cognitive constructs contained within the TPB. The purpose of the present studies was to examine the mediational role of the TPB in the exercise domain using the Five Factor Model (FFM; Costa & McCrae, 1992) as the personality framework. Two studies provided data to answer this question. Study 1 used a cross-sectional design with self-reported exercise behavior from 300 female undergraduate students. Study 2 used a prospective design with objective attendance records from 67 female participants enrolled in structured exercise classes. As expected, extraversion (E), conscientiousness (C), and neuroticism (N) were significantly related to exercise behavior. Contrary to our hypothesis, however, the relation between personality and exercise behavior was only partially mediated by the TPB. Specifically, hierarchical regression analysis of both data sets indicated that E had a direct relation with exercise behavior even after controlling for the TPB. We concluded that personality as operationalized by the FFM may need to be integrated into social-cognitive models applied to exercise behavior. To this end, we suggested that a more sophisticated theoretical description of the relations among personality, the TPB, and exercise behavior is needed.

Older Adults’ Constraints to Participation in Structured Exercise Classes

This study used a qualitative, feminist perspective to examine issues pertaining to exercise constraints among older adults. Participants were 8 male and 9 female older adults (mean age = 76.7) who chose not to engage in structured exercise classes. Twenty-six self-identified constraints were elicited (mean = four per person). Additionally, four constraints per person from previous research were selected. The most frequently cited self-reported constraints were “get enough exercise elsewhere,” health-related items, and issues related to time. From the constraints most frequently cited in past studies, inconvenience, time, and type of activity were selected most often. Gender differences were apparent in the constraints chosen as well as reasons why a particular constraint inhibited or prohibited activity. Specific suggestions for strategies included having programs with a purpose, building in flexibility, and encouraging men to participate. The influence of gender is explored, especially how expanding our understanding of gender issues might improve program planning.

Cohesion correlates with affect in structured exercise classes.

Correlations of scores on the Group Environment Questionnaire measuring cohesion and the Feeling Scale ranged from .17 to .23 and support Carron's model.