An evaluation of three self-report physical activity instruments for older adults

Psychosocial mediators of physical activity and fruit and vegetable consumption in the Faith, Activity, and Nutrition programme

OBJECTIVE

Performing and publishing mediator analyses, whether significant or null, provides insight into where research efforts should focus and will assist in developing effective and powerful behaviour change interventions. The present study examined whether self-efficacy, social support and church support mediated changes in leisure-time physical activity (PA) and fruit and vegetable (F&V) consumption in a faith-based intervention.

DESIGN

A 15-month PA and F&V intervention, guided by the structural ecological model, targeted the social, cultural and policy influences within the church. Outcomes and mediators were measured at baseline and follow-up. Data were collected from 2007 to 2011. MacKinnon's product of coefficients tested for mediation.

SETTING

Sixty-eight African Methodist Episcopal churches in South Carolina, USA.

SUBJECTS

Five hundred and eighty-two (PA) and 588 (F&V) church members.

RESULTS

Despite the significant increases in PA and F&V consumption, none of the hypothesized mediators were significant mediators of change in PA or F&V consumption. When examining each path of the mediation model, the intervention did not change any of the hypothesized mediators. However, changes in some mediators were associated with changes in outcomes.

CONCLUSIONS

Although there was no significant mediation, the association between changes in mediators and changes in PA and/or F&V consumption suggest that these variables likely play some role in changing these behaviours. Future studies should consider mediation analyses a priori, putting careful thought into the types of measures used and the timing of those measures, while also being cognizant of participant and staff burden. Finding a balance will be fundamental in successfully understanding how interventions exert their effects.

Incidental and Planned Exercise Questionnaire for seniors: validity and responsiveness

PURPOSE

This study assessed the criterion validity and responsiveness of the Incidental and Planned Exercise Questionnaire (IPEQ) specifically developed for aging research.

METHODS

The sample comprised 315 community-dwelling inactive older adults (mean age = 73.2 yr) who participated in a trial investigating the effect of a walking program on falls. At baseline, a subsample (n = 177) also wore an accelerometer (ActiGraph GT1M) for 7 d, and 126 of those had four valid days or more of accelerometer data. Validity coefficients (Spearman ρ) were calculated between accelerometer counts per minute, average steps per day, average moderate- to vigorous-intensity physical activity (MVPA) using two cut points (760 and 1041 counts per minute), and IPEQ-MVPA (the sum of physical activity hours per week derived from nine IPEQ items excluding the indoor chores question). Responsiveness was the mean IPEQ change in the intervention group divided by the SD of the mean change in control group.

RESULTS

The correlation coefficients between IPEQ-MVPA and counts per minute per day and steps per day were 0.33 and 0.31, respectively. The coefficients with accelerometer MVPA at low and medium cut points were 0.29 and 0.33, respectively, and 0.26 and 0.35 for walking. The Bland-Altman plot showed increased errors with higher values of IPEQ-MVPA. IPEQ incidental physical activity questions and IPEQ as a whole were significantly correlated with accelerometer light intensity (100-760 counts per minute, ρ = 0.29 and 0.23). The 12-month responsiveness of total IPEQ was 0.30 and 0.44 for the "planned walking" item.

CONCLUSIONS

IPEQ provides a practical and valid measure of MVPA in surveillance and intervention studies. Incidental activities are mostly of a light-intensity nature, and their low ambulatory component may explain the lower correlation between IPEQ as a whole and accelerometer measures.

Assessing the effect of a physical activity intervention in a nursing home ecology: a natural lab approach

Background

Physical activity (PA) is not only an important marker of physical impairment, but also a pathway to improve quality of life and enhance cognitive and social functioning of old individuals. Yet, making interventional use of PA training as a means for prevention and enhancement of quality of life of nursing home residents has found very limited attention worldwide so far. That said, the project ‘Long-term Care in Motion’ (LTCMo) as a part of the INNOVAGE consortium (funded by the European Commission) has the following aims: Overall: Install and assess a socially innovative intervention in the nursing home ecology. Concrete: (a) Conceptualization of a multidimensional intervention program (resident and staff oriented) with the potential to promote PA in nursing home residents; (b) Mixed-methods assessment of the program based on automated recording as well as questionnaire data.

Methods/Design

LTCMo’s PA-related intervention has several components which are applied in parallel manner: (1) Residents are engaged in a physical exercise program that is based on multiple approaches: supervised group sessions, a serious games approach, and specific training in severely impaired persons; (2) Staff members will receive a competence training with a focus on PA motivation and facilitation of residents’ PA engagement. Primary outcome assessment (movement-related behavior of residents) is completely conducted by means of automated data collection strategies (accelerometer-based activity recording, sensor-based life space recording). This is enriched by a broad range of secondary outcomes (e.g., cognitive performance, depression of residents; behavioral and attitudinal components of staff). Pre-, post- and 3-month follow-up assessment will take place in the target intervention setting as well as in a waiting control condition in which we will also replicate the training and its assessment in a later step.

Discussion

Although we are faced with methodological challenges (e.g., rather small sample size; no randomized control trial), we believe that our approach has something to offer and indeed has some unique characteristics that may have the potential to contribute to the enhancement of nursing home residents’ quality of life and at the same time further PA-related research with vulnerable populations at large.

Trial registration

Current Controlled Trials ISRCTN96090441. Registered 31 July 2014.

Geospatial Relationships between Awareness and Utilization of Community Exercise Resources and Physical Activity Levels in Older Adults

Introduction. It is unclear if community-based fitness resources (CBFR) translate to heightened activity levels within neighboring areas. The purpose of this study was to determine whether awareness and utilization of fitness resources and physical activity differed depending on residential distance from CBFR. Methods. Four hundred and seventeen older adults (72.9 ± 7.7 years) were randomly recruited from three spatial tiers (≤1.6, >1.6 to ≤3.2, and >3.2 to 8.0 km) surrounding seven senior centers, which housed CBFR. Participants completed questionnaires on health history, CBFR, and physical activity, gathering data on CBFR awareness, utilization, and barriers, overall levels, and predictors to engagement in moderate to vigorous physical activity (MVPA). Results. Across spatial tiers, there were no differences in positive awareness rates of CBFR or CBFR utilization. Engagement in MVPA differed across spatial tiers (P < 0.001), with the >3.2 to 8.0 km radius having the highest mean energy expenditure. Across all sites, age and income level (P < 0.05) were significant predictors of low and high amounts of MVPA, respectively, and current health status and lack of interest represented barriers to CBFR utilization (P < 0.05). Conclusion. Closer proximity to CBFR did not impact awareness or utilization rates and had an inverse relationship with physical activity.

Yoga and self-reported cognitive problems in breast cancer survivors: a randomized controlled trial

OBJECTIVES

Cancer survivors often report cognitive problems. Furthermore, decreases in physical activity typically occur over the course of cancer treatment. Although physical activity benefits cognitive function in noncancer populations, evidence linking physical activity to cognitive function in cancer survivors is limited. In our recent randomized controlled trial, breast cancer survivors who received a yoga intervention had lower fatigue and inflammation following the trial compared with a wait list control group. This secondary analysis of the parent trial addressed yoga's impact on cognitive complaints.

METHODS

Posttreatment stage 0-IIIA breast cancer survivors (n = 200) were randomized to a 12-week, twice-weekly Hatha yoga intervention or a wait list control group. Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline, immediately postintervention, and 3-month follow-up.

RESULTS

Cognitive complaints did not differ significantly between groups immediately postintervention (p = 0.250). However, at 3-month follow-up, yoga participants' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23% lower than wait list participants' scores (p = 0.003). These group differences in cognitive complaints remained after controlling for psychological distress, fatigue, and sleep quality. Consistent with the primary results, those who practiced yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practiced less frequently (p < 0.001).

CONCLUSIONS

These findings suggest that yoga can effectively reduce breast cancer survivors' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems.

Swimming and other sporting activities and the rate of falls in older men: longitudinal findings from the Concord Health and Ageing in Men Project

Balance training is the most efficacious exercise to prevent falls. This study examined the associations between common sporting activities and the incidence of falls, and whether lower risks can be attributed to the superior balance of sports participants. We studied a population-based cohort of 1,667 older Australian men (mean age = 76.8 years) in the Concord Health and Ageing in Men Project (CHAMP) between 2005 and 2011. Data on incident falls were captured by 12 triannual telephone call cycles per participant and were analyzed using negative binomial regression. The length of follow-up averaged 43.8 months (median, 48 months), during which time 2,662 falls were recorded. In unadjusted models, golfers (n = 160; incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI): 0.47, 0.89) and swimmers (n = 88; IRR = 0.47, 95% CI: 0.30, 0.71) had significantly lower risks of falling. After adjustment for leisure-time physical activity, walking, lifestyle physical activity score (e.g., chores, gardening), and conventional risk factors for falling, swimming was the only activity that was associated with a protective effect (IRR = 0.67, 95% CI: 0.45, 1.00). Swimmers had significantly lower postural sway (β = -5.23 cm(2), P < 0.05) and shorter time to complete a narrow walk test than men who took part in only lifestyle physical activities. Balance indicators were strong predictors of the incidence of falls. The IRR for swimmers was 0.71 (95% CI: 0.48, 1.06) after adding balance measures to the adjusted model.

Components of late-life exercise and cognitive function: an 8-year longitudinal study

The preventive effect of late-life physical exercise on cognitive deterioration has been reported in many cohort studies. However, the effect of exercise, independent of other cognitively demanding and social activities, is equivocal and little is known about the relative contributions of frequency, intensity, and duration of exercise. This study aimed to examine the relationships of exercise and its underlying components with cognitive function and rate of cognitive change over an 8-year period in a nationally representative sample of older Taiwanese. Data from the 1999, 2003, and 2007 phases of the nationwide longitudinal survey were used. Data from a fixed cohort of 1,268 participants aged 70 years or older in 1999 with 8 years of follow-up were analyzed. Cognitive function was assessed using the Short Portable Mental Status Questionnaire. Self-reported frequency, intensity, and duration of exercise were collected. A generalized estimating equation with multivariate adjustment for sociodemographic variables, cognitive and social leisure activities, lifestyle behaviors, and health status was calculated. Participants who were physically active during leisure time had better subsequent cognitive function (incident rate ratios [IRR] = 0.63; 95 % CI, 0.54-0.75) and a slower rate of cognitive decline (p = 0.01). Among the components of exercise, only duration emerged as a predictor of cognitive function (p = 0.01). Older adults engaging in exercise for at least 30 min or more per session are likely to reduce the risk of subsequent cognitive decline. This research supports the case for physical exercise programs for older adults in order to help prevent loss of cognitive function.

Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial

BACKGROUND

Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to.

METHOD/DESIGN

This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores.

DISCUSSION

This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual's exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000475842.

Lifestyle physical activity behavior among South Asian Indian immigrants

Little is known of the physical activity behavior of South Asian Indian immigrants (SAIs), though they have more than twice the risk for cardiovascular disease and diabetes than Whites. This was a cross-sectional descriptive face-to-face survey design, comparing between men and women in leisure time (LTPA), household (HPA), and occupational physical activity (OPA). Participants also wore a Lifecorder EX (NL2200) accelerometer for 7 days. Just over half (51.8 %) of the participants met the recommended PA guidelines (≥150 min moderate-intensity or ≥75 min vigorous-intensity) through LTPA. The average number of daily steps was 6,904.3, which is in the "low active" classification. Increasing lifestyle PA among SAIs is important; PA interventions appealing to gender and culture and with an aerobic component are needed.

Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial

STUDY OBJECTIVES

To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.

DESIGN

Randomized controlled, comparative efficacy trial.

SETTING

Los Angeles community.

PATIENTS

123 older adults with chronic and primary insomnia.

INTERVENTIONS

Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.

MEASUREMENTS

Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.

RESULTS

CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.

CONCLUSIONS

Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.

Psychometric properties of the 8-item english arthritis self-efficacy scale in a diverse sample

Arthritis self-efficacy is important for successful disease management. This study examined psychometric properties of the 8-item English version of the Arthritis Self-Efficacy Scale (ASES-8) and differences in ASES-8 scores across sample subgroups. In 401 participants with self-reported doctor-diagnosed arthritis, exploratory factor analysis and tests of internal consistency were conducted. Concurrent validity was examined by associating ASES-8 scores with disease-specific, psychosocial, functional, and behavioral measures expected to be related to arthritis self-efficacy. All analyses were conducted for the full sample and within subgroups (gender, race, age, education, and weight status). Exploratory factor analysis for the entire sample and in all 12 subgroups demonstrated a one factor solution (factor loadings: 0.61 to 0.89). Internal consistency was high for measures of Cronbach's alpha (0.87 to 0.94), omega (0.87 to 0.93), and greatest lower bound (0.90 to 0.95). ASES-8 scores were significantly correlated with all measures assessed (P < 0.05), demonstrating concurrent validity. Those with a high school education or greater had higher ASES-8 scores than those with less than a high school education (P < .001); no other subgroup differences were found. The ASES-8 is a valid and reliable tool to measure arthritis self-efficacy efficiently and thereby reduce participant burden in research studies.

The effect of widowhood on husbands' and wives' physical activity: the Cardiovascular Health Study

This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64-91 (M age = 72.7 years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.

Fatigue and physical activity after myocardial infarction

BACKGROUND

Fatigue is prevalent after myocardial infarction (MI) and is a barrier to physical activity (PA). Because PA is an important health behavior in preventing or delaying recurrent MIs, examining the influence of biophysical markers and fatigue on PA is important as a prerequisite to developing effective interventions.

OBJECTIVE

This study compared PA in 34 men and 38 women, aged 65 and older, 6-8 months post MI, and examined the influence of biophysiological measures and fatigue on PA in this sample.

METHODS

Using a cross-sectional descriptive correlational design, adults completed a demographic form that included documentation of blood pressure, heart rate, height and weight; the Revised Piper Fatigue Scale (RPFS), and the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for Older Adults, and blood collection for measurement of hemoglobin (Hgb), interleukin-6, and B-natriuretic peptide.

RESULTS

There were no differences in frequency of PA between older men and older women; however, men reported a higher intensity of PA (p = .011). When controlling for sex, age, and biophysiological measures, the RPFS significantly explained 16% of the variance in the frequency of PA (p = .03), with no individual subscale serving as a significant predictor. The RPFS behavior/severity subscale explained 31% of the variance in energy expended on all PA (p < .001) and 40% of the variance in energy expended on moderate-intensity PA (p < .001).

CONCLUSION

The older adults participating in this study did not participate in the recommended levels of PA, and fatigue significantly influenced PA post MI.

Socio-demographic, medical and social-cognitive correlates of physical activity behavior among older adults (45-70 years): a cross-sectional study

Background

Present study aimed to identify socio-demographic, medical and social-cognitive correlates of physical activity among Dutch older individuals.

Methods

A systematic random sample of 2,568 Dutch participants aged 45–70 years filled out the validated modified Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire on physical activity. Socio-demographic and social-cognitive correlates were measured with validated instruments; medical correlates were checked by a general practitioner. The study had a cross-sectional design and the data collection ran from March 2005 until August 2006. Linear regression analyses were conducted to identify correlates of PA. We separated the findings for men from those for women to explore potential gender-specific associations.

Results

Being female, living in North Limburg or North-Brabant, having a higher educational level, a higher perceived behavioral control, more knowledge about PA advantages, a stronger habitual PA behavior, having more action plans and a stronger intention to engage in PA were significantly associated with higher PA levels. Being older, being a smoker, having a higher body mass index (BMI), having a paid job, observing others being physically active and overestimating one's PA level were associated with being less physically active. Socio-demographic and medical correlates significantly explained 20% of the variance of PA behavior while social-cognitive correlates as attitude explained an additional 4% and intention together with actual control explained another 1% of the variance of PA behavior.

Conclusion

There may be stable individual differences that influence PA in view of the fact that several socio-demographic and medical factors were not completely mediated by the socio-cognitive factors. The current study may help to focus PA interventions for individuals aged 45–70 years on influential socio-demographic, medical and social-cognitive correlates. Physical activity was significantly associated with age, gender, education, BMI, work situation, region of residence, smoking, awareness, advantages, descriptive norm, perceived behavioral control, habit, action plans and intention.

Predictors of Weight Loss for African-American Women in the Faith, Activity, and Nutrition (FAN) Study

BACKGROUND

Understanding predictors of weight loss can assist in developing targeted evidence-based programs to reduce obesity in faith-based settings. The purpose of this study was to examine predictors of weight loss for a sample of African-American women taking part in in a church-based study.

METHODS

Participants (N = 350) completed physical assessments and comprehensive surveys at baseline and 15 months later. Analyses examined baseline variables and change in variables from baseline to posttest, as predictors of ≥ 5% weight loss at posttest. Demographic, health-related, and behavioral variables were examined.

RESULTS

Lower baseline stress predicted greater likelihood of weight loss. Increased leisure-time physical activity (LTPA) from baseline to posttest was predictive of greater weight loss. The odds of ≥ 5% weight loss was 38% lower for every 1-point increase in baseline stress (OR = 0.62, CI = 0.39, 0.98, P = .04) and 6% greater for every 1-hour increase in posttest LTPA (OR = 1.06, CI = 1.0, 1.12, P = .049).

CONCLUSIONS

Increased LTPA appears to be an independent predictor of modest but meaningful reductions in weight among African-American women. African-American women reporting higher levels of stress at baseline may require more intense strategies emphasizing increased LTPA to lose weight.

The Maastricht Study: an extensive phenotyping study on determinants of type 2 diabetes, its complications and its comorbidities

The Maastricht Study is an extensive phenotyping study that focuses on the etiology of type 2 diabetes (T2DM), its classic complications, and its emerging comorbidities. The study uses state-of-the-art imaging techniques and extensive biobanking to determine health status in a population-based cohort of 10,000 individuals that is enriched with T2DM individuals. Enrollment started in November 2010 and is anticipated to last 5-7 years. The Maastricht Study is expected to become one of the most extensive phenotyping studies in both the general population and T2DM participants world-wide. The Maastricht study will specifically focus on possible mechanisms that may explain why T2DM accelerates the development and progression of classic complications, such as cardiovascular disease, retinopathy, neuropathy and nephropathy and of emerging comorbidities, such as cognitive decline, depression, and gastrointestinal, musculoskeletal and respiratory diseases. In addition, it will also examine the association of these variables with quality of life and use of health care resources. This paper describes the rationale, overall study design, recruitment strategy and methods of basic measurements, and gives an overview of all measurements that are performed within The Maastricht Study.

Physical and Psychosocial Function in Residential Aged-Care Elders: Effect of Nintendo Wii Sports Games

This mixed-methods, quasi-experimental pilot study examined whether the Nintendo Wii Sports (NWS) active video game (exergame) system could significantly improve the functional ability, physical activity levels, and quality of life of 34 older adults (4 men and 30 women, 83 ± 8 yr) living in 2 residential aged-care (RAC) centers. Change score analyses indicated the intervention group had significantly greater increases in bicep curl muscular endurance, physical activity levels, and psychological quality of life than the control group (p< .05). Analysis of the quotes underlying the 3 themes (feeling silly, feeling good; having fun; and something to look forward to) suggested that intervention group participants developed a sense of empowerment and achievement after some initial reluctance and anxiousness. They felt that the games were fun and provided an avenue for greater socialization. These results add some further support to the utilization of NWS exergames in the RAC context.

Validation of a Computerized Use of Time Recall for Activity Measurement in Advanced-Age Adults

Background:

The Multimedia Activity Recall for Children and Adults (MARCA) is a computerized recall instrument that records use of time during 24 hr the previous day and has been developed to address limitations of current self-report physical activity measures for those in advanced age.

Methods:

Test–retest reliability and convergent validity of the adult MARCA were assessed in a sample of 45 advanced-age adults (age 84.9SD ±1.62 yr) as a subsample of the Life and Living in Advanced-Age Cohort Study New Zealand (LiLACS NZ). Test–retest methods required participants to recall the previous day’s activity using the MARCA twice within the same day. Convergent validity was assessed against accelerometry.

Results:

Test–retest reliability was high, with ICCs greater than .99 for moderate to vigorous physical activity (MVPA) and physical activity level (PAL). Compared with accelerometry, the MARCA demonstrated validity comparable to other self-report instruments with Spearman’s coefficients of .34 and .59 for time spent in nonsedentary physical activity and PAL.

Conclusion:

The MARCA is a valid and reliable self-report tool for physical activity behaviors in advanced-age adults.

Impact of body mass index on the relationship between muscle quality and physical function in older women

OBJECTIVES

To investigate the impact of body mass index (BMI) (normal weight, overweight, obese) on the relationship between muscle quality (MQ) and physical function in community-dwelling older women.

DESIGN

Cross-sectional study.

SETTING

University research laboratory.

PARTICIPANTS

Community-dwelling older women (n = 94, 73.6 ± 5.4 y) stratified by BMI (normal weight: 20.0-24.9 kg/m2; overweight: 25.0-29.9 kg/m2; obese: ≥ 30.0 kg/m2).

MEASUREMENTS

Body mass index using height and weight, leg extension power via the Nottingham power rig, body composition using dual-energy X-ray absorptiometry, and physical function (6-minute walk, 8-foot up-and-go, 30-second chair stand). Muscle quality was defined as leg power (watts) normalized for lower-body mineral-free lean mass (kg).

RESULTS

Following adjustments for covariates, muscle quality was significantly higher in women of normal BMI compared to overweight (10.0 ± 0.4 vs. 8.7 ± 0.4 watts/kg, p = 0.03). Muscle quality was a significant predictor of performance on the 6-minute walk and 8-foot up-and-go in normal and overweight women (all p < 0.05) and performance on the 30-second chair stand in normal and obese women (both p < 0.05). Body mass index did not significantly impact the association between MQ and physical function (all p > 0.05).

CONCLUSIONS

Muscle quality varies by BMI, yet the relationship to physical function is not significantly different across BMI groups. The results imply that interventions that increase MQ in older women may improve physical function, regardless of BMI.

Process evaluation methods, implementation fidelity results and relationship to physical activity and healthy eating in the Faith, Activity, and Nutrition (FAN) study

Faith, Activity and Nutrition (FAN), a community-based participatory research project in African American churches, aimed to increase congregant physical activity and healthy eating. The Health-Promoting Church framework, developed collaboratively with faith-based partners, guided the intervention and a comprehensive process evaluation. The Health-Promoting Church components related to healthy eating and physical activity were getting the message out, opportunities, pastor support, and organizational policy. There was no evidence for sequential mediation for any of the healthy eating components. These results illustrate the complexity of systems change within organizational settings and the importance of conducting process evaluation. The FAN intervention resulted in increased implementation for all physical activity and most healthy eating components. Mediation analyses revealed no direct association between implementation and increased physical activity; rather, sequential mediation analysis showed that implementation of physical activity messages was associated with improved self-efficacy at the church level, which was associated with increased physical activity.

The partners for life program: a couples approach to cardiac risk reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety-three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.

Validity and reproducibility of the Physical Activity Scale for the Elderly (PASE) questionnaire for the measurement of the physical activity level in patients after total knee arthroplasty

Background

The need for valid and reproducible questionnaires to routinely assess the physical activity level of patients after total knee arthroplasty (TKA) is of particular concern in clinical settings. Aims of this study were to evaluate the validity and reproducibility of the physical activity scale for the elderly (PASE) questionnaire in TKA patients, with a particular view on gender differences.

Methods

A total of 50 elderly patients (25 women and 25 men aged 70 ± 6 years) following primary unilateral TKA were recruited. The reproducibility was evaluated by administering the PASE questionnaire during two occasions separated by 7 days. The construct (criterion) validity was investigated by comparing the physical activity level reported by patients in the PASE questionnaire to that measured by accelerometry. Reproducibility was evaluated using intraclass correlation coefficients (ICC_3,1) for reliability and standard error of measurement (SEM) and smallest detectable change (SDC) for agreement, while validity was investigated with Pearson correlation coefficients.

Results

Reliability of the PASE total score was acceptable for men (ICC = 0.77) but not for women (ICC = 0.58). Its agreement was low for both men and women, as witnessed by high SEM (32% and 35%, respectively) and SDC (89% and 97%, respectively). Construct validity of the PASE total score was low in both men (r = 0.45) and women (r = 0.06).

Conclusions

The PASE questionnaire has several validity and reproducibility shortcomings, therefore its use is not recommended for the assessment of physical activity level in patients after TKA, particularly in women.

Retirement community residents' physical activity, depressive symptoms, and functional limitations

This study examined the types of physical activity (PA) retirement community residents report and the effects of PA and depressive symptoms on functional limitations. Elders (N=38) enrolled in a 2-year sensor technology study in senior housing completed regular assessments of functional limitations and depressive symptoms with the Short Physical Performance Battery and Geriatric Depression Scale, respectively. Evaluation of reported PA using the Physical Activity Scale for the Elderly coincided with 12-month functional limitation testing. Subjects were 69% female with mean age of 85 years. Individuals reporting greater PA had significantly fewer functional limitations at 12 months. In multiple regression analysis, baseline functional limitations explained 66% of the variance in 12-month functional limitations, while current PA explained an additional 5%. Although PA explained a small amount of variance in 12-month functional limitations, as a modifiable behavior, PA should be championed and supported to help ameliorate functional limitations in older adults.

Comparison of the EPIC Physical Activity Questionnaire with combined heart rate and movement sensing in a nationally representative sample of older British adults

Objectives

To compare physical activity (PA) subcomponents from EPIC Physical Activity Questionnaire (EPAQ2) and combined heart rate and movement sensing in older adults.

Methods

Participants aged 60–64y from the MRC National Survey of Health and Development in Great Britain completed EPAQ2, which assesses self-report PA in 4 domains (leisure time, occupation, transportation and domestic life) during the past year and wore a combined sensor for 5 consecutive days. Estimates of PA energy expenditure (PAEE), sedentary behaviour, light (LPA) and moderate-to-vigorous PA (MVPA) were obtained from EPAQ2 and combined sensing and compared. Complete data were available in 1689 participants (52% women).

Results

EPAQ2 estimates of PAEE and MVPA were higher than objective estimates and sedentary time and LPA estimates were lower [bias (95% limits of agreement) in men and women were 32.3 (−61.5 to 122.6) and 29.0 (−39.2 to 94.6) kJ/kg/day for PAEE; −4.6 (−10.6 to 1.3) and −6.0 (−10.9 to −1.0) h/day for sedentary time; −171.8 (−454.5 to 110.8) and −60.4 (−367.5 to 246.6) min/day for LPA; 91.1 (−159.5 to 341.8) and 55.4 (−117.2 to 228.0) min/day for MVPA]. There were significant positive correlations between all self-reported and objectively assessed PA subcomponents (rho  = 0.12 to 0.36); the strongest were observed for MVPA (rho = 0.30 men; rho = 0.36 women) and PAEE (rho = 0.26 men; rho = 0.25 women).

Conclusion

EPAQ2 produces higher estimates of PAEE and MVPA and lower estimates of sedentary and LPA than objective assessment. However, both methodologies rank individuals similarly, suggesting that EPAQ2 may be used in etiological studies in this population.

The health and health behaviors of a sample of African American pastors

There is growing concern for the health status of clergy in light of recent studies showing high rates of chronic health conditions and obesity. This manuscript examined the health and health behaviors of South Carolinian African Methodist Episcopal (AME) pastors (n = 40). A majority of pastors were overweight or obese (93%) with hypertension (68%); half had two or more chronic health conditions, 35% had high cholesterol, 30% arthritis, and 20% diabetes. On average, pastors had a waist circumference that put them at an increased risk for disease. Yet, with the exception of fruit and vegetable consumption (mean = 3.4 ± 4.0 cups/day), pastors generally engaged in positive health behaviors. Understanding where the greatest needs lie is the first step in developing programs that can improve pastor health, which may ultimately improve the health of their congregations.

Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial

PURPOSE

To evaluate yoga's impact on inflammation, mood, and fatigue.

PATIENTS AND METHODS

A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale.

RESULTS

Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF-α (P = .027), and IL-1β (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1β (P = .03) production but not in TNF-α production (P > .05).

CONCLUSION

Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.

Exploring older adults' patterns and perceptions of exercise after hip fracture

PURPOSE

To identify exercise patterns and perceived barriers, enablers, and motivators to engaging in exercise for older adults following hip fracture.

METHOD

Telephone interviews were conducted with older adults (aged 62-97 y) within 1 year after hip fracture. Participants were asked about basic demographic information; level of mobility before hip fracture; current level of mobility; and barriers, enablers, and motivators to participating in exercise.

RESULTS

A total of 32 older adults successfully recovering after hip fracture completed the telephone interviews. Participants reported few problems with their mobility, and all were engaging in exercise. There were few reported barriers to exercise; the most common were health-related concerns (pain, fatigue, illness, or injury). The most frequently reported enablers were intrinsic factors (determination, seeing improvements, and making exercise part of their daily routine); in particular, the most common motivator to exercise was recovery of function to improve mobility and complete daily and leisure activities.

CONCLUSIONS

This study highlights the responses of a group of older adults recovering well after hip fracture. Older adults engage in exercise despite the potential limitations associated with a hip fracture. Participants' responses underscore the importance of intrinsic factors and suggest avenues for future investigation.

Reductions in regimen distress are associated with improved management and glycemic control over time

OBJECTIVE Cross-sectional and longitudinal associations among regimen distress (RD), self-management, and glycemic control were undertaken to explore mechanisms of operation among these variables. RESEARCH DESIGN AND METHODS In a behavioral randomized control trial (RCT) to reduce RD, 392 adults with type 2 diabetes were assessed for RD, diet, exercise, medication adherence, and HbA1c at baseline and at 4 and 12 months. Associations among RD, self-management, and HbA1c were examined in cross-sectional analyses at baseline, in prospective analyses using baseline values to predict change over time, and in time-varying analyses. RESULTS At baseline, greater RD and poorer medication adherence were independently associated with higher HbA1c (P = 0.05 and P < 0.001, respectively), and greater RD was associated with poorer medication adherence (P = 0.03). No consistent pattern of significant prospective associations was found. Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence (P < 0.01), physical activity (P < 0.001), and HbA1c (P = 0.02) over time following intervention. Changes in self-management were not associated with changes in HbA1c over time. CONCLUSIONS In the context of an RCT to reduce distress, RD, self-management, and HbA1c were interrelated in cross-sectional and time-varying analyses. Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months. Findings point to the complex and likely multifaceted pathways of association among these key constructs, with results indicating significant linkages between RD and both self-management and glycemic control over time.

Association of body mass index with physical function and health-related quality of life in adults with arthritis

Arthritis and obesity, both highly prevalent, contribute greatly to the burden of disability in US adults. We examined whether body mass index (BMI) was associated with physical function and health-related quality of life (HRQOL) measures among adults with arthritis and other rheumatic conditions. We assessed objectively measured BMI and physical functioning (six-minute walk, chair stand, seated reach, walking velocity, hand grip) and self-reported HRQOL (depression, stiffness, pain, fatigue, disability, quality of life-mental, and quality of life, physical) were assessed. Self-reported age, gender, race, physical activity, and arthritis medication use (covariates) were also assessed. Unadjusted and adjusted linear regression models examined the association between BMI and objective measures of functioning and self-reported measures of HRQOL. BMI was significantly associated with all functional (Ps ≤ 0.007) and HRQOL measures (Ps ≤ 0.03) in the unadjusted models. Associations between BMI and all functional measures (Ps ≤ 0.001) and most HRQOL measures remained significant in the adjusted models (Ps ≤ 0.05); depression and quality of life, physical, were not significant. The present analysis of a range of HRQOL and objective measures of physical function demonstrates the debilitating effects of the combination of overweight and arthritis and other rheumatic conditions. Future research should focus on developing effective group and self-management programs for weight loss for people with arthritis and other rheumatic conditions (registered on clinicaltrials.gov: NCT01172327).

Trajectory of change in pain, depression, and physical functioning after physical activity adoption in fibromyalgia

Fibromyalgia is associated with widespread pain, depression, and declines in physical functioning. The purpose of this study was to examine the trajectory of these symptoms over time related to physical activity adoption and maintenance via motivational interviewing versus education, to increase physical activity. There were no treatment group differences; we divided the sample ( n = 184) based on changes in physical activity. Repeated measures analyses demonstrated differential patterns in depression, pain, and physical functioning at 24 and 36 weeks. Findings suggest increased physical activity may serve as a multiple-target intervention that provides moderate to large, long-lasting benefits for individuals with fibromyalgia.

Association of self-efficacy and outcome expectations with physical activity in adults with arthritis

Background and Purpose. The purpose of this study is to determine whether higher baseline levels of (a) self-efficacy for physical activity, (b) self-efficacy for arthritis self-management, and (c) outcome expectations for exercise are associated with higher physical activity levels following an exercise intervention for adults with arthritis. Methods. A secondary analysis of the intervention cohort (n = 130) within a randomized controlled trial of the People with Arthritis Can Exercise program was performed. Multiple linear regression evaluated the relationship between physical activity at a time point three months after the completion of an exercise intervention and three main explanatory variables. Results. After controlling for baseline physical activity, neither self-efficacy for arthritis self-management nor outcome expectations for exercise related to three-month physical activity levels. There was a relationship between three-month physical activity and self-efficacy for physical activity. Conclusions. Future research is needed to evaluate the ability of self-efficacy-enhancing programs to increase physical activity in adults with arthritis.

Effect of moderate to vigorous physical activity on long-term clinical outcomes and pain severity in fibromyalgia

OBJECTIVE

To evaluate the relationship between long-term maintenance of moderate to vigorous physical activity (MVPA) and clinical outcomes in fibromyalgia (FM).

METHODS

Patients with FM (n = 170) received individualized exercise prescriptions and completed baseline and followup physical activity assessments using the Community Health Activities Model Program for Seniors questionnaire at weeks 12, 24, and 36. The primary outcome was the change in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score. The secondary outcomes included improvements in overall well-being (FIQ total score), pain severity ratings, and depression.

RESULTS

Using a threshold increase in MVPA of ≥10 metabolic equivalent hours/week above usual activities, 27 subjects (15.9%) increased and sustained (SUS-PA), 68 (40%) increased but then declined (UNSUS-PA), and 75 (44.1%) did not achieve (LO-PA) this benchmark. Compared to LO-PA subjects, both SUS-PA and UNSUS-PA subjects reported greater improvement in FIQ-PI (P < 0.01) and FIQ total score (P < 0.05). Additionally, the SUS-PA group reported greater improvement in pain severity compared to the LO-PA group (P < 0.05). However, there were no significant group differences between SUS-PA and UNSUS-PA for any primary or secondary outcome measure.

CONCLUSION

Increased participation in MVPA for at least 12 weeks improved physical function and overall well-being in patients with FM. Although sustained physical activity was not associated with greater clinical benefit compared with unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM. Future research is needed to determine the relationship between sustained MVPA participation and subsequent improvement in patient outcomes.

Differences in Effectiveness of the Active Living Every Day Program for Older Adults With Arthritis

Objective:

The authors explored whether demographic and psychosocial variables predicted differences in physical activity for participants with arthritis in a trial of Active Living Every Day (ALED).

Method:

Participants (N = 280) from 17 community sites were randomized into ALED or usual care. The authors assessed participant demographic characteristics, self-efficacy, outcome expectations, pain, fatigue, and depressive symptoms at baseline and physical activity frequency at 20-wk follow-up. They conducted linear regression with interaction terms (Baseline Characteristic × Randomization Group).

Results:

Being female (p ≤ .05), less depressed (p ≤ .05), or younger (p ≤ .10) was associated with more frequent posttest physical activity for ALED participants than for those with usual care. Higher education was associated with more physical activity for both ALED and usual-care groups.

Discussion:

ALED was particularly effective for female, younger, and less depressed participants. Further research should determine whether modifications could produce better outcomes in other subgroups.

Multiple behavior change among church members taking part in the faith, activity, and nutrition program

OBJECTIVE

To examine the extent to which participants in a combined physical activity (PA) and dietary intervention achieved changes in multiple health behaviors.

DESIGN

Group randomized trial; includes only participants assigned to the intervention group only.

SETTING

Thirty-six churches in South Carolina.

PARTICIPANTS

Three hundred sixty African American church members.

INTERVENTION

A 15-month PA and dietary intervention, guided by the structural ecological model, targeting environmental (i.e., social, cultural, physical) and organizational (ie, policies, practices) changes within the church.

MAIN OUTCOME MEASURES

Self-reported PA, fruit and vegetable consumption, fat-, and fiber-related behaviors.

ANALYSIS

Change in each behavior was defined as unadjusted pretest-posttest improvement ≥ 0.20 of the baseline standard deviation. The total number and each combination of behaviors changed were calculated.

RESULTS

Up to 19% changed no health behaviors as defined above, 31% changed 1 health behavior, 31% changed 2 health behaviors, 13% changed 3 health behaviors, and 5% changed all 4 of the targeted health behaviors. Combinations of multiple behavior change included PA and dietary behaviors, which suggests that both behaviors can be changed simultaneously.

CONCLUSIONS AND IMPLICATIONS

Nearly half of participants changed at least 2 health behaviors. Faith-based interventions targeting environmental and organizational change can successfully change multiple behaviors, potentially leading to greater improvements in public health.

Perceived barriers to initiating and maintaining physical activity among South Asian and White British adults in their 60s living in the United Kingdom: a qualitative study

OBJECTIVE

To explore the barriers to initiating and maintaining regular physical activity (PA) among UK Indian, Pakistani and White British adults in their 60s.

DESIGN

An exploratory qualitative approach was utilised using 15 focus groups and 40 in-depth interviews. Purposive sampling was used to recruit participants with different experiences of participation or non-participation in PA.

RESULTS

Misunderstandings about the value of exercise in later life, particularly for those with ongoing healthcare problems, were identified in UK South Asian and White British older adults' accounts of their experience of the barriers to initiating and maintaining regular PA. Both groups and genders said that PA could exacerbate pre-existing health problems and result in physical harm. Although most beliefs were similar to those of the White British, ethnic-specific factors, such as language barriers, religious beliefs and cultural practices could act as additional barriers to undertaking and maintaining PA among UK South Asian older adults.

CONCLUSIONS AND IMPLICATIONS

Understanding the multiple levels of influence on older adults' PA behaviour can provide the basis for developing comprehensive approaches to health promotion initiatives aimed at increasing PA levels. Healthcare providers need to understand the characteristics and specific barriers faced by these groups of older adults; work with older people from these groups to develop culturally appropriate PA programmes and address the misunderstandings and misconceptions about the value of exercise in later-life, particularly in those with ongoing health problems.

Measuring Physical Activity in Older Adults with and without Early Stage Alzheimer's Disease

We compared subjective reports of physical activity with objective measures of physical fitness including cardiorespiratory capacity, body composition, and physical performance in 146 older adults with and without early stage Alzheimer's disease (ESAD). Respondents reported primarily unstructured and low-intensity activities, including walking and housework. Individuals with ESAD participated in fewer and lower intensity physical activities than those without ESAD. In those without ESAD, housework was related to lower body mass index, leisure walking was related to faster speed on a timed walking test, and participation in sports was related to higher peak oxygen intake. In individuals with ESAD, reported physical activities did not predict any of the physical fitness, body composition, or physical performance measures. We conclude that measures of physical activity require expansion of unstructured and low intensity activities to improve sensitivity in sedentary populations, especially in older adults with ESAD.

The role of pastor support in a faith-based health promotion intervention

Pastor support has been viewed as an integral part of successful faith-based health promotion programs; however, few studies have systematically studied these relationships. This study examined associations between pastor support and program-related variables among African American churches taking part in a physical activity and dietary intervention. Results showed that some pastor support-related variables were associated with participant recruitment, retention, and implementation of study requirements but not to changes in health behavior outcomes. Much work remains in how to conceptualize and measure pastor support. A better understanding of the pastor's role may assist in developing more effective faith-based programs.

Predictors of change in fruit and vegetable consumption in a faith-based intervention with African American adults

A majority of African American adults do not eat the recommended daily amount of fruit and vegetables. This study examined baseline demographic, health-related, and psychosocial variables as predictors of change in fruit and vegetable consumption from baseline to postprogram in a sample of church members taking part in a 15-month intervention. Participants who had a greater waist circumference, greater baseline fruit and vegetable consumption, greater leisure time physical activity, higher levels of social support, greater attendance at worship service, were obese, and did not have diabetes at baseline showed higher posttest fruit and vegetable consumption.

Caloric expenditure assessment among older adults: criterion validity of a novel accelerometry device

Criterion validity of a novel accelerometry device that measures caloric expenditure (Fitbit) was evaluated against a self-report estimation of caloric expenditure (Community Healthy Activities Model Program for Seniors) in older adults. Community Health Activities Model Program for Seniors and Fitbit estimates of total caloric expenditure per day were significantly correlated (r = .61, p < .05). Bland-Altman plots indicated that 70 percent of participants' data were within 1 standard deviation of the mean difference between measures. These preliminary findings suggest that the Fitbit may be considered a viable instrument for measuring daily caloric expenditure among older adults. However, further work is required to determine the optimal measurement technique for caloric expenditure among older adults.

What physical activity surveillance needs: validity of a single-item questionnaire

BACKGROUND

Self-report instruments to assess physical activity are still the most feasible option in many population-wide surveys, and often need to be very short owing to resource constraints. The aim of this study was to test the criterion validity of a single-item physical activity measure using accelerometers and to compare its measurement properties by gender, age group (including older adults) and language region.

METHODS

A validation study was carried out within the second follow-up of a large Swiss cohort study (Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults, SAPALDIA, n=208) and included an additional convenient sample (n=110). Participants wore an accelerometer over eight consecutive days and then completed the single-item measure. Spearman's rank-order correlations were used to assess the criterion validity.

RESULTS

Physical activity levels were higher in men, younger individuals and those from the German-speaking part of Switzerland. Correlation coefficients for the number of days with at least 30 min of moderate-to-vigorous physical activity according to the single item and different accelerometer activity outcomes ranged from 0.40 to 0.54. Correlations were higher for women, younger individuals and participants from the French-speaking and the Italian-speaking parts.

CONCLUSIONS

The single-item physical activity measure performed at least as well as other physical activity questionnaires. The differences in criterion validity between sub groups indicate that factors such as gender and age should be taken into account when developing physical activity questionnaires and in future validation studies.

Factors associated with disability in a sample of adults with arthritis

BACKGROUND

Arthritis is the most common cause of disability among US adults. Few studies have comprehensively examined factors associated with disability in this population.

OBJECTIVE

To investigate the relationship between a number of disease and non-disease related factors and disability in sample of adults with self-reported doctor-diagnosed arthritis.

METHODS

Participants (n = 396) taking part in a randomized controlled trial of arthritis self-management completed a comprehensive survey assessing a number of demographic, arthritis-specific, health-related, behavioral, and psychological variables at baseline. Disability, as measured by the Health Assessment Questionnaire (HAQ), was also measured. Hierarchical regression models examined the independent associations between blocks of variables and disability.

RESULTS

Demographic variables (R(2) = 0.13), arthritis-specific demographics (i.e., type, medication use; ΔR(2) = 0.16), physical health-related variables (ΔR(2) = 0.06), arthritis-specific symptoms (ΔR(2) = 0.12), health behaviors (ΔR(2) = 0.00), and psychological variables (ΔR(2) = 0.03) explained 50% of the variance in disability score (R(2) = 0.50). With the exception of health behaviors, the addition of each block of variables significantly improved the model, explaining additional variance in HAQ scores (p < 0.0001). In the final model, older age, less than a high school education, rheumatoid arthritis, greater arthritis duration, taking steroids, taking narcotics, greater pain, greater stiffness, greater depressive symptoms, and lower arthritis self-efficacy were associated with greater disability whereas male gender, fibromyalgia, and excellent/very good health were associated with less disability.

CONCLUSIONS

A number of disease and non-disease related variables were associated with disability. These findings suggest that disability in adults with arthritis may be a complicated phenomenon; such complexity may make decreasing disability in this population challenging.

An exploratory study of activity in veterans with Parkinson's disease

Movement disorder specialists have limited information on the specifics of how patients with Parkinson’s disease (PD) spend their time. We deemed it important to examine the relationships among activity and daily energy expenditure (DEE), non-motor symptoms, and body mass index in veterans with PD who were outpatients at a Veterans Affairs medical center. In this exploratory study, we mailed demographic and activity questionnaires and gathered data on 100 patients. Activity was categorized into five domains and three intensity levels, and DEE was measured in kilocalories. Light activities accounted for 64.9% of DEE (9.1 h), moderate activities for 32.9% (2.1 h), and vigorous activities for 2.2% (0.1 h) of DEE. Television viewing comprised 10.6% (2.5 h) of the day. The effects of non-motor symptoms were significantly associated with more time spent on activities of daily life (ADL). Patients rated fatigue and pain as having the greatest impact on their daily activities. The overweight/obese group of PD patients expended more overall DEE (p = 0.044) and more DEE on social activities (p = 0.024) and light intensity activities (p = 0.021) than did the underweight/normal group. Leisure activities for both groups changed from active to passive. Veterans with PD primarily expended DEE on ADL, TV viewing, and light intensity activities. Television viewing time may have been under reported. Movement disorder specialists can be more proactive in referring patients to physical therapy and encouraging their participation in community exercise and support groups.

Frailty in older breast cancer survivors: age, prevalence, and associated factors

PURPOSE/OBJECTIVES

To describe frailty and associated factors in breast cancer survivors (BCSs) and evaluate whether BCSs are frail at an earlier age than female participants from in two large epidemiological studies.

DESIGN

Descriptive, cross-sectional.

SETTING

School of Nursing at Oregon Health and Science University.

SAMPLE

216 BCSs aged 53-87 years who were a mean 5-7 years post-treatment and not currently participating in exercise.

METHODS

Performance tests, clinical measures, and self-reported questionnaires provided baseline data on five criteria for frailty.

MAIN RESEARCH VARIABLES

Frailty was defined as meeting three of the five criteria of the frailty phenotype: shrinking, exhaustion, low activity, slowness, and weakness. Data were compared to published data from women in the Cardiovascular Health Study (CHS) and Women's Health and Aging Study (WHAS).

FINDINGS

Eighteen percent of BCSs aged 70-79 years were frail compared to 11% of women of the same age in the CHS and WHAS. Frailty was more common at a younger age in BCSs, and more BCSs were frail in all age groups compared to women in the CHS study until about age 80 years, when prevalence of frailty was similar in the two groups. Fifty percent of BCSs were classified as prefrail because they met one or two of the five frailty criteria. Higher body mass index increased the odds of frailty, and higher physical activity decreased the odds of frailty (odds ratio [OR] = 1.12, p = 0.003, and OR = 0.99, p = 0.000, respectively).

CONCLUSIONS

Frailty and prefrailty may be common in BCSs and may occur at an earlier age than in adults without a history of breast cancer.

IMPLICATIONS FOR NURSING

Nurses should be alert to prefrailty or frailty at a younger age in BCSs. Awareness and early intervention may delay or prevent frailty.

KNOWLEDGE TRANSLATION

BCSs may be frail even when they are not yet considered older adults. Prefrailty in BCSs is important to recognize because it suggests impending frailty that could lead to reduced physical functioning or poor health. Prefrailty and frailty could be assessed in BCSs aged 50 years and older in a clinical setting using a few questions about weight, fatigue, and activity levels, in addition to simple tests of walking speed and grip strength, if warranted.

Multiple days of monitoring are needed to obtain a reliable estimate of physical activity in hip-fracture patients

The aim of the study was to investigate the precision of estimated upright time during one week in community dwelling older adults after hip fracture when monitoring activity for different numbers of consecutive days. Information about upright time was collected by thigh-worn accelerometers during 7 consecutive days in 31 older adults (mean age 81.8 years ± 5.3) 3 months after hip-fracture surgery. Mean time in upright position, including both standing and walking, was 260.9 (± 151.2) min/day. A cutoff value of half an hour was used to provide recommendations about number of recording days. Large variability between participants between days, as well as a nonconstant within-participant variability between days indicates that at least 4 consecutive days of recording should be used to obtain a reliable estimate of upright time for individual persons. However, at a group level, one day of recording is sufficient.

Dose-response relationships between physical activity, social participation, and health-related quality of life in colorectal cancer survivors

PURPOSE

The purpose of this study was to examine the relationships between physical activity (PA), social participation, and health-related quality of life (HQOL) in older, long-term colorectal cancer survivors.

METHODS

Male and female colorectal cancer survivors (n = 1,768), aged ≥65 and ≥5 years post-diagnosis, completed surveys on their current PA, social participation, HQOL, health history, and relevant covariates. Analysis of covariance was used to evaluate the cross-sectional relationship between PA and social participation with the SF-36 subscales, as well as the physical component summary score (PCS) and mental health component summary score (MCS).

RESULTS

The final analytic sample (n = 832) was 81.5 ± 5.8 years and 8.2 ± 1.7 years post-diagnosis (mean ± SD). Meeting the current recommendation of 150 min/week of PA was associated with higher PCS (p < 0.001) but not MCS (p = 0.30). Engaging in any social participation, vs. none, was associated with MCS (p = 0.003), but not PCS (p = 0.13). There was a dose-response relationship between moderate-vigorous-intensity PA and PCS (p trend<0.001). Light-intensity PA was not associated with either summary score after adjustment for moderate-vigorous PA (p > 0.05), but in survivors performing no higher-intensity PA, it was associated with both (p < 0.01, p = 0.02, respectively). Participants reporting greater amounts of both planned exercise and non-exercise PA had significantly higher PCS (p trend<0.01, p trend < 0.01, respectively). Individuals participating in greater weekly hours of social participation had higher PCS and MCS (p trend<0.05) than those participating in less.

CONCLUSIONS

Among older, long-term colorectal cancer survivors, PA is related to their physical health, while social participation is predominantly related to their mental health.

IMPLICATIONS FOR CANCER SURVIVORS

Older colorectal cancer survivors who participate socially and are engaged in PA, even non-exercise and light-intensity activities, have higher levels of physical and mental health.