Buffering effect of leisure self-determination on the mental health of older adults

Leisure self-determination was tested for its capacity to buffer the effects of life stress on the level of depression of older adults. A direct association between leisure-self-determination and level depression was also tested. A sample of 152 individuals aged 49 years and over completed a questionnaire which included measures of stress, leisure self-determination, and depression. Hierarchical multiple regression analysis incorporating an interaction component to represent the buffering effect was used to analyse the data. Higher levels of leisure self-determination were significantly associated with lower levels of depression regardless of life stress. Leisure self-determination also acted as a buffer of the association between life stress and depression. The study has significant theoretical and practical implications. Theoretically, it supports the stress buffering hypothesis of Coleman and Iso-Ahola (1993) when applied to a sample of older adults. The practical implications of the empirical evidence focus on the importance of fostering leisure self-determination dispositions through leisure practices, policies, and leadership styles that facilitate and support older adult autonomy in leisure experiences. <br /

A Clinician Referral and 12-Week Exercise Training Program for Men With Prostate Cancer: Outcomes to 12 Months of the ENGAGE Cluster Randomized Controlled Trial

Background:The ENGAGE (efficacy of a referral and physical activity program for survivors of prostate cancer) study established that a clinician referral and 12-week exercise training program increased vigorous physical activity at 12 weeks among men with prostate cancer. Here, we report the 6- and 12-month outcomes.Methods:In this multicenter cluster randomized controlled trial, we compared a clinician referral and exercise training program to usual care. Discounted gym membership was offered to men in the intervention condition on completion of the 12-week exercise program. Self-reported physical activity at 6 and 12 months was the primary outcome. Quality of life, anxiety, and depressive symptoms were secondary outcomes.Results:A total of 147 men meeting eligibility criteria agreed to participate (54 intervention, 93 control). A positive interaction effect for vigorous physical activity was observed at 6 months, but not 12 months. No significant effects for the secondary outcomes were found.Conclusions:A clinician referral and community-based supervised and unsupervised exercise training program, along with discounted gym membership, had a positive short-term effect on vigorous physical activity levels, but did not improve quality of life, in men with prostate cancer.</jats:sec

Changes in sport and physical activity participation for adolescent females: a longitudinal study

Abstract Background Participation in sport and physical activity is reported to decline during adolescence, particularly for females. However we do not have a clear understanding of changes in the context (i.e., modes and settings) of participation throughout adolescence. This study investigated longitudinal changes in physical activity participation and the specific modes and settings of physical activity, together with cross-sectional comparisons, for two age cohorts of female adolescents. Methods Survey of 729 adolescent girls (489 recruited in Year 7 and 243 in Year 11). Participation in eight different modes/settings was reported. PA was measured using 24-h recall diary and metabolic equivalent weighted energy expenditure (MET-min) in Leisure Time Moderate and Vigorous Physical Activity (LTMVPA) on the previous day was calculated. Results There were no significant changes in duration or total MET-min of LTMVPA on previous day. However, there were significant changes in the modes/settings of participation across time. Participation in school physical education rose during early adolescence before decreasing significantly, and participation in competitive sport and club sport significantly decreased over time; however there were increases in non-competitive forms of physical activity. Conclusions Overall levels of physical activity did not significantly decrease over adolescence, which is positive for physical health. However, the transition from structured sport to non-organised physical activity may effect social and psychological health, which needs to be further examined

Associations of objectively measured moderate-to-vigorous physical activity and sedentary behavior with quality of life and psychological well-being in prostate cancer survivors

PURPOSE: Although evidence is building on the positive effects of physical activity for prostate cancer survivors, less is known about the possible independent effects of sedentary behavior on quality of life and psychological well-being in this population. We determined the extent to which objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary behavior were independently associated with quality of life, anxiety, and depressive symptoms in prostate cancer survivors. METHODS: An exploratory cross-sectional analysis was undertaken on baseline data from a multicenter, cluster randomized controlled trial on the efficacy of a clinician referral and 12-week exercise program for men who had completed active treatment for prostate cancer. Multiple regression analyses were performed using data from 98 prostate cancer survivors who wore hip-mounted accelerometers (time spent sedentary defined as[CPM]; MVPA defined as \u3e1,951 CPM) and completed self-report instruments on their quality of life, anxiety, and depressive symptoms. Results were compared with minimal clinically important differences for the quality of life scales. RESULTS: Independent of sedentary behavior, increases in MVPA of between 15 and 33 min/day were associated with clinically important (but not statistically significant) improvements in three quality of life scales (insomnia, diarrhea, and financial difficulties). Independent of MVPA, decreases in sedentary behavior of 119 and 107 min/day were associated with clinically important (but not statistically significant) improvements in physical functioning and role functioning, respectively. CONCLUSION: Within our exploratory study, modest increases in MVPA and more substantive decreases in sedentary behavior were independently associated with clinically important improvements in several quality of life scales. Further research, including prospective studies, is required to understand sedentary behavior across larger and more representative samples (in terms of their physical, psychological, and social functioning and their engagement in physical activity) of prostate cancer survivors

Family support and ease of access link socio-economic status and sports club membership in adolescent girls : a mediation study

Background Much research has been conducted into the determinants of physical activity (PA) participation among adolescent girls. However, the more specific question of what are the determinants of particular forms of PA participation, such as the link between participation through a sports club, has not been investigated. Accordingly, the aim of this study was to investigate the relationships between participation in a sports club and socio-economic status (SES), access to facilities, and family and peer support, for female adolescents.Methods A survey of 732 female adolescent school students (521 metropolitan, 211 non-metropolitan; 489 Year 7, 243 Year 11) was conducted. The survey included demographic information (living arrangements, ethnicity indicators, and indicators of SES such as parental education and employment status and locality); access to facilities; and family and peer support (travel, encouragement, watching, praise, joint participation). For each characteristic, sports club participants and non-participants were compared using chi-square tests. Multiple mediation analyses were used to investigate the role of access, family and peer support in the link between SES and sport participation.Results There were significant associations (p&lt;0.05) between sports club participation and: all demographic characteristics; all measures of family and peer support; and access to sport-related facilities. Highest levels of participation were associated with monolingual Australian-born families, with two parents, at least one of whom was well-educated, with both parents employed, and high levels of parental assistance, engagement and support. Participation in club sport among both younger and older adolescent girls was significantly positively associated with the SES of both their neighbourhoods and their households, particularly in metropolitan areas. These associations were most strongly mediated by family support and by access to facilities.Conclusions To facilitate and promote greater participation in club sport among adolescent girls from low SES neighbourhoods and households, strategies should target modifiable determinants such as facility access and parental support. This will involve improving access to sports facilities and promoting, encouraging and assisting parents to provide support for their daughters&rsquo; participation in sport clubs.<br /

Trends in body image of adolescent females in metropolitan and non-metropolitan regions: a longitudinal study

Abstract Background Body dissatisfaction is associated with a range of adverse outcomes, including impaired psychological health, low physical activity and disordered eating. This longitudinal study used the Factors Influencing Transitions in Girls’ Active Leisure and Sport (FITGALS) dataset to examine trends in body image of adolescent females. Specifically, the study examined satisfaction with body size, physical appearance and dieting behaviour for two cohorts at transitional life phases in two geographic regions longitudinally over a 3-year period. Methods A sample of 732 adolescent females in Grade 7 (n = 489, 66.8 %) and Grade 11 (n = 243, 33.2 %) at randomly selected Australian metropolitan and non-metropolitan secondary schools responded to a questionnaire in three successive years from 2008 to 2010. Participants reported perceptions about their body size and physical appearance and whether they were, or ought to be, on a diet. The data were analysed using a series of longitudinal logistic regression models. Results Dieting and dissatisfaction with body size significantly increased over time and more so for older than younger girls. Region significantly moderated the effect of grade level regarding dissatisfaction with body size but not dieting. In non-metropolitan regions, those in the younger cohort were significantly more likely to be dissatisfied with their body size than the older cohort; whereas in metropolitan regions, those in the older cohort were significantly more likely to be dissatisfied with their body size than the younger cohort. Adolescent female’s perceptions of their appearance were unchanged over time, region and grade level. Conclusions Differences across time, region and grade level were found among adolescent females on body size and dieting behaviour, but not physical appearance. Adolescent females experience early and increasing body size dissatisfaction and dieting as they age, but stable perceptions of physical appearance. Age and geographic region are important considerations for the timing and targeting of interventions to address body image concerns. Further investigation of regional differences in body image perceptions and factors that affect these is warranted. The findings of this study highlight the ongoing need for strategies during adolescence to promote a healthy appreciation of body size and appearance

Bullosis diabeticorum: a treatment conundrum

Bullosis diabeticorum is an infrequent but significant complication of diabetes Mellitus most commonly affecting the hands and feet. These rapidly developing bullous lesions mostly occur in patients with long standing diabetes and neuropathy. The pathophysiology of this condition remains unknown. Despite reasonably low rates of occurrence this complication potentially has significant and serious ramifications for foot health and creates a treatment conundrum. This case study demonstrates the serious nature of seemingly innocuous presentations in management of the diabetic foot. A 76-year-old man presents to the high-risk foot clinic for treatment of a suspected Charcot foot. He has a complex medical history, which includes Type 2 diabetes, hypertension, congestive cardiac failure, hypercholesterolemia, and Gastro-esophageal reflux disease. The patient undergoes various testing to aid in diagnosing a Charcot foot, such as skin temperature testing, X-ray and bone scans. Fortunately he was not diagnosed with a Charcot foot. During a routine follow-up consult he presents with clear, serous filled blisters which have spontaneously appeared. They are in non weight-bearing areas, and the patient does not recall any trauma to the area. The blisters appear consistent with bullosis diabeticorum. There are no set criteria for appropriate treatment of blistering in these cases. Treatment options were to either leave blisters intact or de-roof them, and their treatment raises many questions. Intact blisters were left intact to maintain a sterile field; broken blisters were de-roofed to prevent infection as per normal protocol for any form of blister management. The healing outcomes were compared, with no significant difference noted. However, after healing was achieved, the patient returned to the clinic, weeks later, with another episode of blistering. The patient recalled a similar history to the first episode, with no traumatic injury to the site, and the blisters occurring overnight. The same treatment protocol was followed. However, on this occasion, the blisters did not heal as successfully, and the patient developed osteomyelitis, and subsequently suffered multiple digital amputations as a result. This case demonstrates that successful wound care can be difficult on a patient with diabetes and associated complications, such as neuropathy, peripheral vascular disease, and an increased susceptibility to infection

Fitness outcomes from a randomised controlled trial of exercise training for men with prostate cancer: the ENGAGE study

Purpose The main purpose of this study was to investigate the effects of a 12-week, clinician-referred, community-based exercise training program with supervised and unsupervised sessions for men with prostate cancer. The secondary purpose was to determine whether androgen deprivation therapy (ADT) modified responses to exercise training.Methods Secondary analysis was undertaken on data from a multicentre cluster randomised controlled trial in which 15 clinicians were randomly assigned to refer eligible patients to an exercise training intervention (n&thinsp;=&thinsp;8) or to provide usual care (n&thinsp;=&thinsp;7). Data from 119 patients (intervention n&thinsp;=&thinsp;53, control n&thinsp;=&thinsp;66) were available for this analysis. Outcome measures included fitness and physical function, anthropometrics, resting heart rate, and blood pressure.Results Compared to the control condition, men in the intervention significantly improved their 6-min walk distance (Mdiff&thinsp;=&thinsp;49.98 m, padj&thinsp;=&thinsp;0.001), leg strength (Mdiff&thinsp;=&thinsp;21.82 kg, padj&thinsp;=&thinsp;0.001), chest strength (Mdiff&thinsp;=&thinsp;6.91 kg, padj&thinsp;=&thinsp;0.001), 30-s sit-to-stand result (Mdiff&thinsp;=&thinsp;3.38 reps, padj&thinsp;=&thinsp;0.001), and reach distance (Mdiff&thinsp;=&thinsp;4.8 cm, padj&thinsp;=&thinsp;0.024). A significant difference (unadjusted for multiplicity) in favour of men in the intervention was also found for resting heart rate (Mdiff&thinsp;=&thinsp;&minus;3.76 beats/min, p&thinsp;=&thinsp;0.034). ADT did not modify responses to exercise training.Conclusions Men with prostate cancer who act upon clinician referrals to community-based exercise training programs can improve their strength, physical functioning, and, potentially, cardiovascular health, irrespective of whether or not they are treated with ADT.Implications for Cancer Survivors Clinicians should inform men with prostate cancer about the benefits of exercise and refer them to appropriately qualified exercise practitioners and suitable community-based programs

Predictors of adherence to a 12-week exercise program among men treated for prostate cancer: ENGAGE study

Understanding the factors that influence adherence to exercise programs is necessary to develop effective interventions for people with cancer. We examined the predictors of adherence to a supervised exercise program for participants in the ENGAGE study – a cluster randomized controlled trial that assessed the efficacy of a clinician-referred 12-week exercise program among men treated for prostate cancer. Demographic, clinical, behavioral, and psychosocial data from 52 participants in the intervention group were collected at baseline through self-report and medical records. Adherence to the supervised exercise program was assessed through objective attendance records. Adherence to the supervised exercise program was 80.3%. In the univariate analyses, cancer-specific quality of life subscales (role functioning r = 0.37, P = 0.01; sexual activity r = 0.26, P = 0.06; fatigue r = −0.26, P = 0.06, and hormonal symptoms r = −0.31, P = 0.03) and education (d = −0.60, P = 0.011) were associated with adherence. In the subsequent multivariate analysis, role functioning (B = 0.309, P = 0.019) and hormonal symptoms (B = −0.483, P = 0.054) independently predicted adherence. Men who experienced more severe hormonal symptoms had lower levels of adherence to the exercise program. Those who experienced more positive perceptions of their ability to perform daily tasks and leisure activities had higher levels of adherence to the exercise program. Hormonal symptoms and role functioning need to be considered when conducting exercise programs for men who have been treated for prostate cancer