B.A.I.L.A. - a Latin dance randomized controlled trial for older Spanish-speaking Latinos: rationale, design, and methods

C.E.R.E.B.R.O.: A home-based physical activity study for older Latino adults

Background

The growing Latino population is 1.5 times more likely to develop Alzheimer's Disease (AD) and Related Dementias (ADRD) than non-Latino Whites. Interventions that can reduce the risk of ADRD are needed. Older Latinos face many barriers to the incorporation of physical activity (PA) into their daily lives given a lack social support, caregiving responsibilities, and lacking resources to maintain PA. Walking and dancing are the two most frequently reported forms of PA among older Latinos, and indoor PA programs conducted in a community location or at home can overcome barriers to participation.

Methods

C.E.R.E.B.R.O. (Cognitive Enhancement and Risk-reduction through Exercise for Brain-Related Outcomes; meaning "brain" in English) is testing two remote intervention programs, the BAILAMOS™ dance program and ¡En Forma y Fuerte! (Fit & Strong!), a PA/behavior change program. Participants are randomly assigned to either study condition. The BAILAMOS™ dance program is a 6-month long dance program, in which participants learn different Latin dances including Merengue, Cha Cha Cha, Bachata, Salsa, Cumbia, and Kizomba. Trained CEREBRO staff also lead monthly discussions. Persons randomized to the 3-month long ¡En Forma y Fuerte! program participate in flexibility and aerobic exercise, strength training, and health education. All classes are held live via Zoom. Trained study staff assist participants with technology-related issues. Data are collected through remote testing at baseline, 12 weeks, and 24 weeks after the start of the interventions. Outcomes include PA, cognition, quality of life, social connectedness, and cost-effectiveness.

Conclusion

CEREBRO has the potential to provide evidence regarding the advantages of providing remote intervention programs to reduce PA barriers in the older Latino community.

Systematic Review and Meta-Analysis of the Effects of Dance on Cognition and Depression in Healthy Older Adults

PURPOSE

Aging is associated with declines in cognition and mental health that might be ameliorated by physical activity (PA). Dance integrates multiple physical, cognitive, and social elements, and might be an avenue for improving cognition and mood. This systematic review and meta-analysis examined the effects of formal and traditional dance on cognition, depression, and anxiety in older adults.

METHODS

Five database searches yielded 17 randomized control trials (RCTs). RCTs were included if participants were ≥60 yr and healthy or living with mild cognitive impairment. We examined interventions of dance against any comparison group. Records were independently screened, and data were extracted by two reviewers. We performed random-effects models using robust variance estimation and tested individual treatment, study, and outcome-level moderators using the approximate Hotelling-Zhang test.

RESULTS

Seventeen RCTs were included in the systematic review, but 13 RCTs were included in the meta-analysis, which included 1174 participants with a mean age of 70.7 yr, and 66.3% were female. There were 76 effect sizes (Hedges g) calculated from the 13 RCTs with a range between -0.97 and 2.88. The overall effect of dance interventions on cognition was significant, yet small (g = 0.27; 95% confidence interval, 0.05-0.50; P = 0.022), and the effect on depression was significant and nearly moderate (g = 0.43; 95% confidence interval, 0.06-0.80; P = 0.036); only one RCT examined anxiety and was not included. No moderator variables significantly explained variation in the effects of dance on cognitive function or depression (P > 0.05).

CONCLUSIONS

Dance interventions can improve cognition and depression in older adults. Additional research is needed regarding the effects of dance on anxiety and depression in older adults.

Comparing Barriers and Facilitators to Physical ActivityAmong Underrepresented Minorities: Preliminary Outcomes from a Mixed-Methods Study

Physical activity (PA)'s benefits are well established, yet many U.S. adults fail to meet PA guidelines. This is especially true for minorities facing social inequities. This study explored PA's barriers and facilitators among urban Midwestern minorities using a mixed-methods approach framed on the socio-ecological model. A cross-sectional survey was conducted between January and June 2024 among community-dwelling minorities. Participants were grouped as completing low (LLPA) or high (HLPA) weekly leisure-time PA for comparison. Quantitative analysis included MANOVA, follow-up ANOVAs, and calculation of effect sizes. Qualitative data were assessed using inductive thematic analysis. Twenty-nine adults (44.83% Black, 41.37% Latino) participated in the study. The HLPA group (n = 18) reported higher leisure-time PA (p = 0.001, d = 2.21) and total PA (p = 0.02, d = 1.00) compared to the LLPA group (n = 11). LLPA participants faced more personal barriers to PA (p = 0.02, d = -0.92). Common barriers identified in the interviews included a lack of time and financial costs. Facilitators included social support and available PA facilities. Both groups achieved the USPA guidelines through different PA domains. Increasing social support and lowering PA-related costs could enhance participation. Addressing barriers and leveraging existing facilitators are crucial to increasing PA among minorities.

Latin dance and cognitive impairment: Importance of una Mezcla of culture and science

Latinos are one of the fastest growing minority groups of the older adult population. More culturally relevant forms of physical activity, such as dance are needed to engage the older Latino population. Dance is considered a type of physical activity and is fun, challenging, and socially engaging. Our research, among others, has shown that dance is an effective form of physical activity and has been shown to improve memory and overall health. Our research demonstrates the significance of culturally relevant physical activity interventions; and the importance of involving the perceptions and input of community members from the intended population.

Using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Framework to Evaluate a Tailored Education Program to Reduce Obesity-Related Cancers in El Paso, Texas

Background: Pasos Para Prevenir Cancer is a tailored lifestyle program that focuses on behavioral modification through knowledge and behavioral strategy education, which was delivered in El Paso, Texas, on the U.S.-Mexico border. Methods: Using the RE-AIM framework, we assessed Pasos Para Prevenir Cancer for efficacy and potential for sustainability. Survey, administrative, and observational data were collected between 2018 and 2022. The program was evaluated to determine reach, effectiveness, adoption, implementation, and maintenance. Results: Tailoring and adapting to the U.S.-Mexico border context is feasible and necessary to deliver evidence-based healthy eating and active living education content. Pasos Para Prevenir Cancer was well received and delivered in diverse settings with varying linguistic needs. Components of the program were adopted by other organizations and integrated into existing programming. Conclusions: Adapting and tailoring evidence-based programs to improve healthy eating and active living is required to meet the needs of Latino subgroup populations, like those on the U.S.-Mexico border.

Latin Dance Effects on Cardiorespiratory Fitness and Physical Function in Middle-Aged and Older Latino Adults

We tested if a dance trial yielded improvements in physical function and cardiorespiratory fitness (CRF) in middle-aged/older Latino adults. Physical activity was assessed using the Community Healthy Activities Model Program for Seniors, physical function with the Short Physical Performance Battery (SPPB) protocol, and estimated CRF with the Jurca nonexercise test model. Multivariate analysis of covariance models found significant change in SPPB protocol total scores, F(1, 329) = 4.23, p = .041, and CRF, F(1, 329) = 5.16, p = .024, between the two study arms in favor of the dance group. Mediation models found moderate- to vigorous-intensity physical activity to mediate to mediate between group and SPPB scores (β = 0.054, 95% confidence interval [0.0142, 0.1247]). Moderate- to vigorous-intensity physical activity and total physical activity were found to partially mediate between group and CRF (β = 0.02, 95% confidence interval [-0.0261, 0.0751]), with the direct pathway no longer being significant (p > .05). This provides support for Latin dance programs to have an effect on SPPB protocol and CRF.

Effect of Latin dance on physical and mental health: a systematic review

BACKGROUND

Latin dance is a well-liked physical activity. It has gained increasing attention as an exercise intervention for improving physical and mental health outcomes. This systematic review examines the effects of Latin dance on physical and mental health.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used to report the data for this review. To gather research from the literature, we used recognized academic and scientific databases such SportsDiscus with Full Text, PsycINFO, Cochrane, Scopus, PubMed, and Web of Science. The systematic review only included 22 studies out of the 1,463 that matched all inclusion criteria. The PEDro scale was used to rate each study's quality. 22 research received scores between 3 and 7.

RESULTS

Latin dance has been demonstrated to promote physical health by helping people lose weight, improve cardiovascular health, increase muscle strength and tone, and improve flexibility and balance. Furthermore, Latin dance can benefit mental health by reducing stress, improving mood, social connection, and cognitive function.

CONCLUSIONS

Finding from this systematic review provide substantial evidence that Latin dance has effect on physical and mental health. Latin dance has the potential to be a powerful and pleasurable public health intervention.

SYSTEMATIC REVIEW REGISTRATION

CRD42023387851, https://www.crd.york.ac.uk/prospero .

Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review

In the United States (US), Latino individuals older than 50 years face health disparities compared to their White counterparts. Considering the rising life expectancy and the projected increase of older Latino adults in the US, this scoping review aimed to determine the effectiveness of theory-based and culturally relevant strategies that promote healthy aging in Latinos. Web of Science and PubMed databases were searched between December 2022 and February 2023 for peer-reviewed articles assessing healthy aging interventions tailored to community-dwelling aging Latino adults. We included nine studies describing the effects of seven interventions on physical activity- or nutrition-related outcomes. Although not always statistically significant, interventions had a beneficial impact on well-being indicators. The most commonly used behavioral theories were Social Cognitive Theory and Attribution Theory. Latino cultural elements in these studies included partnering with community organizations that serve Latinos (such as Catholic churches), delivery of in-person bilingual group sessions by trusted community members (such as promotoras or Latino dance instructors), and incorporating values such as family and religion into the health curriculum, among others. Future strategies that promote healthy aging in Latino adults should proactively culturally adapt the theoretical foundations and the design, recruitment, and implementation processes to ensure their relevance and effectiveness.

Self-rated health as a predictor of cognition among middle-aged and older Latinos

Self-rated health (SRH) has been used to predict cognitive decline in various populations; however, this relationship has not been examined in Latinos. This study examines the relationship between SRH and cognition among middle-aged and older Latinos. A cross-sectional analysis was conducted among Latinos (n = 425, Mage = 64.13 ± 7.65, 82% female). Participants rated their health as poor/fair, good, and excellent and completed cognitive performance tests. Analyses of covariance (ANCOVA) examined differences in cognition between SRH categories. ANCOVAs showed significant differences in SRH categories for working memory (F [2, 357] = 3.63, p = .028) and global cognition (F [2, 348] = 3.074, p = .047), such that those who self-rated their health as good had better scores compared to participants in the poor/fair category. Findings show that SRH is associated with cognition among middle-aged and older Latinos. SRH may serve as an indicator of early signs of cognitive decline.

Physical Activity in South Asian Indians: A Systematic Review of Randomized Controlled Trials

This review systematically examines the characteristics and effectiveness of randomized controlled trials with aerobic physical activity (PA) interventions tailored to South Asian Indians (SAIs). PubMed/MEDLINE, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar were searched. The search yielded 1,842 studies; 11 met the criteria. The Center for Evidence-Based Medicine's critical appraisal tool was used to assess the quality of studies. Studies that used supervised structured PA sessions, educational material in SAI languages, motivational strategies, and positive reinforcement for goal setting, reported significant improvement in PA (p < .05; Cohen's d ≤ 0.3 to >0.8). Future PA studies in India featuring SAIs would benefit from clinic-based one-on-one structured aerobic PA interventions. In contrast, SAI immigrants in Western countries would benefit from community-based structured aerobic PA interventions that are offered in groups and culturally adapted.

The Implementation of Evidence-Based Obesity Education Curricula to Prevent Cancer in a Predominantly Mexican-American Community on the U.S.-Mexico Border

Although cancer is the leading cause of death among Mexican-Americans, few community-based programs target obesity reduction as a way to reduce the prevalence of obesity-related cancer in underserved populations. Evidence suggests that obesity correlates with 13 types of cancer. The objective is to provide an overview of evaluation and selection of evidence-based content; details of the implementation process; modifications needed to tailor education programs to specific needs of different target audiences; and demonstrate challenges of implementing a community-based prevention program intended to reduce cancer incidence and mortality in Mexican-Americans. We used the Social Cognitive Theory (SCT) to develop a 10-topic menu of educational classes using elements of multiple evidence-based curricula. Outcome measures for physical activity and nutrition were determined using the International Physical Activity Questionnaire (IPAQ) and the Dietary Screener Questionnaire (DSQ). Weight status was determined using weight, body fat, and body mass index (BMI). To date, 2845 adults received wellness education from our program. Multiple delivery models were used to reach a larger audience; they included a 4-week model, 5-week model, employer model, low-income housing, 1- and 2-h sessions, and clinic encounters. Individuals were given education at multiple community locations including senior centers (14%), churches (0.6%), employers (17.6%), low-income housing (8.2%), community centers (16.6%), clinics (11.5%), and schools (32.5%). Our study indicates that our delivery model is feasible and can disseminate evidence-based obesity education. Further investigation is necessary to assess long-term behavioral change and to assess the most effective model for delivery.

Do Latino Older Adults and Service Providers Agree on Positive Aging? Using Concept Mapping to Compare Perspectives

BACKGROUND AND OBJECTIVES

In the United States, Latino adults are a growing segment of the aging population who will need research-informed interventions to help them age successfully. Arguably, how Latino older adults and service providers understand "positive aging" serves as an important precursor for the cultivation of such interventions. This investigation explored whether Latino older adults' conceptualizations of positive aging aligned with those of service providers.

RESEARCH DESIGN AND METHODS

We compared how Latino older adults (n = 93) and service providers (n = 45) rated 85 positive aging statements produced by Latino older adults. These 85 items were used to generate a concept map, which displays those items thematically by clusters and overarching regions of meaning.

RESULTS

We found divergences at each level of the map-statements, clusters, and regions-which illuminate differences between how service providers and Latino older adults think about Latino positive aging. For example, whereas Latino older adults prioritized the cluster containing items related to internal well-being, service providers rated it seventh of 11 clusters. The region comprising clusters related to relationships garnered the highest agreement between groups, but also a notable departure; compared to Latino older adults, service providers rated community and social involvement as less important.

DISCUSSION AND IMPLICATIONS

Understanding such differences can help providers tailor services consistent with the interests of Latino older adults. Future studies should examine the extent to which stakeholders believe various aspects of positive aging are modifiable.

BAILA: A Randomized Controlled Trial of Latin Dancing to Increase Physical Activity in Spanish-Speaking Older Latinos

BACKGROUND

Latinos are the fastest growing minority group of the older adult population. Although physical activity (PA) has documented health benefits, older Latinos are less likely to engage in leisure time PA than older non-Latino whites. Dance, popular among Latinos, holds promise as a culturally relevant form of PA.

PURPOSE

To describe self-reported and device-assessed changes in PA as a result of a randomized controlled trial of BAILAMOS, a 4-month Latin dance program with a 4-month maintenance program, versus a health education control group.

METHODS

Adults, aged 55+, Latino/Hispanic, Spanish speaking, with low PA levels at baseline, and risk for disability were randomized to the dance program (n = 167) or health education condition (n = 166). Data were analyzed using multilevel modeling with full information maximum likelihood.

RESULTS

A series of multilevel models revealed significant time × group interaction effects for moderate-to-vigorous physical activity (MVPA), dance PA, leisure PA, and total PA. Exploring the interaction revealed the dance group to significantly increase their MVPA, dance PA, leisure PA, and total PA at months 4 and 8. Household PA and activity counts from accelerometry data did not demonstrate significant interaction effects.

CONCLUSIONS

The study supports organized Latin dance programs to be efficacious in promoting self-reported PA among older Latinos. Efforts are needed to make dancing programs available and accessible, and to find ways for older Latinos to add more PA to their daily lives.

CLINICAL TRIAL INFORMATION

NCT01988233.

Latin Dance and Working Memory: The Mediating Effects of Physical Activity Among Middle-Aged and Older Latinos

Background

Physical activity (PA) is a promising method to improve cognition among middle-aged and older adults. Latinos are at high risk for cognitive decline and engaging in low levels of PA. Culturally relevant PA interventions for middle-aged and older Latinos are critically needed to reduce risk of cognitive decline. We examined changes in cognitive performance among middle-aged and older Latinos participating in the BAILAMOS™ dance program or a health education group and compared the mediating effects of PA between group assignment and change in cognitive domains.

Methods

Our 8-month randomized controlled trial tested BAILAMOS™, a 4-month Latin dance program followed by a 4-month maintenance phase. A total of 333 older Latinos aged 55+ were randomized to either BAILAMOS™, or to a health education control group. Neuropsychological tests were administered, scores were converted to z-scores, and specific domains (i.e., executive function, episodic memory, and working memory) were derived. Self-reported PA was assessed, and we reported categories of total PA, total leisure PA, and moderate-to-vigorous PA as minutes/week. A series of ANCOVAs tested changes in cognitive domains at 4 and 8 months. A mediation analysis tested the mediating effects of each PA category between group assignment and a significant change in cognition score.

Results

The ANCOVAs found significant improvement in working memory scores among participants in the dance group at month 8 [F(1,328) = 5.79, p = 0.017, d = 0.20], but not in executive functioning [F(2,328) = 0.229, p = 0.80, Cohen’s d = 0.07] or episodic memory [F(2,328) = 0.241, p = 0.78, Cohen’s d = 0.05]. Follow-up mediation models found that total PA mediated the relationship between group assignment and working memory, in favor of the dance group (β = 0.027, 95% CI [0.0000, 0.0705]). Similarly, total leisure PA was found to mediate this relationship [β = 0.035, 95% CI (0.0041, 0.0807)].

Conclusion

A 4-month Latin dance program followed by a 4-month maintenance phase improved working memory among middle-aged and older Latinos. Improvements in working memory were mediated by participation in leisure PA. Our results support the current literature that leisure time PA influences cognition and highlight the importance of culturally relevant PA modalities for Latinos.

Clinical Trial Registration

[www.ClinicalTrials.gov], identifier [NCT01988233].

Physical activity outcomes from a randomized trial of a theory- and technology-enhanced intervention for Latinas: the Seamos Activas II study

Latina women report disproportionately high and increasing prevalence of chronic health conditions (obesity, diabetes) related to low physical activity levels. Efforts to date at addressing high rates of physical inactivity in this at-risk population have shown modest success. The original Seamos Saludables (sample size N = 266) was a culturally and linguistically adapted, print-based physical activity intervention that showed significant increases in moderate to vigorous physical activity (MVPA) from baseline to 6 months. However, only 11% of intervention participants reached the national PA guidelines of ≥ 150 min/week of aerobic MVPA. The current study tests the original Seamos Saludables intervention (Original Intervention) against an enhanced iteration Seamos Activas II (Enhanced Intervention). Study aims and intervention refinements focus on increasing the percentage of Latinas meeting national aerobic PA guidelines. For the current study (Seamos Activas II), a randomized controlled trial with (N = 199 participants) of two PA interventions (original intervention, N = 102; vs. enhanced intervention, N = 97) was conducted. Intervention refinements involved further targeting key constructs of the Social Cognitive Theory and incorporating text-message-based strategies for self-monitoring, in response to participant feedback for greater interactivity and accountability. PA assessments were conducted at baseline and 6 months. The sample was predominantly Mexican American (89%) with average age of 43.8 years (SD = 10.11) and mean BMI at baseline was 30.6 (SD = 7.56). There were significant within group increases in MVPA from baseline to 6 months (p < .05) in both Original and Enhanced Intervention arms. However, quantile regression models did not indicate significant differences in 6-month outcomes between conditions controlling for baseline, p = 0.73. There were significant differences between conditions with respect to meeting national guidelines for aerobic MVPA at 6 months, with 57% of Enhanced Intervention participants meeting guidelines compared to 44% of Original Intervention participants, OR = 1.66, 95% CI: 1.09 -2.89. Models suggest trends favoring the enhanced condition for improvements in biomarkers over 6 months. Findings indicate that the intervention enhancements likely helped more Latinas achieve nationally recommended, health enhancing PA levels than the original intervention and showed promise for improving physiological response to exercise.Trial Registration ClinicalTrials.Gov; NCT02630953. Registered 14 December 2015. https://clinicaltrials.gov/ct2/show/NCT02630953 .

The Effects of the BAILAMOSTM Dance Program on Physical Activity Levels and Cognition of Older Latino Adults: A Pilot Study

Objective: To investigate the effects of the BAILAMOS^TM dance program on physical activity (PA), cardiorespiratory, and cognitive health. Methods: A parallel, two-armed pilot study was conducted with 57 older Latinos randomized to the BAILAMOS^TM dance program (n = 28) or health education (HE) (n = 29). We conducted two- and three-way repeated-measures ANOVAs. Results: BAILAMOS^TM participants increased participation in leisure moderate-to-vigorous PA (LMVPA) (F[1,53] = 3.17, p = .048, η²_G = .01) and performance in global cognition relative to HE participants (F[1,52] = 4.19, p = .045, η²_G = .01). Attendance moderated increases in moderate PA, MVPA, LMVPA, and total PA (p < .05). Participants of both groups with ≥75% attendance increased participation in PA. Among participants with <75% attendance, BAILAMOS^TM participants increased PA relative to HE. Discussion: BAILAMOS^TM positively impacted self-reported PA and global cognition in older Latinos. Even smaller doses of dance appear to impact self-reported PA levels.

The S.P.A.C.E Hypothesis: Physical Activity as Medium - Not Medicine - for Public Health Impact

Most scientifically tested physical activity interventions end when research funding ends; interventions that last struggle to sustain benefits. We hypothesize that long-term public health impact will benefit from a shift in how interventionists conceptualize physical activity - from a form of medicine, of value for its innate health benefits, to a malleable medium, of value for the dynamic contexts it creates.

The effects of the BAILAMOS Dance Program on hippocampal volume in older Latinos: a randomized controlled pilot study

Hippocampal atrophy is associated with cognitive decline. Physical activity (PA) can reverse the hippocampal loss. This study investigated the effects of the 4 month BAILAMOS dance program on hippocampal volume and self-reported PA in Latinos. Participants were randomized to the BAILAMOS dance program or waitlist control group (N = 14, n = 10 intervention, n = 4 waitlist, 67 ± 6.1 years old, 70% female). Hippocampal volumes were derived from Magnetic Resonance Imaging whole-brain T1-weighted images. Participants self-reported PA through the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for older adults. There were no statistically significant changes in hippocampal volume preintervention to postintervention (F[1, 8] = .077, p = .79, d = .05) and no associations between PA change and hippocampal volume (F[4, 13] = .71, p = .61). However, dance participants self-reported more PA (d = .54) compared to the control. These findings demonstrate that the BAILAMOS dance program did not decrease hippocampal atrophy; however, it increased self-reported PA. Future studies should include longer and more cognitively demanding interventions to determine whether dance can reduce cognitive decline through hippocampal changes.

The Impact of the BAILAMOS™ Dance Program on Brain Functional Connectivity and Cognition in Older Latino Adults: A Pilot Study

Dance is a culturally salient form of physical activity (PA) for older Latinos. Resting-state functional connectivity (FC) is a putative biomarker for age-related cognitive decline. We aimed to investigate the impact of the BAILAMOS™ dance program on FC in three brain functional networks (Default Mode [DMN], Frontoparietal [FPN], and Salience [SAL] networks), and cognition. Ten cognitively healthy older Latinos participated in the four-month BAILAMOS™ dance program. We assessed PA levels (self-reported and device-assessed) and estimated cardiorespiratory fitness, cognition, and resting-state FC via functional magnetic resonance imaging at baseline and post-intervention. We performed paired t-tests and Pearson correlations. Given the pilot nature of the study, significance levels were set at p < 0.05 and effect sizes are reported. We observed a significant increase in self-reported moderate leisure-time PA from pre- to post-intervention (t(9) = 3.16, p = 0.011, d = 0.66). FC within-FPN regions of interest (ROIs) significantly increased pre- to post-intervention (t(9) = 2.35, p = 0.043, d = 0.70). DMN ROIs showed an increase, with a moderate effect size, in the integration with other networks' ROIs (t(9) = 1.96, p = 0.081, d = 0.64) post-intervention. Increases in moderate leisure-time PA at post-intervention were associated with increases in the FC within-FPN (R = 0.79, p = 0.006). Our results suggest that dance might be a promising approach for improving age-related disruption of FC within- and between-networks commonly associated with cognitive decline.

Using Fitbit as an mHealth Intervention Tool to Promote Physical Activity: Potential Challenges and Solutions

Consumer-based physical activity (PA) trackers, also known as wearables, are increasingly being used in research studies as intervention or measurement tools. One of the most popular and widely used brands of PA trackers is Fitbit. Since the release of the first Fitbit in 2009, hundreds of experimental studies have used Fitbit devices to facilitate PA self-monitoring and behavior change via goal setting and feedback tools. Fitbit's ability to capture large volumes of PA and physiological data in real time creates enormous opportunities for researchers. At the same time, however, it introduces a number of challenges (eg, technological, operational, logistical), most of which are not sufficiently described in study publications. Currently, there are no technical reports, guidelines, nor other types of publications discussing some of these challenges and offering guidance to researchers on how to best incorporate Fitbit devices in their study design and intervention to achieve their research goals. As a result, researchers are often left alone to discover and address some of these issues during the study through "trial and error." This paper aims to address this gap. Drawing on our cumulative experience of conducting multiple studies with various Fitbit PA trackers over the years, we present and discuss various key challenges associated with the use of Fitbit PA trackers in research studies. Difficulties with the use of Fitbit PA trackers are encountered throughout the entire research process. Challenges and solutions are categorized in 4 main categories: study preparation, intervention delivery, data collection and analysis, and study closeout. Subsequently, we describe a number of empirically tested strategies used in 4 of our interventional studies involving participants from a broad range of demographic characteristics, racial/ethnic backgrounds, and literacy levels. Researchers should be prepared to address challenges and issues in a timely fashion to ensure that the Fitbit effectively assists participants and researchers in achieving research and outcome goals.

¡Ojo! What to expect in recruiting and retaining older Latinos in physical activity programs

Older Latinos are the fastest growing cohort among older adults in the USA, and their lives are often fraught with comorbidities, such as diabetes and obesity. Strong evidence has demonstrated health benefits of regular physical activity for older adults. In spite of this, older Latinos participate in low levels of physical activity. Interventions designed to increase the physical activity of older Latinos are lacking, yet more are emerging as the number of older Latinos grows. Unfortunately, older Latinos face many impediments to participating in physical activity interventions that researchers are unaware of. The purpose of the current article was to identify barriers that researchers are likely to face in conducting physical activity interventions for older Latinos, highlighting recently identified barriers, and providing barriers we encountered specifically with older Latino adults; and strategies to overcome these barriers to implementation.

Using a reasoned action approach to identify determinants of organized exercise among Hispanics: a mixed-methods study

BACKGROUND

Research on Hispanics' activity preferences suggest that they prefer engaging in group-oriented physical activities, such as organized exercise. Yet, little is known about pathways to participation in organized exercise among Hispanics. This study used a reasoned action approach (RAA) framework to explore beliefs and determinants of organized exercise among Hispanics. Specifically, we examined the impact of participants' intentions on reported organized exercise behavior, and the relation between intentions and attitudes, subjective norms, perceived behavioral control, and self-efficacy.

METHODS

Our mixed-methods study was part of a larger pre-post design intervention study. Participants completed an interview containing open- and closed-ended questions to identify salient beliefs and practices about attending organized exercise activities. We conducted two separate regression models to assess the effects of intentions on behavior (n = 330) and the associations of RAA constructs on intentions (n = 101), both adjusting for demographics. Qualitative analysis of a sub-sample (n = 105) of responses to open-ended questions identified salient beliefs related to organized exercise attendance.

RESULTS

Our results showed that intentions predicted behavior at follow up (IRR = 2.03, p < .05), and that attitudes and perceived behavioral control were associated with intentions (β = .36, p < .05; β = .36, p <. 05, respectively). Qualitative findings suggest participants value health and the behavioral benefits of attending organized exercise activities; feel approval from family and friends; and identify transportation, time, distance, and costs as factors that influence their attendance to organized exercise activities.

CONCLUSIONS

Consistent with theoretical expectations, we identified statistically significant determinants of intentions and attendance to organized exercise. Findings can inform the development of persuasive messages and interventions to promote exercise in low-income Hispanic populations facing obesity disparities.

Older Chinese Americans' Perspectives on Physical Activity: A Mixed Methods Study

The benefits of physical activity for successful aging are well established. Few interventions however, target older Asian Americans who may have distinct needs for cultural and linguistic tailoring. The heterogeneity among Asian Americans underscores the need to elucidate specific physical activity preferences by ethnic subgroup. To better understand older Chinese Americans' perceptions about physical activity, we conducted a community-engaged, mixed methods study with 60 participants. Through survey and focus groups, four emerging themes characterized perceptions of physical activity: (a) physical activities benefit the body and mind, (b) traditional Chinese culture influences perceptions and preferences for physical activity, (c) physical activity presents opportunities for social engagement, and (d) physical activity facilitates family harmony. Design recommendations includes encouraging mind-body approaches, incorporating culturally specific practices, highlighting opportunities for social engagement, and emphasizing the potential for improved harmony.

Let's walk! Age reattribution and physical activity among older Hispanic/Latino adults: results from the ¡Caminemos! Randomized trial

Background

Many older Hispanics/Latinos are physically inactive and suffer the harmful health consequences associated with prolonged periods of inactivity. Negative age attributions that equate getting older with “slowing down” reinforce this inactive behavior. We implemented a community-based exercise intervention among insufficiently active older Hispanics/Latinos with a randomized trial of an attribution-retraining program, ¡Caminemos! (Let’s Walk!), and measured the effect of the program on walking behavior.

Methods

Five hundred and seventy-two older Hispanics/Latinos (≥60 years) were enrolled in an exercise program that randomly assigned participants to the exercise class and one of two conditions: (a) treatment (attribution retraining to dispel the notion that physical activity inevitably ceases with age) or (b) control (generic health education). Data were collected at baseline and follow-up (1, 12, and 24 months). Physical activity was determined through pedometer data and the Yale Physical Activity Survey. We also measured the intervention effects on age-expectations, self-efficacy expectations, and outcome expectations for physical activity. Mixed-effects regression models were used to determine intervention effects on prospective measures of physical activity and intrapersonal expectations.

Results

The sample had a mean age of 73 years (SD = 6.8) and was 77% female, and 76% of the sample reported income <$20,000. At baseline, control and treatment groups walked about 3000 steps/day. By 24 months, participants in both arms of the intervention maintained greater than 10,000 mean steps/day, but the difference between the groups was not statistically significant. In analyses adjusted for age, sex, education, income, health status, and acculturation, participants in both trial arms increased their mean numbers of steps at 12 and 24 months, with the treatment group showing a greater number of mean steps compared to the controls at 12 months.

Conclusions

In this group of physically inactive older Hispanics/Latinos, attribution retraining in combination with an exercise class was superior to the exercise class alone with regard to increasing walking behavior. This success was sustained at 12 months (the pre-defined primary study outcome) but not at 24 months. For older Hispanics/Latinos, enrollment in an attribution-retraining exercise program can improve an inactive lifestyle.

Trial registration

clinicaltrials.gov identifier: NCT00183014.

The Influence of Exercise on Cognitive Function in Older Hispanic/Latino Adults: Results From the "¡Caminemos!" Study

Purpose of the Study

We examined the prospective effect of an evidence-based exercise intervention (¡Caminemos!) on cognitive function among older Hispanic/Latino adults and the potential synergistic effects (if any) of an attribution-retraining intervention given to a random sample to counter negative ascriptions of the aging process.

Design and Methods

We analyzed baseline and follow-up (1- and 2-year) data collected from Hispanics/Latinos ≥60 years (N = 571) who participated in ¡Caminemos! across 27 senior centers. All participants were randomly assigned to either (a) the treatment group-a 1-hr attribution-retraining session plus a 1-hr exercise class or (b) the control group-health education plus a 1-hr exercise class. Mixed-effects linear regression was used to determine the effects of the exercise class and the attribution-retraining component on longitudinal changes in cognitive functioning, as measured by the Modified Mini-Mental State (3MS) examination.

Results

In analyses adjusted for age, sex, education, income, and medical comorbidities, participants in both trial arms displayed higher cognitive functioning scores at the 1-year (β = 1.76, p = .001) and 2-year (β = 1.37, p = .013) follow-ups when compared with original baseline scores. However, we found no significant difference in cognitive function between the treatment versus control conditions (β = 0.41, p = .582), nor were any differences found across groups over time.

Implications

The exercise intervention improved cognitive function in older Hispanics/Latinos, regardless of whether it was supplemented with the age-related attribution retraining. These findings suggest that limited access to exercise programs may be a greater obstacle in forestalling cognitive decline in older Hispanics/Latinos than the negative beliefs they might hold of the aging process.

Contribution of Psychosocial Factors to Physical Activity in Women of Color in the Saving Lives Staying Active (SALSA) Study

Culturally appropriate, innovative strategies to increase physical activity (PA) in women of color are needed. This study examined whether participation in SALSA, an 8-week randomized, crossover pilot study to promote PA, led to improved psychosocial outcomes and whether these changes were associated with changes in PA over time. Women of color (N = 50) completed Internet-based questionnaires on PA, exercise self-efficacy, motivational readiness, stress, and social support at three time points. Women reported high socioeconomic status, decreases in exercise self-efficacy, and increases in motivational readiness for exercise and a number of stressful events (p < .05); changes in motivational readiness for exercise varied by group (p = .043). Changes in psychosocial factors were associated with increases in PA. Latin dance improved motivational readiness for PA. Future studies are needed to determine whether Latin dance improves other psychological measures and quality of life in women of color in an effort to increase PA and reduce health disparities.