Pedro Teixeira | Universidade de Lisboa (original) (raw)
Papers by Pedro Teixeira
BMC Medicine, 2015
Background: Relapse is high in lifestyle obesity interventions involving behavior and weight chan... more Background: Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium-and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. Methods: A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately. Results: Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. Conclusions: This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.
British Journal of Sports Medicine , 2015
on behalf of the EuroFIT consortium ▸ Additional material is published online only. To view pleas... more on behalf of the EuroFIT consortium ▸ Additional material is published online only. To view please visit the journal online (http://dx.
![Research paper thumbnail of Weight control attempts among Portuguese adults: prevalence, motives and behavioural strategies [portuguese]](https://attachments.academia-assets.com/37235377/thumbnails/1.jpg)
](Acta Médica Portuguesa, 2015
Acta Med Port 2015 Jan-Feb;28(1):77-86 RESUMO Introdução: Em Portugal não existem dados atuais so... more Acta Med Port 2015 Jan-Feb;28(1):77-86 RESUMO Introdução: Em Portugal não existem dados atuais sobre tentativas de controlo do peso nem sobre estratégias e motivos na base dessas tentativas na população. Este estudo teve como objectivos determinar a prevalência das tentativas de perda/manutenção do peso e identificar as estratégias comportamentais e os motivos associados, numa amostra representativa da população adulta portuguesa. Material e Métodos: Estudo transversal constituído por 1098 indivíduos adultos. A informação sociodemográfica, os dados antropométricos e as estratégias e motivos associados à perda/manutenção do peso foram recolhidos por entrevista telefónica. Resultados: Cerca de 44% dos adultos portugueses (53% de mulheres e 35% dos homens) estão ativamente a tentar controlar o peso. Salienta-se que 22% das mulheres com peso normal tentam perder peso e que 53% dos homens e 34% das mulheres com peso excessivo não o fazem. Entre os homens, 49% com nível educacional superior estão a tentar controlar o peso versus 32% com nível educacional básico. A estratégia mais frequentemente adoptada para gerir o peso é o consumo regular de hortícolas e os motivos mais referenciados são melhorar a saúde/prevenir doenças e melhorar o bem-estar. Discussão e Conclusão: Mais de metade das mulheres e cerca de um terço dos homens em Portugal estão ativamente a tentar gerir o seu peso, utilizando estratégias comportamentais consistentes com as recomendações de saúde pública. Os motivos de saúde e bem-estar predominam sobre os restantes. Este estudo contribui para o conhecimento da gestão do peso em Portugal, alertando para o desenvolvimento de estratégias de prevenção da obesidade adequadas ao perfil da população.
International Journal of Behavioral Nutrition and Physical Activity, 2014
Background: This systematic literature review describes the potential public health impact of evi... more Background: This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. Methods: Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. Results: Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. Conclusions: Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
Health Education Research, 2014
This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Dete... more This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) and evaluated their associations with short-and long-term moderate plus vigorous physical activity (MVPA) and lifestyle physical activity (PA) outcomes in women who underwent a weight-management program. 221 participants (age 37.6 ± 7.02 years) completed a 12-month SDT-based lifestyle intervention and were followed-up for 24 months. Multiple linear regression analyses tested associations between psychosocial variables and self-reported short-and long-term PA outcomes. Regression analyses showed that control constructs of both theories were significant determinants of short-and long-term MVPA, whereas affective and self-determination variables were strong predictors of short-and long-term lifestyle PA. Regarding short-term prediction models, TPB constructs were stronger in predicting MVPA, whereas SDT was more effective in predicting lifestyle PA. For long-term models, both forms of PA were better predicted by SDT in comparison to TPB. These results highlight the importance of comparing health behavior theories to identify the mechanisms involved in the behavior change process.
International Journal of Behavioral Medicine, 2014
Background Lifestyle interventions are effective for weight loss and are recommended for persons ... more Background Lifestyle interventions are effective for weight loss and are recommended for persons with a body mass index (BMI) of 25-40 kg m −2 . However, this group is very heterogeneous, which could influence outcomes from lifestyle interventions. Purpose In this systematic review, differences in 1-year weight change and percentage weight change after lifestyle interventions were investigated for participants varying in initial BMI using meta-analyses. Method Twenty-two interventions with healthy Caucasian adults, a mean BMI between 25 and 40 kg m −2 , a dietary as well as a physical activity component aiming at weight loss, and at least five contact sessions guided by a professional health care provider were selected from a systematic search in the MEDLINE database. Participants in each intervention were divided into one of the three BMI classes: overweight (BMI of 25-29.99 kg m −2 ), class-I obesity (BMI of 30-34.99 kg m −2 ), and class-II obesity (BMI of 35-39.99 kg m −2 ). Differences in weight change and percentage weight change were analyzed and compared among different BMI classes within the same intervention by calculating standardized mean differences. Results Overweight participants lost 1.1 kg less (p <0.01) than participants with class-I obesity and 1.5 kg less (p <0.01) than participants with class-II obesity. For percentage weight change, no significant differences were found among the BMI classes. Conclusion Average weight change during lifestyle interventions only differs to a small extent among people with BMI between 25 and 40 kg m −2 . This implies that these interventions are equally appropriate for these BMI classes.
International Journal of Behavioral Medicine, 2014
Background This study aimed at assessing the effects of a self-regulation-based brief physical ac... more Background This study aimed at assessing the effects of a self-regulation-based brief physical activity program for patients suffering from unexplained chronic fatigue, the "4-STEPS to control your fatigue program". Method A 12-week randomized controlled trial was conducted. Adult patients meeting the CDC criteria for idiopathic chronic fatigue were randomized to either the control condition (standard care) or the intervention condition (4-STEPS). The 4-STEPS was based on self-regulation principles and consisted of motivational interviewing and self-regulation skills training. All patients were assessed at baseline and post-treatment (12 weeks) for fatigue severity (primary outcome) and impact, physical activity (leisure time physical activity, number of daily steps and personal activity goal progress), health-related quality of life, somatic distress and psychological distress (depression and anxiety). Results Ninety-one patients (45 intervention and 46 control patients) received the allocated intervention. At post-treatment, statistical analysis revealed a significant difference for subjective experience of fatigue (4.73 points; g=0.51) in favour of the intervention group. Mixed design ANCOVAs showed a significant effect of the 4-STEPS on fatigue severity, leisure time physical activity, personal activity goal progress and healthrelated quality of life. No significant effects were found for number of daily steps and somatic and psychological distress.
Respiratory Medicine, 2014
![Research paper thumbnail of Success in maintaining weight loss in Portugal – The Portuguese Weight Control Registry [portuguese]](https://attachments.academia-assets.com/37235298/thumbnails/1.jpg)
](Ciência & Saúde Coletiva, 2014
Resumo O objetivo deste trabalho é descrever a metodologia do Registo Nacional de Controlo do Pes... more Resumo O objetivo deste trabalho é descrever a metodologia do Registo Nacional de Controlo do Peso e descrever os participantes quanto à sua história individual e familiar relacionada com o peso, tentativas anteriores de redução deste e caraterização psicossocial. A amostra inclui 198 adultos (idade: 39,7 ± 11,1anos; IMC: 26,0 ± 3,9kg/m 2 ), 59% mulheres, que completaram um questionário abordando questões demográficas, motivações e atitudes, e estratégias de perda e de manutenção do peso. Os participantes reportaram uma perda do peso média de 17,4kg e uma duração média de manutenção do peso perdido de 29 meses. Relativamente ao número de tentativas de redução do peso reportadas, 73% indicou ter iniciado uma dieta no máximo por três vezes e 34% reportou ter tentado perder peso apenas uma vez no passado. Este estudo irá permitir conhecer com mais detalhe e representatividade as caraterísticas e as estratégias adoptadas por estas pessoas bem sucedidas na manutenção do peso perdido no longo prazo e contribuir para identificar variáveis preditoras da gestão bem sucedida do peso a longo prazo. Palavras-chave Abstract The scope of this article is to describe the Portuguese Weight Control Registry (PWCR) methodology and the participants currently enrolled specifically with respect to their individual and family weight history, previous weight loss attempts, and psychosocial characteristics. One hundred and ninety-eight adults (age: 39.7±11.1 years; BMI: 26.0±3.9 kg/m2), 59% women, filled out a questionnaire about demographics, healthrelated behaviors and motivation, and methods and strategies used to lose and/or maintain weight loss. Participants reported an average weight loss of 17.4 kg for an average of 29 months. Concerning the number of weight loss attempts, 73% of participants reported a maximum of three attempts of going on a diet, and 34% indicated only one attempt to lose weight in the past. The PWCR now features a considerable number of successful longterm weight loss maintainers in Portugal.
![Research paper thumbnail of I want, I can, and I choose: Basic Psychological Needs and motivation in gym users? [portuguese]](https://attachments.academia-assets.com/37235276/thumbnails/1.jpg)
](Revista Gymnasium, 2013
This study was grounded on the Self-Determination Theory and had as main objective to determine t... more This study was grounded on the Self-Determination Theory and had as main objective to determine the relationship between the satisfaction of the basic psychological needs (BPN) for autonomy, competence and positive interpersonal involvement and the motivational regulations presented (autonomous vs. controlled)
Obesity Facts, 2013
Objective: Successful weight management relies heavily on eating and exercise behaviors.
Revista Portuguesa de Cardiologia, 2013
O que o cardiologista deve saber sobre diabetes: investir no capital vascular Cardiologia Volume ... more O que o cardiologista deve saber sobre diabetes: investir no capital vascular Cardiologia Volume 32 • Suplemento I Abril 2013 Órgão Oficial da Sociedade Portuguesa de Cardiologia O que O cardiOlOgista deve saber sObre diabetes: investir nO capital vascular
Journal of Behavioral Medicine, 2013
The purpose of this study was to evaluate health-related quality of life and other psychosocial c... more The purpose of this study was to evaluate health-related quality of life and other psychosocial characteristics, including eating self-regulation and body image, in a group of successful long-term weight loss maintainers. Women enrolled in the Portuguese Weight Control Registry (n = 107) were matched and compared to women at the end of a behavior weight loss treatment program (n = 107), and also with women in the community who were not trying to lose weight (n = 107). Successful maintainers displayed higher quality of life and a more positive profile in selected eating and exercise markers of self-regulation compared to similarly-weighed women not attempting weight loss, but not when compared to the 'weight loss treatment' group. However, results also suggest that concerns with body shape and size may persist after weight loss and that some aspects of well-being and eating self-regulation can be more successfully targeted in specific weight loss programs.
![Research paper thumbnail of Successful weight loss maintenance in Portugal and in the USA: comparing results from two National Registries [portuguese]](https://attachments.academia-assets.com/37235207/thumbnails/1.jpg)
](Revista Portuguesa de Saúde Pública, 2012
![Research paper thumbnail of Contribution to the study of the basic need satisfaction in general scale to Portuguese language [portuguese]](https://attachments.academia-assets.com/37235195/thumbnails/1.jpg)
](Psicologia, Saúde & Doenças, 2012
________________________________________________________________________________________ RESUMO-E... more ________________________________________________________________________________________ RESUMO-Este estudo descreve o processo de adaptação da versão portuguesa, de 21 itens, da Basic Need Satisfaction in General Scale da teoria de auto-determinação. O instrumento é composto por três subescalas que correspondem às três necessidades básicas (a) competência, (b) autonomia e (c) relações de pertença. Foi administrado em dois estudos independentes, 420 e 408 participantes respectivamente, com amostras de conveniência da comunidade. A primeira fase incluiu tradução, retroversão e retradução; inspecção da equivalência lexical e de conteúdo; e reflexão falada. No processo de adaptação é aferido se a validade de conteúdo está de acordo com a teoria original. O estudo métrico revela valores baixos na consistência interna em algumas das subescalas. Numa análise exploratória inicial, em ambos os estudos, emergem três factores no scree plot, a maioria dos itens apresenta carga factorial apropriada no primeiro factor. Os resultados sugerem que a escala poderá ser utilizada na população portuguesa assumindo os princípios teóricos definidos pelos autores originais e reconhecidos na investigação.
International Journal of Behavioral Nutrition and Physical Activity, 2012
Background: Slow eating has been associated with enhanced satiation, but also with increased wate... more Background: Slow eating has been associated with enhanced satiation, but also with increased water intake. Therefore, the role of water ingestion in regard to eating rate needs to be discerned. This study examined the influence of eating rate on appetite regulation and energy intake when water intake is controlled.
BMC Public Health, 2012
Background: The prevalence of overweight and obesity in Europe is high. It is a major cause of th... more Background: The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM).
International Journal of Behavioral Nutrition and Physical Activity, 2012
Background: Motivation is a critical factor in supporting sustained exercise, which in turn is as... more Background: Motivation is a critical factor in supporting sustained exercise, which in turn is associated with important health outcomes. Accordingly, research on exercise motivation from the perspective of self-determination theory (SDT) has grown considerably in recent years. Previous reviews have been mostly narrative and theoretical. Aiming at a more comprehensive review of empirical data, this article examines the empirical literature on the relations between key SDT-based constructs and exercise and physical activity behavioral outcomes.
Medicine and Science in Sports and Exercise, 2012
Purpose: This study examined effects of a behavioral weight management intervention on body image... more Purpose: This study examined effects of a behavioral weight management intervention on body image (evaluative and investment dimensions) and explored the potential mediating role of structured and lifestyle physical activity (PA). Methods: The study was a longitudinal randomized controlled trial, including a 1-yr behavior change intervention and a 2-yr follow-up (225 women, 37.6 T 7 yr, body mass index = 31.5 T 4.1 kgIm j2 ). Statistical analyses comprised mixed-design ANOVAs with repeated measures, bivariate/partial correlations, and mediation analyses. Results: Body image improved considerably in both groups, favoring the intervention group (small to moderate effect sizes: 0.03-0.05), but began to deteriorate from 12 to 24 months, especially in the intervention group. Consequently, at 24 months, between-group differences were small and did not reach significance. Yet, levels of body dissatisfaction and dysfunctional investment remained below initial values (for both groups). Results were similar for both body image dimensions. Structured PA (at 12 and 24 months) and lifestyle PA (at 24 months) were positively associated with (r 9 j0.25, P G 0.05) and partially mediated body image improvements, especially in the investment component (95% confidence interval of j1.88 to j0.27 for structured PA at 12 months, 95% confidence interval of j1.94 to j0.21 for lifestyle PA at 24 months). In general, change in evaluative body image was not mediated by exercise participation, seeming more dependent on weight change. Conclusions: These findings highlight the importance of PA as a contributing factor in the improvement of body image in overweight/obese women, mainly by reducing excessive salience of appearance to one's life and self. Lifestyle PA may also be a valid option, particularly in the long term. Exercise might provide a buffer against body image deterioration overtime, favoring lasting weight loss maintenance.
BMC Medicine, 2015
Background: Relapse is high in lifestyle obesity interventions involving behavior and weight chan... more Background: Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium-and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. Methods: A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately. Results: Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. Conclusions: This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.
British Journal of Sports Medicine , 2015
on behalf of the EuroFIT consortium ▸ Additional material is published online only. To view pleas... more on behalf of the EuroFIT consortium ▸ Additional material is published online only. To view please visit the journal online (http://dx.
Acta Médica Portuguesa, 2015
Acta Med Port 2015 Jan-Feb;28(1):77-86 RESUMO Introdução: Em Portugal não existem dados atuais so... more Acta Med Port 2015 Jan-Feb;28(1):77-86 RESUMO Introdução: Em Portugal não existem dados atuais sobre tentativas de controlo do peso nem sobre estratégias e motivos na base dessas tentativas na população. Este estudo teve como objectivos determinar a prevalência das tentativas de perda/manutenção do peso e identificar as estratégias comportamentais e os motivos associados, numa amostra representativa da população adulta portuguesa. Material e Métodos: Estudo transversal constituído por 1098 indivíduos adultos. A informação sociodemográfica, os dados antropométricos e as estratégias e motivos associados à perda/manutenção do peso foram recolhidos por entrevista telefónica. Resultados: Cerca de 44% dos adultos portugueses (53% de mulheres e 35% dos homens) estão ativamente a tentar controlar o peso. Salienta-se que 22% das mulheres com peso normal tentam perder peso e que 53% dos homens e 34% das mulheres com peso excessivo não o fazem. Entre os homens, 49% com nível educacional superior estão a tentar controlar o peso versus 32% com nível educacional básico. A estratégia mais frequentemente adoptada para gerir o peso é o consumo regular de hortícolas e os motivos mais referenciados são melhorar a saúde/prevenir doenças e melhorar o bem-estar. Discussão e Conclusão: Mais de metade das mulheres e cerca de um terço dos homens em Portugal estão ativamente a tentar gerir o seu peso, utilizando estratégias comportamentais consistentes com as recomendações de saúde pública. Os motivos de saúde e bem-estar predominam sobre os restantes. Este estudo contribui para o conhecimento da gestão do peso em Portugal, alertando para o desenvolvimento de estratégias de prevenção da obesidade adequadas ao perfil da população.
International Journal of Behavioral Nutrition and Physical Activity, 2014
Background: This systematic literature review describes the potential public health impact of evi... more Background: This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. Methods: Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. Results: Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. Conclusions: Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
Health Education Research, 2014
This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Dete... more This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) and evaluated their associations with short-and long-term moderate plus vigorous physical activity (MVPA) and lifestyle physical activity (PA) outcomes in women who underwent a weight-management program. 221 participants (age 37.6 ± 7.02 years) completed a 12-month SDT-based lifestyle intervention and were followed-up for 24 months. Multiple linear regression analyses tested associations between psychosocial variables and self-reported short-and long-term PA outcomes. Regression analyses showed that control constructs of both theories were significant determinants of short-and long-term MVPA, whereas affective and self-determination variables were strong predictors of short-and long-term lifestyle PA. Regarding short-term prediction models, TPB constructs were stronger in predicting MVPA, whereas SDT was more effective in predicting lifestyle PA. For long-term models, both forms of PA were better predicted by SDT in comparison to TPB. These results highlight the importance of comparing health behavior theories to identify the mechanisms involved in the behavior change process.
International Journal of Behavioral Medicine, 2014
Background Lifestyle interventions are effective for weight loss and are recommended for persons ... more Background Lifestyle interventions are effective for weight loss and are recommended for persons with a body mass index (BMI) of 25-40 kg m −2 . However, this group is very heterogeneous, which could influence outcomes from lifestyle interventions. Purpose In this systematic review, differences in 1-year weight change and percentage weight change after lifestyle interventions were investigated for participants varying in initial BMI using meta-analyses. Method Twenty-two interventions with healthy Caucasian adults, a mean BMI between 25 and 40 kg m −2 , a dietary as well as a physical activity component aiming at weight loss, and at least five contact sessions guided by a professional health care provider were selected from a systematic search in the MEDLINE database. Participants in each intervention were divided into one of the three BMI classes: overweight (BMI of 25-29.99 kg m −2 ), class-I obesity (BMI of 30-34.99 kg m −2 ), and class-II obesity (BMI of 35-39.99 kg m −2 ). Differences in weight change and percentage weight change were analyzed and compared among different BMI classes within the same intervention by calculating standardized mean differences. Results Overweight participants lost 1.1 kg less (p <0.01) than participants with class-I obesity and 1.5 kg less (p <0.01) than participants with class-II obesity. For percentage weight change, no significant differences were found among the BMI classes. Conclusion Average weight change during lifestyle interventions only differs to a small extent among people with BMI between 25 and 40 kg m −2 . This implies that these interventions are equally appropriate for these BMI classes.
International Journal of Behavioral Medicine, 2014
Background This study aimed at assessing the effects of a self-regulation-based brief physical ac... more Background This study aimed at assessing the effects of a self-regulation-based brief physical activity program for patients suffering from unexplained chronic fatigue, the "4-STEPS to control your fatigue program". Method A 12-week randomized controlled trial was conducted. Adult patients meeting the CDC criteria for idiopathic chronic fatigue were randomized to either the control condition (standard care) or the intervention condition (4-STEPS). The 4-STEPS was based on self-regulation principles and consisted of motivational interviewing and self-regulation skills training. All patients were assessed at baseline and post-treatment (12 weeks) for fatigue severity (primary outcome) and impact, physical activity (leisure time physical activity, number of daily steps and personal activity goal progress), health-related quality of life, somatic distress and psychological distress (depression and anxiety). Results Ninety-one patients (45 intervention and 46 control patients) received the allocated intervention. At post-treatment, statistical analysis revealed a significant difference for subjective experience of fatigue (4.73 points; g=0.51) in favour of the intervention group. Mixed design ANCOVAs showed a significant effect of the 4-STEPS on fatigue severity, leisure time physical activity, personal activity goal progress and healthrelated quality of life. No significant effects were found for number of daily steps and somatic and psychological distress.
Respiratory Medicine, 2014
Ciência & Saúde Coletiva, 2014
Resumo O objetivo deste trabalho é descrever a metodologia do Registo Nacional de Controlo do Pes... more Resumo O objetivo deste trabalho é descrever a metodologia do Registo Nacional de Controlo do Peso e descrever os participantes quanto à sua história individual e familiar relacionada com o peso, tentativas anteriores de redução deste e caraterização psicossocial. A amostra inclui 198 adultos (idade: 39,7 ± 11,1anos; IMC: 26,0 ± 3,9kg/m 2 ), 59% mulheres, que completaram um questionário abordando questões demográficas, motivações e atitudes, e estratégias de perda e de manutenção do peso. Os participantes reportaram uma perda do peso média de 17,4kg e uma duração média de manutenção do peso perdido de 29 meses. Relativamente ao número de tentativas de redução do peso reportadas, 73% indicou ter iniciado uma dieta no máximo por três vezes e 34% reportou ter tentado perder peso apenas uma vez no passado. Este estudo irá permitir conhecer com mais detalhe e representatividade as caraterísticas e as estratégias adoptadas por estas pessoas bem sucedidas na manutenção do peso perdido no longo prazo e contribuir para identificar variáveis preditoras da gestão bem sucedida do peso a longo prazo. Palavras-chave Abstract The scope of this article is to describe the Portuguese Weight Control Registry (PWCR) methodology and the participants currently enrolled specifically with respect to their individual and family weight history, previous weight loss attempts, and psychosocial characteristics. One hundred and ninety-eight adults (age: 39.7±11.1 years; BMI: 26.0±3.9 kg/m2), 59% women, filled out a questionnaire about demographics, healthrelated behaviors and motivation, and methods and strategies used to lose and/or maintain weight loss. Participants reported an average weight loss of 17.4 kg for an average of 29 months. Concerning the number of weight loss attempts, 73% of participants reported a maximum of three attempts of going on a diet, and 34% indicated only one attempt to lose weight in the past. The PWCR now features a considerable number of successful longterm weight loss maintainers in Portugal.
Revista Gymnasium, 2013
This study was grounded on the Self-Determination Theory and had as main objective to determine t... more This study was grounded on the Self-Determination Theory and had as main objective to determine the relationship between the satisfaction of the basic psychological needs (BPN) for autonomy, competence and positive interpersonal involvement and the motivational regulations presented (autonomous vs. controlled)
Obesity Facts, 2013
Objective: Successful weight management relies heavily on eating and exercise behaviors.
Revista Portuguesa de Cardiologia, 2013
O que o cardiologista deve saber sobre diabetes: investir no capital vascular Cardiologia Volume ... more O que o cardiologista deve saber sobre diabetes: investir no capital vascular Cardiologia Volume 32 • Suplemento I Abril 2013 Órgão Oficial da Sociedade Portuguesa de Cardiologia O que O cardiOlOgista deve saber sObre diabetes: investir nO capital vascular
Journal of Behavioral Medicine, 2013
The purpose of this study was to evaluate health-related quality of life and other psychosocial c... more The purpose of this study was to evaluate health-related quality of life and other psychosocial characteristics, including eating self-regulation and body image, in a group of successful long-term weight loss maintainers. Women enrolled in the Portuguese Weight Control Registry (n = 107) were matched and compared to women at the end of a behavior weight loss treatment program (n = 107), and also with women in the community who were not trying to lose weight (n = 107). Successful maintainers displayed higher quality of life and a more positive profile in selected eating and exercise markers of self-regulation compared to similarly-weighed women not attempting weight loss, but not when compared to the 'weight loss treatment' group. However, results also suggest that concerns with body shape and size may persist after weight loss and that some aspects of well-being and eating self-regulation can be more successfully targeted in specific weight loss programs.
Revista Portuguesa de Saúde Pública, 2012
Psicologia, Saúde & Doenças, 2012
________________________________________________________________________________________ RESUMO-E... more ________________________________________________________________________________________ RESUMO-Este estudo descreve o processo de adaptação da versão portuguesa, de 21 itens, da Basic Need Satisfaction in General Scale da teoria de auto-determinação. O instrumento é composto por três subescalas que correspondem às três necessidades básicas (a) competência, (b) autonomia e (c) relações de pertença. Foi administrado em dois estudos independentes, 420 e 408 participantes respectivamente, com amostras de conveniência da comunidade. A primeira fase incluiu tradução, retroversão e retradução; inspecção da equivalência lexical e de conteúdo; e reflexão falada. No processo de adaptação é aferido se a validade de conteúdo está de acordo com a teoria original. O estudo métrico revela valores baixos na consistência interna em algumas das subescalas. Numa análise exploratória inicial, em ambos os estudos, emergem três factores no scree plot, a maioria dos itens apresenta carga factorial apropriada no primeiro factor. Os resultados sugerem que a escala poderá ser utilizada na população portuguesa assumindo os princípios teóricos definidos pelos autores originais e reconhecidos na investigação.
International Journal of Behavioral Nutrition and Physical Activity, 2012
Background: Slow eating has been associated with enhanced satiation, but also with increased wate... more Background: Slow eating has been associated with enhanced satiation, but also with increased water intake. Therefore, the role of water ingestion in regard to eating rate needs to be discerned. This study examined the influence of eating rate on appetite regulation and energy intake when water intake is controlled.
BMC Public Health, 2012
Background: The prevalence of overweight and obesity in Europe is high. It is a major cause of th... more Background: The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM).
International Journal of Behavioral Nutrition and Physical Activity, 2012
Background: Motivation is a critical factor in supporting sustained exercise, which in turn is as... more Background: Motivation is a critical factor in supporting sustained exercise, which in turn is associated with important health outcomes. Accordingly, research on exercise motivation from the perspective of self-determination theory (SDT) has grown considerably in recent years. Previous reviews have been mostly narrative and theoretical. Aiming at a more comprehensive review of empirical data, this article examines the empirical literature on the relations between key SDT-based constructs and exercise and physical activity behavioral outcomes.
Medicine and Science in Sports and Exercise, 2012
Purpose: This study examined effects of a behavioral weight management intervention on body image... more Purpose: This study examined effects of a behavioral weight management intervention on body image (evaluative and investment dimensions) and explored the potential mediating role of structured and lifestyle physical activity (PA). Methods: The study was a longitudinal randomized controlled trial, including a 1-yr behavior change intervention and a 2-yr follow-up (225 women, 37.6 T 7 yr, body mass index = 31.5 T 4.1 kgIm j2 ). Statistical analyses comprised mixed-design ANOVAs with repeated measures, bivariate/partial correlations, and mediation analyses. Results: Body image improved considerably in both groups, favoring the intervention group (small to moderate effect sizes: 0.03-0.05), but began to deteriorate from 12 to 24 months, especially in the intervention group. Consequently, at 24 months, between-group differences were small and did not reach significance. Yet, levels of body dissatisfaction and dysfunctional investment remained below initial values (for both groups). Results were similar for both body image dimensions. Structured PA (at 12 and 24 months) and lifestyle PA (at 24 months) were positively associated with (r 9 j0.25, P G 0.05) and partially mediated body image improvements, especially in the investment component (95% confidence interval of j1.88 to j0.27 for structured PA at 12 months, 95% confidence interval of j1.94 to j0.21 for lifestyle PA at 24 months). In general, change in evaluative body image was not mediated by exercise participation, seeming more dependent on weight change. Conclusions: These findings highlight the importance of PA as a contributing factor in the improvement of body image in overweight/obese women, mainly by reducing excessive salience of appearance to one's life and self. Lifestyle PA may also be a valid option, particularly in the long term. Exercise might provide a buffer against body image deterioration overtime, favoring lasting weight loss maintenance.
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](Treino da Força: Fundamentos e Aplicações
ACSM’s Behavioral Aspects of Physical Activity and Exercise, 2013
130 ACSM's Behavioral Aspects of Physical Activity and Exercise • www.acsm.org One of the biggest... more 130 ACSM's Behavioral Aspects of Physical Activity and Exercise • www.acsm.org One of the biggest challenges facing practitioners is that physical activity (PA) counseling must take into account both individual motivational variables (e.g., whether an individual wants to exercise or not, perceived barriers to being physically active) and the sociocultural context in which we live. A natural tendency for some practitioners is to attempt to motivate a client by showing clients the error of their ways; using fear messages or exhortation or by prescribing a ready-made exercise plan. However, these approaches often fail to yield the desired results. Indeed, in much the same way that most people in the developed world know that smoking tobacco is dangerous for their health, they also already know that being more physically active is something they "should do" to be healthier. Yet most are not doing enough of it. Information is not the key driver.
Body Image: Gender Differences, Sociocultural Influences and Health Implications, 2013
Body image investment refers to the psychological significance that people attribute to their bod... more Body image investment refers to the psychological significance that people attribute to their body image evaluations and to the consequences of those evaluations to their selfdefinition and adaptive functioning. The current social environment fosters the development of a dysfunctional body image investment, due to the high emphasis placed on the pursuit of ultra-slender body ideals and concurrent devaluation and stigmatization of overweight and obesity. Appearance becomes central to many people's identity, and their self-worth and well-being contingent on meeting the thin body ideals, achievable by only a few. As a result, many people, especially women, feel pressured to lose weight and end up engaging in unhealthy, often non-sustainable, behavioral efforts to lose weight and improve appearance. However, being motivated to lose weight for reasons such as changing appearance and body weight could be experienced as controlling and/or as a self-imposed pressure to engage in treatment. Consequently, it can elicit a less autonomous form of self-regulation regarding weight-related behaviors, which in turn might constitute an additional obstacle to successful and sustainable weight management.
Encyclopedia of Exercise Medicine in Health and Disease, 2012
Exercise and Chronic Disease: an Evidence-Based Approach, 2011
Personal Autonomy in Cultural Contexts: Global Perspectives on The Psychology of Agency, Freedom, and People's Well-Being, 2011