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

Design of the Steps to Health Study of Physical Activity in Survivors of Endometrial Cancer: Testing a Social Cognitive Theory Model

Physical activity has been shown to benefit cancer survivors' physical functioning, emotional well-being, and symptoms. Physical activity may be of particular benefit to survivors of endometrial cancer because they are more likely to be obese and sedentary than the general population, as these are risk factors for the disease, and thus experience a number of related co-morbid health problems. However, there is little research systematically studying mechanisms of physical activity adherence in cancer survivor populations. This paper describes the design of the Steps to Health study, which applies a Social Cognitive Theory-based model of endometrial cancer survivors' adoption and maintenance of exercise in the context of an intervention to increase walking or other moderate intensity cardiovascular activity. In Steps to Health we will test the influence of self-efficacy and outcome expectations on adherence to exercise recommendations, as well as studying the determinants of self-efficacy. Endometrial cancer survivors who are at least 6 months post-treatment are provided with an intervention involving print materials and telephone counseling, and complete assessments of fitness, activity, self-efficacy and outcome expectations, and determinants of self-efficacy every two months for a six month period. In addition to testing an innovative model, the Steps to Health study employs multiple assessment methods, including ecological momentary assessment, implicit tests of cognitive variables, and ambulatory monitoring of physical activity. The study results can be used to develop more effective interventions for increasing physical activity in sedentary cancer survivors by taking into account the full complement of sources of self-efficacy information and outcome expectations.

Validity and reliability of community health activities model program for seniors and short-form international physical activity questionnaire as physical activity assessment tools in patients with fibromyalgia

PURPOSE

There currently is a paucity of well-validated instruments to quantitatively measure physical activity (PA) levels in patients with fibromyalgia syndrome (FMS). This study aims to determine the construct validity and test-retest reliability of two self-report physical activity questionnaires [short-form international physical activity questionnaire (s-IPAQ) and community health activities model program for seniors (CHAMPS)] in a fibromyalgia population.

METHODS

Thirty subjects (mean age 49.1 +/- 9.6 years; 90% females) who met the American College of Rheumatology criteria for FMS were invited to participate in the study. Two-week test-retest reliability was evaluated for the CHAMPS and s-IPAQ. Construct validity was evaluated by comparing PA reported from these questionnaires with data obtained from accelerometry (steps/week, counts/week) and the 6-minute walk test (6-MWT).

RESULTS

CHAMPS showed greater test-retest reliability (r = 0.58; p < 0.001) compared with s-IPAQ (r = 0.18; p = 0.15). No significant correlations were observed between the self-report PA questionnaires and the 6-MWT or accelerometry data (p > 0.05).

CONCLUSIONS

In a fibromyalgia population, the s-IPAQ does not appear to be a reliable and valid PA assessment tool. CHAMPS displayed moderate test-retest reliability; however, no associations were found between CHAMPS and objectives measures of PA. In view of the known benefits of exercise in patients with FMS, there is a need to develop new measures or validate other existing well-established PA questionnaires.

A comparison of questionnaire, accelerometer, and pedometer: measures in older people

PURPOSE

To compare (i) the convergent validity of the self-report Zutphen Physical Activity Questionnaire with the 7-d objective physical activity (PA) measurement by accelerometers and pedometers and (ii) the construct validity of these measures by examining their associations with physical health and psychological and anthropometric variables.

METHODS

Five hundred and sixty community-dwelling people aged > or =65 yr were invited from a UK primary care practice and 238 (43%) participated (mean age = 74, 53% male). PA was assessed subjectively by the Zutphen questionnaire (modified to include housework questions) and objectively by the 7-d accelerometer monitoring: a random half also had a pedometer. A questionnaire assessed health, disability, and psychological factors, and anthropometric assessment was performed.

RESULTS

Mean daily PA levels were as follows: Zutphen = 9.1 kcal x kg(-1) x d(-1) (SD = 6.6 kcal x kg(-1) x d(-1)); accelerometer activity count = 226,648 (SD = 121,966); accelerometer step count = 6495 (SD = 3212); and pedometer step count = 6712 (SD = 3526). Zutphen score was moderately correlated with accelerometer activity count (R = 0.34, P < 0.001) and pedometer step count (R = 0.36, P < 0.001). Pedometer step count was highly correlated with accelerometer activity count (R = 0.82, P< 0.001) and accelerometer step count (R = 0.86, P < 0.001). Objective PA measures showed strong associations with health and anthropometric and psychological variables. Zutphen score was not significantly related to most health or anthropometric measures but was associated with psychological variables and provided information about activity type.

CONCLUSIONS

Convergent validity was strong between accelerometers and pedometers but weaker between these and self-report Zutphen. Pedometers may be preferred to accelerometers for simple studies due to their lower cost. Objective measures had better construct validity, being more strongly associated with established PA determinants, and thus offered better value to researchers than the questionnaire, but the latter provided useful detail on activity type, so a combined approach to PA assessment may be preferable.

Research to Encourage Exercise for Fibromyalgia (REEF): use of motivational interviewing design and method

Fibromyalgia (FM), defined as the presence of both chronic widespread pain and the finding of 11/18 tender points on examination, is an illness associated with major personal and societal burden. Supervised aerobic exercise is an important treatment modality to improve patient symptoms. Unfortunately, adherence to an exercise regimen after a structured supervised program is disappointingly low. Since FM is a chronic illness, studies are needed to test strategies that would enhance exercise adherence in these individuals. Individuals who are able to adhere to exercise almost always maintain the symptomatic benefits of exercise. The objective of this paper was to describe the protocol of the Research to Encourage Exercise for Fibromyalgia (REEF). REEF is a randomized attention-controlled trial that seeks to test the efficacy of 6 sessions of telephone delivered motivational interviewing (MI) that targets exercise adherence to improve FM-relevant clinical outcomes (i.e., physical function and pain severity). The trial has recently completed enrolling 216 subjects, and randomization has resulted in well-balanced groups. Details on the study design, MI program, and treatment fidelity are provided in the paper. Outcome assessments at week 12, week 24 and week 36 will test the immediate, intermediate and long-term effects of exercise-based MI on adherence (as measured by the Community Health Activities Model Program for Seniors/CHAMPS and accelerometer) and clinical outcomes. When completed, REEF will determine whether exercise-based MI could be utilized as a management strategy to sustain the clinical benefits of exercise for FM.

Self-administered physical activity questionnaires for the elderly: a systematic review of measurement properties

OBJECTIVE

To systematically review and appraise studies examining self-administered physical activity questionnaires (PAQ) for the elderly. This article is one of a group of four articles in Sports Medicine on the content and measurement properties of PAQs. LITERATURE SEARCH METHODOLOGY: Searches in PubMed, EMBASE and SportDiscu (until May 2009) on self-administered PAQ. Inclusion criteria were as follows: (i) the study examined (at least one of) the measurement properties of a self-administered PAQ; (ii) the questionnaire aimed to measure physical activity (PA) in older people; (iii) the average age of the study population was >55 years; (iv) the article was written in English. We excluded PA interviews, diaries and studies that evaluated the measurement properties of a self-administered PAQ in a specific population, such as patients. We used a standard checklist (qualitative attributes and measurement properties of PA questionnaires [QAPAQ]) for appraising the measurement properties of PAQs.

FINDINGS

Eighteen articles on 13 PAQs were reviewed, including 16 reliability analyses and 25 validity analyses (of which 15 were on construct validity, seven on health/functioning associations, two on known-groups validity and one on responsiveness). Many studies suffered from methodological flaws, e.g. too small sample size or inadequate time interval between test and retest. Three PAQs received a positive rating on reliability: IPAQ-C (International Physical Activity Questionnaire-Chinese), intraclass correlation coefficient (ICC) > or = 0.81; WHI-PAQ (Women's Health Initiative-PAQ), ICC = 0.76; and PASE (Physical Activity Scale for the Elderly), Pearson correlation coefficient (r) = 0.84. However, PASE was negatively rated on reliability in another study (ICC = 0.65). One PAQ received a positive rating on construct validity: PASE against Mini-Logger (r > 0.52), but PASE was negatively rated in another study against accelerometer and another PAQ, Spearman correlation coefficient = 0.17 and 0.48, respectively. Three of the 13 PAQs were tested for health/functioning associations and all three were positively rated in some categories of PA in many studies (r > 0.30).

CONCLUSIONS

Even though several studies showed an association between the tested PAQ and health/functioning variables, the knowledge about reliability and construct validity of self-administrated PAQs for older adults is still scarce and more high-quality validation studies are needed.

What do IPAQ questions mean to older adults? Lessons from cognitive interviews

Background

Most questionnaires used for physical activity (PA) surveillance have been developed for adults aged ≤65 years. Given the health benefits of PA for older adults and the aging of the population, it is important to include adults aged 65+ years in PA surveillance. However, few studies have examined how well older adults understand PA surveillance questionnaires. This study aimed to document older adults' understanding of questions from the International PA Questionnaire (IPAQ), which is used worldwide for PA surveillance.

Methods

Participants were 41 community-dwelling adults aged 65-89 years. They each completed IPAQ in a face-to-face semi-structured interview, using the "think-aloud" method, in which they expressed their thoughts out loud as they answered IPAQ questions. Interviews were transcribed and coded according to a three-stage model: understanding the intent of the question; performing the primary task (conducting the mental operations required to formulate a response); and response formatting (mapping the response into pre-specified response options).

Results

Most difficulties occurred during the understanding and performing the primary task stages. Errors included recalling PA in an "average" week, not in the previous 7 days; including PA lasting <10 minutes/session; reporting the same PA twice or thrice; and including the total time of an activity for which only a part of that time was at the intensity specified in the question. Participants were unclear what activities fitted within a question's scope and used a variety of strategies for determining the frequency and duration of their activities. Participants experienced more difficulties with the moderate-intensity PA and walking questions than with the vigorous-intensity PA questions. The sitting time question, particularly difficult for many participants, required the use of an answer strategy different from that used to answer questions about PA.

Conclusions

These findings indicate a need for caution in administering IPAQ to adults aged ≥65 years. Most errors resulted in over-reporting, although errors resulting in under-reporting were also noted. Given the nature of the errors made by participants, it is possible that similar errors occur when IPAQ is used in younger populations and that the errors identified could be minimized with small modifications to IPAQ.

Longitudinal physical activity changes in older men in the Osteoporotic Fractures in Men Study

OBJECTIVES

To describe the change in physical activity (total, leisure, household, occupational) in men over a mean 5-year follow-up period and to identify sociodemographic and health factors associated with change in physical activity.

DESIGN

Prospective cohort study; Osteoporotic Fractures in Men Study; data collected March 2000 through May 2006.

SETTING

Six U.S. clinical centers.

PARTICIPANTS

Volunteer sample of ambulatory community-dwelling men aged 65 and older (N=5,161).

MEASUREMENTS

Self-reported physical activity assessed at baseline and Visit 2 (V2) (5 years apart) according to the Physical Activity Scale for the Elderly (PASE) (unitless, relative measure of physical activity).

RESULTS

At baseline, PASE scores averaged 16.8+/-35.5 for occupational, 37.0+/-34.0 for leisure, 95.9+/-43.2 for household, and 149.7+/-67.6 for total physical activity. Occupational (-6.2+/-33.9), leisure (-3.2+/-37.3), household (-9.9+/-44.3), and total (-19.3+/-67.7) physical activity change scores declined, on average, from baseline to V2. On average, change in total PASE scores declined more with age: -15.6+/-71.6 for men younger than 70, -16.4+/-67.0 for men aged 70 to 74, -21.4+/-66.9 for men aged 75 to 79, and -29.5+/-60.7 for men aged 80 and older. Living alone, smoking cigarettes, poor health, and higher blood pressure were associated with greater declines in physical activity over time. Although average scores declined, some older men (1,335, 26%) reported increasing physical activity levels. Better physical and mental health, living with others, and being younger were associated with the probability of increasing physical activity over time.

CONCLUSION

Over the 5-year period, the majority of men reported declines in total physical activity. Older men in poor health who live alone have a high risk of physical activity declines and may be an important group to target for exercise interventions.

The faith, activity, and nutrition (FAN) program: design of a participatory research intervention to increase physical activity and improve dietary habits in African American churches

BACKGROUND

African Americans are at increased risk for cardiovascular disease and cancer morbidity and mortality. Physical activity and healthy dietary practices can reduce this risk. The church is a promising setting to address health disparities, and community-based participatory research is a preferred approach.

OBJECTIVES

Using a community-based participatory approach and the social ecologic model, the FAN trial aims to increase self-reported moderate-intensity physical activity and fruit and vegetable consumption and reduce blood pressure in African American church members. Secondary aims are to increase objectively measured moderate-intensity physical activity and fiber/whole grain consumption and reduce fat consumption.

DESIGN

FAN is a group randomized trial (GRT) with two levels of clustering: participants (N=1279; n=316 accelerometer subgroup) within church and church within church cluster. In the first wave, seven clusters including 23 churches were randomized to an immediate intervention or delayed intervention. In subsequent waves, 51 churches were randomized to an immediate or delayed intervention.

METHODS

Church committee members, pastors, and cooks participate in full-day trainings to learn how to implement physical activity and dietary changes in the church. Monthly mailings and technical assistance calls are delivered over the 15-month intervention. Members complete measurements at baseline and 15 months. A detailed process evaluation is included.

SUMMARY

FAN focuses on modifying the social, cultural, and policy environment in a faith-based setting. The use of a community-based participatory research approach, engagement of church leaders, inclusion of a detailed process evaluation, and a formal plan for sustainability and dissemination make FAN unique.

Comparison of diet quality, physical activity and biochemical values of older adults either reporting or not reporting use of lipid-lowering medication

OBJECTIVES

The aim of this study was to compare standard lipid profile, reported dietary intake, and physical activity in older adults who reported taking or not taking a lipid-lowering medication, namely statins.

DESIGN

Cross-sectional study utilizing baseline data collected from a subsample of a larger randomized clinical trial, The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) Project.

PARTICIPANTS AND SETTING

A total of 115 participants, 33 males and 82 females, over the age of 60, community-dwelling, primarily retired, and from East Providence, Rhode Island and surrounding communities in Rhode Island and Massachusetts.

MEASUREMENTS

Height and weight were measured and used to calculate body mass index. Waist circumference was measured. Medical history and medication use surveys were completed. Dietary assessment was done via three 24 hour recalls using NDS-R. The Yale Physical Activity Survey was used to determine energy expenditure during exercise and a physical activity summary score. Fasting blood samples were obtained to determine lipid profile.

RESULTS

37 participants (32.2%) reported taking lipid-lowering medication, statins exclusively, and 78 (67.8%) reported not taking any lipid-lowering medication. Participants who reported taking statins had better lipid profiles than those participants who reported not taking statins but had significantly lower intakes of vitamin B12, vitamin K, calcium, and potassium. There were no differences between groups on reported physical activity. However, the mean intakes for both groups did not meet the Dietary Reference Intakes for multiple nutrients.

CONCLUSION

Older adults need additional education on the importance of lifestyle changes in reducing CHD risk, whether taking lipid-lowering medications or not.

Improving lifestyle and risk perception through patient involvement in nurse-led cardiovascular risk management: a cluster-randomized controlled trial in primary care

OBJECTIVE

To determine if lifestyle improved at a short term through an intervention to involve patients in cardiovascular risk management by the practice nurse.

METHODS

The IMPALA study (2006, the Netherlands) was a cluster-randomised controlled trial involving 25 general practices and 615 patients who were eligible for cardiovascular risk management. The intervention consisted of (1) individual 10-year cardiovascular risk assessment, (2) risk communication, (3) use of a decision aid and (4) adapted motivational interviewing, applied by practice nurses in two consultations. Outcomes were smoking, alcohol, diet, physical activity and the secondary outcomes risk perception, anxiety, confidence about the decision and satisfaction with the communication, measured at baseline and after 12 weeks.

RESULTS

Patients of both groups improved their lifestyle, but no relevant significant differences between the groups were found. Intervention group patients improved in terms of the appropriateness of risk perception, although not significantly. Intervention group patients improved significantly in terms of appropriateness of anxiety and were more satisfied with the communication compared to control group patients.

CONCLUSION

The intervention seems to have improved the patients' risk perception, anxiety and satisfaction with the communication, which are important conditions for shared decision making. However, we found no additional effect of the intervention on lifestyle.

Involving patients in cardiovascular risk management with nurse-led clinics: a cluster randomized controlled trial

BACKGROUND

Preventive guidelines on cardiovascular risk management recommend lifestyle changes. Support for lifestyle changes may be a useful task for practice nurses, but the effect of such interventions in primary prevention is not clear. We examined the effect of involving patients in nurse-led cardiovascular risk management on lifestyle adherence and cardiovascular risk.

METHODS

We performed a cluster randomized controlled trial in 25 practices that included 615 patients. The intervention consisted of nurse-led cardiovascular risk management, including risk assessment, risk communication, a decision aid and adapted motivational interviewing. The control group received a minimal nurse-led intervention. The self-reported outcome measures at one year were smoking, alcohol use, diet and physical activity. Nurses assessed 10-year cardiovascular mortality risk after one year.

RESULTS

There were no significant differences between the intervention groups. The effect of the intervention on the consumption of vegetables and physical activity was small, and some differences were only significant for subgroups. The effects of the intervention on the intake of fat, fruit and alcohol and smoking were not significant. We found no effect between the groups for cardiovascular 10-year risk.

INTERPRETATION

Nurse-led risk communication, use of a decision aid and adapted motivational interviewing did not lead to relevant differences between the groups in terms of lifestyle changes or cardiovascular risk, despite significant within-group differences.

The effects of 8-week balance training or weight training: For the elderly on fear of falling measures and social activity levels

The purpose of this study was to examine the influence of participating in an 8-week physical training (ie: balance or weight training) on psychosocial outcomes for independently living healthy older adults. Eighteen older adults (65 years old or older) voluntarily participated for this study. Participants were randomly and evenly distributed in 3 different groups such as balance, weight, or control group; 6 participants each. Fear of falling and social activity levels were statistically tested by evaluating questionnaires validated in previous studies. Psychological factors improved in all groups after 8 weeks (P < 0.05). Social interaction level did not improve in any of the three groups, although all participants exhibited improvements in being physically independent (P < 0.05). Results suggested that being physically active as well as being socially active could result in being less fearful of falls, more confident of leaving residency, being more independent, and being more active.

Prevalence and determinants of physical activity and fluid intake in kidney transplant recipients

BACKGROUND AND SIGNIFICANCE

Self-care for kidney transplantation is recommended to maintain kidney function. Little is known about levels of self-care practices and demographic, psychosocial, and health-related correlates.

AIM

To investigate patients' self-reported exercise and fluid intake, demographic and psychosocial factors associated with these self-care practices, and health-related quality of life.

METHODS

Eighty-eight of 158 kidney recipients from two academic medical centers completed a semi-structured interview and surveys 2 months post-transplant.

RESULTS

Most patients were sedentary (76%) with a quarter exercising either regularly (11%) or not at current recommendations (13%). One-third (35%) reported drinking the recommended 3 L of fluid daily. Multivariate analyses indicated that private insurance, high self-efficacy, and better physical functioning were significantly associated with engaging in physical activity (p < 0.05); while male gender, private insurance, high self-efficacy, and not attributing oneself responsible for transplant success were significant predictors of adherence to fluid intake (p < 0.05). Despite the significance of these predictors, models for physical activity and fluid intake explained 10-15% of the overall variance in these behaviors. Multivariate analyses indicated that younger age, high value of exercise, and higher social functioning significantly (p < 0.05) predicted high self-efficacy for physical activity, while being married significantly (p < 0.05) predicted high self-efficacy for fluid intake.

CONCLUSION

Identifying patients at risk of inadequate self-care practice is essential for educating patients about the importance of self-care.

Longitudinal analysis of physical activity, fluid intake, and graft function among kidney transplant recipients

Self-care is recommended to kidney transplant recipients as a vital component to maintain long-term graft function. However, little is known about the effects of physical activity, fluid intake, and smoking history on graft function. This longitudinal study examined the relationship between self-care practices on graft function among 88 new kidney transplant recipients in Chicago, IL and Albany, NY between 2005 and 2008. Participants were interviewed, completed surveys, and medical charts were abstracted. Physical activity, fluid intake, and smoking history at baseline were compared with changes in estimated glomerular filtration rate (eGFR) (every 6 months up to 1 year) using bivariate and multivariate regression analysis, while controlling for sociodemographic and clinical transplant variables. Multivariate analyses revealed that greater physical activity was significantly (P < 0.05) associated with improvement in GFR at 6 months; while greater physical activity, absence of smoking history, and nonwhite ethnicity were significant (P < 0.05) predictors of improvement in GFR at 12 months. These results suggest that increasing physical activity levels in kidney recipients may be an effective behavioral measure to help ensure graft functioning. Our findings suggest the need for a randomized controlled trial of exercise, fluid intake, and smoking history on GFR beyond 12 months.

Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women

BACKGROUND

African American women are at increased risk for CVD morbidity and mortality relative to white women. Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk. Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD, yet few lifestyle counseling interventions have been conducted in this setting.

METHODS

The HHER Lifestyle trial is a randomized controlled trial to compare the effects of a standard care intervention (provider counseling, nurse goal setting, and educational materials) to a comprehensive intervention (standard care intervention plus 12 months of telephone counseling and tailored print materials) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months. Secondary outcomes are body mass index, central adiposity, and total cholesterol. Potential mediators of outcome are self-efficacy for overcoming barriers, social support, and decisional balance.

RESULTS

African American women (N=266; 130 standard care, 136 comprehensive intervention) 35 years and older from nine clinics within two community health centers were enrolled. Most participants were overweight or obese with existing chronic health conditions.

CONCLUSION

The HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers, incorporates a standard care intervention into a routine clinical appointment, and includes a comprehensive process evaluation. The design will permit further research examining the added effect of regular telephone counseling and tailored print materials to a primary care provider and nurse intervention.

Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors

BACKGROUND

Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, to the authors' knowledge, little is known regarding the health behaviors of older cancer survivors and the associations of those behaviors with quality-of-life outcomes, especially during the long-term post-treatment period.

METHODS

In total, 753 older (aged > or =65 years) long-term survivors (> or =5 years postdiagnosis) of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for a diet and exercise intervention trial. The interviews assessed exercise, diet, weight status, and quality of life.

RESULTS

Older cancer survivors reported a median of 10 minutes of moderate-to-vigorous exercise per week, and only 7% had Healthy Eating Index scores >80 (indicative of healthful eating habits relative to national guidelines). Despite their suboptimal health behaviors, survivors reported mental and physical quality of life that exceeded age-related norms. Greater exercise and better diet quality were associated with better physical quality-of-life outcomes (eg, better vitality and physical functioning; P < .05), whereas greater body mass index was associated with reduced physical quality of life (P < .001).

CONCLUSIONS

The current results indicated a high prevalence of suboptimal health behaviors among older, long-term survivors of breast, prostate, and colorectal cancer who were interested in lifestyle modification. In addition, the findings pointed to the potential negative impact of obesity and the positive impact of physical activity and a healthy diet on physical quality of life in this population.

Analysis of Individual Social-ecological Mediators and Moderators and Their Ability to Explain Effect of a Randomized Neighborhood Walking Intervention

BACKGROUND

Using data from the SHAPE trial, a randomized 6-month neighborhood-based intervention designed to increase walking activity among older adults, this study identified and analyzed social-ecological factors mediating and moderating changes in walking activity.

METHODS

Three potential mediators (social cohesion, walking efficacy, and perception of neighborhood problems) and minutes of brisk walking were assessed at baseline, 3-months, and 6-months. One moderator, neighborhood walkability, was assessed using an administrative GIS database. The mediating effect of change in process variables on change in brisk walking was tested using a product-of-coefficients test, and we evaluated the moderating effect of neighborhood walkability on change in brisk walking by testing the significance of the interaction between walkability and intervention status.

RESULTS

Only one of the hypothesized mediators, walking efficacy, explained the intervention effect (product of the coefficients (95% CI) = 8.72 (2.53, 15.56). Contrary to hypotheses, perceived neighborhood problems appeared to suppress the intervention effects (product of the coefficients (95% CI = -2.48, -5.6, -0.22). Neighborhood walkability did not moderate the intervention effect.

CONCLUSION

Walking efficacy may be an important mediator of lay-lead walking interventions for sedentary older adults. Social-ecologic theory-based analyses can support clinical interventions to elucidate the mediators and moderators responsible for producing intervention effects.

[Structured review of physical activity measurement with questionnaires and scales in older adults and the elderly]

OBJECTIVE

To characterize the distinct questionnaires and scales used to measure physical activity, their conceptual frameworks, psychometric properties and application norms.

METHOD

The review included original articles that used questionnaires or scales to assess physical activity in older adults or the elderly. The CINAHL and MEDLINE databases were consulted for the years 1993 to 2007. The studies selected had to provide information on the use, development and psychometric properties of the instruments. Instruments used in the population aged more than 45 years old were included. Articles that assessed physical activity by direct estimation, complex methods, or physical performance were excluded.

RESULTS

The search produced 166 references and 36 instruments were identified. Most of the studies quantified physical activity, and a minority assessed self-efficacy in physical activity performance and the stage of change. Half of the instruments were self-administered. The most frequently studied reliability was test-retest. Criterion validity was studied in 14 instruments, and 11 of these used at least two alternative methods of measurement. Construct validity was assessed in 26 instruments. Responsiveness was evaluated in only three instruments (YPAS, CHAMPS and Exercise Stage of Change) in addition to reliability and validity.

CONCLUSIONS

The Exercise Stage of Change questionnaire showed responsiveness and sufficient reliability to allow individual use. The 7Day PAR questionnaire and the Modified Baecke Questionnaire (Spanish version), which evaluate physical activity, can be used on an individual basis, although their responsiveness has not been studied. In general, the instruments analyzed do not assess mild intensity activities.

Validation of a physical activity questionnaire (CHAMPS) as an indicator of postoperative recovery after laparoscopic cholecystectomy

BACKGROUND

Although many surgical innovations are said to "shorten recovery," recovery has not been consistently defined or measured. The goal of this study was to assess the validity of a physical activity questionnaire (The Community Health Activities Model Program for Seniors [CHAMPS]) as an indicator of postoperative recovery.

METHODS

CHAMPS includes 41 questions asking the subject to estimate the time spent on a range of activities in the previous week; responses are converted into kcal/kg/wk. Patients scheduled for laparoscopic cholecystectomy were assessed preoperatively, 1 week and 1 month postoperatively (sensitivity to change). To assess construct validity, results were compared with other measures used to estimate recovery, including pain (VAS), health-related quality of life (SF-36), and complications. CHAMPS was also compared with a measure of exercise capacity, the 6-minute walk test (6MWT). Data expressed as median (IQR).

RESULTS

A total of 50 patients, 72% female, mean (SD) age 51 (17) years, participated. CHAMPS-estimated energy expenditure decreased from 42 [25-64] preop to 18 [9-30] kcal/kg/wk (P < .001) 1 week postoperatively. It remained below baseline at 30 [16-61] kcal/kg/wk 1 month postoperatively (P = .042). At all time points, SF-36 Physical Function, pain with movement, and 6MWT distance significantly correlated with CHAMPS. At 1 month, physical activity was lower in patients reporting complications (16 [10-32] vs 42 [18-77], P < .01).

CONCLUSION

Evidence is provided for construct validity for a physical activity questionnaire as a measure of surgical recovery.

Self-care strategies and barriers among kidney transplant recipients: a qualitative study

OBJECTIVES

We investigated kidney transplant recipients' self-reported levels of exercise and fluid intake. We also examined attitudes about, barriers to undertaking, and strategies used to initiate and maintain adequate self-care for fluid intake, exercise and dietary practices.

METHODS

A qualitative approach was used and supplemented by quantitative data to examine self-care among kidney transplant recipients (n = 82), including a semi-structured interview and survey of physical activity.

RESULTS

One-third of patients (33%) reported drinking the recommended 3 L of fluid each day. However, the majority (60%) reported not receiving this or any specific fluid intake recommendation. Twenty percent reported engaging in moderate to regular physical activity while 78% were sedentary. However, many reported that clinicians did not specify the amount of exercise (39%) or did not discuss exercise (15%). Attitudes towards fluid intake, exercise and maintaining a low-salt diet were mostly positive; patients expressed relatively more negative attitudes towards maintaining a low-cholesterol diet. Major barriers to fluid intake were not feeling thirsty, difficulty breaking the habit of limiting fluid intake formed while on dialysis, feeling full and limited access to fluids. Patients devised creative strategies to initiate and maintain appropriate hydration, physical activity and dietary levels, including intentionally drinking when not thirsty, modifying the environment, tracking intake and relying on social supports.

CONCLUSIONS

Few kidney recipients practiced optimal self-care for fluid intake or physical activity. Most patients encountered barriers to self-care that should be ameliorated to assist patients with managing their transplant. Understanding barriers and strategies is essential for developing educational interventions.

Factors associated with recurrence of venous leg ulcers: a survey and retrospective chart review

BACKGROUND

Chronic venous leg ulcers have a significant impact on older individuals' well-being and health care resources. Unfortunately after healing, up to 70% recur.

OBJECTIVE

To examine the relationships between leg ulcer recurrence and physical activity, compression, nutrition, health, psychosocial indicators and self-care activities in order to provide information for preventive strategies.

DESIGN

Survey and retrospective chart review.

SETTINGS

Two metropolitan hospital and three community-based leg ulcer clinics.

SUBJECTS

A sample of 122 community living patients with leg ulcer of venous aetiology which had healed between 12 and 36 months prior to the survey.

METHODS

Data were collected from medical records on demographics, medical history and previous ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer recurrences and history, compression and other self-care activities. All variables clinically or statistically significantly associated with recurrence at the bivariate level were entered into a logistic regression model to determine their independent influences on recurrence.

RESULTS

Median follow-up time was 24 months (range 12-40 months). Sixty-eight percent of participants had recurred. Bivariate analysis found recurrence was positively associated with ulcer duration, cardiac disease, a body mass index< or =20, scoring as at risk of malnutrition and depression; and negatively associated with increased physical activity, leg elevation, wearing Class 2 (20-25 mmHg) or Class 3 (30-40 mmHg) compression hosiery, and higher self-efficacy scores. After adjusting for all variables, an h/day of leg elevation (OR=0.04, 95% CI=0.01-0.17), days/week in Class 2 or 3 compression hosiery (OR=0.53, 95% CI=0.34-0.81), Yale Physical Activity Survey score (OR=0.95, 95% CI=0.92-0.98), cardiac disease (OR=5.03, 95% CI=1.01-24.93) and General Self-efficacy scores (OR=0.83, 95% CI=0.72-0.94) remained significantly associated (p<0.05) with recurrence.

CONCLUSIONS

Results indicate a history of cardiac disease is a risk factor for recurrence; while leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence.

Nurse-led motivational interviewing to change the lifestyle of patients with type 2 diabetes (MILD-project): protocol for a cluster, randomized, controlled trial on implementing lifestyle recommendations

Background

The diabetes of many patients is managed in general practice; healthcare providers aim to promote healthful behaviors, such as healthful diet, adequate physical activity, and smoking cessation. These measures may decrease insulin resistance, improve glycemic control, lipid abnormalities, and hypertension. They may also prevent cardiovascular disease and complications of diabetes. However, professionals do not adhere optimally to guidelines for lifestyle counseling. Motivational interviewing to change the lifestyle of patients with type 2 diabetes is intended to improve diabetes care in accordance with the national guidelines for lifestyle counseling. Primary care nurses will be trained in motivational interviewing embedded in structured care in general practice. The aim of this paper is to describe the design and methods of a study evaluating the effects of the nurses' training on patient outcomes.

Methods/Design

A cluster, randomized, controlled trial involving 70 general practices (35 practices in the intervention arm and 35 in the control arm) starting in March 2007. A total of 700 patients with type 2 diabetes will be recruited. The patients in the intervention arm will receive care from the primary care nurse, who will receive training in an implementation strategy with motivational interviewing as the core component. Other components of this strategy will be adaptation of the diabetes protocol to local circumstances, introduction of a social map for lifestyle support, and educational and supportive tools for sustaining motivational interviewing. The control arm will be encouraged to maintain usual care. The effect measures will be the care process, metabolic parameters (glycosylated hemoglobin, blood pressure and lipids), lifestyle (diet, physical activity, smoking, and alcohol), health-related quality of life, and patients' willingness to change behaviors. The measurements will take place at baseline and after 14 months.

Discussion

Applying motivational interviewing for patients with diabetes in primary care has been studied, but to our knowledge, no other study has yet evaluated the implementation and sustainability of motivating and involving patients in day-to-day diabetes care in general practice. If this intervention proves to be effective and cost-effective, large-scale implementation of this nurse-oriented intervention will be considered and anticipated.

Trial registration

Current Controlled Trials ISRCTN68707773.

Physical activity and function in older, long-term colorectal cancer survivors

OBJECTIVE

Increasing age and cancer history are related to impaired physical function. Since physical activity has been shown to ameliorate age-related functional declines, we evaluated the association between physical activity and function in older, long-term colorectal cancer survivors.

METHODS

In 2006-2007, mailed surveys were sent to colorectal cancer survivors, aged > or = 65 years when diagnosed during 1995-2000, and identified through a state cancer registry. Information on physical activity, physical function, and relevant covariates was obtained and matched to registry data. Analysis of covariance and linear regression were used to compare means and trends in physical function across levels of activity in the final analytic sample of 843 cases.

RESULTS

A direct, dose-dependent association between physical activity and function was observed (p(trend) < .001), with higher SF-36 physical function subscores in those reporting high versus low activity levels (65.0 +/- 1.7 vs. 42.7 +/- 1.7 (mean +/- standard error)). Walking, gardening, housework, and exercise activities were all independently related to better physical function. Moderate-vigorous intensity activity (p(trend) < .001) was associated with function, but light activity (p(trend) = 0.39) was not.

CONCLUSION

Results from this cross-sectional study indicate significant associations between physical activity and physical function in older, long-term colorectal cancer survivors.

Restorative yoga in adults with metabolic syndrome: a randomized, controlled pilot trial

BACKGROUND

Metabolic syndrome increases the risk of diabetes and cardiovascular disease. Yoga improves some metabolic parameters, but it has not been studied in persons with metabolic syndrome. We conducted a randomized controlled pilot trial to determine whether a restorative yoga intervention was feasible and acceptable in underactive, overweight adults with metabolic syndrome.

METHODS

Twenty six underactive, overweight adult men and women with metabolic syndrome were randomized to attend 15 yoga sessions of 90 minutes each over 10 weeks or to a wait-list control group. Feasibility was measured by recruitment rates, subject retention, and adherence. Acceptability was assessed by interview and questionnaires. Changes in metabolic outcomes and questionnaire measures from baseline to week 10 were calculated.

RESULTS

A total of 280 people were screened by phone, and 93 with high likelihood of metabolic syndrome were invited to a screening visit. Of the 68 who attended screening visits, 26 (38%) were randomized, and 24 (92%) completed the trial. Attendance at yoga classes and adherence to home practice exceeded our goals. In the yoga group, all participants gave the study the highest possible satisfaction rating, and the majority (87%) felt that the yoga poses were easy to perform. There was trend to reduced blood pressure (p = 0.07), a significant increase in energy level (p < 0.009), and trends to improvement in well-being (p < 0.12) and stress (p < 0.22) in the yoga versus control group.

CONCLUSIONS

Restorative yoga was a feasible and acceptable intervention in overweight adults with metabolic syndrome. The efficacy of yoga for improving metabolic parameters in this population should be explored in a larger randomized controlled trial.

The Phone-FITT: a brief physical activity interview for older adults

The purpose of this study was to develop a brief physical activity interview for older adults (Phone-FITT) and evaluate its test-retest reliability and validity. Summary scores were derived for household, recreational, and total PA. Reliability was evaluated in a convenience sample from a fall-prevention study (N = 43, 79.4 +/- 2.9 years, 51% male), and validity, in a random sample of individuals in older adult exercise programs (N = 48, 77.4 +/- 4.7 years, 25% male). Mean time to complete the Phone-FITT was 10 min for participants sampled from exercise programs. Evaluation of test-retest reliability indicated substantial to almost perfect agreement for all scores, with intraclass correlation coefficients (95% confidence intervals) ranging from .74 (.58-.85) to .88 (.8-.94). For validity, Spearman's rho correlations of Phone-FITT scores with accelerometer counts ranged from .29 (.01-.53) to .57 (.34-.73). Correlations of Phone-FITT recreational scores with age and seconds to complete a self-paced step test ranged from -.29 (-.53 to -.01) to -.45 (-.68 to -.14). This study contributes preliminary evidence of the reliability and validity of the Phone-FITT.

A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review

BACKGROUND

Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults.

METHODS

Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.

RESULTS

Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.

CONCLUSION

The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report - direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.

Active for life: final results from the translation of two physical activity programs

BACKGROUND

Most evidence-based programs are never translated into community settings and thus never make a public health impact.

DESIGN

Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008.

SETTING/PARTICIPANTS

Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white).

INTERVENTION

In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4.

MAIN OUTCOME MEASURE

Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure.

RESULTS

Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites.

CONCLUSIONS

Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult's health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

Use of accelerometry to measure physical activity in older adults at risk for mobility disability

The authors explored using the ActiGraph accelerometer to differentiate activity levels between participants in a physical activity (PA, n = 54) or "successful aging" (SA) program (n = 52). The relationship between a PA questionnaire for older adults (CHAMPS) and accelerometry variables was also determined. Individualized accelerometry-count thresholds (ThreshIND) measured during a 400-m walk were used to identify "meaningful activity." Participants then wore the ActiGraph for 7 days. Results indicated more activity bouts/day > or =10 min above ThreshIND in the PA group than in the SA group (1.1 +/- 2.0 vs 0.5 +/- 0.8, p = .05) and more activity counts/day above ThreshIND for the PA group (28,101 +/- 27,521) than for the SA group (17,234 +/- 15,620, p = .02). Correlations between activity counts/hr and CHAMPS ranged from .27 to .42, p < .01. The ActiGraph and ThreshIND might be useful for differentiating PA levels in older adults at risk for mobility disability.

Assessment of physical activity in middle-aged and older adults with schizophrenia

BACKGROUND

Regular physical activity (PA) decreases morbidity in the general population; yet, information about the amount and effects of PA in persons with schizophrenia is scant. To develop interventions to increase PA and to assess its potential benefits in this group, accurate measurement of PA is needed. The purpose of this study was to characterize PA and determine the test-retest reliability and concurrent validity of the Yale Physical Activity Scale (YPAS), a self-report measure, in persons with schizophrenia.

METHODS

PA was assessed with the YPAS, a scale of motivational readiness for PA, and accelerometry in middle-aged and older persons with a diagnosis of schizophrenia (n=54) and in a comparison group with no known psychiatric diagnosis (n=27).

RESULTS

On the YPAS measures, persons with schizophrenia reported on average 11 h per week of PA, whereas the non-psychiatric comparison group reported about 32 h per week. Only about 30% of schizophrenia subjects were classified as being regularly active relative to 62% of the comparison group on PA motivational stages of readiness. On the accelerometry measures, the schizophrenia group had lower levels of light activity than the comparison group, but there were no differences in moderate and vigorous activity or sedentary behavior. Only in the comparison group were there significant associations between YPAS and accelerometer variables. Several YPAS scores demonstrated high test-retest reliability in both groups, and concurrent validity was supported between the YPAS and PA motivational stages of readiness.

CONCLUSIONS

We found that the YPAS is a reliable measure of PA in schizophrenia for some indices. Although the YPAS demonstrated concurrent validity with other self-report measures, it did not demonstrate concurrent validity when compared to PA measured by accelerometry in persons with schizophrenia. Use of multiple measures, both subjective and objective, is recommended when assessing PA in schizophrenia.

The relation between neighborhood built environment and walking activity among older adults

The association of neighborhood built environment with walking activity has received growing attention, although most studies have relied upon subjective measures of the built environment and few have examined the relation between built environment and walking among older adults. This 2001 study examined the relation between objectively measured characteristics of the local neighborhood and walking activity among a sample of 546 community-dwelling older adults in Portland, Oregon. A geographic information system was used to derive measures of the built environment within a quarter-mile (0.4 km) and half-mile (0.8 km) radius around each participant's residence. Multilevel regression analysis was used to examine the association of built environment with walking behavior. No association between built environment and the likelihood of walking or not walking was observed in this cohort of older adults. However, among those participants who reported some degree of walking activity, average time spent walking per week was significantly associated with amount of automobile traffic and number of commercial establishments in their local neighborhood. These findings suggest that built environment may not play a significant role in whether older adults walk, but, among those who do walk, it is associated with increased levels of activity.

A randomized trial to increase physical activity among native elders

OBJECTIVE

Physical inactivity is common among older populations and American Indians. Our objective was to compare two methods for increasing physical activity and walking among American Indian elders.

METHODS

We conducted a two arm randomized trial to increase physical activity in 125 American Indians aged 50-74 years at the Seattle Indian Health Board in 2005. Participants were randomized into either an activity monitoring (N=63) or activity monitoring with a pedometer (N=62) arm over a six-week period. Outcomes included self-reported physical activity and well-being, and the 6-min walk test.

RESULTS

There were no group differences in self-reported physical activities and well-being. The 6-min walk test yielded no between-group differences. All participants increased the frequency of leisure walking (p<0.01), frequency of all exercise-related activities (p<0.01), frequency of moderate-intensity exercise activities (p<0.01), and improved weekly caloric expenditure for all exercise activities (p<0.05) by the end of the trial.

CONCLUSIONS

Pedometers did not confer enhanced performance on the physical activity outcomes beyond those achieved through self-monitoring. Physical activity can be promoted among at-risk groups in a brief, inexpensive manner in primary care. Exercise prescription and culturally relevant enhancement strategies may optimize physical activity outcomes for elder American Indians.

Physical activity and psychological well-being among Hong Kong Chinese older adults: exploring the moderating role of self-construal

This study examined the association between physical activity (PA) and psychological well-being--self-esteem and relatedness satisfaction--among 102 Hong Kong Chinese older adults. It also tested whether independent-interdependent self-construal moderated the association. Physical activity, self esteem, relatedness satisfaction, and self-construal were measured by the Yale Physical Activity Scale, the Rosenberg's Self-Esteem Scale, the Relatedness Satisfaction subscale of the Basic Need Satisfaction in General Questionnaire, and Gudykunst, Matsunoto, Ting-Toomey, and Nishida's (1996) Self-Construal Scale respectively. Findings revealed a positive association between PA and relatedness satisfaction, but not self-esteem. Interdependent self-construal moderated the relationship between physical exercise and relatedness satisfaction. These findings suggest that PA may be psychologically beneficial to older adults across cultures, but its benefits may depend on cultural emphasis and individual self-construal.

A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease

BACKGROUND

The purpose of this pilot study was to examine the effects of lifestyle physical activity in caregivers (CGs) of persons with Alzheimer's disease.

METHODS

Fifteen CGs engaged in lifestyle physical activity during a 6-month, home-based health promotion program. Mean changes in self-reported physical activity were compared using repeated-measures analysis of variance.

RESULTS

Fifty percent of CGs increased total self-reported minutes and 42% increased total moderate minutes of physical activity from preintervention to postintervention; however, no CG engaged in vigorous physical activity and there were no significant improvements in self-reported physical activity for the total group. Hot summer weather, heavy non-caregiving responsibilities, heavy caregiving responsibilities, and feelings of anxiety, depressive symptoms, and fatigue were the most frequently identified physical activity barriers.

CONCLUSION

Incorporating an individualized, home-based program of lifestyle physical activity appears feasible; however, attention needs to be given in the future to physical activity barriers identified by this select group of CGs.

[Instrument for the assessment of middle-aged and older adults' physical activity: design, eliability and application of the German-PAQ-50+]

Existing physical activity questionnaires have focused either on young and middle-aged adults or on the elderly. They have mainly assessed only a portion of possible physical activities or contained nation-specific sports. As there is no gold standard for a questionnaire-based assessment of physical activity in the over-50 population, recommendations for such a questionnaire relating to German-speaking countries were developed. This work included a systematic literature research, a survey of experts, and the design of a questionnaire based on validated measuring instruments. Finally, to test its reliability and application in the field, the complete questionnaire, including a retest, was applied by telephone interview (n = 57). The test-retest-correlation was r = 0.60 for the total time of physical activity and r = 0.52 for total energy expenditure. The researchers determined that the instrument is comprehensive in its coverage of all relevant domains of physical activity for the over-50 population; it is economically feasible and showed good acceptance.

The skeletal benefits of calcium- and vitamin D3-fortified milk are sustained in older men after withdrawal of supplementation: an 18-mo follow-up study

BACKGROUND

In a previous 2-y randomized controlled trial, we showed that calcium- and vitamin D3-fortified milk stopped or slowed bone loss at several clinically relevant skeletal sites in older men.

OBJECTIVE

The present study aimed to determine whether the skeletal benefits of the fortified milk were sustained after withdrawal of the supplementation.

DESIGN

One hundred nine men >50 y old who had completed a 2-y fortified milk trial were followed for an additional 18 mo, during which no fortified milk was provided. Bone mineral density (BMD) of the total hip, femoral neck, lumbar spine, and forearm was measured by using dual-energy X-ray absorptiometry.

RESULTS

Comparison of the mean changes from baseline between the groups (adjusted for baseline age, BMD, total calcium intake, and change in weight) showed that the net beneficial effects of fortified milk on femoral neck and ultradistal radius BMD at the end of the intervention (1.8% and 1.5%, respectively; P < 0.01 for both) were sustained at 18-mo follow-up (P < 0.05 for both). The nonsignificant between-group differences at the total hip (0.8%; P = 0.17) also persisted at follow-up (0.7%; P = 0.10), but there were no lasting benefits at the lumbar spine. The average total dietary calcium intake in the milk supplementation group at follow-up approximated recommended amounts for Australian men >50 y old (1000 mg/d) but did not differ significantly from that in the control subjects (1021 versus 890 mg/d).

CONCLUSION

Supplementation with calcium- and vitamin D3-fortified milk for 2 y may provide some sustained benefits for BMD in older men after withdrawal of supplementation.

Construct validation of physical activity surveys in culturally diverse older adults: a comparison of four commonly used questionnaires

The purpose of this study was to establish validity evidence of four physical activity (PA) questionnaires in culturally diverse older adults by comparing self-report PA with performance-based physical function. Participants were 54 older adults who completed the Continuous Scale Physical Functional Performance 10-item Test (CS-PFP10), Physical Activity Scale for the Elderly (PASE), HAMPS Physical Activity Questionnaire for Older Adults, Yale Physical Activity Survey (YPAS), and modified Baecke questionnaire. The total PASE score, three outcome scores for the CHAMPS, and three summary indices for the YPAS were significantly correlated with total CS-PFP10 score. The modified Baecke exhibited no correlations with CS-PFP10 scores. The PASE, CHAMPS, and YPAS appear to be the most valid PA self-report questionnaires for culturally diverse older adults.

Development and evaluation of the physical activity questionnaire for elderly Japanese: the Nakanojo study

The Physical Activity Questionnaire for Elderly Japanese (PAQ-EJ) is a self-administered physical activity questionnaire for elderly Japanese; the authors report here on its repeatability and direct and indirect validity. Reliability was assessed by repeat administration after 1 month. Direct validation was based on accelerometer data collected every 4 s for 1 month in 147 individuals age 65-85 years. Indirect validation against a 10-item Barthel index (activities of daily living [ADL]) was completed in 3,084 individuals age 65-99 years. The test-retest coefficient was high (r = .64-.71). Total and subtotal scores for lower (transportation, housework, and labor) and higher intensity activities (exercise/sports) were significantly correlated with step counts and durations of physical activity <3 and >or=3 METs (r = .41, .28, .53), respectively. Controlling for age and ADL, scores for transportation, exercise/sports, and labor were greater in men, but women performed more housework. Sex- and ADL- or age-adjusted PAQ-EJ scores were significantly lower in older and dependent people. PAQ-EJ repeatability and validity seem comparable to those of instruments used in Western epidemiological studies.

Improving patient adherence to lifestyle advice (IMPALA): a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol)

BACKGROUND

Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on diet, physical exercise, smoking and alcohol, have moderate, but potentially relevant effects in these patients, adherence to lifestyle advice in general practice is not optimal. The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics. The aim of this paper is to describe the design and methods of a study to evaluate an intervention aimed at involving patients in cardiovascular risk management.

METHODS

A cluster-randomised controlled trial in 20 general practices, 10 practices in the intervention arm and 10 in the control arm, starting on October 2005. A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited. In both arms, the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management. Nurses in the intervention arm will receive an extended training in risk assessment, risk communication, the use of a decision aid and adapted motivational interviewing. This communication technique will be used to support the shared decision-making process about risk reduction. The intervention comprises 2 consultations and 1 follow-up telephone call. The nurses in the control arm will give usual care after the risk estimation, according to the national guideline. Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment. Secondary outcome measures are the patients' perception of risk and their motivation to change their behaviour. The measurements will take place at baseline and after 12 and 52 weeks. Clinical endpoints will not be measured, but the absolute 10-year risk of cardiovascular events will be estimated for each patient from medical records at baseline and after 1 year.

DISCUSSION

The combined use of risk communication, a decision aid and motivational interviewing to enhance patient involvement in decision making is an innovative aspect of the intervention.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN51556722.

Measuring physical activity in older adults: use of the Community Health Activities Model Program for Seniors Physical Activity Questionnaire and the Yale Physical Activity Survey in three behavior change consortium studies

The purpose of this study was to use data from three Behavior Change Consortium intervention studies to consider the practicality of use of two surveys of physical activity (PA) relevant for older adults, provide support for the validity of these surveys, and provide guidance to researchers for decisions on use of one survey as opposed to the other. The samples included 218 participants in the Community Health Advice by Telephone Study, 150 participants in the Study of Exercise and Nutrition in Older Rhode Islanders, and 150 participants from the Testing the Effectiveness of the Exercise Plus Program. PA surveys included the Yale PA Survey and the Community Health Activities Model Program for Seniors PA Questionnaire. Older adults were able to complete either survey, although for frailer participants, an interview format is recommended. The Community Health Activities Model Program for Seniors PA Questionnaire was more likely to elicit information about moderate-intensity physical activities and was more likely to be related to vitality. Conversely, the Yale PA Survey may more comprehensively describe overall PA and provide information about moderate-intensity physical activity.

The Reliability and Validity of the Physical Activity Survey in Long-Term Care

The purpose of this study was to develop and test a measure of physical activity for residents in long-term-care facilities, the Physical Activity Survey in Long-Term Care (PAS-LTC). Sixty-six activities are included in the PAS-LTC: routine physical activity, personal-care activities, structured exercise, recreational activities, caretaking activities, and repetitive activities. The study included 13 residents in a long-term-care facility, most of whom were women (62%), with an average age of 84 years (± 6.0) and an average Mini Mental State Examination score of 6 (± 6.9). There was evidence of interrater reliability of the PAS-LTC with intraclass correlations of .83-.94. There was some evidence of validity of the measure with statistically significant correlations between PAS-LTC recorded during the evening and night shifts and the number of counts of activity per the ActiGraph (r= .60 andr= .57, respectively,p< .05) and the calories estimated (r= .58 andr= .60, respectively,p< .05). The PAS-LTC completed during the day shift and total activity based on the PAS-LTC showed nonsignificant correlations of .40 or greater with the ActiGraph activity counts and calories.

Effect of a weight-loss program on mental stress–induced cardiovascular responses and recovery

OBJECTIVE

We assessed the effect of weight loss on blood pressure (BP) and pulse rate during rest, psychological stress, and recovery after stress.

METHODS

Two groups of men completed two mental stress tests 12 wk apart. The control group continued their usual diet, whereas the weight-loss group underwent a dietary weight-loss program in which they were randomized to a high-fruit/vegetable and low-fat dairy diet or a low-fat diet.

RESULTS

Fifty-five men with a baseline BP of 125.9 +/- 6.9/83.6 +/- 7.1 mmHg (mean +/- SD) completed the study (weight-loss group, n = 28; control group, n = 27). The weight-loss group lost weight (mean +/- SEM, -4.3 +/- 0.3 versus +0.4 +/- 0.4 kg, P = 0.001) compared with controls and had a significant decrease in resting systolic BP (SBP; -2.0 +/- 1.1% versus +2.0 +/- 1.1%, P < 0.05). There was a greater decrease in SBP (P < 0.05) and pulse rate (P < 0.05) at all time points during the stress test in the weight loss compared with the control group. At week 12, SBP in 23 (82%) subjects in the weight-loss group and 24 (89%) in the control group returned to resting levels, with recovering levels in the weight-loss group returning to resting levels 6.1 +/- 2.6 min earlier than in the control group (P < 0.05). There was an overall greater decrease in diastolic BP (DBP; P < 0.05) and DBP during recovery up to 27 min after stress (P < 0.05) in the high-fruit/vegetable and low-fat dairy diet group (n = 14) compared with the low-fat diet group (n = 14).

CONCLUSION

A 5% loss of weight decreased BP during rest and returned SBP to resting levels faster, thus decreasing the period of increased BP as a result of mental stress, which is likely to lower the risk of cardiovascular disease in the long term.

Physical Activity Behavior Change in Middle-aged and Older Women: The Role of Barriers and of Environmental Characteristics

The majority of North American women are insufficiently active. Using an ecological approach to examine physical activity behavior in a sample of middle-aged and older women, this study aimed to (1) describe barriers to physical activity behavior change as well as environmental characteristics present in their neighborhoods, (2) examine relationships between barriers and physical activity behavior change, and (3) investigate environmental characteristics that may contribute to physical activity behavior change. Participants were 149 women ranging in age between 39 and 68. At Time 1, self-reported physical activity was assessed. Six months later (Time 2), barriers and environmental characteristics were measured, and physical activity was re-assessed. The most prevalent barriers were daily activities and fatigue. Over time, inactive women reported higher levels of barriers (e.g. fatigue, lack of interest in physical activity) than women who remained active or increased their physical activity level. Certain environmental characteristics (e.g. enjoyable scenery, seeing others exercising in their neighborhood) are suggested as potential contributors to physical activity behavior change.

Physical activity patterns assessed by accelerometry in older people

Research into daily physical activity (PA) patterns of older adults (>or=70 years) has primarily relied on self-report. This study used accelerometry, an objective measure of minute-by-minute movement, to assess PA volume and intensity performed by older adults recruited to the Better Ageing project. Results were used to estimate the degree to which current health recommendations for PA were met. Participants [91 older females (OF) aged 76.0 +/- 4.0 years (mean +/- SD), 70 older males (OM) 76.3 +/- 3.9 years, 23 young females (YF) 26.8 +/- 4.1 years and 22 young males (YM) 27.0 +/- 4.2 years] wore an MTI actigraph model 7164 recording activity in 1-min epochs for 7 days. Only those with at least 5 days, and 10 h of actigraph data per day, were included in the analysis, using Caloric.Bas (CSA Inc. 1999) software and a tailored Microsoft Access 2000 macro. Mean counts min(-1) day(-1) were 37% lower for older adults than for young adults [OF 236.1 +/- 84.4 vs. YF 370.0 +/- 81.1 counts min(-1) day(-1) t(114) = -6.86, P < 0.001; OM 255.1 +/- 103.0 vs. YM 404.3 +/- 134.0 ct min(-1) day(-1), t(91) = -5.55, P < 0.001]. Older adults were more restricted in activity intensity range performing significantly fewer minutes of moderate to vigorous (MV) PA day(-1) than young adults [OF 16.7 +/- 12.2 vs. YF 38.4 +/- 18.4 MVPA min day(-1), t(114) = -6.90, P < 0.001; OM 23.8 +/- 20.0 vs. YM 40.4 +/- 19.2 MVPA min day(-1), t(91) = -3.47, P = 0.001]. Nearly half of older adults did not perform any sustained 10-min MVPA bouts (OF 48.4% vs. YF 13.0%, chi2 = 8.10, P = 0.004; OM 44.3% vs. YM 4.5%, chi2 = 9.97, P = 0.002), and none met current PA recommendations for health. This study is the first to provide objective data on a large sample of adults aged 70 years and over and indicates low levels of daily movement that are likely to be inadequate for optimal health benefit.

Perceived environments as physical activity correlates and moderators of intervention in five studies

PURPOSE

Few studies have explored how relationships of perceived environment and physical activity vary across different activity domains and populations. This question was explored in five physical activity intervention trials funded by the National Institutes of Health Behavior Change Consortium.

DESIGN

Observational.

SETTINGS

San Francisco peninsula, California (N = 94); Eugene, Oregon (N = 122); Atlanta, Georgia (N = 256); Kingston, Rhode Island (N = 109); Memphis, Tennessee (N = 64).

SUBJECTS

Ethnically diverse community adults ages 18 to 85 years.

MEASURES

The Neighborhood Environment Walkability Scale and CHAMPS physical activity questionnaire. Response rate among those invited to complete these measures was 90%.

RESULTS

Cross-sectional pooled signal detection analysis indicated that people who reported living in neighborhoods with more attractive scenery and ease of walking were more likely to meet national physical activity recommendations (67%) compared with those without these neighborhood attributes (36%; chi2 = 13.04, p = .0003). Within-site multiple regression identified two additional variables--seeing others when walking and encountering loose dogs that make it difficult to walk--as correlates across multiple sites and activity domains (i.e., minutes of weekly moderate or more vigorous activity, walking for errands, walking leisurely) (incremental R2 = 2.0-7.5; p < .05). Analyses of covariance suggested that traffic safety might be particularly important in facilitating or impeding physical activity in response to a formal intervention (for traffic-arm assignment interactions, F = 3.8-7.0, p < or = .05).

CONCLUSIONS

Relationships between perceived environments and physical activity may differ depending upon population groups and activity domains and merit investigation by using stronger prospective designs.

The effectiveness of a health promotion programme for women in southern Taiwan

The purpose of this study was to assess the effectiveness of an 8 week aerobic exercise class for women on changes in their physical activity behaviour. This was a descriptive, retrospective and comparison study. Because the data were collected after an 8 week aerobic exercise class, there were two groups of subjects. Subjects in the exercise group had attended exercise classes, but subjects in the control group had not. Results showed statistically significant differences between the two groups in the frequency/week of moderately intense exercise-related activities, caloric expenditure/week in all exercise-related activities and caloric expenditure/week in moderately intense exercise-related activities. However, there was no statistically significant difference in the frequency/week of all exercise-related activities. The result that women in the exercise group practised physical activities more than women in the control group might be related to their high exercise self-efficacy expectations.

Measurement properties of the CHAMPS physical activity questionnaire in a sample of older Australians

BACKGROUND

The effective evaluation of physical activity interventions for older adults requires measurement instruments with acceptable psychometric properties that are sufficiently sensitive to detect changes in this population.

AIM

To assess the measurement properties (reliability and validity) of the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in a sample of older Australians.

METHODS

CHAMPS data were collected from 167 older adults (mean age 79.1 S.D. 6.3 years) and validated with tests of physical ability and the SF-12 measures of physical and mental health. Responses from a sub-sample of 43 older adults were used to assess 1-week test-retest reliability.

RESULTS

Approximately 25% of participants needed assistance to complete the CHAMPS questionnaire. There were low but significant correlations between the CHAMPS scores and the physical performance measures (rho=0.14-0.32) and the physical health scale of the SF-12 (rho=0.12-0.24). Reliability coefficients were highest for moderate-intensity (ICC=0.81-0.88) and lowest for vigorous-intensity physical activity (ICC=0.34-0.45). Agreement between test-retest estimates of sufficient physical activity for health benefits (> or =150min and > or =5 sessions per week) was high (percent agreement=88% and Cohen's kappa=0.68).

CONCLUSION

These findings suggest that the CHAMPS questionnaire has acceptable measurement properties, and is therefore suitable for use among older Australian adults, as long as adequate assistance is provided during administration.