Exercise self-efficacy and its correlates among socioeconomically disadvantaged older adults

Physical activity motives and self-efficacy to overcome physical activity barriers in first-year undergraduates: Do they differ based on physical activity levels?

Objective: Physical activity (PA) declines during the transition to university. Identifying contributing factors is imperative. Participants: Participants were first-year undergraduate students (N = 283). Methods: Participants completed validated surveys. Participants were categorized as meeting PA guidelines or not meeting PA guidelines. MANCOVA's with Bonferroni correction and Kruskal Wallis tests examined differences in PA motives and self-efficacy to overcome PA barriers across PA groups. Results: Significant multivariate effects were observed across PA groups for PA motives and self-efficacy. Univariate analyses revealed students meeting PA guidelines reported significantly higher PA motives of fitness/health management, appearance/weight management, and stress/mood management compared to students not meeting PA guidelines. Students meeting PA guidelines reported significantly higher self-efficacy for all PA barriers compared to students not meeting PA guidelines. Conclusions: Universities should prioritize education about the physical and psychological benefits of PA and teach first-year students behavioral skills to increase PA motivation, self-efficacy, and PA behavior.

Hope and Physical Exercise: The Contributions of Hope, Self-Efficacy, and Optimism in Accounting for Variance in Exercise Frequency

We examine the relationship of hope with exercise using Snyder’s hope model, which defines hope as a combination of goal-directed planning (pathways) and motivation (agency). We surveyed 102 participants online via Amazon MTurk. The Adult Hope Scale and Goal-Specific Hope Scale assessed general hope and hope regarding exercise. The Leisure-Time Exercise Questionnaire assessed frequency of exercise and of any activity “long enough to work up a sweat.” We also measured optimism, exercise self-efficacy, depression, anxiety, and stress. Because hope emphasizes planning and motivation (both likely needed in fitness regimens), we expected it to relate to exercise frequency after controlling for these other variables. Indeed, exercise goal-specific hope was correlated with frequency of exercise and activity long enough to sweat, though general hope was not. This relationship held after controlling for all other variables. Future research may be useful in investigating causality, including whether hope-based interventions result in increased exercise engagement.

Exercise self-efficacy correlates in people with psychosis

Despite the recognition of the importance of exercise self-efficacy in exercise adoption and maintenance, previous investigations on exercise self-efficacy in people with psychosis is scarce. The present study aimed to (1) explore if exercise self-efficacy differed between stages of behavior change in Ugandan outpatients with psychosis, and (2) assess sociodemographic, clinical and motivational correlates of exercise self-efficacy. In total, 48 patients (24 women) completed the Exercise Self-Efficacy Scale (ESES), the Patient-centered Assessment and Counseling for Exercise questionnaire, the Brief Symptoms Inventory-18 (BSI-18), and questions pertaining to intrinsic motivation in the Behavioral Regulation in Exercise Questionnaire-2. Additionally, participants were asked about their exercise behavior in the past 7 days and screened for cardio-metabolic risk factors. Higher ESES-scores were observed in those in the maintenance (n = 17) versus those in the pre-action stage (n = 17) of behavior change. Higher ESES-scores were also significantly associated with lower BSI-18 somatization and higher intrinsic motivation scores. Our data indicated that health care professionals should assist patients with psychosis in interpreting physiological states during exercise. Future research should explore whether bolstering such sources of information might directly or indirectly effect exercise self-efficacy.

The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer

BACKGROUND

Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status.

METHODS

The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into 'more deprived' (SIMD 1-2, n = 58) and 'less deprived' (SIMD 3-5, n = 105). Socio-economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status.

RESULTS

At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes.

CONCLUSIONS

Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio-economic groups.

Depression, distress and self-efficacy: The impact on diabetes self-care practices

The prevalence of type 2 diabetes is increasing in Malaysia, and people with diabetes have been reported to suffer from depression and diabetes distress which influences their self-efficacy in performing diabetes self-care practices. This interviewer administered, cross sectional study, conducted in the district of Hulu Selangor, Malaysia, involving 371 randomly selected patients with type 2 diabetes, recruited from 6 health clinics, aimed to examine a conceptual model regarding the association between depression, diabetes distress and self-efficacy with diabetes self-care practices using the partial least square approach of structural equation modeling. In this study, diabetes self-care practices were similar regardless of sex, age group, ethnicity, education level, diabetes complications or type of diabetes medication. This study found that self-efficacy had a direct effect on diabetes self-care practice (path coefficient = 0.438, p<0.001). Self-care was not directly affected by depression and diabetes distress, but indirectly by depression (path coefficient = -0.115, p<0.01) and diabetes distress (path coefficient = -0.122, p<0.001) via self-efficacy. In conclusion, to improve self-care practices, effort must be focused on enhancing self-efficacy levels, while not forgetting to deal with depression and diabetes distress, especially among those with poorer levels of self-efficacy.

Green Neighborhoods, Food Retail and Childhood Overweight: Differences by Population Density

Purpose.

This study examines relationships between overweight in children and two environmental factors—amount of vegetation surrounding a child's place of residence and proximity of the child's residence to various types of food retail locations. We hypothesize that living in greener neighborhoods, farther from fast food restaurants, and closer to supermarkets would be associated with lower risk of overweight.

Design.

Cross-sectional study.

Setting.

Network of primary care pediatric clinics in Marion County, Indiana.

Subjects.

We acquired data for 7334 subjects, ages 3 to 18 years, presenting for routine well-child care.

Measures.

Neighborhood vegetation and proximity to food retail were calculated using geographic information systems for each subject using circular and network buffers. Child weight status was defined using body mass index percentiles.

Analysis.

We used cumulative logit models to examine associations between an index of overweight, neighborhood vegetation, and food retail environment.

Results.

After controlling for individual socio-demographics and neighborhood socioeconomic status, measures of vegetation and food retail significantly predicted overweight in children. Increased neighborhood vegetation was associated with decreased risk for overweight, but only for subjects residing in higher population density regions. Increased distance between a subject's residence and the nearest large brand name supermarkets was associated with increased risk of overweight, but only for subjects residing in lower population density regions.

Conclusions.

This research suggests that aspects of the built environment are determinants of child weight status, ostensibly by influencing physical activity and dietary behaviors.

Role-Specific Control, Personal Meaning, and Health in Late Life

The purpose of this study is to develop and empirically evaluate a latent variable model that examines the relationships among role-specific control, personal meaning, and health in late life. It is hypothesized that older adults with high levels of role- specific control are likely to develop a deep sense of personal meaning. This conceptual scheme further specifies that elderly people who derive a sense of meaning will, in turn, enjoy better health than older adults who are unable to find meaning in life. Data from a nationwide survey of older people provide support for this theoretical rationale.

Utilizing an integrated infrastructure for outcomes research: a systematic review

OBJECTIVE

To explore the ability of an integrated health information infrastructure to support outcomes research.

METHODS

A systematic review of articles published from 1983 to 2012 by Regenstrief Institute investigators using data from an integrated electronic health record infrastructure involving multiple provider organisations was performed. Articles were independently assessed and classified by study design, disease and other metadata including bibliometrics.

RESULTS

A total of 190 articles were identified. Diseases included cognitive, (16) cardiovascular, (16) infectious, (15) chronic illness (14) and cancer (12). Publications grew steadily (26 in the first decade vs. 100 in the last) as did the number of investigators (from 15 in 1983 to 62 in 2012). The proportion of articles involving non-Regenstrief authors also expanded from 54% in the first decade to 72% in the last decade. During this period, the infrastructure grew from a single health system into a health information exchange network covering more than 6 million patients. Analysis of journal and article metrics reveals high impact for clinical trials and comparative effectiveness research studies that utilised data available in the integrated infrastructure.

DISCUSSION

Integrated information infrastructures support growth in high quality observational studies and diverse collaboration consistent with the goals for the learning health system. More recent publications demonstrate growing external collaborations facilitated by greater access to the infrastructure and improved opportunities to study broader disease and health outcomes.

CONCLUSIONS

Integrated information infrastructures can stimulate learning from electronic data captured during routine clinical care but require time and collaboration to reach full potential.

Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury

Background

Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity.

Methods

Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n = 28 and peak oxygen uptake, n = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity.

Results

Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = −1.93, p = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output (ρ = 0.58, p = 0.02). The relation of ESE with wheeled physical activity was ρ = 0.36, p = 0.09.

Conclusions

In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.

Antecedents and mediators of physical activity in endometrial cancer survivors: Increasing physical activity through steps to health

OBJECTIVE

Research has shown that physical activity (PA) has a positive effect on cancer survivors, including improving quality of life, improving physical fitness, and decreasing risk for cancer recurrence in some cancer types. Theory-based intervention approaches have identified self-efficacy as a potential mediator of PA intervention. This study examines the temporal relationships at 4 time points (T1-T4) between several social-cognitive theory constructs and PA among a group of endometrial cancer survivors receiving PA intervention.

METHOD

A sample of 98 sedentary women who were at least 6 months posttreatment for endometrial cancer were given interventions to increase their PA. We tested whether modeling, physiological somatic sensations, and social support at previous time points predicted self-efficacy at later time points, which in turn would predict PA at later time points.

RESULTS

Results indicated that, as physiological somatic sensations at T2 decreased, self-efficacy at T3 increased, which led to an increase in PA at T4. This suggests that self-efficacy is a significant mediator between physiological somatic sensations and PA. Exploratory follow-up models suggest that model fit can be improved with the addition of contemporaneous effects between self-efficacy and PA at T3 and T4, changing the timing of the mediational relationships.

CONCLUSION

Physiological somatic sensations appear to be an important construct to target to increase PA in this population. Self-efficacy appeared to mediate the relationship between physiological somatic sensations and PA, but the timing of this relationship requires further study. (PsycINFO Database Record

Influences on neighborhood walking in older adults

The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.

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

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

Environmental and socio-economic factors as contributors to racial disparities in diabetes prevalence

BACKGROUND

We deployed a study design that attempts to account for racial differences in socioeconomic and environmental risk exposures to determine if the diabetes race disparity reported in national data is similar when black and white Americans live under similar social conditions.

DESIGN & METHODS

We compared data from the 2003 National Health Interview Survey (NHIS) with the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study, which was conducted in a racially-integrated urban community without race differences in socioeconomic status.

RESULTS

In the NHIS, African Americans had greater adjusted odds of having diabetes compared to whites (OR: 1.61, 95% CI: 1.26-2.04); whereas, in EHDIC-SWB white and African Americans had similar odds of having diabetes (OR: 1.07, 95% CI: 0.71-1.58). Diabetes prevalence for African Americans was similar in NHIS and EHDIC-SWB (10.4%, 95%CI: 9.5-11.4 and 10.5%, 95%CI: 8.5-12.5, respectively). Diabetes prevalence among whites differed for NHIS (6.6%, 95%CI: 6.2-6.9%) and EHDIC-SWB (10.1%, 95%CI: 7.6-12.5%).

CONCLUSIONS

Race disparities in diabetes may stem from differences in the health risk environments that African Americans and whites live. When African Americans and whites live in similar risk environments, their health outcomes are more similar.

A conceptual framework for integrating workplace health promotion and occupational ergonomics programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health--especially ergonomics--with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Assessing outcome expectations in older adults: the multidimensional outcome expectations for exercise scale

Outcome expectations, an important element of social cognitive theory, have been associated with physical activity in older adults. Yet, the measurement of this construct has often adopted a unidimensional approach. We examined the validity of a theoretically consistent three-factor (physical, social, and self-evaluative) outcome expectations exercise scale in middle-aged and older adults (N = 320; M age = 63.8). Participants completed questionnaires assessing outcome expectations, physical activity, self-efficacy, and health status. Comparisons of the hypothesized factor structure with competing models indicated that a three-factor model provided the best fit for the data. Construct validity was further demonstrated by significant association with physical activity and self-efficacy and differential associations with age and health status. Further evidence of validity and application to social cognitive models of physical activity is warranted.

Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke

BACKGROUND AND PURPOSE

The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke.

SUBJECTS

The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada.

METHODS

A cross-sectional mail survey was conducted.

RESULTS

Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature.

DISCUSSION AND CONCLUSION

Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.

How do women change osteoporosis-preventive behaviours in their children?

OBJECTIVE

We have reported that a lifestyle intervention with mothers improved calcium intake and physical activity in both mothers and their children. In this study, we aimed to describe the strategies and approaches used by these mothers to improve their children's calcium intake and physical activity.

DESIGN

A qualitative study using semistructured interviews.

SETTING

Population-based convenience sample.

SUBJECTS

A subsample of 39 mothers were taken from a population-based random sample of 354 mothers who had participated in the original osteoporosis-prevention trial.

RESULTS

Mothers described specific dietary changes they made to increase their children's calcium intake. They also described strategies for improving calcium intake and physical activity such as raising awareness of the importance of calcium; ensuring calcium-rich foods were accessible; assessing their children's likes and dislikes and working within these; role modelling; information provision; taking a balanced approach to attempting behaviour change; and encouraging activities that they could do with their children. Mothers emphasized the general importance of a balanced diet and lifestyle, rather than just focussing on lifestyle factors specific to osteoporosis prevention.

CONCLUSION

Even without specific guidance, mothers are adept at developing strategies to apply to changing lifestyle behaviours in their children and identifying barriers to change. These results provide information, which could be incorporated into future interventions for lifestyle change in children and also provide further support for considering parent-focused approaches to this problem.

Balance Self-Efficacy and Its Relevance to Physical Function and Perceived Health Status After Stroke

OBJECTIVES

To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status.

DESIGN

Secondary analysis of baseline, postintervention, and 6-month follow-up data from a randomized trial.

SETTING

General community.

PARTICIPANTS

Ninety-one subjects with a first or recurrent stroke, discharged from rehabilitation therapy with a residual walking deficit.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Activities-Specific Balance Confidence (ABC) Scale, Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale, and the EQ-5D visual analog scale of perceived health status.

RESULTS

Average balance self-efficacy was 59 out of 100 points on the ABC scale (95% confidence interval, 55-64; n=89). After adjusting for age and sex, functional walking capacity explained 32% and 0% of the respective variability in physical function and perceived health status scores obtained 6 months later. After adjustment for age, sex, and functional walking capacity, balance self-efficacy explained 3% and 19% of variation in 6-month physical function and perceived health status scores, respectively.

CONCLUSIONS

Subjects living in the community after stroke experience impaired balance self-efficacy. Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement, primarily in perceived health status, but also in physical function, than the enhancement of functional walking capacity alone.

Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients

BACKGROUND

Active for Life After Cancer is a randomized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program (Lifestyle) for prostate cancer patients to improve quality of life (QOL) including physical and emotional functioning compared to a group-based Educational Support Program and a Standard Care Program (no group).

METHOD

A total of 134 prostate cancer patients receiving continuous androgen-ablation were randomly assigned to one of the three study conditions.

RESULTS

Results indicated no significant improvements in QOL at 6 or 12 months. Both group-based programs were positively received and yielded good attendance and retention. Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity. Despite these improvements, no significant changes were found for most physical activity measures.

CONCLUSIONS

Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients.

SELF-EFFICACY AND HEALTH PROMOTION BEHAVIORS OF OLDER ADULTS IN IRAN

Increasing healthy behaviors is the major challenge facing health professionals and populations globally. The purpose of this study was to ascertain if a relationship exists between selfefficacy and health promotion behaviors in a sample of older Iranian adults. The organizing framework for the study was Pender's revised Health Promotion Model (Pender, 1996). The study participants were 102 community-dwelling old people residing in Yazd district. The results supported Pender's Health Promotion Model in which self-efficacy accounted for 58% of variance in health promotion behaviors. Health promotion behaviors were found to be correlated with level of education. Additionally, there were associations between self-efficacy and gender, marital status, and level of education. It was concluded that interventions aimed at improving self-efficacy may improve health promotion behaviors of older adults.

The Effect of a Task-Oriented Walking Intervention on Improving Balance Self-Efficacy Poststroke: A Randomized, Controlled Trial

OBJECTIVES

To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific, influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity.

DESIGN

Secondary analysis of a two-center, observer-blinded, randomized, controlled trial.

SETTING

General community.

PARTICIPANTS

Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke.

INTERVENTION

Task-oriented interventions targeting walking or upper extremity (UE) function were provided three times a week for 6 weeks.

MEASUREMENTS

Activities-specific Balance Confidence Scale, Six-Minute Walk Test, 5-m walk, Berg Balance Scale, and Timed "Up and Go" administered at baseline and postintervention.

RESULTS

The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention. Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practiced. In the walking group, change in balance self-efficacy correlated with change in functional walking capacity (correlation coefficient=0.45, 95% confidence interval=0.16-0.68). Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age, sex, comorbidity, time poststroke, and functional mobility on change in self-efficacy.

CONCLUSION

Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke. Benefits may be partially the result of improvement in walking capacity. The influence of baseline level of self-efficacy, depressive symptoms, and prognostic variables on treatment effects are of clinical importance and must be verified in future studies.

Effects of bone density feedback and group education on osteoporosis knowledge and osteoporosis self-efficacy in premenopausal women: a randomized controlled trial

In this 2-yr randomized controlled trial, we examined the effect of bone mineral density feedback and two different educational interventions (an osteoporosis information leaflet and group-based behavioral education [OPSMC]) on osteoporosis knowledge and self-efficacy in 470 women aged 25-44 yr. Osteoporosis knowledge increased across all intervention groups. Women receiving the OPSMC had a greater increase in both short (beta = +1.33, 95% confidence interval [CI] = 0.72-1.94) and long-term (beta = +0.64, 95% CI = 0.0034-1.25) osteoporosis knowledge, compared to those receiving the leaflet. In contrast, a low T-score was associated with a significant increase in long-term (beta = +0.66, 95% CI = 0.0034-1.25) but not short-term (beta = +0.57, 95% CI = -0.036 to 1.17) osteoporosis knowledge, compared to a normal T-score. Changes in osteoporosis self-efficacy were not associated with either low bone mineral density or receiving the OPSMC but were negatively associated with number of children (beta = -0.9, 95% CI = - 1.4 to -0.3) and working more than 20 h per week (beta = -2.7, 95% CI = -4.6 to -0.8). In conclusion, both the OPSMC and bone density feedback increased osteoporosis knowledge but not self-efficacy over 2 yr. Women with children or who worked full time have decreased osteoporosis self-efficacy, suggesting that this group should be a specific target for future interventional strategies.

Older women and exercise: explanatory concepts

BACKGROUND

Older women remain predominantly sedentary despite potential health benefits and reduced risks of cardiovascular disease associated with regular exercise. Primary care interventions to increase exercise need to focus on constructs amenable to intervention that predict exercise behavior.

PURPOSE

The study tested an explanatory model of older women's exercise behavior using concepts from social cognitive theory, the transtheoretical model, and the theory of planned behavior (self-efficacy, outcome expectancy, perceived exercise barriers, processes of change, perceived health, and age).

METHODS

Data were collected by interviews with 203 older community-dwelling women physically capable of some exercise. Ordinary least squares regression results were used to determine the direct and indirect effects in a path model.

FINDINGS

All concepts and 13 hypothesized paths were retained in the trimmed model. The constructs accounted for 46% of the variance in exercise behavior. Outcome expectancy had the largest total effect. Processes of change had the largest direct effect on exercise behavior. Exercise self-efficacy and perceived exercise barriers accounted for similar amounts of variance in exercise behavior, whereas age and health had only modest effects.

CONCLUSION

Important constructs for future exercise model testing and intervention research should include outcome expectancy, processes of change, exercise self-efficacy, and perceived barriers to exercise. Primary care interventions designed to increase older women's exercise should focus on these same constructs.

Rehabilitation of a Functionally Limited, Chronically Ill Older Adult: A Case Study

This case study presents MV, a 78-year-old woman who was being treated pharmacologically for several common chronic health problems and who presented with self-reported and observed limitations in her functional ability. After being screened for contraindications to exercise, MV participated in a 16-week rehabilitation program of regular exercise that included aerobic and resistance training. She maintained a high level of compliance with this rehabilitation training and showed improvements in her aerobic capacity, strength, ability to complete functional tasks, blood components, and lipid profile. She also reported decreased levels of pain and improved perceptions of functional ability. This case study indicates that older adults with chronic illness can benefit from participating in a program of regular exercise.

Outcomes of an exercise program for older women recruited through primary care

OBJECTIVES

This study reports the social cognitive, health status, and health service use outcomes of an exercise intervention among women over 50 years of age.

METHODS

A random sample of patients was drawn from two primary care centers that serve a predominantly low-income and African American population. After provider screen, 412 women were eligible and invited to participate in the study. Of these, 123 participated and 1-year follow-up data are available for 72 participants.

RESULTS

Participants were more likely to be African American and had a higher average body weight than nonparticipants. Perceived health was the only variable that differed by adherence group at baseline. At 1 year, differences were apparent for body weight, body mass index, hip and waist circumference, triceps skinfold, and exercise self-esteem. The no-adherence group got worse, whereas the moderate adherence group improved.

DISCUSSION

These data suggest that even suboptimal adherence to moderate-intensity exercise can yield health benefits

The Impact of Chronic Musculoskeletal Pain on Exercise Attitudes, Self-Efficacy, and Physical Activity

The authors examined the relationship between musculoskeletal pain, self-efficacy, attitudes and beliefs about exercise, and physical activity in 75- to 85-year-old adults. Participants rated their pain during the preceding month in their back, hips, knees, and feet on a scale of 0 to 10. Pain was categorized by number of sites of moderate to severe pain. Among the 325 participants, 42.8% reported at least moderate pain in at least 1 site. Having more pain sites was associated with younger age, lower income, depressed mood, and poorer self-rated health. Participants with more pain sites scored lower on exercise attitudes, beliefs, and self-efficacy, but the self-efficacy scale was most strongly associated with physical activity. Participants with 2–4 pain sites and low self-efficacy were >4 times as likely to be sedentary as those with no pain and high self-efficacy. These findings suggest that improving self-efficacy for exercise might be an important component of programs to increase physical activity in adults with chronic musculoskeletal pain.

Participation in recreational physical activity: why do socioeconomic groups differ?

This qualitative study explored how influences on recreational physical activity (RPA) were patterned by socioeconomic position. Face-to-face interviews were conducted with 10 males and 10 females in three socioeconomic groups (N = 60). Influences salient across all groups included previous opportunities, physical health. social assistance. safety. environmental aesthetics and urban design, physical and health benefits, and barriers of self-consciousness, low skill, and weather/time of year. Influences more salient to the high socioeconomic group included social benefits, achieving a balanced lifestyle, and the barrier of an unpredictable lifestyle. Influences more salient to the high and mid socioeconomic groups included efficacy, perceived need, activity demands, affiliation, emotional benefits, and the barrier of competing demands. Influences more salient to the low socioeconomic group included poor health and barriers of inconvenient access and low personal functioning. Data suggest that efforts to increase RPA in the population should include both general and socioeconomically targeted strategies.

Correlates of adults' participation in physical activity: review and update

PURPOSE

To review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults.

METHODS

Systematic review of the peer-reviewed literature to identify papers published between 1998 and 2000 with PA (and including exercise and exercise adherence). Qualitative reports or case studies were not included.

RESULTS

Thirty-eight new studies were located. Most confirmed the existence of factors already known to be correlates of PA. Changes in status were noted in relation to the influence of marital status, obesity, smoking, lack of time, past exercise behavior, and eight environmental variables. New studies were located which focused on previously understudied population groups such as minorities, middle and older aged adults, and the disabled.

CONCLUSION

The newly reported studies tend to take a broader "ecological" approach to understanding the correlates of PA and are more focused on environmental factors. There remains a need to better understand environmental influences and the factors that influence different types of PA. As most of the work in this field still relies on cross-sectional studies, longitudinal and intervention studies will be required if causal relationships are to be inferred.

Beliefs, perceptions, and practices related to osteoporosis risk reduction among women with multiple sclerosis

Women with multiple sclerosis (MS) are at increased risk for osteoporosis and fracture; in turn, osteoporosis has the potential to exacerbate the physical limitations imposed by MS. This qualitative study explored the understanding of osteoporosis risk and risk reduction, strategies being used to reduce risk, and related beliefs among 27 women with MS. Participants were recruited at a regional MS Society meeting. The women completed personal data forms, and responded to open-ended questions during taped interviews, which were transcribed and subjected to comparative content analysis. Five themes emerged from the data: knowledge about osteoporosis, sense of vulnerability, interactions with healthcare providers, preventive actions, and sense of control. All of the women had some knowledge about osteoporosis risk reduction, and most of the women were actively attempting to reduce their risk. However, few of the women had full knowledge, or were doing all that they might do, to minimize their risk. Few of their healthcare providers had discussed the issue or responded to their concerns, even when women had histories of multiple fractures. The women did comprehened their increased risk and most attempted to manage it, although input was lacking from healthcare providers about osteoporosis risk reduction.

Theoretical approaches to the promotion of physical activity: forging a transdisciplinary paradigm

BACKGROUND

Research in the physical activity promotion arena has focused on the application of theoretical perspectives aimed primarily at personal levels of understanding and analysis. The investigation of such theories has provided some insights related to potentially useful mediators of physical activity behavior. However, to continue to expand this field, new perspectives on personal-level theories, in addition to the exploration of more macro-level conceptual perspectives, are required.

OBJECTIVE

The purpose of this article is to: (1) briefly review the current strengths and limitations of the personal-level, physical activity-theory literature; and (2) introduce concepts and perspectives from other fields, including the social-ecology and urban-planning fields, of potential relevance to the physical activity arena.

METHOD

We provide an overview of potentially relevant theoretical perspectives aimed at different levels of understanding and analysis, from the personal level through the broader-scale meso- and macro-environmental perspectives. In addition, we suggest initial steps to take in developing a transdisciplinary paradigm encompassing all such levels of analysis and investigation.

CONCLUSIONS

Given the scope of the physical inactivity epidemic facing the U.S. population currently and in the future, methods and approaches that integrate theory and concepts across a broader group of disciplines will be increasingly necessary.

Predictors of older primary care patients' participation in a submaximal exercise test and a supervised, low-impact exercise class

OBJECTIVES

This study is an investigation of physical activity promotion among a nonvolunteer sample of community-dwelling, older, urban primary care patients. Our primary interest was in the rates of exercise test and class participation. Of secondary interest were the medical record and baseline survey predictors of test and class participation.

METHODS

The first 500 nonterminally ill women ages 50 years or more with a visit at one of two predominantly African-American, inner-city primary care clinics received a physician screen, a referral to a submaximal exercise test, and, subsequently, a free, supervised exercise program located in a nearby community center.

RESULTS

Eighty-one percent were eligible for the exercise test per provider screen. Of these, 29% completed the exercise test and 28% attended at least one exercise class. After 1 year, 9.2% were attending the exercise classes. Higher exercise outcome expectations, not smoking, and clinic site were associated with exercise test and class participation.

CONCLUSIONS

Providing free, traditional exercise classes and a primary care referral to the classes resulted in limited physical activity participation among older, urban primary care patients. More development and testing of physical activity promotion programs are needed in this population.