Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making.
ABSTRACT Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.
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ABSTRACT: Many older adults are physically inactive and inactivity increases with age. This knowledge comes from cross-sectional studies. Cross-sectional studies may miss important trajectories within the older adults as a result of retirements, and poor health impact of promotional efforts. The aim of this study was to analyse, longitudinally, the annual effects of age group and birth cohort on self-reported regular exercise in the Swedish population aged 53-84 years during a 16-year period, for each sex separately. A random sample of non-institutionalized persons was interviewed three times from 1988 to 2004 by professional interviewers. In addition to three time-related variables - year of interview, age at the time of the interview, and year of birth - we included the following explanatory variables in the analyses: educational level, body mass index, smoking, and self-reported health status. The data were analysed by a mixed model with a random intercept. The total prevalence of self-reported regular exercise increased between 1988/89 and 2004/05 among both men and women, from 27.1 to 43.1% and from 21.1 to 41.1%, respectively. There was a mean annual change in all age-groups in exercise of between 0.76 and 1.24% among men and between 0.86 and 1.38% among women. Low prevalence of self-reported regular exercise was associated with low educational level, obesity, smoking, and poor self-reported health, although those with poor self-reported health the greatest increase of physical activity. There was a steady, albeit inadequate, increase in self-reported regular exercise in older adults between 1988 and 2004. Physical activity promotion in older adults should be of high priority for both primary and secondary prevention of diseases, especially among groups with known risk factors for low levels of exercise.BMC Public Health 12/2014; 14(1):1327. DOI:10.1186/1471-2458-14-1327 · 2.32 Impact Factor
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ABSTRACT: Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.Journal of anxiety disorders 03/2014; 28(3):318-325. DOI:10.1016/j.janxdis.2014.02.004 · 2.68 Impact Factor
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ABSTRACT: Psychological stress and physical activity (PA) are believed to be reciprocally related; however, most research examining the relationship between these constructs is devoted to the study of exercise and/or PA as an instrument to mitigate distress. The aim of this paper was to review the literature investigating the influence of stress on indicators of PA and exercise. A systematic search of Web of Science, PubMed, and SPORTDiscus was employed to find all relevant studies focusing on human participants. Search terms included "stress", "exercise", and "physical activity". A rating scale (0-9) modified for this study was utilized to assess the quality of all studies with multiple time points. The literature search found 168 studies that examined the influence of stress on PA. Studies varied widely in their theoretical orientation and included perceived stress, distress, life events, job strain, role strain, and work-family conflict but not lifetime cumulative adversity. To more clearly address the question, prospective studies (n = 55) were considered for further review, the majority of which indicated that psychological stress predicts less PA (behavioral inhibition) and/or exercise or more sedentary behavior (76.4 %). Both objective (i.e., life events) and subjective (i.e., distress) measures of stress related to reduced PA. Prospective studies investigating the effects of objective markers of stress nearly all agreed (six of seven studies) that stress has a negative effect on PA. This was true for research examining (a) PA at periods of objectively varying levels of stress (i.e., final examinations vs. a control time point) and (b) chronically stressed populations (e.g., caregivers, parents of children with a cancer diagnosis) that were less likely to be active than controls over time. Studies examining older adults (>50 years), cohorts with both men and women, and larger sample sizes (n > 100) were more likely to show an inverse association. 85.7 % of higher-quality prospective research (≥7 on a 9-point scale) showed the same trend. Interestingly, some prospective studies (18.2 %) report evidence that PA was positively impacted by stress (behavioral activation). This should not be surprising as some individuals utilize exercise to cope with stress. Several other factors may moderate stress and PA relationships, such as stages of change for exercise. Habitually active individuals exercise more in the face of stress, and those in beginning stages exercise less. Consequently, stress may have a differential impact on exercise adoption, maintenance, and relapse. Preliminary evidence suggests that combining stress management programming with exercise interventions may allay stress-related reductions in PA, though rigorous testing of these techniques has yet to be produced. Overall, the majority of the literature finds that the experience of stress impairs efforts to be physically active. Future work should center on the development of a theory explaining the mechanisms underlying the multifarious influences of stress on PA behaviors.09/2013; DOI:10.1007/s40279-013-0090-5