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Jiakponnah NN, Unson C, Chukwurah QC. Correlates of Strength and Balance Training Exercises in Older African American Adults. THE GERONTOLOGIST 2021; 61:1062-1070. [PMID: 33539509 DOI: 10.1093/geront/gnab016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study investigated the behavioral and psychological correlates of strength and balance training (SBT) participation among older African Americans. RESEARCH DESIGN AND METHODS A cross-sectional survey of 90 older African Americans (M = 66.7 ± 8.7 years; 70% female) was conducted to assess correlates of intention to undertake SBT exercises and the number of days that they currently engage in SBT. The Theory of Planned Behavior (TPB) and the threat appraisal of the Protection Motivation Theory (PMT) were used as frameworks for the analyses. RESULTS The intention to do SBT exercises was positively associated with favorable attitudes and subjective norm, knowledge about the benefits of SBT, and hours worked per week. The frequency of SBT participation was significantly correlated with behavioral intention, high fear of falling, and a low score on the kinesiophobia scale. DISCUSSION AND IMPLICATIONS This study demonstrated the utility of the TPB and PMT's threat appraisal construct in modeling intention and number of days of SBT participation among African American older adults. The study affirmed the link between intention and behavior and between knowledge of the benefits of SBT and intention. Fear of falling's positive association with days of SBT suggests that respondents' saw SBT's efficacy in reducing falls. The unique contributions of this study are the inclusions of kinesiophobia as a correlate and multiple threat appraisals in the PMT. Health promotion interventions should consider the interrelationship among these constructs.
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Affiliation(s)
| | - Christine Unson
- Department of Public Health, Southern Connecticut State University, New Haven, USA
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Remennick LI, Raanan O. Institutional and Attitudinal Factors Involved in Higher Mortality of Israeli Women after Coronary Bypass Surgery: Another Case of Gender Bias. Health (London) 2016. [DOI: 10.1177/136345930000400403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite their lower cardiovascular risks, women have higher case-fatality ratios after myocardial infarction (MI) and cardiac surgery. Along with women’s older age and co-morbidity, this reflects gender bias in the timely diagnosis and treatment of heart disease in many western countries. Drawing on the theoretical framework offered by McKinlay (1996), current study examined attitudes and practices contributing to late diagnosis and substandard treatment of cardiac symptoms in women. Personal interviews were conducted with 30 women and 25 men sampled via the data set of the national survey of coronary bypass operations in Israel in 1994. In this survey, women’s post-operative mortality has been found to be double that of men, also after adjustment for age and socio-economic factors. Interviews with the survivors helped elucidate some non-biological causes for female mortality disadvantage. Women’s accounts confirmed that primary practitioners often denied cardiac nature of symptoms presented by women and delayed their referral for in-depth testing and intensive treatment, while no such delays occurred with men presenting with similar complaints. Gender bias was stronger during the initial diagnostic process and gradually abated after women were labeled as ‘cardiac cases’ and referred for intensive treatment. At all stages of their ‘cardiac career,’ women received less support from their family members than did men. However, women’s own beliefs about their low cardiac risks and the primacy of family roles over health concerns may have also contributed to later diagnosis and poorer prognosis in women.
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Affiliation(s)
| | - Ofra Raanan
- Bar-Ilan University & Academic School of Nursing, Sheba Medical Centre, Israel
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Baxter S, Blank L, Johnson M, Everson-Hock E, Woods HB, Goyder E, Payne N, Mountain G. Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIt has been argued that transition points in life, such as the approach towards and early years of retirement, present key opportunities for interventions to improve the health of the population. Interventions that may change or preserve activity levels around the time of retirement have the potential to provide benefits in terms of increased health and well-being for people in later life. Research has highlighted health inequalities in health statuses in the retired population and in response to interventions.ObjectiveWe aimed to conduct a systematic review and meta-synthesis of the types and effectiveness of interventions to increase physical activity among people around the time of retirement. We also aimed to identify factors that may underpin the effectiveness or acceptability of interventions, and how issues of health inequalities may be addressed.Data sourcesThe following electronic databases were searched: (1) MEDLINE; (2) Applied Social Sciences Index and Abstracts; (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database); (4) Cumulative Index to Nursing and Allied Health Literature; (5) Science Citation Index; (6) Social Science Citation Index; (7) PsycINFO; (8) Evidence for Policy and Practice Information and Co-ordinating Centre; (9) SPORTDiscus; (10) Social Policy and Practice; (11) Health Management Information Consortium; and (12) Sociological Abstracts. We also searched for grey literature, checked reference lists of included papers and screened other reviews.Review methodsA systematic review of quantitative and qualitative literature was carried out between February 2014 and April 2015. The searches aimed to identify, first, evidence of effectiveness of interventions for older adults at the point of transition to retirement and, second, data relating to perceptions of barriers and facilitators to intervention effectiveness. A meta-synthesis of the two types of evidence was also carried out to provide further interpretation of the review findings.ResultsA systematic search of the literature identified a large number of potentially relevant studies. Of these, 103 studies examining the effectiveness of interventions and 55 qualitative papers met the criteria for inclusion. A review of the effectiveness literature indicated a dearth of studies that investigate interventions that specifically examine the transition to retirement. More general studies in older adults indicated that a range of interventions might be effective for people around retirement age. The qualitative literature indicated the importance of considering the appeal and enjoyment, and social aspects, of interventions. Although there were a range of different measures in use, many were self-reported and few studies included an evaluation of sedentary time. A meta-synthesis across the data types indicated that elements reported as significant by participants did not always feature in the interventions.LimitationsOwing to the lack of evidence relating to the retirement transition, we examined the literature relating to older adults. The applicability of these data to people around retirement age may need consideration.ConclusionsAlthough the retirement transition is considered a significant point of life change, only a small volume of literature has reported interventions specifically in this period. The included literature suggests that interventions should take account of views and preferences of the target population and evaluate effectiveness by measuring meaningful outcomes and using a control group design.Study registrationThis study is registered as PROSPERO CRD42014007446.FundingThe National Institute for Health Research Public Health Research programme.
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Baxter S, Johnson M, Payne N, Buckley-Woods H, Blank L, Hock E, Daley A, Taylor A, Pavey T, Mountain G, Goyder E. Promoting and maintaining physical activity in the transition to retirement: a systematic review of interventions for adults around retirement age. Int J Behav Nutr Phys Act 2016; 13:12. [PMID: 26830026 PMCID: PMC4735960 DOI: 10.1186/s12966-016-0336-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/26/2016] [Indexed: 01/10/2023] Open
Abstract
It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age.
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Affiliation(s)
- S Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK.
| | - M Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
| | - N Payne
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
| | - H Buckley-Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
| | - L Blank
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
| | - E Hock
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
| | - A Daley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Taylor
- Peninsula Schools of Medicine & Dentistry, Plymouth University, Plymouth, UK
| | - T Pavey
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - G Mountain
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
| | - E Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S14DA, UK
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Émile M, Chalabaev A, Pradier C, Clément-Guillotin C, Falzon C, Colson S, d’Arripe-Longueville F. Effects of supervised and individualized weekly walking on exercise stereotypes and quality of life in older sedentary females. Sci Sports 2014. [DOI: 10.1016/j.scispo.2013.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lindelöf N, Rosendahl E, Gustafsson S, Nygaard J, Gustafson Y, Nyberg L. Perceptions of participating in high-intensity functional exercise among older people dependent in activities of daily living (ADL). Arch Gerontol Geriatr 2013; 57:369-76. [PMID: 23768799 DOI: 10.1016/j.archger.2013.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 05/17/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
Abstract
The purpose of the study was to evaluate how older people, dependent in ADL perceive their participation in a high-intensity, functional exercise program compared to the perceptions of those participating in a control activity. Forty-eight older people living in residential care facilities answered a questionnaire about their perceptions of participating in an activity for three months. They were aged 65-98, had a mean score of 24 on Mini Mental State Examination (MMSE) and 14 on Barthel ADL Index. The participants had been randomized to exercise (n=20) or control activity (n=28). Differences in responses between exercise and control activity were evaluated using logistic and ordinal regression analyses. The results show that a majority of the exercise group perceived positive changes in lower limb strength, balance, and in the ability to move more safely and securely compared to a minority of the control group (p<0.001). Significantly more respondents in the exercise activity answered that they felt less tired due to the activity (p=0.027) and that they prioritized this activity above other activities (p=0.010). More exercise participants reported that meeting for three months was too short, and fewer that it was too long compared to the control group (p=0.038). This study shows that older people living in residential care facilities, dependent in ADL, and with mild or no cognitive impairment had positive perceptions about participating in high-intensity functional exercise. The findings support the use of a high-intensity exercise program in this population of older people.
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Affiliation(s)
- N Lindelöf
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-90187 Umeå, Sweden.
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McMurdo MET, Argo I, Crombie IK, Feng Z, Sniehotta FF, Vadiveloo T, Witham MD, Donnan PT. Social, environmental and psychological factors associated with objective physical activity levels in the over 65s. PLoS One 2012; 7:e31878. [PMID: 22359640 PMCID: PMC3281090 DOI: 10.1371/journal.pone.0031878] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/14/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To assess physical activity levels objectively using accelerometers in community dwelling over 65 s and to examine associations with health, social, environmental and psychological factors. Design Cross sectional survey. Setting 17 general practices in Scotland, United Kingdom. Participants Random sampling of over 65 s registered with the practices in four strata young-old (65–80 years), old-old (over 80 years), more affluent and less affluent groups. Main Outcome Measures Accelerometry counts of activity per day. Associations between activity and Theory of Planned Behaviour variables, the physical environment, health, wellbeing and demographic variables were examined with multiple regression analysis and multilevel modelling. Results 547 older people (mean (SD) age 79(8) years, 54% female) were analysed representing 94% of those surveyed. Accelerometry counts were highest in the affluent younger group, followed by the deprived younger group, with lowest levels in the deprived over 80 s group. Multiple regression analysis showed that lower age, higher perceived behavioural control, the physical function subscale of SF-36, and having someone nearby to turn to were all independently associated with higher physical activity levels (R2 = 0.32). In addition, hours of sunshine were independently significantly associated with greater physical activity in a multilevel model. Conclusions Other than age and hours of sunlight, the variables identified are modifiable, and provide a strong basis for the future development of novel multidimensional interventions aimed at increasing activity participation in later life.
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Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2011:CD001561. [PMID: 21249647 DOI: 10.1002/14651858.cd001561.pub3] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Multiple risk factor interventions using counselling and educational methods assumed to be efficacious and cost-effective in reducing coronary heart disease (CHD) mortality and morbidity and that they should be expanded. Trials examining risk factor changes have cast doubt on the effectiveness of these interventions. OBJECTIVES To assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence CHD.. SEARCH STRATEGY We updated the original search BY SEARCHING CENTRAL (2006, Issue 2), MEDLINE (2000 to June 2006) and EMBASE (1998 to June 2006), and checking bibliographies. SELECTION CRITERIA Randomised controlled trials of more than six months duration using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups or specific risk factors (i.e. diabetes, hypertension, hyperlipidaemia, obesity). DATA COLLECTION AND ANALYSIS Two authors extracted data independently. We expressed categorical variables as odds ratios (OR) with 95% confidence intervals (CI). Where studies published subsequent follow-up data on mortality and event rates, we updated these data. MAIN RESULTS We found 55 trials (163,471 participants) with a median duration of 12 month follow up. Fourteen trials (139,256 participants) with reported clinical event endpoints, the pooled ORs for total and CHD mortality were 1.00 (95% CI 0.96 to 1.05) and 0.99 (95% CI 0.92 to 1.07), respectively. Total mortality and combined fatal and non-fatal cardiovascular events showed benefits from intervention when confined to trials involving people with hypertension (16 trials) and diabetes (5 trials): OR 0.78 (95% CI 0.68 to 0.89) and OR 0.71 (95% CI 0.61 to 0.83), respectively. Net changes (weighted mean differences) in systolic and diastolic blood pressure (53 trials) and blood cholesterol (50 trials) were -2.71 mmHg (95% CI -3.49 to -1.93), -2.13 mmHg (95% CI -2.67 to -1.58 ) and -0.24 mmol/l (95% CI -0.32 to -0.16), respectively. The OR for reduction in smoking prevalence (20 trials) was 0.87 (95% CI 0.75 to 1.00). Marked heterogeneity (I(2) > 85%) for all risk factor analyses was not explained by co-morbidities, allocation concealment, use of antihypertensive or cholesterol-lowering drugs, or by age of trial. AUTHORS' CONCLUSIONS Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations.
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Affiliation(s)
- Shah Ebrahim
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK, WC1E 7HT
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Ebrahim S, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2006:CD001561. [PMID: 17054138 PMCID: PMC4160097 DOI: 10.1002/14651858.cd001561.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. OBJECTIVES To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. SEARCH STRATEGY MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE (2000 to September 2001) and EMBASE (1998 to September 2001). SELECTION CRITERIA Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. DATA COLLECTION AND ANALYSIS Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. MAIN RESULTS A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) -3.6 mmHg (95% CI -3.9 to -3.3 mmHg), -2.8 mmHg (95% CI -2.9 to -2.6 mmHg) and -0.07 mMol/l (95% CI -0.8 to -0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. AUTHORS' CONCLUSIONS The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population.
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Affiliation(s)
- S Ebrahim
- London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, Keppel Street, London, UK.
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Jørstad-Stein EC, Hauer K, Becker C, Bonnefoy M, Nakash RA, Skelton DA, Lamb SE. Suitability of Physical Activity Questionnaires for Older Adults in Fall-Prevention Trials: A Systematic Review. J Aging Phys Act 2005; 13:461-81. [PMID: 16301756 DOI: 10.1123/japa.13.4.461] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to identify physical activity questionnaires for older adults that might be suitable outcome measures in clinical trials of fall-injury-prevention intervention and to undertake a systematic quality assessment of their measurement properties. PubMed, CINAHL, and PsycINFO were systematically searched to identify measurements and articles reporting the methodological quality of relevant measures. Quality extraction relating to content, population, reliability, validity, responsiveness, acceptability, practicality, and feasibility was undertaken. Twelve outcome measures met the inclusion criteria. There is limited evidence about the measures’ properties. None of the measures is entirely satisfactory for use in a large-scale trial at present. There is a need to develop suitable measures. The Stanford 7-day Physical Activity Recall Questionnaire and the Community Health Activities Model Program for Seniors questionnaire might be appropriate for further development. The results have implications for the designs of large-scale trials investigating many different geriatric syndromes.
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Affiliation(s)
- Ellen C Jørstad-Stein
- Warwick Emergency Care and Rehabilitation, Warwick Medical School, University of Warwick, Coventry, UK
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Kleppinger A, Litt M, Kulldorff M, Unson C, Judge J. Health Perceptions As Predictors of Exercise Adherence in Older Women. Eur J Sport Sci 2003. [DOI: 10.1080/17461390300073405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Despite well-documented benefits of exercise, aging women remain largely sedentary. Further understanding of beliefs associated with exercise could result in more-effective public health interventions to increase exercise in this vulnerable population. This study examined the relationships between theory of planned behavior constructs and exercise behavior and exercise intention in older women. Constructs from the theory of planned behavior (behavioral beliefs, perceived control beliefs, and normative beliefs) were examined in a sample of 225 women aged 65 and older. Exercise was measured with the Baecke Physical Activity Scale. All women were interviewed, to prevent literacy and vision problems from hampering participation. Significant predictors of exercise behavior were perceived control beliefs and behavioral beliefs. Significant predictors of exercise intentions were perceived control beliefs, behavioral beliefs, and normative beliefs. Specific belief items predicting exercise behavior were that exercise is good for health and that exercise is difficult because of tiredness, as well as the lack of commitment and time. These findings provide partial support for the application of the theory of planned behavior to exercise in older women. The findings suggest that interventions should focus on increasing women's confidence that they can overcome barriers to exercise.
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Affiliation(s)
- Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia 65211, USA.
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Conn VS, Valentine JC, Cooper HM. Interventions to increase physical activity among aging adults: a meta-analysis. Ann Behav Med 2003; 24:190-200. [PMID: 12173676 DOI: 10.1207/s15324796abm2403_04] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES This review applied meta-analytic procedures to integrate primary research findings that test interventions to increase activity among aging adults. METHODS We performed extensive literature searching strategies and located published and unpublished intervention studies that measured the activity behavior of at least five participants with a mean age of 60 years or greater. Primary study results were coded, and meta-analytic procedures were conducted. RESULTS The overall effect size, weighted by sample size, was d(w) = .26 +/- .05. Effect sizes were larger when interventions targeted only activity behavior, excluded general health education, incorporated self-monitoring, used center-based exercise, recommended moderate intensity activity, were delivered in groups, used intense contact between interventionists and participants, and targeted patient populations. Effect sizes were larger for studies that measured exercise duration and studies with a time interval of less than 90 days between intervention and behavior measurement. CONCLUSIONS These findings suggest that group-delivered interventions should encourage moderate activity, incorporate self-monitoring, target only activity, and encourage center-based activity. Findings also suggest that patient populations may be especially receptive to activity interventions. Primary research testing interventions in randomized trials to confirm causal relationships would be constructive.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri-Columbia, 65211, USA.
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Hunt K, Ford G, Mutrie N. Is sport for all? Exercise and physical activity patterns in early and late middle age in the West of Scotland. HEALTH EDUCATION 2001. [DOI: 10.1108/09654280110398725] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ebrahim S, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2000:CD001561. [PMID: 10796813 DOI: 10.1002/14651858.cd001561] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. OBJECTIVES To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from coronary heart disease among adults without clinical evidence of established cardiovascular disease. SEARCH STRATEGY We searched Medline using a standard randomised trial filter. Date of the most recent search was April 1995. SELECTION CRITERIA Intervention studies using counseling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. DATA COLLECTION AND ANALYSIS Both reviewers, independently extracted data. Investigators were contacted to obtain missing information. MAIN RESULTS A total of 18 trials were found of which 10 reported clinical event data. Net changes in systolic and diastolic blood pressure, smoking prevalence, and blood cholesterol were -3.9mmHg (95% CI -4.2,-3.6 mmHg), -2.9 mmHg (95% CI -3.1,-2.7 mmHg), -4.2% (95% CI -4.8, -3.6%), and -0.08mMol/l (95% CI -0.1.-0.06 mMol/l) respectively. In the ten trials with clinical event end-points, the pooled odds ratios for total and coronary heart disease mortality were 0.97 (95% confidence intervals (CI) 0.92-1.02) and 0.97 (95% CI 0.88-1.04) respectively. Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. Only these trials demonstrating significant reductions in mortality. REVIEWER'S CONCLUSIONS The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counseling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population.
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Affiliation(s)
- S Ebrahim
- Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK, BS8 2PR.
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Tai SS, Gould M, Smith P, Iliffe S. Promoting physical activity in general practice: should prescribed exercise be free? J R Soc Med 1999; 92:65-7. [PMID: 10450214 PMCID: PMC1297062 DOI: 10.1177/014107689909200205] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the UK there are numerous schemes whereby general practitioners can prescribe exercise programmes, usually based in leisure centres. Of the factors that discourage adherence to such programmes in the USA, cost has proved important. We collected demographic and questionnaire data from 152 inner-London patients (108 women, 44 men) before they started an exercise programme on a National Health Service prescription, and analysed the results according to whether they dropped out of the programme (78%) or not. Use of logistic regression revealed only one previous barrier to exercise, 'not knowing about local exercise facilities', as a significant positive determinant of adherence (adjusted odds ratio 3.51, 95% confidence interval, 1.04 to 11.86). For 'lack of money' patients were more likely to drop out of the programme (adjusted odds ratio 0.25, 95% CI 0.07-0.85). The very low cost of participation in this scheme, did not encourage adherence, particularly by those who had cited 'lack of money' as a previous barrier. The case of making prescribed exercise free or even low-cost remains unproven.
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Affiliation(s)
- S S Tai
- Department of Primary Care and Population Sciences, Royal Free and University College London School of Medicine, Whittington Hospital, UK
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Abstract
Physical activity may contribute to important health and well-being outcomes among older adults. Efforts to understand determinants of physical activity are necessary to plan effective interventions. The theory of planned behavior has been successfully applied to a variety of health behaviors. Previous research using the theory of planned behavior has not addressed beliefs about overall physical activity among community-dwelling older women. Qualitative interviews were conducted with 30 older women to identify behavioral beliefs, perceived control beliefs, and normative beliefs, which influence physical activity decisions. Content analyses of responses revealed three major themes: social influences on physical activity, psychosocial benefits of activity, and joint problems and fatigue as factors that interfere with activity. These findings about physical activity were compared with published findings about episodic exercise among 30 similar women who took part in an episodic exercise study. The result was the discovery that the women in this study talked about physical activity as embedded in their social lives while the women in the episodic exercise study viewed exercise as separate from their daily lives. These findings of beliefs about overall physical activity suggest a social model may be useful in planning public health interventions to increase activity among older women.
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Affiliation(s)
- V S Conn
- College of Nursing, University of Iowa, Iowa City
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Foss FA, Dickinson E, Hills M, Thomson A, Wilson V, Ebrahim S. Missed opportunities for the prevention of cardiovascular disease among British hypertensives in primary care. Br J Gen Pract 1996; 46:571-5. [PMID: 8945793 PMCID: PMC1239780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND High-risk strategies for the prevention of cardiovascular disease (CVD) among hypertensive patients require knowledge of the prevalence and interaction of modifiable risk factors to ensure effective targeting of interventions. Comparatively little is known of risk-factor profiles and their modification among hypertensives in primary care. AIM The present study was designed to explore relationships between patients' knowledge of CVD risk factors, their perception of personal risk and health behaviours, and their use of lifestyle interventions. METHOD A cross-sectional survey of 2676 men and women with mild to moderate hypertension (diastolic blood pressure 95-115 mmHg), and their general practitioners, recruited from 1044 general practices throughout the UK, was conducted. RESULTS Levels of modifiable risk factors were high, although there was considerable variation by age and sex; most (98.5%) patients had at least one additional CVD risk factor. A lower standard of living was associated with a higher prevalence of 'unhealthy' behaviours. Out of those with a current lifestyle problem, 85% of obese patients, 59% of smokers, 47% of excess drinkers, 49% of those with dietary risk factors and 32% of inactive patients claimed to have adopted healthier behaviours within the past 3 months. Older subjects and those with a lower standard of living were less likely to acknowledge risks, and those who did were less likely to report improving their lifestyles. While 71% of patients recalled receiving lifestyle advice, the coverage and targeting of specific interventions was generally poor. Overall, 60% of the sample had received advice on weight control, 47% on diet, 38% on exercise, 38% on smoking and 36% on alcohol. Women and older people were less likely to be given relevant counseling, and there was no evidence of targeting with respect to subjects' social class, level of hypertension or duration of diagnosis. CONCLUSION Lifestyle interventions are welcomed and are viewed as helpful by patients receiving them. Potential health gains among high-risk hypertensives are being lost because of poor targeting and coverage of those at greatest risk.
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Affiliation(s)
- F A Foss
- Department of Public Health and Primary Care, Royal Free Hospital Medical School, London
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Ebrahim S, Rowland L. Towards a new strategy for health promotion for older women: Determinants of physical activity. PSYCHOL HEALTH MED 1996. [DOI: 10.1080/13548509608400004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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