We examine the concepts of stress, distress, and eustress and develop three tenets that are used to relate these concepts to three major theories or models of occupational stress. Selye's concept of eustress or “good stress” appears to be largely ignored in the literature, while the Yerkes Dodson Law is illustrated as a model for management practice. We suggest that the meaning assigned to the word stress has shifted from Selye's original formulation, and that this shift, in conjunction with the use of the Yerkes Dodson Law leads to inappropriate management of stress in organizations. We conclude that the concept that some stress is good and enhances performance should be rejected in favour of more useful and accurate concepts.

Objectives-An 18 month prospective injury survey was conducted on 64 Australian elite and subelite female gymnasts. The aims were to determine the rate of injury, anatomical location, and types of injury incurred by female competitive gymnasts, and to compare the findings with data collected retrospectively from the same sample of gymnasts. Methods-Thegymnasts recorded (weekly) in an injury record booklet the number of hours trained and information on any injuries suVered over that week. Results-The sample reported 349 injuries, a rate of 5.45 per person (6.29 for the elite and 4.95 for subelite gymnasts) over the 18 month survey. Injuries to the ankle and foot (31.2%) were the most commonly reported, followed by the lower back (14.9%). The most prevalent type of injury were sprains (29.7%), followed by strains (23.2%), and growth plate injuries (12.3%). The elite gymnasts reported that, for each injury, they missed fewer training sessions (p = 0.01), but modified more sessions (p = 0.0001) than their subelite counterparts. Further, the elite gymnasts spent 21.0% of the year training at less than full capacity because of injury. Although a significantly higher number of injuries were recorded in the prospective study (p = 0.0004), no diVerences were found between the distribution of injury by anatomical location or type between the two methods of data collection. Conclusions-The findings have important implications in terms of training procedures and periodic screening of gymnasts. (Br J Sports Med 1999;33:312-318)

Objective. To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA). Methods. A total of 168 inactive adults ages ‡50 years with knee pain on a numeric rating scale ‡4 (NRS; range 0-10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n 5 84) or PTonly (n 5 84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT1coaching participants also received 6-12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0-68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data. Results. A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) 20.4, 1.3]) and in WOMAC function (1.8 [95% CI 21.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT1coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes. Conclusion. The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program.

Research on variables that encourage older adults to exercise is limited. This study was carried out to identify the participation motives of older Australians involved in regular exercise and sport. The 815 participants (399 men, 416 women) ranged in age from 55 to 93 years (M = 63.6, SD = 7.8) and were participating in their activities of choice at least once per week. All participants completed the Participation Motivation Questionnaire for Older Adults. The most common exercise/sport activities that participants were involved in were walking, golf, lawn bowls, tennis, and swimming. The most highly reported motives for participation were to keep healthy, liking the activity, to improve fitness, and to maintain joint mobility. Principal-components analysis of the questionnaire revealed 6 factors: social, fitness, recognition, challenge/benefits, medical, and involvement. Analyses of variance showed significant differences in reasons for participation in exercise and sport based on gender, age, education level, and occupation.

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10Objective. To assess the effect of an intervention designed to enhance physiotherapists' 11 communication skills on chronic low back pain patients' adherence to home-based rehabilitation 12 recommendations. 13Design. Cluster randomized controlled trial. 14 Setting. Publicly funded physiotherapy clinics in Dublin, Ireland 15 Participants. Physiotherapists (N = 53) and patients with chronic low back pain (N = 255, 54% 16 female, M age = 45.3 years). 17 Interventions. Patients received publicly funded individual physiotherapy care. In the control arm, 18 care was delivered by a physiotherapist who had completed a 1-hour workshop on evidence-based 19 chronic low back pain management. Patients in the experimental arm received care from 20 physiotherapists who had also completed 8 hours of communications skills training. 21 Main Outcome Measure. Patient-reported adherence to their physiotherapist's recommendations 22regarding home-based rehabilitation, measured at 1, 4, 12, and 24 weeks after initial treatment 23 session. Pain and pain-related function measured at baseline, 4, 12 and 24 weeks. 24Results. Linear mixed model analysis showed the experimental arm patients' ratings of adherence 25 were greater than controls (overall mean difference = .41 [95% CI = .10 to .72, d = .28, p = .01). 26Moderation analyses showed that men, regardless of intervention, showed improvements in pain-27 related function over time. Only women in the experimental condition showed functional 28 improvements; female controls saw little change in function over time. The CONNECT 29 intervention did not influence patients' pain, regardless of their sex. 30 Conclusions. Communication skills training for physiotherapists had short-term positive effects on 31 patient adherence. This training may provide a motivational basis for behavior change and could be 32 a useful component in complex interventions to promote adherence. Communication skills training 33 may also improve some clinical outcomes for women, but not men. Trial 34 registration: ISRCTN63723433. 35 3 Abbreviations. 37 CONNECT: Communication Style and Exercise Compliance in Physiotherapy 38 RCT: Randomized controlled trial 39 40 41 4Patient adherence to interventions based on self-management principles is often poor [1]. For 42 example, patients with chronic musculoskeletal conditions often do not complete their home-based 43 exercise programs as recommended by their healthcare practitioners [2, 3]. Poor adherence to 44 treatment recommendations is problematic for both clinicians and patients, as it can limit the 45 potential for positive treatment outcomes [4, 5]. Despite acknowledgement that interventions 46 targeting patient behavior should be grounded in relevant behavior change theory [6], there is 47 limited evidence regarding the effect of theory-based interventions to promote adherence in chronic 48 pain populations [7][8][9]. 49According to self-determination theory [10] people have psychological needs for autonomy 50 (feeling free to engage in an activity), competence (feel...

Background/AimWeb 2.0 internet technology has great potential in promoting physical activity. This trial investigated the effectiveness of a Web 2.0-based intervention on physical activity behaviour, and the impact on website usage and engagement.Methods504 (328 women, 126 men) insufficiently active adult participants were randomly allocated to one of two web-based interventions or a paper-based Logbook group. The Web 1.0 group participated in the existing 10 000 Steps programme, while the Web 2.0 group participated in a Web 2.0-enabled physical activity intervention including user-to-user interaction through social networking capabilities. ActiGraph GT3X activity monitors were used to assess physical activity at four points across the intervention (0, 3, 12 and 18 months), and usage and engagement were assessed continuously through website usage statistics.ResultsTreatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). In the Web 2.0 group, physical activity increased at 3 (mean change 6.8 min/day, 95% CI 3.9 to 9.6) and 12 months (3.8 min/day, 95% CI 0.5 to 7.0), but not 18 months. The Logbook group also increased physical activity at 3 (4.8 min/day, 95% CI 1.8 to 7.7) and 12 months (4.9 min/day, 95% CI 0.7 to 9.1), but not 18 months. The Web 1.0 group increased physical activity at 12 months only (4.9 min/day, 95% CI 0.5 to 9.3). The Web 2.0 group demonstrated higher levels of website engagement (p=0.3964).ConclusionsIn comparison to a Web 1.0 intervention, a more interactive Web 2.0 intervention, as well as the paper-based Logbook intervention, improved physical activity in the short term, but that effect reduced over time, despite higher levels of engagement of the Web 2.0 group.Trial registration numberACTRN12611000157976.

This paper investigates the motives for (Study 1) and barriers to (Study 2) participation in physical activity by older Asian Indian immigrants to the United States. In Study 1, 100 older Asian Indians living in the United States completed the Participation Motivation Questionnaire for Older Adults. The most highly reported motives for participation were based around medical reasons and keeping healthy and active. Analyses of variance showed significant differences in reasons for participation in physical activity based on gender and age. In