Towards a new strategy for health promotion for older women: Determinants of physical activity

Barriers and Facilitators to Participation in Vigorous Lifestyle Physical Activity in Adults Aged 55-75 Years: A Scoping Review

Despite the well-known benefits of physical activity, less than half of adults aged 55-75 years participate in sufficient physical activity. Short bouts of vigorous intermittent lifestyle physical activity (VILPA) accumulated throughout the day can contribute toward the recommended volume of physical activity. A rich characterization of the barriers and facilitators to participation in VILPA is needed to develop targeted interventions. This scoping review aimed to identify barriers and facilitators to participation in different components of VILPA in adults aged 55-75 years, and to map barriers and facilitators to the Theoretical Domains Framework. Within the 18 eligible studies, the most prevalent barriers were related to a person's skills, environmental context, and social influences. Most facilitators were related to a person's goals, social influences, and environmental context. Interventions to promote VILPA should test the effectiveness of behavioral change measures related to the unique barriers and facilitators in this age group.

Men and women trainers equally effective at promoting exercise adherence, self-efficacy, and fitness in women

BACKGROUND

This study examined the effect of a personal trainer's sex on self-efficacy and fitness in woman clients.

METHODS

Women (n: 28; mean ± SD; age, 41.6 ± 15.0 yrs.; height, 153.49 ± 28.11cm; BMI, 25.9 ± 6.4 kg•m-2) completed a perceptual scale of self-efficacy (BARSE) and fitness tests before and after a training program. Trainers (men and women) met one-on-one with the volunteers on a biweekly basis for 8 weeks. Univariate analyses of change scores and repeated measures analysis of variance with Fisher's LSD pairwise comparisons tested changes in dependent variables by trainer sex.

RESULTS

Significant increases were seen in (mean ± SE; change for men trainers; change for woman trainers): self-efficacy (7.3 ± 3.4; 7.3 ± 2.7%); leg press strength (18.2 ± 3.7; 16.4 ± 3.3 kg); seated row (6.1 ± 1.5; 5.3 ± 1.3 kg); muscular endurance in 60° flexion hold (20.5 ± 5.8; 24.8 ± 5.0 sec) and wall-sit (19.9 ± 6.4; 33.5 ± 5.8 sec); but not flexibility (V-sit, 7.11 ± 5.51; 4.23 ± 4.50 cm). Chest press strength significantly increased for women trainers only (2.7 ± 2.2; 5.3 ± 1.8 kg). Despite this, there were no significant differences for any variable in the change from pre-to-post based on the sex of the trainer.

CONCLUSIONS

Both men and woman-led training was effective for increasing markers of self-efficacy and fitness in woman clients.

Effectiveness of SaBang-DolGi Walking Exercise Program on Physical and Mental Health of Menopausal Women

Objective: We investigated the effectiveness of a 12-week SaBang-DolGi walking exercise program on the physical and mental health of menopausal women and aimed to provide the basic data needed to develop health promotion programs for the active and healthy aging of menopausal women. Materials and methods: The participants comprised 40 women aged 50–65 years who were divided into two randomly selected groups in training sessions (exercising group, n = 21 and control group, n = 19). A physical (grip, muscle and endurance) test and mental health test (simple mental health test II) were conducted using questionnaires with the aim of examining subjects’ physical and mental health before and after exercise. Results: After the intervention, the participants experienced positive changes in the physical dimension, with significant enhancements particularly in mental well-being and menopause-related health and subdomains. Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Conclusions: We found that the SaBang-DolGi walking exercise program helps to promote the physical and mental health of menopausal women who are exposed to the various stresses and depressions that accompany physical deterioration; the program was found to encourage active and healthy aging.

Exploring Fear of Falling and Exercise Self-Efficacy in Older Women With Vertebral Fractures

Fear of falling is a common issue among older adults, which decreases quality of life and leads to an avoidance of activities they are still able to do. The goal of this secondary data analysis was to explore the relationship between fear of falling and exercise self-efficacy in 141 women with at least one nontraumatic Genant Grade 2 vertebral fracture. Fear of falling, exercise self-efficacy, history of falling, the number of falls, the use of assisting devices, and pain at rest or during movement were obtained using medical history and health status questionnaires. There was a negative association between fear of falling and exercise self-efficacy (pseudo R2 = .253; p = .004), which persisted when the analysis was adjusted for history and number of falls, use of assistive devices, and pain at rest (pseudo R2 = .329; p < .0001) or during movement (pseudo R2 = .321; p < .0001). Fear of falling may be negatively associated with exercise self-efficacy in older women with vertebral fracture.

An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension

BACKGROUND

Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence.

METHODS

We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression.

RESULTS

Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes.

CONCLUSIONS

Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.

Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review

OBJECTIVE

Our goal was to explore the range and characteristics of published papers on therapeutic walking programs for menopausal women and to identify program features that resulted in successful outcomes including reduced symptoms and improved long-term wellness.

METHODS

We searched biomedical and exercise-related databases for articles published up to June 1, 2017, using keywords related to menopause and walking. Data were collected into EndNote X8 reference manager to identify and remove duplicates. The final selection included all articles that studied walking as a health intervention for women in menopause transition or postmenopausal.

RESULTS

A total of 3,244 papers were collected from the six databases. After removing duplicates and applying inclusion and exclusion criteria, 96 articles were charted, including 77 different walking programs. Walking interventions ranged from 4 weeks to 3 years with an average weekly frequency of 3.8 ± 1.8 and were applied to a variety of symptoms and their biological markers and risk factors. Overall, 91% of the programs showed a beneficial outcome in at least one menopause-related medical issue. Information on menopause-specific symptoms, especially vasomotor symptoms and sleep problems, was scarce.

CONCLUSION

The scoping review highlights the growing interest in walking programs as therapies for menopause and related symptoms and provides evidence of their possible benefit as a wellness option for women in menopause and beyond. Further research would be recommended to establish the therapeutic value of walking programs for women with specific focus on typical menopause symptoms at different stages of menopause. : Video Summary:http://links.lww.com/MENO/A587.

Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

OBJECTIVE

A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n = 63, aged 35-69).

DESIGN

Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email.

MAIN OUTCOME MEASURES

Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect.

RESULTS

Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level.

CONCLUSION

Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.

Exercise Behavior among Female Occupational Health Nurses

Physical fitness of the American worker is a core element of personal good health and a key factor in corporate cost containment. The Centers for Disease Control and Prevention specifically notes that health professionals should be physically active not only to benefit their own health but also to make more credible their endorsement of an active lifestyle. Guided by Pender's Health Promotion Model, this study gives a profile of the current status of exercise behaviors, physical self efficacy, and perceived health control among a sample of occupational health nurses. Surveys were mailed to a random sample of 300 female members from a midwestern state association of the American Association of Occupational Health Nurses. The mean exercise score was 30.7 MET hours per week, with walking the activity most often selected. Physical self efficacy was a significant positive predictor of exercise practice, while age exerted a significant inverse effect on exercise. The study findings may be used to stimulate discussion among occupational health nurses about how their own physical self efficacy and perceived health control may influence their exercise behaviors, and how in turn these beliefs and exercise practices may influence their decisions about promoting exercise programs at their workplaces.

Barriers to physical activity in older adults in Germany: a cross-sectional study

BACKGROUND

Data on barriers to physical activity in older adults in Germany are scarce. The aim of this study was to analyse barriers to physical activity in a cohort of older adults, allowing comparisons between men and women, and age groups.

METHODS

1,937 older adults with a median age of 77 (range 72-93) years (53.3% female) took part in the 7-year follow-up telephone interviews of the getABI cohort. Participants who stated that they did not get enough physical activity were surveyed with respect to barriers to physical activity. Barriers were analysed for all respondents, as well as by sex and age group for cases with complete data. Multivariate logistic regression analysis was performed to evaluate differences between sexes and age groups. The level of significance (alpha < 0.05) was adjusted for multiple testing according to Bonferroni (p < .004).

RESULTS

1,607 (83.0%) participants stated that they were sufficiently physically active. 286 participants rated their physical activity as insufficient and responded to questions on barriers to physical activity completely. The three most frequently cited barriers were poor health (57.7%), lack of company (43.0%), and lack of interest (36.7%). Lack of opportunities for sports or leisure activities (30.3% vs. 15.6%), and lack of transport (29.0% vs. 7.1%) were more frequently stated by female respondents than male respondents. These differences between men and women were significant (p = .003; p < .001) after adjustment for respondents' age. Analyses by age groups revealed that poor health was more frequently considered a barrier to physical activity by participants aged 80+ years compared to the younger age group (71.1% vs. 51.5%). This age-dependent difference was significant (p = .002) irrespective of the participants' sex.

CONCLUSIONS

The present study provides relevant data on barriers to physical activity in older adults. By revealing appreciable differences between men and women, and age groups, this study has implications for efforts to increase older adults' physical activity. Promotion and intervention strategies should consider the barriers and tailor measures to the specific needs of older adults in order to reduce their constraints to physical activity.

Perceived barriers to health care and health behaviours: implications for Native American elders' self-rated health

Little is known about how Native American adults appraise their health in later life. Perceived barriers to health care and health behaviours were examined among 6813 Native elders to determine their unique associations with self-rated health (SRH). Hierarchical regression results showed inability to access needed medical care predicted poorer SRH. Statistically accounting for sociodemographics and barriers to care, health behaviours predicted SRH. The current findings suggest opportunities to improve Native elders' SRH particularly via exercise and good nutrition. In turn, enhanced SRH may lead to improved quality of life.

Exercise self-efficacy and control beliefs: effects on exercise behavior after an exercise intervention for older adults

The current study examined exercise self-efficacy and exercise behavior during and after a strength-training intervention program with older adults. A model with cross-lagged and contemporaneous paths was tested with structural equations. Within testing occasions, higher physical resistance was related to greater beliefs in efficacy and control over exercise. At 3 months into the intervention, those who had higher physical resistance were less likely to show subsequent changes in beliefs. Those who had higher self-efficacy and control beliefs at 6 months were more likely to report that they were still exercising at 9 and 12 months after the intervention. Findings indicate that exercise self-efficacy and exercise behavior are associated with one another and that beliefs developed during an intervention are important for maintenance of an exercise regimen.

Do attitudes toward exercise vary with differences in mobility and disability status? - a study among low-income seniors

PURPOSE

To examine attitudes toward exercise among a vulnerable aged population characterized by low socioeconomic status, poor functional status and lack of available therapeutic exercise resources.

METHOD

This cross-sectional survey among public low-income housing residents (n = 94), aged > 70 years utilizes these assessments: Physician-based Assessment & Counseling for Exercise (PACE) scale, exercise self-efficacy score, Short Physical Performance Battery (SPPB), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales.

RESULTS

Readiness to exercise differed significantly (p < 0.001) across physical performance levels, and ADL and IADL groups. Exercise self-efficacy also differed significantly (p < 0.001) across performance levels. The highest performance level (score 7 - 12) had a significantly (p < 0.05) higher self-efficacy score (x=7.0+/-2.8) than the medium performance level (score 4 - 6) (x=5.3+/-2.8) and the lowest performance level (0 - 3) (x=4.3+/-2.5) groups. Exercise self-efficacy also differed significantly (p < 0.001) across ADL and IADL groups. However, interest in home-based or class-based exercise participation was high among all groups. More than 70% of subjects reported interest with no significant difference noted among groups.

CONCLUSION

Attitudes toward exercise are significantly associated with observed physical function and self-reported disability among vulnerable older adults living in public low-income housing.

Grip strength and physical demand of previous occupation in a well-functioning cohort of Chinese older adults

The grip strength of 214 independently ambulatory Chinese older adults (M age = 75.1 +/- 7.0 yr.) was measured, and preliminary mean values presented. Their previous occupations were recorded, and the physical demands of those occupations in terms of oxygen consumption and work done were classified. Grip strength generally decreased across age groups. The physical demand of individuals' previous occupations had significant associations with grip strength, for example, participants who previously worked as construction site workers had a greater grip strength than those who worked previously as office workers.

Influencing exercise and diet to prevent osteoporosis: lessons from three studies

Osteoporosis is a major public health problem, causing fractures of wrist, back and hip with high associated morbidity and mortality. Particularly at risk are postmenopausal women. Recent moves away from hormone replacement therapy as a preventative measure have focused attention on exercise and dietary supplementation with calcium for prevention and treatment. This article reports three studies of women screened for osteoporosis - an outpatient sample (n = 129), a GP sample (n = 25) of women before and after bone mineral density screening, and a sample of women diagnosed with osteoporosis in the past 5 years (n = 26). Only 57% in the outpatient sample consume the recommended amount of calcium (1500 mg calcium daily); 65% in primary care consume 1200 mg five times per week, although 90% intend to do so. For bone-loading exercise, the recommendation is three 20-minute periods per week. Most women thought they were undertaking enough exercise, and diaries showed that 74% of the women undertook 60 minutes per week, and 44% undertook 30 minutes five times per week. Women were more willing to change diet than exercise. Suggestions are made to help primary care teams to motivate women to make sustained changes in diet and exercise.

Psychosocial and Perceived Environmental Correlates of Physical Activity in Rural and Older African American and White Women

African American and rural older women are among the least active segments of the population. This study, guided by social cognitive theory, examined the correlates of physical activity (PA) in 102 rural older women (41% African American; 70.6 +/- 9.2 years). In bivariate associations, education, marital status, self-efficacy, greater pros than cons, perceived stress, social support, and perceived neighborhood safety were positively associated with PA; age, depressive symptoms, perceived sidewalks, health care provider discussion of PA, and perceived traffic were negatively associated with PA. In a hierarchical regression analysis, the sociodemographic (R(2) = 23%), psychological (IR(2) = 9%), social (IR(2) = 6%), and perceived physical environmental (IR(2) = 9%) sets of variables were significant (p <.05) predictors of PA (model R(2) = 47%). In response to open-ended questions, most women cited individual and social factors as PA barriers and motivators; falls, injuries, and heart attacks were identified most often as risks. These findings support the importance of multilevel influences on PA in older rural women and are useful for informing PA interventions.

The Association of Physical-Performance Level with Attitude Toward Exercise in Older Adults

The Hebrew Home Study of Impairment and Exercise is a cross-sectional community-based study of nondisabled adults age 75–85 years that assessed attitude toward exercise by asking level of agreement with four statements evaluating participants’ perceptions of the health benefits and personal rewards of exercise. A physical-performance battery evaluated lower extremity function on a scale of 0 to 12. Attitude toward exercise was compared across 4 groups: non-vigorous exercisers with scores of 4–6 (n= 21), 7–9 (n= 90), or 10–12 (n= 113) and vigorous exercisers (n= 71). Vigorous exercisers had a significantly better attitude toward exercise than the reference group did, with odds ratios of 1.8-5.5 in all attitude statements. The lowest and moderate-performance groups had less positive attitudes toward exercise than the reference group did, with odds ratios of 0.27–0.62 for all statements. There was a highly significant gradient with better attitude toward exercise and higher functional-status level. Future work in improving older adults’ compliance with exercise should take into account the less positive attitude of those with functional limitations toward the benefits of exercise.

Motivators and Barriers to Exercise in an Older Community-Dwelling Population

This study aimed to ascertain perceived barriers and motivators to exercise in people age 74–85 and to clarify the meaning of these barriers and motivators by examining participant characteristics that relate to them. 324 community-dwelling participants age 74–85 completed a health questionnaire that included items on barriers and motivators to exercise, as well as questions on demographic variables, health, and exercise. Selected participants then completed a physical-performance battery to measure functional performance. Barriers and motivators were related internally, as well as to many other factors including pain and depressed affect on the Geriatric Depression Scale. The findings suggest a need for individualized and comprehensive approaches to the presentation of exercise programs. Health interventions are needed that will address both physical pain and depressed affect and explain the importance of exercise even in the presence of health problems. An understanding of the context of reported barriers and motivators is necessary for correct interpretation and program development.

Correlates of physical activity among women from diverse racial/ethnic groups

OBJECTIVE

Women have lower rates of participation in leisure time physical activity than men and have been studied to a lesser extent than men. Because physical activity plays a vital role in overall health, it is important to identify factors than can help increase physical activity rates for women.

METHODS

Defining and understanding correlates of physical activity is critical for at-risk populations and for planning effective interventions. This paper reviews research conducted in the past two decades on correlates of physical activity in women. An ecological model with an added physical environment component was used to organize the correlates. Studies conducted among adult white, black, American Indian, Asian, and Hispanic women are included. A total of 91 studies were reviewed. Many studies included white women, fewer studies included black and Hispanic women, and even fewer included American Indian women, and only 3 studies included Asian women.

RESULTS

The correlates most studied are sociodemographic variables, with nonwhite race, lower educational levels, and older age most consistently associated with lower levels of physical activity. Few studies focused on environmental and policy correlates. Social support was an overwhelmingly positive determinant of physical activity for all groups of women.

CONCLUSIONS

Based on these findings, we recommend that future research include more diverse groups of women and evaluate modifiable factors, such as psychological, interpersonal, and environmental correlates. Future research also should include more intervention and longitudinal studies.

Factors associated with physical activity in women across the life span: implications for program development

This study examined the rates and factors associated with physical activity in women of various ages. Adult women (n = 653) from four community-based family medicine clinics completed a self-administered behavioral and health questionnaire while waiting to see their physician. Findings suggested variation in physical activity over the life span, with older women performing less physical activity than younger women. Family characteristics (e.g., having children) were strongly associated with performing less structured, less intense physical activities of daily living among women 49 years and younger. Younger women reported having high self-efficacy for physical activity, but also reported the greatest numbers of barriers. Women in the oldest age category reported health as the most common motivator for physical activity, but were also least likely to perform physical activity. Interventions designed to meet the unique needs of women at different stages in their lives will potentially reduce the rate of inactivity among women. Creative, flexible strategies that incorporate physical activity into the daily routine should be used in the program development.

Physical activity and women in the United States: an overview of health benefits, prevalence, and intervention opportunities

Despite decades of physical activity research and interventions conducted on men, very little is known about the patterns of physical activity among US women. Rates from several national surveys show much lower rates of physical activity for women than for men. Among women, rates may vary by socioeconomic status. Studies relating physical activity and experience with heart disease, cancer, osteoporosis, and mental health are discussed. Interventions in the workplace and the community may increase the level of physical activity among US women. A history of not participating in exercise and lack of time for this activity appear to be important constraints for many women. The Surgeon General's Report on physical activity sanctioned future research on specific groups, such as women. Applied research coupled with community and workplace policies that support women's efforts to be more physically active may decrease the rates of some chronic diseases in this population.

The health status of women with cerebral palsy

OBJECTIVE

To determine preliminary associations between collected health status variables of women with cerebral palsy (CP) residing in the community.

DESIGN

Cross-sectional study using survey research.

PARTICIPANTS

Sixty-three women residing in the community were administered the Telephone Questionnaire when contacted to arrange their visit to the study site located within the medical clinic of a local developmental services office. During the course of their visit to the study site, all 63 women completed the CP Study Protocol, in addition to the Mail-in Questionnaire upon completion of study participation. The women ranged in age from 20 to 74 years.

MAIN OUTCOME MEASURES

Health status, consisting of four elements: (1) self-reported health status; (2) associated conditions; (3) secondary conditions; and (4) health behaviors (alcohol and tobacco use, physical activity, diet, and health care visit).

RESULTS

Women with CP residing in community living arrangements perceived themselves as healthy. The majority of women did not smoke (98%), had not consumed alcohol in the previous month (95%), and ate a balanced diet (52%). Participants also reported engaging in common physical activities (83%) and stretching and doing range-of-motion exercises in the previous week (43%), and participation in aerobic exercise in the previous week (43%). Sixty-eight percent (41 of 60) of the women walked, and more than 50% of the women did not require assistance with activities of daily living. The ability to walk and the use of a wheelchair were associated with participation in the common physical activities. The women reported associated conditions of mental retardation (34%), learning disabilities (26%), and a seizure history (40%). Additionally, the women in the sample reported the occurrence of several secondary conditions common among individuals with CP, including pain (84%), hip and back deformities (59%), bowel problems (56%), bladder problems (49%), poor dental health (43%), and gastroesophageal reflux (28%). Poor dental health was associated with a history of seizures, and associations were also found between pain and mental retardation, and between gastroesophageal reflux and mental retardation.

CONCLUSIONS

Women with CP residing in the community perceived themselves as healthy, and the observed health status measures (eg, self-reported health, associated conditions, secondary conditions, and selected health behaviors) support this concept. For the most part, independent relationships were found between several of these measures indicating no significant association among the variables. Where associations were found, however, such as between walking and participation in physical activity, further investigation is warranted for a better understanding of their ramifications in the design of health promotion activities for women with CP.