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Background Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults’ exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence. Methods The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at “risk of falling”. Experimental group will receive the T&E programme ( N  = 162). Second group will receive the Otago programme ( N  = 162) and the third group will receive the Helsana programme ( N  = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up). Discussion Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy. Trial registration ClinicalTrials.gov: NCT02926105 , First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.

Background Physical activity is effective for the prevention and treatment of chronic disease, yet insufficient evidence is available to make comparisons regarding adherence to aerobic physical activity interventions among chronic disease populations, or across different settings. The purpose of this review is to investigate and provide a quantitative summary of adherence rates to the aerobic physical activity guidelines among people with chronic conditions, as physical activity is an effective form of treatment and prevention of chronic disease. Methods Randomized controlled (RCTs) trials where aerobic physical activity was the primary intervention were selected from PsychInfo, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Clinical Key, and SCOPUS from 2000 to 2018. Studies were included if the program prescription aligned with the 2008 aerobic physical activity guidelines, were at least 12 weeks in length, and included adult participants living with one of three chronic diseases. The data was extracted by hand and the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines were used to evaluate risk-of-bias and quality of evidence. Data were pooled using random-effect models. The primary outcome measure was program adherence and the secondary outcome measures were dropout and setting (e.g. home vs. clinic-based). Pooled effect sizes and 95% CiIs (confidence intervals) were calculated using random-effect models. Results The literature search identified 1616 potentially eligible studies, of which 30 studies (published between 2000 and 2018, including 3,721 participants) met the inclusion criteria. Three clinical populations were targeted: cancer ( n  = 14), cardiovascular disease ( n  = 7), and diabetes ( n  = 9). Although not statistically significant, adherence rates varied across samples (65, 90, and 80%, respectively) whereas dropout rates were relatively low and consistent across samples (5, 4, and 3%). The average adherence rate, regardless of condition, is 77% (95% CI = 0.68, 0.84) of their prescribed physical activity treatment. The pooled adherence rates for clinic-based and home-based programs did not differ (74% [95% CI, 0.65, 0.82] and 80% [95% CI, 0.65, 0.91], respectively). Conclusions The current evidence suggests that people with chronic conditions are capable of sustaining aerobic physical activity for 3+ months, as a form of treatment. Moreover, home-based programs may be just as feasible as supervised, clinic-based physical activity programs.

The family plays an immensely crucial role in the development of adolescents, significantly influencing their behavioral patterns. To explore the impact mechanism of the family physical activity environment on adolescents’ exercise adherence, and analyze the chain-mediating role of exercise self-efficacy and exercise satisfaction. A questionnaire was administered to 500 adolescents and their parents using the Family Physical Activity Environment Scale, Exercise Adherence Scale, Exercise Self-Efficacy Scale and Satisfaction Scale. The direct impact value of the family physical activity environment on adolescents’ exercise adherence is 0.148, with an effect size of 32.81%. The impact values of exercise self-efficacy and satisfaction between the family physical activity environment and adolescents’ exercise adherence are 0.113 and 0.092 respectively, with effect sizes of 25.05% and 20.39%. The chain-mediating effect of exercise self-efficacy and satisfaction is significant, with an effect value of 0.097 and an effect size of 21.50%. Family physical activity environment can directly and positively predict adolescents’ exercise adherence, positively predict adolescents’ exercise adherence through the independent mediating role of exercise self-efficacy and satisfaction, and also positively predict adolescents’ exercise adherence through the chain mediating role of exercise self-efficacy and satisfaction. This provides a theoretical reference for enhancing adolescents’ exercise adherence and improving their levels of physical health.

Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration's risk of bias tool. The results were narratively reviewed. In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.

This study explored the relationships between social support, cognitive reappraisal, emotional intelligence, and college students' exercise adherence. We investigated the mechanism underlying the relationship between social support and exercise adherence to provide a potential route through which to promote exercise adherence among college students. Using convenience sampling, we recruited 1,621 college students in Liaoning Province, China, who completed scales measuring social support, exercise adherence, cognitive reappraisal, and emotional intelligence. The results showed that (a) social support directly and positively influenced college students' exercise adherence, and (b) social support indirectly influenced college students' exercise adherence through the independent mediating effect of emotional intelligence and the chain mediating effect of cognitive reappraisal and emotional intelligence. This research deepens understanding of the influence of social support on exercise adherence in college students.

Regular physical activity (PA) is an essential component of a successful type 2 diabetes treatment. However, despite the manifest evidence for the numerous health benefits of regular PA, most patients with type 2 diabetes remain inactive, often due to low motivation and lack of PA enjoyment. A recent and promising approach to help overcome these PA barriers and motivate inactive individuals to change their PA behavior is PA-promoting smartphone games. While short-term results of these games are encouraging, the long-term success in effectively changing PA behavior has to date not been confirmed. It is possible that an insufficient incorporation of motivational elements or flaws in gameplay and storyline in these games affect the long-term motivation to play and thereby prevent sustained changes in PA behavior. We aimed to address these design challenges by developing a PA-promoting smartphone game that incorporates established behavior change techniques and specifically targets inactive type 2 diabetes patients. To investigate if a self-developed, behavior change technique-based smartphone game designed by an interdisciplinary team is able to motivate inactive individuals with type 2 diabetes for regular use and thereby increase their intrinsic PA motivation. Thirty-six inactive, overweight type 2 diabetes patients (45-70 years of age) were randomly assigned to either the intervention group or the control group (one-time lifestyle counseling). Participants were instructed to play the smartphone game or to implement the recommendations from the lifestyle counseling autonomously during the 24-week intervention period. Intrinsic PA motivation was assessed with an abridged 12-item version of the Intrinsic Motivation Inventory (IMI) before and after the intervention. In addition, adherence to the game-proposed PA recommendations during the intervention period was assessed in the intervention group via the phone-recorded game usage data. Intrinsic PA motivation (IMI total score) increased significantly in the intervention group (+6.4 (SD 4.2; P<.001) points) while it decreased by 1.9 (SD 16.5; P=.623) points in the control group. The adjusted difference between both groups was 8.1 (95% CI 0.9, 15.4; P=.029) points. The subscales \"interest/enjoyment\" (+2.0 (SD 1.9) points, P<.001) and \"perceived competence\" (+2.4 (SD 2.4) points, P<.001) likewise increased significantly in the intervention group while they did not change significantly in the control group. The usage data revealed that participants in the intervention group used the game for an average of 131.1 (SD 48.7) minutes of in-game walking and for an average of 15.3 (SD 24.6) minutes of strength training per week. We found a significant positive association between total in-game training (min) and change in IMI total score (beta=0.0028; 95% CI 0.0007-0.0049; P=.01). In inactive individuals with type 2 diabetes, a novel smartphone game incorporating established motivational elements and personalized PA recommendations elicits significant increases in intrinsic PA motivation that are accompanied by de-facto improvements in PA adherence over 24 weeks. ClinicalTrials.gov NCT02657018; https://clinicaltrials.gov/ct2/show/NCT02657018.

Young adult women have unique barriers to exercise, but assessing the psychological and behavioral strategies of women who overcome these barriers may be beneficial for informing future exercise programs. This study assessed differences in motives and self-regulation by type (aerobic or muscle-strengthening) and frequency of exercise, along with preferences for exercise amongst young adult women who exercise regularly. A survey assessed exercise frequency (International Physical Activity Questionnaire), intensity (Borg's scale), type, and social and physical preferences. The Exercise Motivations Inventory-2 measured motivators for exercise and the Physical Activity Self-Regulation Scale measured self-regulation. Characteristics and preferences for exercise were examined using descriptives and frequencies. MANOVAs assessed differences in motivators and self-regulation by frequency of exercise, and regression analyses assessed differences in exercise predictors by type. The sample consisted of 269 women ages 18-34 (66.5% White), of whom 80.3% met the national guidelines for aerobic exercise, 78.4% met the guidelines for muscle-strengthening exercise, and 32.3% identified resistance exercise as their preferred type of exercise. Weight management and self-regulation (p = .021, R 2  = .073) were the strongest predictors of aerobic exercise. Positive health, strength and endurance, and self-regulation (p = .023, R 2  = .161) were predictors of muscle-strengthening exercise. Women who participated in high amounts of aerobic exercise were motivated by interpersonal factors while psychological factors motivated high frequency of muscle-strengthening exercise. Programs for young adult women should consider incorporating resistance exercise as this study shows it may evoke motivation that could lead to regular participation. Self-regulation strategies were associated with adherence to both aerobic and muscle-strengthening exercises, highlighting the potential importance for inclusion in future interventions.

Background ‘Exercise snacking’, which is characterised by shorter and more frequent exercise bouts compared with traditional exercise guidelines, may be an acceptable strategy for increasing physical activity and reducing sedentary behaviour in older adults. Aim The aim of this study was to evaluate the enablers and barriers for older adults associated with participation in a home-based exercise snacking program delivered and monitored using an Amazon Echo Show 5 device (Alexa). Methods This study used an interpretive description qualitative design to conduct semi-structured interviews following a 12-week pilot study in 15 adults aged 60–89 years with at least one chronic condition. All participants were prescribed a home based, individualised, lower limb focussed ‘exercise snacking’ program (involving ≤ 10 min of bodyweight exercises 2–4 times per day) delivered and monitored by an Alexa. Qualitative interview data were analysed using thematic analysis. Results All 15 participants (mean age 70.3 years) attended the semi-structured interview. Themes including time efficiency, flexibility, perceived health benefits, and motivation were enablers for participation in the ‘exercise snacking’ program. A lack of upper body exercises and omission of exercise equipment in the program, as well as a lack of time and motivation for performing exercise snacks three or more times per day, were barriers to participation. Conclusion While ‘exercise snacking’ is acceptable for older adults, future trials should provide equipment (e.g. adjustable dumbbells, exercise bands), prescribe whole-body exercise programs, and establish strategies to support participation in more than three exercise snacks per day.

The expansion of outdoor gyms have been a valuable public health strategy adopted to promote social well-being and contribute to increased quality of life in hypertensive individuals [2], despite being underutilized. [See PDF for image] Fig. 1 Perspective for the role of clinical exercise professionals in healthcare centers aimed at facilitating participation and adherence to exercise programs in individuals with hypertension Created in BioRender.com For example, the prescription by an exercise professional in a clinical environment would offer a more targeted approach, specifically focused on exercise; the system would enhance the utilization of exercise professionals and their abilities for treating chronic diseases through exercise-based interventions; it would enable a more personalized approach to exercise practice and better monitoring, scheduling patients’ return visits at shorter intervals; it would allow for the selection and adaptation of exercises for hypertensive individuals when necessary; it would assertively focus not only on treatment through exercise but also on prioritizing health promotion; and it would help promote a modified perception of the healthcare environment, shifting from a perception of an environment of ‘illness’ to one of ‘health promotion’. Physical training in outdoor fitness gym improves blood pressure, physical fitness, and quality of life of hypertensive patients: a randomized controlled trial.

We explored the relationship between exercise adherence and body dysmorphic disorder with a convenience sample of 964 Chinese college students. Participants completed the Scale of Exercise Adherence, the Fear of Negative Evaluation Scale, the Appearance-Based Rejection Sensitivity Scale, and the Body Dysmorphic Disorder Examination Self-Report Scale. Exercise adherence was negatively correlated with body dysmorphic disorder. Appearance-based rejection sensitivity and social anxiety had both independent and chain mediating effects on the relationship between exercise adherence and body dysmorphic disorder. The results have revealed the mechanism of the relationship between exercise adherence and body dysmorphic disorder, and they provide a preliminary basis for studying the causal relationship of these variables. Our findings also provide a theoretical basis for the intervention and treatment of body dysmorphic disorder.