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      Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial

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          Abstract

          Background

          The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation.

          Methods

          An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.

          Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.

          Blood pressure and weight were assessed at baseline and 6 months.

          Results

          Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported.

          Conclusions

          Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed.

          Trial registration

          The trial is registered as Current Controlled trials ISRCTN07682833.

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          Most cited references25

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          Physical activity assessment methodology in the Five-City Project.

          Previous measures of physical activity for epidemiologic studies were considered inadequate to meet the needs of a community-based health education trial. Therefore, new methods of quantifying the physical activity habits of communities were developed which are practical for large health surveys, provide information on the distribution of activity habits in the population, can detect changes in activity over time, and can be compared with other epidemiologic studies of physical activity. Independent self-reports of vigorous activity (at least 6 metabolic equivalents (METs) ), moderate activity (3-5 METs), and total energy expenditure (kilocalories per day) are described, and the physical activity practices of samples of California cities are presented. Relationships between physical activity measures and age, education, occupation, ethnicity, marital status, and body mass index are analyzed, and the reliabilities of the three activity indices are reported. The new assessment procedure is contrasted with nine other measures of physical activity used in community surveys.
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            The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity.

            To describe the 1) lifestyle intervention used in the Finnish Diabetes Prevention Study, 2) short- and long-term changes in diet and exercise behavior, and 3) effect of the intervention on glucose and lipid metabolism. There were 522 middle-aged, overweight subjects with impaired glucose tolerance who were randomized to either a usual care control group or an intensive lifestyle intervention group. The control group received general dietary and exercise advice at baseline and had an annual physician's examination. The subjects in the intervention group received additional individualized dietary counseling from a nutritionist. They were also offered circuit-type resistance training sessions and advised to increase overall physical activity. The intervention was the most intensive during the first year, followed by a maintenance period. The intervention goals were to reduce body weight, reduce dietary and saturated fat, and increase physical activity and dietary fiber. The intervention group showed significantly greater improvement in each intervention goal. After 1 and 3 years, weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group, respectively. Measures of glycemia and lipemia improved more in the intervention group. The intensive lifestyle intervention produced long-term beneficial changes in diet, physical activity, and clinical and biochemical parameters and reduced diabetes risk. This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system.
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              Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women.

              Behavior change interventions are effective to the extent that they affect appropriately-measured outcomes, especially in experimental controlled trials. The primary goal of this study was to analyze the impact of a 1-year weight management intervention based on self-determination theory (SDT) on theory-based psychosocial mediators, physical activity/exercise, and body weight and composition. Participants were 239 women (37.6 +/- 7.1 years; 31.5 +/- 4.1 kg/m(2)) who received either an intervention focused on promoting autonomous forms of exercise regulation and intrinsic motivation, or a general health education program (controls). At 12 months, the intervention group showed increased weight loss (-7.29%,) and higher levels of physical activity/exercise (+138 +/- 26 min/day of moderate plus vigorous exercise; +2,049 +/- 571 steps/day), compared to controls (P < 0.001). Main intervention targets such as more autonomous self-regulation (for treatment and for exercise) and a more autonomous perceived treatment climate revealed large effect sizes (between 0.80 and .96), favoring intervention (P < 0.001). Results suggest that interventions grounded in SDT can be successfully implemented in the context of weight management, enhancing the internalization of more autonomous forms of behavioral regulation, and facilitating exercise adherence, while producing clinically-significant weight reduction, when compared to a control condition. Findings are fully consistent with previous studies conducted within this theoretical framework in other areas of health behavior change.
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                Author and article information

                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central
                1479-5868
                2014
                29 January 2014
                : 11
                : 10
                Affiliations
                [1 ]School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
                [2 ]Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York 14627, USA
                [3 ]School of Health & Population Sciences, University of Birmingham, Birmingham B15 2TT, UK
                [4 ]School of Education, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK
                Article
                1479-5868-11-10
                10.1186/1479-5868-11-10
                3931311
                24475766
                6d3a3999-574b-478e-a9c7-37cd86d21e32
                Copyright © 2014 Duda et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                : 13 October 2011
                : 28 November 2013
                Categories
                Research

                Nutrition & Dietetics
                autonomy support,exercise on referral,dartmouth co-op charts,autonomous motivation,physical activity promotion,self determination theory,need satisfaction,subjective vitality

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