[Show abstract][Hide abstract] ABSTRACT: The rapid pace of modern life requires working-age women to juggle occupational, family and social demands. This modern lifestyle has been shown to have a detrimental effect on health, often associated with increased smoking and alcohol consumption, depression and cardiovascular disease risk factors. Despite the proven benefits of regular moderate-to-vigorous intensity physical activity (MVPA), few are meeting the current physical activity (PA) recommendations of 150 min of MVPA/week. It is important that appropriate and effective behavioural interventions targeting PA are developed and identified to improve the MVPA levels of working-age women. As working-age women spend a substantial proportion of their waking hours at work, workplaces may be an opportune, efficient and relatively controlled setting to implement programmes and strategies to target PA in an effort to improve MVPA levels and impact cardiometabolic health. The purposes of this systematic review are to compare the effectiveness of individual-level workplace interventions for increasing MVPA levels in working-age women in high-income/developed countries and examine the effectiveness of these interventions for improving the known beneficial health sequelae of MVPA.Methods/design: Eight electronic databases will be searched to identify all prospective cohort and experimental studies that examine the impact of individual-level workplace interventions for increasing MVPA levels among working-age (mean age 18-65 years) women from high-income/developed countries. Grey literature including theses, dissertations and government reports will also be included. Study quality will be assessed using a modified Downs and Black checklist, and risk of bias will be assessed within and across all included studies using the Cochrane's risk of bias tool and Grades of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses will be conducted where possible among studies with sufficient homogeneity.
This review will determine the effectiveness of individual-level workplace interventions for increasing MVPA levels in working-age women in high-income/developed countries, and form a current, rigorous and reliable research base for policy makers and stakeholders to support the development and implementation of effective workplace interventions that increase MVPA levels in this population.Systematic review registration: PROSPERO CRD42014009704.
[Show abstract][Hide abstract] ABSTRACT: The majority of North American adult females do not meet current physical activity recommendations (150 min of moderate-to-vigorous intensity physical activity (MVPA) per week accrued in >=10 min bouts) ultimately placing themselves at increased risk of morbidity and mortality. Working-age females face particular challenges in meeting physical activity recommendations as they have multiple demands, including occupational, family and social demands. To develop effective interventions to increase MVPA among working-age females, it is necessary to identify and understand the strongest modifiable determinants influencing these behaviours. Therefore, the objective of this systematic review is to examine the available evidence to identify intrapersonal, social and environmental determinants of MVPA among working-age females.Methods/design: Six electronic databases will be searched to identify all prospective cohort studies that report on intrapersonal, social and/or environmental determinants of MVPA in working-age females. Grey literature sources including theses, published conference abstracts and websites from relevant organizations will also be included. Articles that report on intrapersonal (e.g. health status, self-efficacy, socio-economic status (SES), stress, depression), social environmental (e.g. crime, safety, area SES, social support, climate and capital, policies), and environmental (e.g. weather, workplace, home, neighbourhood, recreation environment, active transportation) determinants of MVPA in a working-age (mean age 18-65 years) female population will be included. Risk of bias will be assessed within and across all included studies using the Tool to Assess Risk of Bias in Cohort Studies and the Grades of Recommendation, Assessment, Development and Evaluation approach. Harvest plots will be used to synthesize results across all determinants, and meta-analyses will be conducted where possible among studies with sufficient homogeneity.
[Show abstract][Hide abstract] ABSTRACT: Quitting smoking is the single most effective strategy to reduce morbidity and premature mortality in smokers. Research has demonstrated the effectiveness of pharmacotherapy in smoking cessation, but few studies have directly compared varenicline and monotherapy nicotine replacement therapy (NRT) and none have examined varenicline and combinations of NRT products. The majority of smoking cessation trials involve carefully circumscribed populations, making their results less generalizable to those with severe medical conditions or psychiatric comorbidities. This paper reports on the rationale, methodology and participant characteristics of a randomized controlled trial designed to: (1) determine which pharmacotherapy - NRT, long term combinations of NRT, or varenicline - is most effective in achieving abstinence; (2) investigate the incidence of neuropsychiatric symptoms among participants over the course of their quit attempt; and, (3) assess whether there is a significant difference in the incidence of neuropsychiatric symptoms in those receiving differing pharmacotherapies, and between those with or without psychiatric illnesses. The primary outcome was carbon monoxide confirmed abstinence from weeks 5-52 following a target quit date. Secondary outcomes included neuropsychiatric (i.e., depression, suicidal ideation, anxiety, anger) and withdrawal symptoms. Smokers (N=737) were randomly assigned to one of three treatment conditions, and were scheduled to attend 8 follow-up appointments over 12months. All participants received 6-15 minute practical counseling sessions with nurse counselors experienced in treating tobacco dependence. We expect that the results will lead to an enhanced understanding of the efficacy of these pharmacotherapies, including those with a history of psychiatric illness.
[Show abstract][Hide abstract] ABSTRACT: There is increasing awareness of the impact of post-traumatic stress disorder (PTSD) on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and risk for recurrence in cardiac patients. We explore possible mechanisms to explain these relationships, as well as appropriate assessment and treatment strategies for this population. Our main conclusion is that screening and referral for appropriate treatments are important given the high prevalence rates of PTSD in cardiac populations and the associated impact on morbidity and mortality.
[Show abstract][Hide abstract] ABSTRACT: We conducted a qualitative investigation of patients with type 2 diabetes to determine their perceived facilitators and barriers to exercise at multiple time points while enrolled in a randomized exercise trial including aerobic, resistance or combined exercise. We explored differences in these themes over time, between intervention groups and by adherence level after intervention.
Interviews were conducted by telephone at 3 weeks (run-in period), and at 3 (midintervention), 6 (end of intervention) and 9 months (maintenance) after enrollment to assess factors that facilitated and hampered adherence to the exercise program. Audiotapes were transcribed verbatim and subjected to content analysis.
Participants (n=28) with type 2 diabetes engaged in the interviews. Social support from family and the trainer, future health benefits, a sense of well-being and perceived fitness improvements were exercise facilitators. Experiencing illness or injury, work commitments and inclement weather were highlighted barriers. A sense of well-being, fitness improvements and enjoyment frequently were expressed by participants assigned to the combined and resistance exercise conditions. Participants who maintained prescribed exercise levels tended to be engaged in resistance exercise, and spoke of support from their personal trainers, the importance of strategies and enjoyment more frequently than those who did not maintain their exercise level. Exercise maintainers also cited more facilitators; no differences were found for barriers.
Patients with type 2 diabetes require social support, including continued contact with exercise specialists. Patients need assistance with motivational enhancement and strategies to increase facilitators to maintain exercise behaviour. Incorporating resistance exercise improves well-being and enjoyment-2 important factors linked to exercise maintenance.
Canadian Journal of Diabetes 12/2013; 37(6):367-74. · 0.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose was to examine experiences of obese youth aged 14 to 18 years during their participation in the Healthy Eating, Aerobic, and Resistance Exercise in Youth (HEARTY) randomized controlled exercise trial.
A longitudinal qualitative approach was used to investigate youths' experiences across time points in the trial: 3-weeks (run-in phase; n = 44, 52% males), 3-months (midpoint; n = 25), and 6-months (end of intervention; n = 24). Participants completed telephone interviews on perceived exercise facilitators, barriers, outcomes, and program preferences. Responses were subject to content analyses and are reported as frequencies.
Participants joined the trial initially to lose weight, but focused more on fitness over time. Exercise behavior was influenced by a sense of achieving results, and by family and peers (ie, supportive comments, transportation). At 6-months, the most commonly perceived changes were improved fitness (50%) and appearance (46%). Suggested changes to the HEARTY trial included initial guidance by a trainer, and more varied and group-based activity.
Exercise facilitators, barriers and perceived changes in an exercise trial are reported. Access to a gym, initial direction by a trainer, variety, and group-based activities were reported as desired components of an exercise intervention. Findings also point to the importance of involving family and peer supports.
Journal of Physical Activity and Health 07/2012; 9(5):650-60. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of the Healthy Eating Aerobic and Resistance Training in Youth (HEARTY) trial (ClinicalTrials.Gov # NCT00195858) was to examine the effects of resistance training, with and without aerobic training, on percent body fat in sedentary, post-pubertal overweight or obese adolescents aged 14-18 years. This paper describes the HEARTY study rationale, design and methods.
After a 4-week supervised low-intensity exercise run-in period, 304 overweight or obese adolescents with a body mass index≥85th percentile for age and sex were randomized to 4 groups for 22 weeks (5 months): diet+aerobic exercise, diet+resistance exercise, diet+combined aerobic and resistance exercise, or a diet only waiting-list control. All participants received dietary counseling designed to promote healthy eating with a maximum daily energy deficit of -250 kcal.
The primary outcome is percent body fat measured by Magnetic Resonance Imaging. Secondary outcomes include changes in anthropometry, regional body composition, resting energy expenditure, cardiorespiratory fitness, musculoskeletal fitness, cardiometabolic risk markers, and psychological health.
To our knowledge, HEARTY is the largest clinical trial examining effects of aerobic training, resistance training, and combined aerobic and resistance training on changes in adiposity and cardiometabolic risk markers in overweight and obese adolescents. The findings will have important clinical implications regarding the role that resistance training should play in the management of adolescent obesity and its co-morbidities.
[Show abstract][Hide abstract] ABSTRACT: Patient-reported outcomes including health-related quality of life are important in clinical care and research studies. The MacNew Heart Disease Health-Related Quality Of Life Questionnaire has been validated in English-speaking patients with myocardial infarction. The aim of this study was to validate the MacNew in English-speaking patients with angina or ischemic heart failure.
Canadian and American patients with angina or ischemic heart failure completed the MacNew, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale.
We administered questionnaires to 276 patients with angina (mean age, 65.9 years) and 155 patients with ischemic heart failure (mean age, 70.3 years). The mean ± SD MacNew global score in patients with ischemic heart failure (5.1 ± 1.2) was statistically (P < 0.001), but not clinically, poorer than in patients with angina (5.3 ± 1.1). The three-factor measurement model explained 46.1% of the observed variance in the MacNew in patients with angina and 46.5% in patients with ischemic heart failure. Internal consistency was ≥0.90, and test-retest reliability was ≥0.70 for each MacNew scale and the a priori convergent and discriminative validity hypotheses were confirmed in both diagnoses. The MacNew was highly accepted by patients with little respondent or administrative burden.
The English version of the MacNew is reliable and valid in patients with angina or ischemic heart failure. This permits health-related quality of life outcome comparisons in patients with angina, ischemic heart failure, and myocardial infarction with the MacNew and provides a better understanding of the full range of health-related quality of life outcomes.
Value in Health 01/2012; 15(1):143-50. · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The CardioFit internet-based expert system was designed to promote physical activity in patients with coronary heart disease (CHD) who were not participating in cardiac rehabilitation. Design: This randomized controlled trial compared CardioFit to usual care to assess its effects on physical activity following hospitalization for acute coronary syndromes. Methods: A total of 223 participants were recruited at the University of Ottawa Heart Institute or London Health Sciences Centre and randomly assigned to either CardioFit (n = 115) or usual care (n = 108). The CardioFit group received a personally tailored physical-activity plan upon discharge from the hospital and access to a secure website for activity planning and tracking. They completed five online tutorials over a 6-month period and were in email contact with an exercise specialist. Usual care consisted of physical activity guidance from an attending cardiologist. Physical activity was measured by pedometer and self-reported over a 7-day period, 6 and 12 months after randomization. Results: The CardioFit internet-based physical activity expert system significantly increased objectively measured (p = 0.023) and self-reported physical activity (p = 0.047) compared to usual care. Emotional (p = 0.038) and physical (p = 0.031) dimensions of heart disease health-related quality of life were also higher with CardioFit compared to usual care. Conclusions: Patients with CHD using an internet-based activity prescription with online coaching were more physically active at follow up than those receiving usual care. Use of the CardioFit program could extend the reach of rehabilitation and secondary-prevention services.
European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 09/2011; · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Little longitudinal research exists on the relationship between exercise self-determination and stage of change. This study investigated how self-determined motivation changes in patients with type 2 diabetes (N = 175) as they moved through the stages of change over a six-month exercise trial. Hierarchical linear modelling revealed that patients who progressed through the stages of exercise change had an overall increase in self-determined motivation, while non-progressors experienced a reduction in self-determined motivation from three to six months. These results indicate that individuals engaging in regular exercise at six months maintain initial increases in self-determined motivation. Findings are discussed in light of self-determination theory.
Journal of Health Psychology 05/2011; 17(1):87-99. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few studies have explored exercise and motivational patterns of cardiac rehabilitation patients in the long term.
We explored differential patterns of exercise and motivation in cardiac rehabilitation patients over a 24-month period and examined the relationship between these emerging patterns.
Participants (n = 251) completed an exercise, barrier self-efficacy, outcome expectations and self-determined motivation questionnaire. Latent class growth modelling was used to classify patients in different exercise and motivational patterns.
Three exercise patterns emerged: inactive, non-maintainers and maintainers (16%, 67% and 17% of sample per pattern, respectively). Multiple trajectories were found for barrier self-efficacy, outcome expectations and self-determined motivation (3, 5, and 4, respectively). Patients in high barrier self-efficacy, outcome expectation and self-determined groups had greater probability of being in the maintainer exercise group.
Identifying a patient's exercise and motivational profile could help cardiac rehabilitation programmes tailor their intervention to optimize the potential for continued exercise activity.
Annals of Behavioral Medicine 03/2011; 42(1):55-63. · 4.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few studies have compared changes in cardiorespiratory fitness between aerobic training only or in combination with resistance training. In addition, no study to date has compared strength gains between resistance training and combined exercise training in type II diabetes mellitus (T2DM).
We evaluated the effects of aerobic exercise training (A group), resistance exercise training (R group), combined aerobic and resistance training (A + R group), and sedentary lifestyle (C group) on cardiorespiratory fitness and muscular strength in individuals with T2DM.
Two hundred and fifty-one participants in the Diabetes Aerobic and Resistance Exercise trial were randomly allocated to A, R, A + R, or C. Peak oxygen consumption (V O(2peak)), workload, and treadmill time were determined after maximal exercise testing at 0 and 6 months. Muscular strength was measured as the eight-repetition maximum on the leg press, bench press, and seated row. Responses were compared between younger (aged 39-54 yr) and older (aged 55-70 yr) adults and between sexes.
VO(2peak) improved by 1.73 and 1.93 mL O(2)*kg(-1)*min(-1) with A and A + R, respectively, compared with C (P < 0.05). Strength improvements were significant after A + R and R on the leg press (A + R: 48%, R: 65%), bench press (A + R: 38%, R: 57%), and seated row (A + R: 33%, R: 41%; P < 0.05). There was no main effect of age or sex on training performance outcomes. There was, however, a tendency for older participants to increase VO(2peak) more with A + R (+1.5 mL O(2)*kg(-1)*min(-1)) than with A only (+0.7 mL O(2)*kg(-1)*min(-1)).
Combined training did not provide additional benefits nor did it mitigate improvements in fitness in younger subjects compared with aerobic and resistance training alone. In older subjects, there was a trend to greater aerobic fitness gains with A + R versus A alone.
Medicine and science in sports and exercise 08/2010; 42(8):1439-47. · 4.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Diabetes Aerobic and Resistance Exercise (DARE) study showed that aerobic and resistance exercise training each improved glycaemic control and that a combination of both was superior to either type alone in patients with type 2 diabetes mellitus. Here we report effects on patient-reported health status and well-being in the DARE Trial.
We randomised 218 inactive participants with type 2 diabetes mellitus in parallel to 22 weeks of aerobic exercise (n = 51), resistance exercise (n = 58), combined aerobic and resistance exercise (n = 57) or no exercise (control; n = 52). Intervention allocation was managed by a central office. Outcomes included health status as assessed by the physical and mental component scores of the Medical Outcomes Trust Short-Form 36-item version (SF-36) and well-being as measured by the Well-Being Questionnaire 12-item version (WBQ-12); these were measured at the Ottawa Hospital.
Using a p value of 0.0125 for statistical significance due to multiple comparisons, mixed model analyses indicated that resistance exercise led to clinically but not statistically significant improvements in the SF-36 physical component score compared with aerobic exercise (Delta = 2.7 points; p = 0.048) and control (i.e. no exercise; Delta = 3.3 points; p = 0.015). For mental component scores, there were clinically important improvements favouring no (control) compared with resistance (Delta = 7.6 points; p < 0.001) and combined (Delta = 7.2 points; p < 0.001) exercise. No effects on WBQ-12 scores were noted. Overall, 59/218 (27%) of participants included in this analysis sustained an adverse event during the course of the study, including 16 participants in the combined exercise group, 19 participants in the resistance exercise group, 16 participants in the aerobic exercise group, and eight participants in the control group. All participants were included in the intent-to-treat analyses. The trial is now closed to follow-up.
Resistance exercise was better than aerobic or no exercise for improving physical health status in these patients. No exercise was superior to resistance or combined exercise for improving mental health status. Well-being was unchanged by intervention.
This study was funded by the Canadian Institutes of Health Research (grant MCT-44155) and the Canadian Diabetes Association (The Lillian Hollefriend Grant).
[Show abstract][Hide abstract] ABSTRACT: This study was set out to test if autonomous motivation mediated the relationship between self-efficacy and 12-month physical activity (PA) in adults with type 2 diabetes involved in a randomized exercise trial. Participants (n = 234) completed questionnaires measuring barrier self-efficacy at 3 months, autonomous motivation at 6 months, and PA at 12 months. A mediational analysis of longitudinal data revealed that autonomous motivation mediated the relationship between barrier-self-efficacy and PA. High barrier self-efficacy can therefore help predict 12-month PA in adults with type 2 diabetes, although this effect is attenuated by autonomous motivation. Hence, participating in PA for autonomous reasons such as by choice and/or for fun further explains PA at 12 months in this population. Results of this study extend our understanding of the motivational constructs involved in PA in the maintenance phase. This study has important theoretical implications in that it helps to organize and consolidate well-known correlates of PA by proposing a temporal relationship between them that could be tailored in interventions.
Psychology Health and Medicine 09/2009; 14(4):419-29. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n = 787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients' confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.
Psychology & Health 03/2009; 24(3):255-69. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous trials have evaluated the effects of aerobic training alone and of resistance training alone on glycemic control in type 2 diabetes, as assessed by hemoglobin A1c values. However, none could assess incremental effects of combined aerobic and resistance training compared with either type of exercise alone.
To determine the effects of aerobic training alone, resistance training alone, and combined exercise training on hemoglobin A1c values in patients with type 2 diabetes.
Randomized, controlled trial.
8 community-based facilities.
251 adults age 39 to 70 years with type 2 diabetes. A negative result on a stress test or clearance by a cardiologist, and adherence to exercise during a 4-week run-in period, were required before randomization. Interventions: Aerobic training, resistance training, or both types of exercise (combined exercise training). A sedentary control group was included. Exercise training was performed 3 times weekly for 22 weeks (weeks 5 to 26 of the study).
The primary outcome was the change in hemoglobin A1c value at 6 months. Secondary outcomes were changes in body composition, plasma lipid values, and blood pressure.
The absolute change in the hemoglobin A1c value in the combined exercise training group compared with the control group was -0.51 percentage point (95% CI, -0.87 to -0.14) in the aerobic training group and -0.38 percentage point (CI, -0.72 to -0.22) in the resistance training group. Combined exercise training resulted in an additional change in the hemoglobin A1c value of -0.46 percentage point (CI, -0.83 to -0.09) compared with aerobic training alone and -0.59 percentage point (CI, -0.95 to -0.23) compared with resistance training alone. Changes in blood pressure and lipid values did not statistically significantly differ among groups. Adverse events were more common in the exercise groups.
The generalizability of the results to patients who are less adherent to exercise programs is uncertain. The participants were not blinded, and the total duration of exercise was greater in the combined exercise training group than in the aerobic and resistance training groups.
Either aerobic or resistance training alone improves glycemic control in type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training. ClinicalTrials.gov registration number: NCT00195884.
Annals of internal medicine 10/2007; 147(6):357-69. · 16.10 Impact Factor