Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review

Objectives

Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia.

Methods

We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise.

Results

Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons.

Conclusions

We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia.

     

Adherence to exercise programs and determinants of maintenance in older adults with mild cognitive impairment

After a randomized controlled trial showing that improvement on some aspects of cognitive function was related to adherence to an exercise program, determinants of adherence and maintenance were further studied. Older adults with mild cognitive impairment were contacted 6 mo after the end of exercise programs for a telephone interview addressing patterns of adherence and determinants of maintenance. Mean adherence during the trial was 53%. About one third of participants had lapses during the trial but completed, one third had no lapses, and one third dropped out or never started. Practical barriers (time, location) were related to not starting and functional limitations to dropout. After the trial 25% of participants continued the programs, 14% reported intention to continue, and 61% quit. Maintenance was determined by fewer health complaints, higher satisfaction with the programs, and better adherence during the programs. Although maintenance was low, this study identified several reasons and barriers to adherence and maintenance that could be addressed.     

Tra i Leoni: Revealing the preferences behind a superstition

We examine a superstition for which adherence is nearly universal among its target population. Using a combination of field interventions that involve unsuspecting participants and a lab-style value elicitation, we investigate the nature and strength of peoples’ underlying preferences. While a substantial minority of people are willing to incur a relatively high individual cost in order to adhere to the superstition, for many, adherence is contingent on the behavior of others. Our findings are consistent with the idea that it is the conforming nature of the majority that sustains the false beliefs of the minority.     

College students' motivation for physical activity: differentiating men's and women's motives for sport participation and exercise

Despite the many clear benefits of an active lifestyle, lack of physical activity is a significant health problem in the college population. A key issue in physical activity research is developing an understanding of motivation. Although physical activity takes many forms, most research designed to enhance motivation for and adherence to physical activity focuses on exercise behavior and ignores sport participation. In this study, the authors compare motivations for sport participation versus exercise among college students. Results indicate that participants were more likely to report intrinsic motives, such as enjoyment and challenge, for engaging in sport, whereas motivations for exercise were more extrinsic and focused on appearance and weight and stress management. The findings suggest that motives for sport participation are more desirable than those for exercise and may facilitate improved adherence to physical activity recommendations.     

Barriers and facilitators for walking in individuals with intermittent claudication

This study aimed to identify barriers and facilitators associated with walking for exercise among people who experience intermittent claudication. Fifteen individuals (7 men and 8 women) participated in 3 focus groups that were tape-recorded and content analyzed. A social-cognitive framework was used to categorize barriers and facilitators as those related to the person, to the activity, or to the environment. Variables identified included those specific to intermittent claudication and those common among the general population. Barriers to walking included irregular or graded walking surfaces, uncertainty about the outcome of walking, ambiguity regarding pain, the need to take rest breaks, and the presence of leg pain. Facilitating factors included availability of a resting place, use of cognitive coping strategies, companionship support, and availability of a treadmill-walking program. Findings are interpreted in light of current research on exercise determinants and encourage prospective examinations of the predictive validity of these factors for walking.     

REPRESENTATIVE TRUST AND RECIPROCITY: PREVALENCE AND DETERMINANTS

This paper provides evidence about the determinants of trust and reciprocal inclinations, that is, a tendency for people to respond in kind to hostile or kind actions, in a representative setting. We investigate the prevalence of reciprocity in the population, the correlation between trust and positive and negative reciprocal inclinations within person, the individual determinants of reciprocity, and the relationship with psychological measures of personality. We find that most people state reciprocal inclinations, in particular in terms of positive reciprocity, as well as substantial heterogeneity in the degree of trust and reciprocity. Trust and positive reciprocity are only weakly correlated, while trust and negative reciprocity exhibit a negative correlation. In terms of determinants, being female and increasing age are associated with stronger positive and weaker negative reciprocal tendencies. Taller people are more positively reciprocal, but height has no impact on negative reciprocity. Psychological traits also affect trust and reciprocity. ( JEL D63, J3, J6)     

The Declining Significance of Race in Federal Civil Rights Law: The Social Structure of Employment Discrimination Claims

We examine changes in the nature and rate of complaints filed with the federal Equal Employment Opportunity Commission (EEOC) in the past 35 years. The EEOC's role has shifted over this period from ensuring job access for racial minorities to providing diverse protections for a much broader class of incumbent workers. We first describe trends in discrimination complaints, most notably the shift from racial discrimination to other bases of discrimination, and develop a conceptual model of choice among socially structured alternatives to account for them. We then test the model with a time series analysis of changes in the complaint rate among different worker groups to evaluate the relative importance of legal, political, and socioeconomic determinants of civil rights complaints. Net of changes in the political climate, benefit compensation, inequality, and education levels, we find that legal changes and group-specific unemployment rates are the strongest and most consistent determinants of the rate of race, sex, and total discrimination complaints. Our results suggest that people will bear the costs of filing a complaint when legal options are relatively attractive and when employment options on the external labor market are unattractive.     

Reducing HIV risk among people with serious mental illness

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.     

Academic incentives for students can increase participation in and effectiveness of a physical activity program

The authors sought to determine whether a greater academic incentive would improve the effectiveness and student adherence to a 12-week voluntary exercise program designed to decrease students' percentage of body fat. They randomly assigned 210 students to 1 of 2 groups with different academic reward structures. The group with the greater reward structure showed better exercise adherence and lost more body fat than those without the additional incentive. These findings suggest that an academic incentive can increase overall student adherence to a voluntary exercise program and can boost the effectiveness of the program in a university environment. The findings also have potential implications for on-campus promotion of physical activity.     

Exercise, health, and aging

The aims of this study were to examine the level of exercise among elderly people with regard to the current Norwegian recommendations, demographic correlates of exercise, and the relationship between exercise and subjective health among elderly men and women. A representative sample of 3,770 Norwegian men and women between 65 and 97 years of age (mean 75 years) completed a questionnaire. The response rate was 83.4 %. Results showed that 6 % of the participants exercise at the level recommended. The oldest old (>80 years), those who have an illness and use medication, and individuals with lower levels of education and income are the least active segments of the sample. After adjusting for age, marital status, income, and education, results showed that exercise at moderate intensity 3-4 days per week is a significant predictor for positive subjective health.     

Results of a Recent Survey of Funding Patterns of Student Health Services

The authors sought to determine whether a greater academic incentive would improve the effectiveness and student adherence to a 12-week voluntary exercise program designed to decrease students' percentage of body fat. They randomly assigned 210 students to 1 of 2 groups with different academic reward structures. The group with the greater reward structure showed better exercise adherence and lost more body fat than those without the additional incentive. These findings suggest that an academic incentive can increase overall student adherence to a voluntary exercise program and can boost the effectiveness of the program in a university environment. The findings also have potential implications for on-campus promotion of physical activity.     

Mechanisms of Adherence in a Harm Reduction Housing Program

Advances in clinical therapies for people living with HIV have greatly increased life expectancies, but the high levels of adherence that are necessary for clinical success are infrequently achieved, especially for chronically homeless substance users. The Open Door is a harm reduction housing program that seeks to improve clinical outcomes for this population. We present findings from qualitative interviews with residents of the program, conducted to explore facilitators of residents’ success in the program, which is ultimately defined as HIV clinical adherence. Two major themes developed. Positive changes captures processes or characteristics that residents reported as having changed as a result of living in the program. Mechanisms of success reflects aspects of the program to which residents attributed their improved adherence. Given that improving adherence in vulnerable populations has both clinical and public health implications, our study suggests future avenues for research and foundations on which to build future interventions.     

Factors associated with exercise participation in adults with arthritis

Most people with arthritis are not regularly active. Understanding what factors influence exercise is essential for designing programs to increase participation. The objective of this study was to examine the correlates of exercise in people with arthritis. Using a cross-sectional design, sociodemographic, health-related, and psychosocial variables were collected from community-dwelling individuals with arthritis (N = 141). Associations with exercise level were examined with bivariate statistics (ANOVAs, chi-squares) and logistic-regression analyses. Exercisers were less likely than nonexercisers and insufficiently active people to report that arthritis negatively affected their physical and social functioning, and they reported more positive affect and greater self-efficacy (p < .05). Exercisers also reported less pain than nonexercisers (p < .05). In multiple logistic-regression analyses, self-efficacy and physical limitations remained independent predictors of exercise. The results suggest the need to target exercise self-efficacy when designing exercise interventions. Results also suggest the need to tailor exercise programs to individuals' physical limitations.     

Sex-dependent associations between daily physical activity and leg exercise blood pressure responses

The authors examined interindividual and sex-specific variation in systolic (SBP) and diastolic (DBP) blood pressure responses to graded leg-extension exercise in healthy older (60-78 yr) women (n = 21) and men (n = 19). Maximal oxygen uptake (VO2max), body composition, physical activity (accelerometry), and vascular function were measured to identify predictors of exercise BP. Neither VO2max nor activity counts were associated with the rise in SBP or DBP during exercise in men. The strongest predictors of these responses in men were age (SBP: r2 = .19, p = .05) and peak exercise leg vasodilation (DBP: r2 = -.21, p < .05). In women, the modest relationship observed between VO2max and exercise BP was abolished after adjusting for central adiposity and activity counts (best predictors, cumulative r2 = .53, p < .05, for both SBP and DBP). These results suggest that determinants of variation in submaximal exercise BP responses among older adults are sex specific, with daily physical activity influencing these responses in women but not men.     

Older Adults’ Trait Impressions of Faces Are Sensitive to Subtle Resemblance to Emotions

Younger adults (YA) attribute emotion-related traits to people whose neutral facial structure resembles an emotion (emotion overgeneralization). The fact that older adults (OA) show deficits in accurately labeling basic emotions suggests that they may be relatively insensitive to variations in the emotion resemblance of neutral expression faces that underlie emotion overgeneralization effects. On the other hand, the fact that OA, like YA, show a ‘pop-out’ effect for anger, more quickly locating an angry than a happy face in a neutral array, suggests that both age groups may be equally sensitive to emotion resemblance. We used computer modeling to assess the degree to which neutral faces objectively resembled emotions and assessed whether that resemblance predicted trait impressions. We found that both OA and YA showed anger and surprise overgeneralization in ratings of danger and naiveté, respectively, with no significant differences in the strength of the effects for the two age groups. These findings suggest that well-documented OA deficits on emotion recognition tasks may be more due to processing demands than to an insensitivity to the social affordances of emotion expressions.     

Life-course perspective for physical activity and sports participation

The purpose of this paper was to discuss physical activity and sports participation in a life-course framework, long-term tracking, determinants, and correlates of physical activity from childhood to old age, and present possible causal links and pathways for the continuity of physical activity. It seems that intensive participation in general in physical activity and sports, as well as participation at school age, are important predictors of adulthood participation. Especially, inactivity rather than activity tends to track from youth to adulthood. Socioeconomic status, place of residence, and personal upward social mobility are related to participation. If physical activity is at a low level in early adulthood, it does not easily become a part of life later on, particularly among blue-collar workers, women, and people with initially poor perceived health. Furthermore, in old age, earlier physical activity seems to be the key determinant along with gender. Repeated social reinforcement in the form of support for autonomy, competence, and relatedness is important especially in transition periods and life events such as secondary schooling, change in employment, and change in family structure. In contrast, retirement presented itself as a good chance of starting new leisure time activities. A life-course approach provides understanding on long-ranging developmental trajectories. According to these results in particular, the polarization of exercise to the active and inactive portions of the population is accumulated over time, and gender and social background features require special attention.     

Behavioral Determinants of Nonprofit Board Performance

There is an increased awareness that the performance of boards (good governance) is not only determined by structural determinants but by behavioral determinants as well. These behavioral determinants might be particularly important for public and nonprofit governance, where the role of the board is more diffuse and heterogeneous than in corporate governance. Here we investigate how social dynamics within boards in secondary education influence their performance. We follow a concise model that includes cognitive conflict, the use of expertise, effort norms, and social cohesion as determinants of board task performance. A survey among all secondary schools in the Netherlands serves as the empirical underpinning for this process‐oriented model of good governance. We show that the behavioral determinants have different effects on the control task and advice task of boards. Also, we find that cognitive conflicts in supervisory boards do not lead to less but rather to more social cohesion within boards. Building on these findings, we suggest a revised model of the behavioral determinants of nonprofit board performance.     

Motives for and barriers to physical activity among older adults with mobility limitations

The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N=645) age 75-81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.     

Bodywork and bodily capital among youth using fitness gyms

In this article, we explore what had become a predominant focus on the body and on shaping and refining the body through frequent, intensive workout and strict, controlled diets among a group of young people engaged in strength training in fitness gyms in Denmark. Theoretically and analytically, we draw inspiration from French sociologist Loïc Wacquant’s ethnographic study of professional boxers in Chicago around 1990. First, we use the concept of bodywork to explore and understand the meaning of the young people’s exercise and diet practices. We argue that the young people’s bodywork can be understood as the building up of bodily capital. Second, we aim to explore the social implications of this bodywork. We explore how and in what ways the young people’s bodily capital can be converted into other resources, or forms of capital, that are essentially social: social relations and sense of connectedness; knowledge, expertise and future plans; and recognition, self-worth and identity.