<p> Exercise programs designed for cardiac patients frequently report high dropout rates. Little is known about the reasons for this high rate of dropout; further, little is known about health behavior patterns including physical activity subsequent to graduation or dropout from exercise programs. Identification of reasons for dropout and the pattern of physical activity after participation in formal exercise rehabilitation would provide information regarding achievement and maintenance of treatment goals.</p> <p> Entry characteristics were determined for 84 male cardiac patients (45 compliers and 39 dropouts) from the McMaster Cardiac Rehabilitation Exercise Program. Follow-up information pertaining to areas of: a) health; b) employment, smoking, activity, and dietary status; c) reasons for joining the program; d) perceived benefits achieved; and e) factors contributing to compliance with or dropout from the exercise program was obtained from 63 subjects (41 compliers and 22 dropouts) who responded to a questionnaire by mail.</p> <p> The dropout rate at the end of the 6 month program was 46.4% (39 of 84 subjects) with one-half of all dropout occurring within the first 2 months of the 6 month program. Upon entry into the exercise program, a significantly greater proportion of dropouts (43.6%, n=17) than compliers (8.9%, n=4) were found to be regular smokers. Likewise, a significantly greater proportion of dropouts (82.1%, n=32) than compliers (55.6%, n=25) were found to be inactive in their leisure habits upon entry. Dropouts were also more likely to be blue collar workers (71.8%, n=28), and younger in age (x̅ age = 48.4 years) when compared to compliers (37.8%, n=17; x̅ age = 54.3 years) upon entry into the exercise program. Upon follow-up, compliers were significantly more likely to report active leisure habits (85.4%, n=35) than were responding dropouts (45.5%, n=10). Compliers were also significantly more likely to report moderate work activity levels upon follow-up (54.8%, n=17) compared to dropouts (22.2%, n=4). Reasons for compliance to and withdrawal from the exercise program provided by respondents centred around psychosocial and personal convenience categories.</p> <p> Although statistically significant, the greater follow-up activity levels noted among compliers in this study appear to be only temporary, short-term patterns which tend to diminish with time. It is suggested that compliance-improving strategies be developed through further study with the aim of encouraging the long-term maintenance of desired behavior change.</p> / Thesis / Master of Science (MSc)

BakgrundDen fysiska aktivitetsnivån sänks för många i samband med graviditet och kan vara kvarstående en längre tid efter förlossning. Det finns begränsad kunskap om vilka faktorer som stärker self-efficacy (S-E) att utföra träning, underlättande och hindrande faktorer för initiering eller återupptagande av fysisk aktivitet och träning efter förlossning. SyfteSyftet var att undersöka upplevelser efter deltagande i gruppträning på en vårdcentral hos kvinnor med kvarstående besvär efter förlossning, S-E till fortsatt träning på egen hand samt hindrande och underlättande faktorer för träning. Design och metod  En kvalitativ deskriptiv design användes och fem semistrukturerade intervjuer genomfördes. Vid databearbetning användes en kvalitativ innehållsanalys. ResultatResultatet beskriver betydelsen av ledarledd gruppträning och dess innehåll, S-E till- och underlättande samt hindrande faktorer för träning på egen hand, individuella strategier för träning, betydelsen av att ha drivkraft och omgivningsfaktorer som påverkar träningen. KonklusionInformanterna beskrev positiva aspekter gällande ledarledd gruppträning med andra mödrar. Fler träningstillfällen och ytterligare vägledning beskrevs kunna stärka S-E för träning på egen hand. Olika underlättande och hindrande faktorer påverkade om kvinnorna tränade på egen hand eller inte. Denna information kan vara till nytta för fysioterapeuter och barnmorskor för att främja fysisk aktivitet och träning efter förlossning. / BackgroundThe physical activity level decreases among many women during pregnancy and this decline may remain a long period of time postpartum. There is limited knowledge about the factors, such as self-efficacy (S-E) and barriers for exercise, influencing physical activity postpartum. ObjectivesThe aim of this study was to investigate how women with postpartum complications experienced group training in primary healthcare. The purpose was also to analyze their S-E for self-managed exercise and facilitating factors and barriers for exercise. Design and methodA qualitative descriptive study design was used. Five semi-structured interviews were conducted and analyzed with qualitative content analysis. ResultsThe informants described the impact of supervised group training and how self-efficacy and different factors, influenced self-managed exercise. They described individual exercise strategies, the importance of motivation and environmental factors affecting the exercise.   ConclusionDifferent positive aspects emerged regarding supervised exercise and exercise in a group with other mothers. To enhance S-E in individual exercise additional supervised exercise and further guidance were highlighted.Different facilitating factors and barriers for exercise affected whether or not the informants exercised on their own. This information can be of use for physiotherapists and midwives to promote physical activity and exercise postpartum.

The purpose of this study was to determine the effects of following either the Curves® Fitness and Weight Management Plan or the Weight Watchers® Momentum™ Plan on body composition and markers of health and fitness in previously sedentary obese women. Fifty-one women (age 35±8 yrs; height 163±7 cm; weight 90±1 kg; BMI 34±5 kg/m2; 47±7% body fat) were randomized to participate in the Curves® (C) or Weight Watchers® (W) weight loss programs for 16-wks. Participants in the C group (n=24) followed a 1,200 kcal/d diet for 1-wk; 1,500 kcal/d diet for 3 wks (~30%:45% CHO:PRO); and 2,000 kcals/d for 2-wks (45:30) and repeated this diet while participating in a supervised Curves® with Zumba program 3-d-wk. Remaining subjects (n=27) followed the W point-based diet program, received weekly group counseling, and were encouraged to exercise. Body composition, anthropometrics, resting energy expenditure (REE), lipid biomarkers, and hormone concentrations were assessed at 0, 4, 10, and 16 weeks. Maximal cardiopulmonary exercise capacity and upper and lower body isotonic strength and endurance were assessed at 0 and 16 weeks. Data were analyzed using multivariate analysis of variance for repeated measures. MANOVA analysis of body composition data revealed overall time (Wilks’ Lamda p=0.001) and time by diet effects (Wilks’ Lamda p=0.003). Subjects in both groups lost a similar amount of total mass (C -2.4±2.0, -4.1±3.4, -5.1±3.9; W -2.3±2.3, -4.5±3.0, -5.5±4.6 kg, p=0.78). However, subjects in the C group tended to have a greater reduction in percent body fat (C -3.3±5.2, -3.2±4.6, -4.7±5.4; W 0.6±6.7, -0.6±8.3, -1.4±8.1%, p=0.10) and body fat mass (C -3.9±5.5, -4.6±5.3, -6.4±5.9; W -0.4±5.7, -2.1±6.7, -2.9±7.8 kg, p=0.09), while maintaining FFM (C 1.5±4.3, 0.52±3.7, 1.3±4.0; W -1.8±5.4, -2.4±5.8, -2.5±5.1, p=0.01). While both groups had increases cardiovascular fitness, the C group experienced improvements in upper body muscular endurance (C 1.4±3.9; W -1.2±2.4 repetitions, p=0.006). Both groups experienced improvements in lipid biomarkers; however, only the C group experienced a moderate increase in HDL-c. Results indicate that participants following the C program experienced more favorable changes in body composition and markers of fitness and health than participants in the W program.

The purpose of this study was to investigate physical activity (PA) engagement among older adults (OA) following discharge from a medically supervised group exercise program and to explore the facilitators and barriers that influenced maintained PA engagement. While facilitators and barriers to PA among OA in general have been well documented, facilitators and barriers particular to maintaining PA after discharge from a supervised exercise program have not been widely explored with qualitative methods or a mixed method design. Data for this mixed method, case study approach were collected in two phases. In Phase I, questionnaires were used to investigate PA engagement as well as semi-structured qualitative interviews were completed (n = 12; Mage = 80.0 years) to explore facilitators and barriers that influenced PA engagement. In Phase II, reviews of medical charts were conducted retrospectively to gather further information on PA engagement and barriers (n = 12). All 12 individuals in Phase I remained engaged in PA activity 2 – 48 months post completion of the medically supervised exercise program. This particular group of OA identified facilitators for and barriers to maintaining PA that were personally-, socially-, and program-based, and also provided suggestions to alleviate cited barriers. Four themes identified in regards to PA engagement were: (1) Personal drive: highly aware of the need to keep moving; (2) Social connections and support: we all need people; (3) Program components matter; and, (4) Convenient, Affordable, Relevant: suggestions to improve program access. The power of multi-level, multi-sector approaches that consider the broader determinants of health was highlighted in this study. Participants identified the need for health care providers (HCP) and PA instructors to continue to communicate the benefits of PA, the importance of ongoing HCP support, and the necessity of working across sectors to reduce program related barriers to promote PA engagement among OA discharged from a medically supervised exercise program. / Graduate / melodyburgoyne@hotmail.com

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