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James Annesi

Background:

Behavioral interventions for weight-loss have been largely unsuccessful. Exercise is the strongest predictor of maintained weight loss and much of its effects may be from associated changes in psychosocial factors.

Methods:

Middle-aged, formerly sedentary adults with severe obesity were randomly selected to 6-month treatments of cognitive-behavioral exercise support paired with either standard nutrition education (n = 99) or nutrition change supported by cognitive-behavioral means with an emphasis on self-regulation (n = 101).

Results:

Overall improvements in self-efficacy and self-regulation for both exercise and managed eating, and mood, were found, with significantly greater improvements associated with the cognitive-behavioral nutrition condition in self-regulation for eating and mood. Change scores trended toward being stronger predictors of increased exercise and fruit and vegetable intake than scores at treatment end. Multiple regression analyses indicated that significant portions of the variance in both increased volume of exercise (R 2 = 0.45) and fruit and vegetable intake (R 2 = 0.21) were explained by changes in self-regulatory skill usage, self-efficacy, and mood.

Conclusions:

Cognitive-behavioral methods for improved eating paired with behavioral support of exercise may improve weight loss through effects on the psychosocial factors of self-regulation, self-efficacy, and overall mood more than when standard nutrition education is incorporated.

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James Annesi

Background: Physical activity is a strong predictor of sustaining weight loss. Yet physical activity has been challenging to maintain. Adolescent bariatric surgery is increasing, and there is typically an initial 6-month period when improving health behaviors such as physical activity are addressed by a clinic-based team. However, there is minimal understanding of how to target psychosocial factors relevant for behavioral changes. Methods: A group of 15 adolescent candidates for bariatric surgery (mean age = 15.1 y; mean body mass index = 55.9 kg/m2) were assessed on changes in 3 theory-based predictors of physical activity from baseline–month 3 and baseline–month 6. Results: Changes in physical activity-related self-regulation and self-efficacy over 3 months significantly predicted change in physical activity over 6 months. Reciprocal relationships were also significant, including the prediction of physical activity change by change in negative mood. The clinical psychology-based factor of weight-related quality-of-life significantly moderated the prediction of self-regulation via physical activity, and degree of depressive symptoms significantly moderated the prediction of changes in physical activity through self-efficacy changes. Conclusions: Because improvements in several theory-based psychosocial variables related to physical activity have demonstrated a carry-over to controlling eating, the improved understanding of those variables for treating adolescents with severe obesity was useful.

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James J. Annesi

Effects of a precompetitive anxiety regulation system, based upon tenets of the individual zones of optimal functioning (IZOF) model, multidimensional anxiety theory, and the specific-effects hypothesis, were tested. In Phase I, case studies (3 elite adolescent tennis players) were used to analyze the IZOF model within a multidimensional state anxiety framework. In Phase II, the effectiveness of a precompetitive anxiety regulation system, based upon IZOF and the specific-effects hypothesis, was tested for enhancing match performance. Essential elements of IZOF theory were supported. In Phase II, inzone/out-of-zone A-state assessment was used to guide athletes’ treatment selections. After training athletes in prematch psychological skills designed to regulate specific cognitive state anxiety, somatic state anxiety, and state selfconfidence dimensions, posttreatment performances yielded higher values (ps < .05) than pretreatment. The need to replicate findings through different sample types, sports, and expertise levels was emphasized. Concerns with intrusion into athletes’ precompetitive routines were discussed.

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James J. Annesi

The accuracy of athletes in recalling precompetition anxiety was tested using the Competitive State Anxiety Inventory-2. Young and adolescent female gymnastics and field hockey athletes (N = 34) were tested one hour precompetition and again 48 hours postcompetition (with instructions to recall precompetition feelings). Correlations were significantly different (weaker) than when the State-Trait Anxiety Inventory was used within the same time frame (Harger & Raglin, 1994). After establishing individual “zones” around actual state anxiety values, based on individual zone of optimal functioning (IZOF) theory (Hanin, 1980, 1986, 1989), it was determined that the weaker correlations in the present study translated into enough incorrect in-zone/out-of-zone assessments that two-day recall, using the CSAI-2, may not be useful for IZOF research and practice. The necessity to further this research with other samples and sports was emphasized. The possibility of using alternate methods was discussed in an effort to provide accurate, minimally intrusive state anxiety measurement which may, ultimately, guide practitioners in effective intervention design through the use of IZOF, multidimensional anxiety theory, and the specific-effects (matching) hypothesis.

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James J. Annesi

Background: Physical activity (PA)–related mood improvement is important because it positively affects predictors of weight-management behaviors. Methods: Decline in PA, mood, and exercise self-efficacy after an initial 6 months of gains were assessed in 93 women in a behavioral obesity treatment. Results: Reduction in change in PA during months 6 to 24, but not actual PA, significantly predicted increased negative mood. For participants whose negative mood increased, their 7 days per week PA regimens were reduced by ∼2.5 days per week versus ∼1 day per week without an increase. Exercise self-efficacy significantly mediated the PA–mood change relationship. Conclusions: Mood-related benefits of sustaining PA beyond initial treatment months were clarified.

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James J. Annesi

Background: The relationship between exercise and long-term weight loss is definitive. However, in deconditioned individuals, the basis of that relationship beyond minimal energy expenditures is unclear. Effects emanating from exercise’s proposed association with changes in emotional eating and its psychosocial correlates were tested. Methods: Women with class 1 (n = 67) and class 2 (n = 53) obesity, participating in a new community-based weight-loss treatment based on tenets of social cognitive theory, were assessed at baseline and Months 3, 6, 12, and 24 on weight and measures of exercise outputs, emotional eating, eating self-regulation, and negative mood. An exercise-support component was provided for 2 months prior to group nutrition-change sessions. Results: Improvements from baseline were significant on all measures but did not significantly differ by group. Although not for the initial 3 months, changes in exercise significantly predicted weight changes over 6, 12, and 24 months from baseline. However, only 26%–31% of the lost weight was directly attributable to exercise-related energy expenditures. Changes in emotional eating significantly mediated the exercise–weight-loss relationship, and changes in self-regulation and mood significantly mediated the exercise–emotional eating relationship. Conclusions: Findings supported exercise’s role in long-term weight loss primarily through psychosocial factors.