BACKGROUND: Head tremor poses diagnostic problems, especially when present as an isolated or predominant symptom. OBJECTIVES: To assess how maneuvers activating upper limb postural tremor can help differentiate head tremor in essential tremor (ET) from dystonic tremor (DT) in cervical dystonia. METHODS: 48 patients with head tremor (25 ET, 23 DT), underwent clinical examination and accelerometric evaluation of head and upper limb tremor during routine tremor-inducing tasks. RESULTS: While accelerometric power and clinical scores of head tremor did not significantly differ between patient groups, task-induced variations revealed distinctions. ET patients exhibited increased head tremor power and clinical scores during forward outstretched and lateral wing-beating arm positions, unlike DT patients. Coherence between head and upper limb tremor remained consistent. Tremor stability index showed no significant differences. CONCLUSIONS: Task-induced changes in head tremor could aid in distinguishing between ET and DT. Further research is needed to refine diagnostic approaches for head tremor.
- MeSH
- Accelerometry instrumentation methods MeSH
- Diagnosis, Differential MeSH
- Adult MeSH
- Dystonia diagnosis physiopathology MeSH
- Essential Tremor * diagnosis physiopathology MeSH
- Head * physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Arm * physiopathology MeSH
- Posture physiology MeSH
- Aged MeSH
- Torticollis diagnosis physiopathology MeSH
- Tremor * diagnosis physiopathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Cíl: Cílem studie je zjistit, zda existují rozdíly v 24hodinovém pohybovém chování, tj. spánku, sedavém chování (SB) a pohybové aktivitě (PA), u 3–8letých dívek a chlapců z rodin s odlišným socioekonomickým zázemím. Metodika: 24hodinové pohybové chování bylo kontinuálně monitorováno po dobu 7 dnů prostřednictvím akcelerometrů u rodin s 3–8letými dětmi z městských a venkovských obcí z regionů Čech, Moravy a Slezska. Socioekonomický status rodin (SES) byl zjišťován pomocí Škály rodinného blahobytu vyplňované rodiči na konci monitorování. Finálně analyzovaný soubor tvoří reprezentativní vzorek 363 rodin s dostupnými daty o 24hodinovém pohybovém chování a SES. Analýza rozptylu byla použitá pro identifikování rozdílů v pohybovém chování dětí s ohledem na jejich pohlaví a SES. Výsledky: Celková doba spánku (resp. hlubokého spánku), jako nejdelší složka z 24hodinového chování, trvala u dětí v rozmezí 9,05–9,32 (resp. 7,51–7,83) hodin denně bez statisticky významných rozdílů mezi dívkami a chlapci nebo dětmi s odlišným SES. V délce trvání každodenního SB (7,63–8,33 hodin), celkové PA (6,61–7,05 hodin) ani PA střední až vysoké intenzity (70–82 minut) nebyl nalezen statisticky významný rozdíl mezi dívkami a chlapci či dětmi s nízkým, středním a vysokým SES. Závěr: Socioekonomický status rodin ani pohlaví dítěte nejsou zdroji rozdílu v délce trvání celkového ani hlubokého spánku, SB či celkové PA 3–8letých dívek a chlapců z rodin s odlišným socioekonomickým zázemím.
Objective: The aim of this study is to investigate whether there are differences in 24-hour physical behaviours, i.e., sleep, sedentary behaviours (SB), and physical activity (PA), in 3–8-year-old girls and boys from families with different socioeconomic backgrounds. Methods: 24-hour movement behaviour was continuously monitored for seven days using accelerometers in families with 3–8-year-old children from urban and rural areas from the regions of Bohemia, Moravia and Silesia. Socioeconomic status (SES) of families was measured using the Family Affluence Scale completed by parents at the end of the monitoring. The final analysis set is a representative sample of 363 families with available data on 24-hour movement behaviour and SES. Analysis of variance was used to identify differences in children’s movement behaviour with respect to their gender and SES. Results: Total sleep time (or deep sleep), as the longest component of the 24-hour behavioural time, ranged from 9.05–9.32 (or 7.51–7.83) hours per day for children with no statistically significant differences between girls and boys or children with different SES. There was no statistically significant difference in the duration of daily SB (7.63–8.33 hours), total PA (6.61–7.05 hours) or moderate to high intensity PA (70–82 minutes) between girls and boys or children with low, moderate, and high SES. Conclusion: Neither the socioeconomic status of families nor the gender of the child are the sources of differences in the duration of total or deep sleep, SB or total PA of 3–8-year-old girls and boys from families with different socioeconomic backgrounds.
- MeSH
- Accelerometry methods instrumentation MeSH
- Child MeSH
- Humans MeSH
- Motor Activity * MeSH
- Observation MeSH
- Child, Preschool MeSH
- Surveys and Questionnaires MeSH
- Sedentary Behavior MeSH
- Socioeconomic Factors * MeSH
- Sleep MeSH
- Statistics as Topic MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Child, Preschool MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Assessing parent-child relationship in sleep behaviours is important for facilitating changes in the sleep guideline compliance in preschool age children. The aim of this study was to examine accelerometer-measured sleep quantity and quality in families with children aged 3-8 years and investigate the parents' influence on the child's sleep. The data were obtained from the Czech cross-sectional FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study, with a final sample of 374 families. Families were recruited through the enrolment of their children in kindergartens/primary schools between March 2022 and May 2023. The sleep time window and total sleep time were assessed using a wrist-worn ActiGraph accelerometer. Participants wore this device continuously for 24 h/day over a period of 7 consecutive days. Demographic data and potential correlates were obtained via questionnaires completed by parents. Statistical analyses were completed using logistic regression and independent-samples Mann-Whitney U test. In all, 65.5% of children (60% boys, 70.9% girls) and 58.3% of parents (52.4% fathers, 64.3% mothers) achieved the recommended sleep duration. Greater sleep quantity and duration in good-quality sleep were significantly higher in girls/mothers, compared to boys/fathers. Preschoolers were more likely to comply with sleep guidelines if their mother (but not father) met the sleep recommendation and their mothers did not have a higher education level. Adhering to sleep guidelines in children was also associated with children's female gender, absence of screen device in the bedroom, and being more active. Given the high concurrence in mother-child sleep quantity, it is important to promote healthy sleep behaviours in the whole family.
- MeSH
- Accelerometry * instrumentation MeSH
- Exercise * MeSH
- Child MeSH
- Guideline Adherence * statistics & numerical data MeSH
- Adult MeSH
- Sleep Quality MeSH
- Humans MeSH
- Child, Preschool MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Parents MeSH
- Sedentary Behavior * MeSH
- Sleep * physiology MeSH
- Parent-Child Relations * MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Chronická plicní onemocnění, z nichž nejčastěji se vyskytujícím je chronická obstrukčníplicní nemoc (CHOPN), u nás ročně připraví o život asi 3 500 pacientů. Jedním z faktorů,který může přispívat ke zhoršení zdravotního stavu těchto pacientů, je nedostatek pohybovéaktivity (PA). Cílem příspěvku je popsat vliv plicní rehabilitace a následné telerehabilitace natoleranci zátěže a úroveň PA u pacientky s CHOPN. Při zahájení rehabilitační léčby nebylaúroveň PA dostatečná a převládal sedavý způsob života. Po absolvování ambulantní rehabi-litační léčby došlo k navýšení denního počtu kroků z 2 437 na 5 093 a toto navýšení se podařiloudržet i během následující dvouměsíční telerehabilitace. U pacientky se zlepšila i tolerancezátěže, kvalita života a snížil se výskyt únavy. Subjektivně vnímala přínos léčby i ve sníženízávislosti na pomoci manžela. Z uvedené kazuistiky vyplývá přínos rehabilitační léčby a ná-sledné telerehabilitace na snazší vykonávání běžných denních i pohybových činností. Protoby bylo vhodné při zjištění nedostatečné úrovně PA zařadit pacientům do komplexní léčbytaké plicní rehabilitaci a pro udržení jejich benefitů i následnou telerehabilitaci.
Chronic obstructive pulmonary disease (COPD) is the most frequent one among chronicpulmonary diseases. It is a cause of death in 3 500 patients in the Czech Republic per year.One of the factors which possibly contribute to the worsening of the health status is a lack ofphysical activity (PA). Therefore, this article should aim to describe the impact of pulmonaryrehabilitation and the following telerehabilitation program on the level of PA in patients withCOPD. The PA level of this patient had not been sufficient before the rehabilitation program.She manifested predominantly sedentary behaviour. After the pulmonary rehabilitation pro-gram, she manifested an increased number of steps/day – 2 437 vs. 5 093. The increase wasmaintained during the two-month telerehabilitation program as well. The exercise toleranceand quality of life were higher after the pulmonary rehabilitation program and telerehabili-tation. The patient subjectively perceived benefits of this treatment mainly because of de-creased dependence on her husband’s help. This case study demonstrates the positive effectof the rehabilitation treatment and the following telerehabilitation on daily-life activities aswell as PA. We stress the suitability of pulmonary rehabilitation when the lack of PA is presentin a COPD patient. Moreover, telerehabilitation seems to improve the persistence of pul-monary rehabilitation benefits.
- MeSH
- Accelerometry instrumentation MeSH
- Anti-Asthmatic Agents therapeutic use MeSH
- Pulmonary Disease, Chronic Obstructive * rehabilitation therapy MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Sleep MeSH
- Spirometry statistics & numerical data MeSH
- Telerehabilitation * methods MeSH
- Exercise Therapy MeSH
- Exercise Tolerance MeSH
- Treatment Outcome MeSH
- Exercise Test methods statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Purpose: School physical activity (SPA) is a significant component of daily PA. We investigated differences in PA between boys and girls in two differing education systems-Poland and the Czech Republic-which have four and two physical education lessons (PELs) per week, respectively. Method: This project was conducted from 2012-2016 at 17 Polish and 23 Czech secondary schools (N = 921; mean age = 16.2 ± 0.7 years). ActiTrainer accelerometers were used to monitor participants' PA and heart rate during school days. Weekly PA was measured using pedometers. Subjective levels of weekly PA were self-reported on the International Physical Activity Questionnaire-long form. Results: The Polish education system enabled adolescents to meet the recommendations for moderate-to-vigorous PA more likely than did the Czech system. SPA also represented a higher portion of daily PA in the Polish (vs. Czech system); however, the differences in total daily step count between Polish and Czech adolescents were non-significant. SPA accounted for 30-37% of the daily PA (as measured by step count) of Polish girls (23-30% of Czech girls) and 28-39% of Polish boys (25-37% of Czech boys). Conclusions: Participation in PELs was associated with a higher rate of meeting SPA recommendations in both countries. Compared with the Czech Republic, more PELs in the Polish education system was associated with increased daily vigorous PA and a greater portion of SPA in daily PA. Differences in overall daily and weekly moderate-to-vigorous PA between Polish and Czech adolescents were non-significant.
- MeSH
- Accelerometry instrumentation MeSH
- Time Factors MeSH
- Exercise * physiology MeSH
- Humans MeSH
- Adolescent MeSH
- Wearable Electronic Devices MeSH
- Heart Rate MeSH
- Physical Education and Training * MeSH
- Healthy Lifestyle MeSH
- Self Report MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
- Poland MeSH
INTRODUCTION: Although numerous activity trackers have been validated in healthy populations, validation is lacking in chronic heart failure patients who normally walk at a slower pace, making it difficult for researchers and clinicians to implement activity monitors during physical activity interventions. METHODS: Six consumer-level activity monitors were validated in a 3-day field study in patients with chronic heart failure and healthy individuals under free living conditions. Furthermore, the same devices were evaluated in a lab-based study during treadmill walking at speeds of 2.4, 3.0, 3.6, and 4.2 km·h-1. Concordance correlation coefficients (CCC) were used to evaluate the agreement between the activity monitors and the criterion, and mean absolute percentage errors (MAPE) were calculated to assess differences between each device and the criterion (MAPE <10% was considered as a threshold for validity). RESULTS: In the field study of healthy individuals, all but one of the activity monitors showed a substantial correlation (CCC ≥0.95) with the criterion device and MAPE <10%. In patients with heart failure, the correlation of only two activity monitors (Garmin vívofit 3 and Withings Go) was classified as at least moderate (CCC ≥0.90) and none of the devices had MAPE <10%. In the lab-based study at speeds 4.2 and 3.6 km·h-1, all activity monitors showed substantial to almost perfect correlations (CCC ≥0.95) with the criterion and MAPE in the range 1%-3%. However, at slower speeds of 3.0 and 2.4 km·h-1, the accuracy of all devices substantially deteriorated: their correlation with the criterion decreased below 90% and their MAPE increased to 4-8% and 10-45%, respectively. CONCLUSIONS: Even though none of the tested activity monitors fall within arbitrary thresholds for validity, most of them perform reasonably well enough to be useful tools that clinicians can use to simply motivate chronic heart failure patients to walk more.
- MeSH
- Accelerometry instrumentation methods MeSH
- Monitoring, Ambulatory instrumentation methods MeSH
- Chronic Disease MeSH
- Walking physiology MeSH
- Exercise physiology MeSH
- Adult MeSH
- Fitness Trackers MeSH
- Humans MeSH
- Reproducibility of Results MeSH
- Aged MeSH
- Heart Failure physiopathology MeSH
- Exercise Test instrumentation methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
PURPOSE: The aim of this study was to compare gait stability and variability between walking conditions and age groups. METHODS: Twenty-six healthy younger and older females participated. Trunk acceleration in the vertical (V), medial-lateral (ML) and anteriorposterior (AP) directions during 5 minutes walking overground and 3 minutes walking on the treadmill at self-selected speed were recorded. Root mean square and standard deviations of acceleration, stride time and its variability, Lyapunov exponents (LE), multiscale entropy (MSE) and harmonic ratios (HR) were computed. RESULTS: Both age groups showed significantly higher stride time variability and short-term LE in all directions during overground walking. For the older group, overground walking showed higher V and AP standard deviation. Significantly lower values for overground walking were observed for long-term LE (V and ML for the younger group, ML for the older group), HR (ML for the older group) and MSE (V for the older group). Significant age-related differences were found for V long-term LE for overground walking. CONCLUSIONS: The present findings suggest that both linear and advanced computational techniques for gait stability and variability assessment in older adults are sensitive to walking conditions.
- MeSH
- Accelerometry instrumentation MeSH
- Walking physiology MeSH
- Entropy * MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Nonlinear Dynamics * MeSH
- Aged MeSH
- Exercise Test * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
Východiska: Lokomoci osob s poraněním páteřní míchy v oblasti Th1–L2 zajišťuje především manuální pohon invalidního vozíku. Metodika měření objemu a intenzity jejich pohybové aktivity pomocí akcelerometru ActiGraph GT3X+ není dosud jednotně stanovena. Cíle: Hlavním cílem bylo charakterizovat vliv dominance horní končetiny u paraplegických osob na hodnocení objemu pohybové aktivity měřené pomocí akcelerometru ActiGraph GT3X+ v habituálních podmínkách. Vedlejším cílem studie bylo nalezení optimálního místa fixace akcelerometru ActiGraph GT3+ v průběhu měření. Metodika: Studie se zúčastnilo 14 probandů (3 ženy a 11 mužů), všichni s dominantní pravou horní končetinou. V průběhu jednoho dne měl každý z probandů upnut jeden třívektorový akcelerometr ActiGraph GT3X+ na dorzální straně zápěstí nedominantní horní končetiny, druhý na dorzální straně dominantní horní končetiny a třetí na straně nedominantní horní končetiny v oblasti pasu. V první variantě byla statisticky vyhodnocena data, která byla ponechána v surovém stavu. Ve druhé variantě byla data před statistickým zpracováním převedena na hodnoty aktivního energetického výdeje. Výsledky: Analýza výsledků prokázala nejednoznačnou dominanci pravé horní končetiny u pravorukých probandů v průběhu měření habituální pohybové aktivity. Statisticky nejvýznamnější korelační shoda byla zjištěna mezi objemy surových dat z akcelerometrů upnutých na nedominantních horních končetinách s akcelerometry upnutými v pase (0,737; p≤0,01). Závěry: Za optimální místo fixace akcelerometru ActiGraph GT3X+ pro snímání habituální pohybové aktivity paraplegiků bylo určeno zápěstí nedominantní horní končetiny.
Background: Mobility of persons with spinal cord injury in Th1-L2 area is primarily assured by manual wheelchair propulsion. It has not been exactly determined yet which methods have to be used to evaluate the volume and the intensity of their physical activity. Objective: The principal aim of this study was to characterize the influence of upper limb dominance in paraplegic persons on the evaluation of the volume of physical activity measured with the ActiGraph GT3X+ accelerometer in habitual conditions. The secondary aim was to determine the optimal fixation position of the accelerometer during the measurement of the habitual physical activity. Methods: The study involved 14 subjects, 3 women and 11 men, all of them with a dominant right upper limb. Each of them wore three accelerometers simultaneously, one each on the non-dominant wrist and dominant wrist and one on the waist on course of one day. The data obtained from the accelerometers were used in raw, not adapted numbers. In the second version, the data were calculated as units of active energy output. Results: The results showed arguable dominance of the right upper limbs during physical activity in habitual conditions. The results of the correlation match indicated the highest similarity between the raw data obtained from accelerometers fixed in the waist with the data from accelerometers fixed in the wrist of the non-dominant upper limb 0,737 (p ≤ 0,01). Conclusions: The wrist of the non-dominant upper limb was determined as the optimal fixation point for the ActiGraph GT3X+ accelerometer for reading the habitual physical activity of paraplegics.
BACKGROUND: Micra is a leadless pacemaker that is implanted in the right ventricle and provides rate response via a 3-axis accelerometer (ACC). Custom software was developed to detect atrial contraction using the ACC enabling atrioventricular (AV) synchronous pacing. OBJECTIVE: The purpose of this study was to sense atrial contractions from the Micra ACC signal and provide AV synchronous pacing. METHODS: The Micra Accelerometer Sensor Sub-Study (MASS) and MASS2 early feasibility studies showed intracardiac accelerations related to atrial contraction can be measured via ACC in the Micra leadless pacemaker. The Micra Atrial TRacking Using A Ventricular AccELerometer (MARVEL) study was a prospective multicenter study designed to characterize the closed-loop performance of an AV synchronous algorithm downloaded into previously implanted Micra devices. Atrioventricular synchrony (AVS) was measured during 30 minutes of rest and during VVI pacing. AVS was defined as a P wave visible on surface ECG followed by a ventricular event <300 ms. RESULTS: A total of 64 patients completed the MARVEL study procedure at 12 centers in 9 countries. Patients were implanted with a Micra for a median of 6.0 months (range 0-41.4). High-degree AV block was present in 33 patients, whereas 31 had predominantly intrinsic conduction during the study. Average AVS during AV algorithm pacing was 87.0% (95% confidence interval 81.8%-90.9%), 80.0% in high-degree block patients and 94.4% in patients with intrinsic conduction. AVS was significantly greater (P <.001) during AV algorithm pacing compared to VVI in high-degree block patients, whereas AVS was maintained in patients with intrinsic conduction. CONCLUSION: Accelerometer-based atrial sensing is feasible and significantly improves AVS in patients with AV block and a single-chamber leadless pacemaker implanted in the right ventricle.
- MeSH
- Accelerometry instrumentation MeSH
- Atrioventricular Block physiopathology therapy MeSH
- Equipment Design MeSH
- Adult MeSH
- Electrocardiography methods MeSH
- Pacemaker, Artificial * MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Follow-Up Studies MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Rate physiology MeSH
- Heart Ventricles physiopathology MeSH
- Heart Atria physiopathology MeSH
- Feasibility Studies MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
Dle zveřejněných ročenek Všeobecné zdravotní pojišťovny se za poslední desetiletí výrazně nemění počet případů cévních mozkových příhod a dalších poškození mozku a tendence výskytu těchto poškození spíše nepatrně klesá (24). Léčba těchto pacientů je však finančně velmi náročná (26). U pacientů po poškození mozku se projevuje celá řada obtíží. Těmi nejčastějšími jsou problémy motorické. Až 85 % pacientů postihuje funkční omezení (paréza), nebo úplná ztráta funkce (plegie) horní končetiny (22). Díky tomuto omezení nemohou pacienti zapojovat plně svoji horní končetinu do běžných denních činností (ADL), což může vést k jejich nesoběstačnosti a dlouhodobé závislosti na druhé osobě. Z toho důvodu jsou v rehabilitaci stále více využívány moderní technologie jako prostředek podporující rehabilitaci horních končetin (22). Mezi trendy současné doby se řadí možnost využití inerciálních senzorů, které jsou označovány jako neinvazivní systémy pro monitorování pohybu pacienta. Mezi inerciální senzory se řadí akcelerometry. Akcelerometr je přístroj nebo součást přístroje měřící zrychlení a může monitorovat pohyb např. horních končetin. Hlavní výhodou z pohledu ergoterapie je možnost monitorování tohoto pohybu během provádění ADL v přirozeném, domácím prostředí pacienta. Akcelerometry navíc také poskytují zpětnou vazbu, která pacientům umožňuje zpětně sledovat jejich pohyb a jejich event. zlepšení, a tím je motivuje, aby svou horní končetinu zapojovali do běžných denních činností. Monitorování a zpětná vazba jsou nezbytné principy v podpoře funkčního zdraví a vedou ke změně chování, jelikož cvičení je významně ovlivněno takzvanou "důvěrou uplatnit své vlastní schopnosti" (14, 22, 23).
According to published yearbooks of the General Health Insurance Company, the number of cases of cerebral vascular events and other brain damage has not changed significantly over the last decade, and the tendency for these damages tends to drop slightly. However, the treatment of these patients is very financially demanding (26). There are a number of difficulties in brain damage. The most common are motor problems. Up to 85% of patients suffer from functional impairment or complete loss of function of the upper limb (22). Because of this limitation, patients cannot fully engage their upper limb in the activities of daily living (ADL), which may lead to their incompetence and long-term dependence on the other person. For this reason, modern technology is increasingly used in rehabilitation as a means of rehabilitation of upper limbs (22). Current trends include the use of inertial sensors, which are referred to as non-invasive patient monitoring systems. Inertial sensors include accelerometers. Accelerometer is an instrument or part of an acceleration meter and can monitor the movement of the upper limbs. The main advantage from the perspective of occupational therapy is the possibility of monitoring this movement during the performance of ADL in the native, domestic environment of the patient. In addition, accelerometers provide feedback to allow patients to track their movement and event. improvement and thus motivates them to engage their upper limbs in ADL. Monitoring and feedback are essential principles in promoting functional health and lead to a change in behavior, as exercise is significantly influenced by the so-called "self-confidence to exercise one's own abilities" (14, 22, 23).
