Heather Tulloch

University of Ottawa, Ottawa, Ontario, Canada

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Publications (19)50.19 Total impact

  • [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
  • Canadian Journal of Diabetes 10/2013; 37S4:S9-S10. · 0.46 Impact Factor
  • Canadian Journal of Diabetes 10/2013; 37S4:S50-S51. · 0.46 Impact Factor
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    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
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    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.
    Contemporary clinical trials 04/2012; 33(4):839-47. · 1.51 Impact Factor
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    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. · 2.19 Impact Factor
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    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
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    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. · 1.22 Impact Factor
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    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
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    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. · 3.71 Impact Factor
  • Medicine and Science in Sports and Exercise - MED SCI SPORT EXERCISE. 01/2010; 42:778-779.
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    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. ClinicalTrials.gov NCT00195884 This study was funded by the Canadian Institutes of Health Research (grant MCT-44155) and the Canadian Diabetes Association (The Lillian Hollefriend Grant).
    Diabetologia 12/2009; 53(4):632-40. · 6.49 Impact Factor
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    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. · 1.38 Impact Factor
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    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
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    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. · 13.98 Impact Factor
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    ABSTRACT: We describe transitions between exercise stages of change in people with coronary artery disease (CAD) over a 6-month period following a CAD-related hospitalization and evaluate constructs from Protection Motivation Theory, Theory of Planned Behavior, Social Cognitive Theory, the Ecological Model, and participation in cardiac rehabilitation as correlates of stage transition. Seven hundred eighty-two adults hospitalized with CAD were recruited and administered a baseline survey including assessments of theory-based constructs and exercise stage of change. Mailed surveys were used to gather information concerning exercise stage of change and participation in cardiac rehabilitation 6 months later. Progression from pre-action stages between baseline and 6 month follow-up was associated with greater perceived efficacy of exercise to reduce risk of future disease, fewer barriers to exercise, more access to home exercise equipment, and participation in cardiac rehabilitation. Regression from already active stages between baseline and 6 month follow-up was associated with increased perceived susceptibility to a future CAD-related event, fewer intentions to exercise, lower self-efficacy, and more barriers to exercise.
    Canadian Journal of Physiology and Pharmacology 02/2007; 85(1):17-23. · 1.56 Impact Factor
  • Heather Tulloch, Michelle Fortier, William Hogg
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    ABSTRACT: To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA. MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings. Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (>6 months). There was substantial variation in the location and counseling approach employed by allied health professionals. We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors. With physical activity counselors' specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance.
    Patient Education and Counseling 12/2006; 64(1-3):6-20. · 2.37 Impact Factor
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    Michelle Fortier, Heather Tulloch, William Hogg
    Canadian family physician Medecin de famille canadien 09/2006; 52:942-4, 947-9. · 1.19 Impact Factor
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    ABSTRACT: Little is known about physical activity levels in patients with coronary artery disease (CAD) who are not engaged in cardiac rehabilitation. We explored the trajectory of physical activity after hospitalization for CAD, and examined the effects of demographic, medical, and activity-related factors on the trajectory. A prospective cohort study. A total of 782 patients were recruited during CAD-related hospitalization. Leisure-time activity energy expenditure (AEE) was measured 2, 6 and 12 months later. Sex, age, education, reason for hospitalization, congestive heart failure (CHF), diabetes, and physical activity before hospitalization were assessed at recruitment. Participation in cardiac rehabilitation was measured at follow-up. AEE was 1948+/-1450, 1676+/-1290, and 1637+/-1486 kcal/week at 2, 6 and 12 months, respectively. There was a negative effect of time from 2 months post-hospitalization on physical activity (P<0.001). Interactions were found between age and time (P=0.012) and education and time (P=0.001). Main effects were noted for sex (men more active than women; P<0.001), CHF (those without CHF more active; P<0.01), diabetes (those without diabetes more active; P<0.05), and previous level of physical activity (those active before hospitalization more active after; P<0.001). Coronary artery bypass graft patients were more active than percutaneous coronary intervention (PCI) patients (P=0.033). Physical activity levels declined from 2 months after hospitalization. Specific subgroups (e.g. less educated, younger) were at greater risk of decline and other subgroups (e.g. women, and PCI, CHF, and diabetic patients) demonstrated lower physical activity. These groups need tailored interventions.
    European Journal of Cardiovascular Prevention and Rehabilitation 08/2006; 13(4):529-37. · 2.63 Impact Factor