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Participant experiences in the Diabetes REmission Clinical Trial (DiRECT).
Rehackova, L, Rodrigues, AM, Thom, G, Brosnahan, N, Barnes, AC, McCombie, L, Leslie, WS, Zhyzhneuskaya, S, Peters, C, Adamson, AJ, et al
Diabetic medicine : a journal of the British Diabetic Association. 2022;(1):e14689
Abstract
INTRODUCTION The Diabetes REmission Clinical Trial (DiRECT) has shown that sustained remission of type 2 diabetes in primary care is achievable through weight loss using total diet replacement (TDR) with continued behavioural support. Understanding participants' experiences can help optimise the intervention, support implementation into healthcare, and understand the process of behaviour change. METHODS Thirty-four DiRECT participants were recruited into this embedded qualitative evaluation study. In-person and telephone interviews were conducted before the TDR; at week 6-8 of the TDR; 2 weeks into food reintroduction (FR); and at 1 year, to learn about participant experiences with the programme. Transcribed narratives were analysed thematically, and we used interpretation to develop overarching themes. RESULTS Initiation of the TDR and transition to FR were challenging and required increased behavioural support. In general, adhering to TDR proved easier than the participants had anticipated. Some participants chose the optional extension of TDR. Rapid weight loss and changes in diabetes markers provided ongoing motivation. Further weight loss, behavioural support and occasional use of TDR facilitated weight loss maintenance (WLM). A process of behaviour adaptation to change following regime disruption was identified in three stages: (1) expectations of the new, (2) overcoming difficulties with adherence, and (3) acceptance of continuous effort and establishment of routines. CONCLUSIONS The DiRECT intervention was acceptable and regularity, continuity, and tailoring of behavioural support was instrumental in its implementation in primary care. The adaptation process accounts for some of the individual variability of experiences with the intervention and highlights the need for programme flexibility.
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Human reproductive behavior, life history, and the Challenge Hypothesis: A 30-year review, retrospective and future directions.
Gray, PB, Straftis, AA, Bird, BM, McHale, TS, Zilioli, S
Hormones and behavior. 2020;:104530
Abstract
The Challenge Hypothesis (Wingfield et al., 1990) originally focused on adult male avian testosterone elevated in response to same-sex competition in reproductive contexts. The purpose of the present paper is to demonstrate how the Challenge Hypothesis has shaped ideas about human life histories. We conduct a citation analysis, drawing upon 400 Google Scholar citations in the human literature to identify patterns in this body of scholarship. We cover key factors, such as context and personality traits, that help explain variable testosterone responses such as winning/losing to adult competitive behavior. Findings from studies on courtship and sexual behavior indicate some variation in testosterone responses depending on factors such as motivation. A large body of research indicates that male testosterone levels are often lower in contexts of long-term committed partnerships and nurturant fathering and aligned with variation in male mating and parenting effort. As the Challenge Hypothesis is extended across the life course, DHEA and androstenedione (rather than testosterone) appear more responsive to juvenile male competitive behavior, and during reproductive senescence, baseline male testosterone levels decrease just as male life history allocations show decreased mating effort. We discuss how research on testosterone administration, particularly in older men, provides causal insight into effects of testosterone in humans, and how this "natural experiment" can be viewed in light of the Challenge Hypothesis. We synthesize central concepts and findings, such as an expanded array of costs of testosterone that inform life history tradeoffs between maintenance and reproductive effort, and we conclude with directions for future research.
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Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications.
Lakerveld, J, Palmeira, AL, van Duinkerken, E, Whitelock, V, Peyrot, M, Nouwen, A
Diabetic medicine : a journal of the British Diabetic Association. 2020;(3):464-472
Abstract
AIM: Motivation to take up and maintain a healthy lifestyle is key to diabetes prevention and management. Motivations are driven by factors on the psychological, biological and environmental levels, which have each been studied extensively in various lines of research over the past 25 years. Here, we analyse and reflect on current and emerging knowledge on motivation in relation to lifestyle behaviours, with a focus on people with diabetes or obesity. Structured according to psychological, (neuro-)biological and broader environmental levels, we provide a scoping review of the literature and highlight frameworks used to structure motivational concepts. Results are then put in perspective of applicability in (clinical) practice. RESULTS Over the past 25 years, research focusing on motivation has grown exponentially. Social-cognitive and self-determination theories have driven research on the key motivational concepts 'self-efficacy' and 'self-determination'. Neuro-cognitive research has provided insights in the processes that are involved across various layers of a complex cortical network of motivation, reward and cognitive control. On an environmental - more upstream - level, motivations are influenced by characteristics in the built, social, economic and policy environments at various scales, which have provided entry points for environmental approaches influencing behaviour. CONCLUSIONS Current evidence shows that motivation is strongly related to a person's self-efficacy and capability to initiate and maintain healthy choices, and to a health climate that supports autonomous choices. Some approaches targeting motivations have been shown to be promising, but more research is warranted to sustainably reduce the burden of diabetes in individuals and populations.
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Association of motivations and barriers with participation and performance in a pedometer-based intervention.
Sheshadri, A, Kittiskulnam, P, Delgado, C, Sudore, R, Lai, JC, Johansen, KL
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020;(8):1405-1411
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Abstract
BACKGROUND A randomized trial of a pedometer-based intervention with weekly activity goals led to increased walking among dialysis patients. However, the association of participant-expressed motivations and barriers to participation and performance in such an intervention has not been determined. METHODS Thirty dialysis patients were randomized to a 12-week pedometer-based intervention with weekly step goals. Participants were asked about motivations and barriers to the increasing activity via weekly semi-scripted telephone interviews. We examined the association of these motivations and barriers with achieving weekly goals, reaching overall targets and increasing steps through multivariable linear and logistic regression analyses adjusted for age, sex, body mass index, dialysis modality and baseline steps. RESULTS The most common motivations were desire to maintain/improve functional ability (30%) and activity (30%). The most common barriers were health-related (33%). Motivation to maintain/improve functional ability was associated with achieving weekly goals 17.9% more often [95% confidence interval (CI) 1.7-34.2] and with a greater increase in steps (1524 steps; 95% CI 61-2989) than those lacking this motivation. Experiencing a health-related barrier was not associated with the decreased achievement of weekly goals but was associated with lower odds of reaching overall targets (odds ratio = 0.06; 95% CI 0.01-0.53) and a smaller increase in steps (-1640 steps, 95% CI -3244 to -36). No patients who reported weather/environmental barriers or safety concerns reached overall targets. CONCLUSIONS Participants who express a desire to maintain/improve functional ability may be particularly suited for activity interventions. Health-related setbacks should be met with revised goals. Reporting environmental or safety concerns may merit lowering overall targets.
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Influence of Self-Efficacy and Motivation to Follow a Healthy Diet on Life Satisfaction of Patients with Cardiovascular Disease: A Longitudinal Study.
Castillo-Mayén, R, Cano-Espejo, C, Luque, B, Cuadrado, E, Gutiérrez-Domingo, T, Arenas, A, Rubio, SJ, Delgado-Lista, J, Pérez-Martínez, P, Tabernero, C
Nutrients. 2020;(7)
Abstract
Today, cardiovascular disease has a great impact on the global population due to its high prevalence. One challenge that cardiovascular patients face to achieve a better prognosis is to follow a healthy diet. This study focused on psychological factors linked to adaptation to a healthy diet in these patients. The main objective was to analyze the interrelationship between motivation to follow a healthy diet and self-efficacy to adhere to the Mediterranean diet with life satisfaction over time. The sample consisted of cardiovascular patients who were assessed at three measurement moments (NT1 = 755; NT2 = 593; NT3 = 323, average interval time: nine months). Correlation analyses showed that self-efficacy, motivation, and life satisfaction followed a pattern of positive relations across the three measurements. A time effect over the study variables was also observed. The results of path analyses showed that self-efficacy positively predicted autonomous motivation, which in turn was associated with patients' life satisfaction. This interrelation was stable over a period of 18 months. Moreover, life satisfaction predicted self-efficacy nine months later. Psychological interventions might be a positive resource for cardiovascular patients, since psychological variables influence their life satisfaction and their subsequent quality of life in their new health condition.
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Do children with a high level of eating motivation consume less when foods are partitioned?
Rigal, N, Champel, C
Physiology & behavior. 2019;:112636
Abstract
Eating behaviors, especially the control of intake, are modulated by both internal and external factors. The objective of our study was to examine the effect of the interaction between eating motivation (as an internal factor) and food partition (as an external factor) on chocolate intake in children, with the hypothesis, based on the paradigm of motivated perception, that the effect of partition, i.e. reduced intake, is higher for children with a high level of eating motivation than for other children. A mixed model design was used in which 80 children aged 8-11 yrs. were offered, in their natural setting, two standardized afternoon snacks that included, among other things, 100 g of chocolate presented once as a whole (one bar) and once segmented (six pieces). The amount of chocolate eaten was weighed and compared between conditions (Bar vs Pieces). Children completed questionnaires in order to assess two of their eating motivational features (appetite arousal, chocolate specific appetite). Results indicated no effect of Partition: children ate the same quantity of chocolate in the two conditions (Bar or Pieces). Only chocolate specific appetite was associated with the amount of chocolate eaten, with children with a higher level eating more than other children (+13 g). Contrary to adults, children are not influenced by the "many is more effect". Methodological and developmental interpretations were suggested, linked to the size of the portion, the network of attention and the sensibility to the external cues underlying the control of intake.
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Motivation to eat and not to eat - The psycho-biological conflict in anorexia nervosa.
Frank, GKW, DeGuzman, MC, Shott, ME
Physiology & behavior. 2019;:185-190
Abstract
Anorexia nervosa is a severe psychiatric illness with high mortality. Brain imaging research has indicated altered reward circuits in the disorder. Here we propose a disease model for anorexia nervosa, supported by recent studies, that integrates psychological and biological factors. In that model, we propose that there is a conflict between the conscious motivation to restrict food, and a body-homeostasis driven motivation to approach food in response to weight loss. These opposing motivations trigger anxiety, which maintains the vicious cycle of ongoing energy restriction and weight loss.
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Reward sensitivity in Parkinson's patients with binge eating.
Terenzi, D, Rumiati, RI, Catalan, M, Antonutti, L, Furlanis, G, Garlasco, P, Polverino, P, Bertolotti, C, Manganotti, P, Aiello, M
Parkinsonism & related disorders. 2018;:79-84
Abstract
BACKGROUND Parkinson's disease (PD) patients who are treated with dopamine replacement therapy are at risk of developing impulse control disorders (ICDs) (such as gambling, binge eating, and others). According to recent evidence, compulsive reward seeking in ICDs may arise from an excessive attribution of incentive salience (or 'wanting') to rewards. OBJECTIVES In this study, we tested this hypothesis in patients with PD who developed binge eating (BE). METHODS Patients with BE, patients without BE, and healthy controls performed different experimental tasks assessing food liking and wanting. Participants first rated the degree of liking and wanting for different foods using explicit self-report measures. They then performed an affective priming task that measured participants' affective reactions towards foods (liking), and a grip-force task that assessed their motivation for food rewards (wanting). All participants also completed several questionnaires assessing impulsivity, reward sensitivity, anxiety and depression, and underwent a neuropsychological evaluation. RESULTS Patients with BE displayed an altered liking for sweet foods compared to controls but not to patients without BE. Furthermore, this difference emerged only when implicit measures were used. Importantly, an increased wanting was not associated with binge eating even if wanting, but not liking scores significantly correlated with LED levodopa, confirming the hypothesis of a distinction between the two components of rewards. Lastly, binge eating was associated with depression and lower working memory scores. CONCLUSIONS Take together these results suggest that binge eating in PD is associated with cognitive abnormalities, and to lesser extent affective abnormalities, but not with an increased incentive salience.
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Increasing physical activity through an Internet-based motivational intervention supported by pedometers in a sample of sedentary students: A randomised controlled trial.
Miragall, M, Domínguez-Rodríguez, A, Navarro, J, Cebolla, A, Baños, RM
Psychology & health. 2018;(4):465-482
Abstract
OBJECTIVE The aim of this study was to analyse the effect of an Internet-based motivational intervention (IMI) supported by pedometers (in comparison with IMI alone and non-intervention) on increasing daily steps and changing constructs related to physical activity (PA) in a sample of sedentary students. DESIGN A randomised-controlled trial was conducted with 76 sedentary or low-active college students. The purpose of the IMI was to deliver information to increase motivation and set individualised PA goals. It involved a 3-week intervention and a 3-months follow-up. OUTCOME MEASURES Objective measures were used to measure daily steps, and self-report questionnaires to assess different constructs related to PA. RESULTS Results revealed that IMI supported by pedometers condition increased significantly more the daily steps (post-intervention: M = 2069; SD = 1827; follow-up: M = 2227; SD = 2477) and enjoyment than non-intervention condition at both points in time. Moreover, results showed that IMI alone condition increased more the scores in variables involved in PA behaviour than non-intervention condition. CONCLUSIONS This study shows the effectiveness of a self-administered IMI using pedometers in increasing PA and enjoyment, and the effectiveness of the IMI alone in changing different theoretical constructs related to the PA behaviour.
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Triggering Mechanisms for Motor Actions: The Effects of Expectation on Reaction Times to Intense Acoustic Stimuli.
Leow, LA, Uchida, A, Egberts, JL, Riek, S, Lipp, OV, Tresilian, J, Marinovic, W
Neuroscience. 2018;:226-235
Abstract
Motor actions can be released much sooner than normal when the go-signal is of very high intensity (>100 dBa). Although statistical evidence from individual studies has been mixed, it has been assumed that sternocleidomastoid (SCM) muscle activity could be used to distinguish between two neural circuits involved in movement triggering. We summarized meta-analytically the available evidence for this hypothesis, comparing the difference in premotor reaction time (RT) of actions where SCM activity was elicited (SCM+ trials) by loud acoustic stimuli against trials in which it was absent (SCM- trials). We found ten studies, all reporting comparisons between SCM+ and SCM- trials. Our mini meta-analysis showed that premotor RTs are faster in SCM+ than in SCM- trials, but the effect can be confounded by the variability of the foreperiods employed. We present experimental data showing that foreperiod predictability can induce differences in RT that would be of similar size to those attributed to the activation of different neurophysiological pathways to trigger prepared actions. We discuss plausible physiological mechanisms that would explain differences in premotor RTs between SCM+ and SCM- trials.