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Entwicklung, Design und Pilotierung eines Gruppenkonzepts zum "Lifestyle-integrated Functional Exercise" (LiFE) Programm

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Einleitung: Das „Lifestyle-Integrated Functional Exercise“ (LiFE) Programm steigert über alltagsinte-grierte Übungen die Kraft (K), Gleichgewichtsfähigkeit (GW) sowie körperliche Aktivität (KA) und senkt die Sturzrate bei älteren Menschen. Bislang werden dessen theoretische und praktische Inhalte mit hohem personellen Aufwand personalisiert über Hausbesuche vermittelt. Eine gruppenbasierte Variante (gLiFE) könnte eine ressourcenschonende, großflächige Implementierung des Programms erlauben. Ziel war es, eine gLiFE Variante zu konzipieren und die Durchführbarkeit mittels Pilotstudie zu überprüfen. Methode: Im Rahmen einer Workshop-Reihe entwickelte ein interdisziplinäres Forschungsteam auf Basis internationaler Leitlinien sowie unter Berücksichtigung von Theorien der Bewe-gungswissenschaft, Psychologie und Pädagogik das gLiFE Konzept. In einer Pilotstudie (N=6, MAlter=71,7 Jahre) wurden sieben wöchentliche gLiFE Sitzungen von zwei geschul-ten Trainern durchgeführt. Die Evaluation der Durchführbarkeit, Akzeptanz (subjektive Einschätzung der Nützlichkeit zur Steigerung der K, GW, KA), Sicherheit, Implementie-rung und Adhärenz erfolgte fragebogenbasiert. Zusätzlich wurde ein Fokusgruppeninter-view durchgeführt, um gLiFE hinsichtlich Struktur, Inhalt, verwendeten Materialien und Gruppenformat zu evaluieren und weiterzuentwickeln. Ergebnisse: gLiFE zeigte sich in der Zielgruppe als durchführbar und geeignet. Das Gruppenkonzept wurde von den TN sehr gut angenommen (Mdn=1; 1=sehr gut bis 6=ungenügend). Die in der Gruppe vermittelten Kraft- und Gleichgewichtsübungen wurden zur Steigerung der Kraft, Gleichgewichtsfähigkeit und KA als nützlich (MdnK=6.5, MdnGW=6.5, MdnPA=6; 1=gar nicht nützlich bis 7=sehr nützlich) und sehr sicher (Mdn=7; 1=sehr unsicher bis 7=sehr sicher) empfunden. Die TN integrierten während des Interventionszeitraums 10.5±2.9 (Bereich:7-14) LiFE Übungen in ihren Alltag. Der Stundenaufbau sowie Inhalt der einzelnen Einheiten wurden als gut strukturiert und die verwendeten Materialien als geeig-net wahrgenommen. Diskussion: Die Pilotstudie liefert wichtige Hinweise zur sicheren und altersgerechten Durchführbarkeit von gLiFE und weist auf eine hohe Akzeptanz hin. Eine Aussage zur Effektivität kann nicht getroffen werden. Die positiven Befunde bilden die Grundlage für eine laufende randomi-sierte Studie (NZiel=300), welche die Effektivität und Kosten von gLiFE mit dem originalen LiFE vergleichen wird. Die Studienergebnisse werden im Herbst 2020 veröffentlicht.

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Background: The Lifestyle-integrated Functional Exercise (LiFE) programme is a fall prevention programme originally taught in a resource-intensive one-to-one format with limited feasibility for large-scale implementation. The aim of this paper is to present the conceptual framework and initial feasibility evaluation of a group-based LiFE (gLiFE) format developed for large-scale implementation. Methods: The conceptual gLiFE framework (part I) is based on three pillars, LiFE Activities and Principles, Theory of Behaviour Change and Behaviour Change Techniques, and Instruction. The feasibility of gLiFE was tested (part II) within a multimodal approach including quantitative questionnaires measuring safety, acceptability (1 = best to 7 = insufficient), and adherence to the LiFE activities (range = 0-14) as well as a focus group interview. Exploratory self-reported measures on behaviour change including self-determined motivation (range = 1-5), intention, planning, action control, and habit strength (range = 1-6) were assessed pre and post intervention. Data analyses were performed using descriptive statistics and qualitative content analysis. Results: The development process resulted in a manualised gLiFE concept containing standardised information on gLiFE's content and structure. Feasibility testing: Six older adults (median = 72.8 years, 5 female) completed the feasibility study and rated safety (median = 7.0, IQR = 0.3) and acceptability as high (median = 1, IQR = 1). Participants implemented 9.5 LiFE activities (IQR = 4.0) into their daily routines. No adverse events occurred during the study. In the focus group, the group format and LiFE activities were perceived as positive and important for maintaining strength and balance capacity. Self-determined motivation intention, planning, and habit strength were rated higher post intervention. Conclusion: The developed conceptual gLiFE framework represents the basis for a gLiFE format with potential for standardised large-scale implementation. Proof-of-concept could be demonstrated in a group of community-dwelling older adults at risk of falling. The public health potential of gLiFE in terms of (cost-)effectiveness is currently being evaluated in a large trial. Trial registration: ClinicalTrials.gov NCT03412123. Registered on January 26, 2018.
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BACKGROUND: The Lifestyle-integrated Functional Exercise (LiFE) program is an intervention integrating balance and strength activities into daily life, effective at reducing falls in at-risk people ≥70 years. There is potential for LiFE to be adapted to young seniors in order to prevent age-related functional decline. OBJECTIVE: We aimed to (1) develop an intervention by adapting Lifestyle-integrated Functional Exercise (aLiFE) to be more challenging and suitable for preventing functional decline in young seniors in their 60s and (2) perform an initial feasibility evaluation of the program. Pre-post changes in balance, mobility, and physical activity (PA) were also explored. METHODS: Based on a conceptual framework, a multidisciplinary expert group developed an initial aLiFE version, including activities for improving strength, neuromotor performances, and PA. Proof-of-concept was evaluated in a 4-week pre-post intervention study measuring (1) feasibility including adherence, frequency of practice, adverse events, acceptability (i.e., perceived helpfulness, adaptability, level of difficulty of single activities), and safety, and (2) changes in balance/mobility (Community Balance and Mobility Scale) and PA (1 week activity monitoring). The program was refined based on the study results. RESULTS: To test the initial aLiFE version, 31 young seniors were enrolled and 30 completed the study (mean age 66.4 ± 2.7 years, 60% women). Of a maximum possible 16 activities, participants implemented on average 12.1 ± 1.8 activities during the intervention, corresponding to mean adherence of 76%. Implemented activities were practiced 3.6-6.1 days/week and 1.8-7.8 times/day, depending on the activity type. One noninjurious fall occurred during practice, although the participant continued the intervention. The majority found the activities helpful, adaptable to individual lifestyle, appropriately difficult, and safe. CMBS score increased with medium effect size (d = 0.72, p = 0.001). Increase in daily walking time (d = 0.36) and decrease in sedentary time (d = -0.10) were nonsignificant. Refinements included further increasing the task challenge of some strength activities and defining the most preferred activities in the trainer's manual to facilitate uptake of the program. CONCLUSION: aLiFE has the potential to engage young seniors in regular lifestyle-integrated activities. Effectiveness needs to be evaluated in a randomized controlled trial. https://www.karger.com/Article/Abstract/499962
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Background: At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community. Search methods: We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies. Selection criteria: We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. Main results: We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.Exercise (all types) versus control Eighty-one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high-certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall-related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low-certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low-certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low-certainty evidence). Exercise may make little important difference to health-related quality of life: conversion of the pooled result (standardised mean difference (SMD) -0.03, 95% CI -0.10 to 0.04; 3172 participants, 15 studies; low-certainty evidence) to the EQ-5D and SF-36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non-serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.Different exercise types versus controlDifferent forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high-certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high-certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control. Authors' conclusions: Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.
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Background The Lifestyle-Integrated Functional Exercise (LiFE) program is effective in improving strength, balance, and physical activity (PA) while simultaneously reducing falls in older people by incorporating exercise activities in recurring daily tasks. However, implementing the original LiFE program includes substantial resource requirements. Therefore, as part of the LiFE-is-LiFE project, a group format (gLiFE) of the LiFE program has been developed, which will be tested regarding its noninferiority to the individually delivered LiFE in terms of PA-adjusted fall incidence and overall cost-effectiveness. Methods In a multi-centre, single-blinded noninferiority trial, an envisaged sample of N = 300 participants (> 70 years; faller and/or confirmed falls risk; community-dwelling) will be randomized in either LiFE or gLiFE. Both groups will undergo the same strength and balance activities as well as PA promotion activities and habitualization strategies as described in the LiFE programme, however, based on different approaches of delivery: During the 6-month intervention phase, LiFE participants will receive seven home visits and two telephone calls; in gLiFE, the program will be delivered in seven group sessions and also two telephone calls. Main outcomes are a) fall incidence per PA and b) incremental cost-effectiveness ratio comparing costs and quality-adjusted life years between the two interventions. Secondary outcomes include PA behaviour, motor performance, health status, psychosocial status, program evaluation, and adherence. Measurements will be conducted at baseline, 6-month and 12-month follow-up; evaluation of intervention sessions and assessment of psychosocial variables related to execution and habitualization of LiFE activities will be made during the intervention period as well. Discussion Compared to LiFE, we expect gLiFE to (a) reduce falls per PA by a similar rate; (b) be more cost-effective; (c) comparably enhance physical performance in terms of strength and balance as well as PA. By investigating the economic and societal benefit, this study will be of high practical relevance as noninferiority of gLiFE would facilitate large-scale implementation due to lower resource usage. This would result in better reach and increased accessibility, which is important for subjects with a history of falls and/or being at risk of falls. Trial registration ClinicalTrials.gov NCT03462654. Registered on March 12, 2018.
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Background: Traditionally, exercise programmes for improving functional performance and reducing falls are organised as structured sessions. An alternative approach of integrating functional exercises into everyday tasks has emerged in recent years. Objectives: Summarising the current evidence for the feasibility and effectiveness of interventions integrating functional exercise into daily life. Methods: A systematic literature search was conducted including articles based on the following criteria: (1) individuals ≥60 years; (2) intervention studies of randomised controlled trials (RCTs) and non-randomised studies (NRS); (3) using a lifestyle-integrated approach; (4) using functional exercises to improve strength, balance, or physical functioning; and (5) reporting outcomes on feasibility and/or effectiveness. Methodological quality of RCTs was evaluated using the PEDro scale. Results: Of 4,415 articles identified from 6 databases, 14 (6 RCTs) met the inclusion criteria. RCT quality was moderate to good. Intervention concepts included (1) the Lifestyle-integrated Functional Exercise (LiFE) programme integrating exercises into everyday activities and (2) combined programmes using integrated and structured training. Three RCTs evaluated LiFE in community dwellers and reported significantly improved balance, strength, and functional performance compared with controls receiving either no intervention, or low-intensity exercise, or structured exercise. Two of these RCTs reported a significant reduction in fall rate compared with controls receiving either no intervention or low-intensity exercise. Three RCTs compared combined programmes with usual care in institutionalised settings and reported improvements for some (balance, functional performance), but not all (strength, falls) outcomes. NRS showed behavioural change related to LiFE and feasibility in more impaired populations. One NRS comparing a combined home-based programme to a gym-based programme reported greater sustainability of effects in the combined programme. Conclusions: This review provides evidence for the effectiveness of integrated training for improving motor performances in older adults. Single studies suggest advantages of integrated compared with structured training. Combined programmes are positively evaluated in institutionalised settings, while little evidence exists in other populations. In summary, the approach of integrating functional exercise into daily life represents a promising alternative or complement to structured exercise programmes. However, more RCTs are needed to evaluate this concept in different target populations and the potential for inducing behavioural change.
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Qualitative content analysis: theoretical foundation, basic procedures and software solution Mayring, Philipp Erstveröffentlichung / Primary Publication Monographie / monograph Empfohlene Zitierung / Suggested Citation: Mayring, Philipp : Qualitative content analysis: theoretical foundation, basic procedures and software solution. Klagenfurt, 2014. URN: http://nbn-resolving.de/urn:nbn:de:0168-ssoar-395173 Nutzungsbedingungen: Dieser Text wird unter einer CC BY-NC-ND Lizenz (Namensnennung-Nicht-kommerziell-Keine Bearbeitung) zur Verfügung gestellt. Nähere Auskünfte zu den CC-Lizenzen finden Sie hier: http://creativecommons.org/licenses/ Terms of use: This document is made available under a CC BY-NC-ND Licence (Attribution Non Comercial-NoDerivatives). For more Information see: http://creativecommons.org/licenses/
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To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home. Three arm, randomised parallel trial; assessments at baseline and after six and 12 months. Randomisation done by computer generated random blocks, stratified by sex and fall history and concealed by an independent secure website. Residents in metropolitan Sydney, Australia. Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruited from Veteran's Affairs databases and general practice databases. Exclusion criteria were moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises. Three home based interventions: Lifestyle integrated Functional Exercise (LiFE) approach (n=107; taught principles of balance and strength training and integrated selected activities into everyday routines), structured programme (n=105; exercises for balance and lower limb strength, done three times a week), sham control programme (n=105; gentle exercise). LiFE and structured groups received five sessions with two booster visits and two phone calls; controls received three home visits and six phone calls. Assessments made at baseline and after six and 12 months. Primary measure: rate of falls over 12 months, collected by self report. Secondary measures: static and dynamic balance; ankle, knee and hip strength; balance self efficacy; daily living activities; participation; habitual physical activity; quality of life; energy expenditure; body mass index; and fat free mass. After 12 months' follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group. We saw a significant reduction of 31% in the rate of falls for the LiFE programme compared with controls (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99)); the corresponding difference between the structured group and controls was non-significant (0.81 (0.56 to 1.17)). Static balance on an eight level hierarchy scale, ankle strength, function, and participation were significantly better in the LiFE group than in controls. LiFE and structured groups had a significant and moderate improvement in dynamic balance, compared with controls. The LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity. Australia and New Zealand Clinical Trials Registry 12606000025538.
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Verbessern Sie Ihre Muskelkraft und Ihr Gleichgewicht im Alltag Es ist leider eine Tatsache: Mit zunehmendem Alter baut der menschliche Körper ab. Ein unebener Boden, falsches Schuhwerk oder eine kleine Unachtsamkeit genügt manchmal schon, um ältere Menschen ins Straucheln zu bringen. Die Folgen sind oft Stürze mit schmerzhaften und langwierigen Verletzungen, wie zum Beispiel Knochenbrüchen. Hier setzt das LiFE Programm an. Es steht für Lebensstil-integrierte funktionelle Übungen und wurde an der Universität von Sydney erstellt, um die körperliche Fitness zu verbessern und damit das Sturzrisiko im Alltag zu senken. Die Teilnehmer lernen dabei, wie sie Übungen zur Verbesserung des Gleichgewichts und der Muskelkraft ganz leicht in ihren Alltag integrieren können. So werden tägliche Routinen wie etwa Zähneputzen zu einem effektiven Training. LiFE vermittelt viele Tipps und Anregungen, im Alltag körperlich aktiv zu sein. Selbstständigkeit und Lebensqualität können so bis ins hohe Alter erhalten bleiben. Inhalt • Das LiFE-Konzept einfach erklärt: Hintergründe und Ziele des Programms • Mit Videos zu den jeweiligen Übungen, abrufbar über die Springer Multimedia App • Mit detailliertem Übungskalender Die Autoren Prof. Lindy Clemson, Jo Munro und Prof. Maria Fiatarone Singh sind die Autoren der Originalpublikation des LiFE Programms. Dr. Michael Schwenk ist Sportwissenschaftler und Leiter der Nachwuchsgruppe "Bewegung, körperliche Leistung und Gesundheit in der zweiten Lebenshälfte" am Netzwerk AlternsfoRschung (NAR) der Universität Heidelberg. Prof. Dr. med. Clemens Becker ist Chefarzt der Klinik für Geriatrische Rehabilitation am Robert-Bosch-Krankenhaus in Stuttgart.
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Background: Lower extremity functioning is important for maintaining activity in elderly people. Optimal cutoff points for standard measurements of lower extremity functioning would help identify elderly people who are not disabled but have a high risk of developing disability. Objective: The purposes of this study were: (1) to determine the optimal cutoff points of the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test for predicting the development of disability and (2) to examine the impact of poor performance on both tests on the prediction of the risk of disability in elderly people dwelling in the community. Design: This was a prospective cohort study. Methods: A population of 4,335 elderly people dwelling in the community (mean age = 71.7 years; 51.6% women) participated in baseline assessments. Participants were monitored for 2 years for the development of disability. Results: During the 2-year follow-up period, 161 participants (3.7%) developed disability. The optimal cutoff points of the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test for predicting the development of disability were greater than or equal to 10 seconds and greater than or equal to 9 seconds, respectively. Participants with poor performance on the Five-Times Sit-to-Stand Test (hazard ratio = 1.88; 95% CI = 1.11, 3.20), the Timed "Up & Go" Test (hazard ratio = 2.24; 95% CI = 1.42, 3.53), or both tests (hazard ratio = 2.78; 95% CI = 1.78, 4.33) at the baseline assessment had a significantly higher risk of developing disability than participants who had better lower extremity functioning. Limitations: All participants had good initial functioning and participated in assessments on their own. Causes of disability were not assessed. Conclusions: Assessments of lower extremity functioning with the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test, especially poor performance on both tests, were good predictors of future disability in elderly people dwelling in the community.
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In a recent article in this journal, Lombard, Snyder-Duch, and Bracken (2002) surveyed 200 content analyses for their reporting of reliability tests, compared the virtues and drawbacks of five popular reliability measures, and proposed guidelines and standards for their use. Their discussion revealed that numerous misconceptions circulate in the content analysis literature regarding how these measures behave and can aid or deceive content analysts in their effort to ensure the reliability of their data. This article proposes three conditions for statistical measures to serve as indices of the reliability of data and examines the mathematical structure and the behavior of the five coefficients discussed by the authors, as well as two others. It compares common beliefs about these coefficients with what they actually do and concludes with alternative recommendations for testing reliability in content analysis and similar data-making efforts.
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Mental simulation provides a window on the future by enabling people to envision possibilities and develop plans for bringing those possibilities about. In moving oneself from a current situation toward an envisioned future one, the anticipation and management of emotions and the initiation and maintenance of problem-solving activities are fundamental tasks. In the program of research described in this article, mental simulation of the process for reaching a goal or of the dynamics of an unfolding stressful event produced progress in achieving those goals or resolving those events. Envisioning successful completion of a goal or resolution of a stressor--recommendations derived from the self-help literature--did not. Discussion centers on the characteristics of effective and ineffective mental simulations and their relation to self-regulatory processes.
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