Community-based Walking Program Research Articles

An Outdoor Walking Program for Immigrant Muslim Older Adults: A Community-Based Participatory Intervention.

To explore Muslim immigrant older adults' experiences of a modified community-based outdoor walking program and identify factors that facilitate or hinder program acceptance and participation. An exploratory qualitative description single-group pilot study was designed and implemented in three phases: (1) pre-intervention focus group interviews; (2) intervention implementation with tracking of physical activity levels using personal activity monitors; and (3) postintervention individual interviews. Participants were recruited using a convenience sampling strategy in a mosque in Edmonton, Canada, in June 2019. After focus group discussions with participants, walking sessions were conducted for 10 weeks in a local accessible park with required amenities such as benches and restrooms. A fitness instructor delivered the weekly program that was followed by individual semistructured interviews to explore participants' satisfaction and program acceptance. Content analysis was used for qualitative data and sociodemographic, health and physical activity level (via step counts) data was documented for all participants. Thirteen participants with a mean age of 66.9 years completed the program. The majority of participants led a sedentary lifestyle. Participants identified three motivators that increased program satisfaction, which were socialising with peers, having a fitness instructor, and using Fitbit activity trackers. Difficulties with transportation and lack of appropriate educational components were areas for improvement that could enhance acceptability of the program. This study suggests that early incorporation of older immigrants' preferences increases acceptance of physical activity programs. Nurses' engaging in healthy lifestyle support for older immigrants can identify the influences on positive uptake of physical activity programs in this population. Immigrant Muslim older adults lack access to evidence-based physical activity programming that meets their cultural and religious preferences. This study provides some insights into ways to engage this population in similar programs. Community-dwelling older adults who participated in this study completed focus groups and interviews and engaged in the 10-week pilot intervention. Their input informed the modifications to the intervention.

Causal mediation analysis of factors influencing physical activity and community access among people with mild to moderate Parkinson's disease

ObjectiveTo examine how known causal factors (exercise self-efficacy, balance, walking capacity) affect outcomes (moderate intensity physical activity, community access) in people with Parkinson's disease (PD): through a direct pathway, indirectly through potential mediators (non-motor impairments), or through combined direct and mediated paths. DesignCausal mediation analyses using baseline and three-month data from pooled treatment groups in a randomized controlled trial. SettingData were collected at two university clinical research centers. ParticipantsOne hundred thirty-eight people with PD. InterventionsHome and community-based walking and strength exercise program. Main Outcome Measure(s)Exposures were exercise self-efficacy, walking ability, and balance. Potential mediators included pain, fatigue, mood (anxiety, depression, affect, apathy), stigma, and cognition (executive function and cognitive flexibility). Outcomes were physical activity and community access behaviour at three-month follow-up. Separate models were developed for each causal factor-mediator-outcome combination. To minimise bias, all models were adjusted for known confounders (comorbidities, freezing of gait, severity of motor impairments, and/or age) and baseline values of the outcomes. ResultsSelf-efficacy of walking duration had a causal relationship with moderate intensity physical activity through direct and combined paths (p<.001). Walking capacity had a causal relationship with community access through direct (p=.03-.04) and combined (p=.02-.03) paths. Balance did not affect community access (p>.05). There were no significant mediation effects through indirect pathways for either outcome. ConclusionsThe effect of known causal factors on physical activity and community access was not mediated by non-motor impairments. Walking self-efficacy and walking capacity remain the primary intervention targets for improving physical activity and community access, respectively, in people with PD.

Evaluating a Community-Based Walking Program: A Mixed-Methods Assessment of Community Capacity.

The Border Coalition for Fitness (BCF) is a university-community-based partnership that aims to improve physical activity rates in El Paso, Texas, via walking challenges. This mixed-methods program evaluation assessed the BCF's efforts to expand the El Paso community's capacity to support physical activity through the walking challenge campaign. Informants were divided between members, which was subdivided into BCF members and team captains, and walking challenge participants. Informants completed demographic and community capacity questionnaires that assessed 3 constructs: leadership (L), resources (R), and ability, and commitment to organizing action (C). Participants for this study were recruited by email through participant and member listservs. Of the 2000 participants with active emails, 102 agreed to participate. Quantitative results (n = 102) revealed high ratings across all constructs; however, BCF members consistently rated each construct higher than team captains (members L: 9.71; R: 9.50; C: 9.36 vs community leadership L: 7.97; R: 7.72; C: 7.59). BCF members (n = 5) and former walking challenge participants (n = 3) completed semistructured interviews. While qualitative results revealed BCF leadership is effective, programming is appropriately resourced, and the BCF does drives sustainable action in the community, there were areas the participants identify as areas that needed improvement. Specifically, participants felt that membership recruitment and retention should be improved, and that membership should include more community members and challenge participants.

A natural experiment to determine if FitEx works: Impact of a statewide walking program.

The National Cooperative Extension System offers walking programs, but impacts are underreported. One program offered in two state systems is FitEx, an 8-week, group-based behavior change intervention. The purpose of this work was to evaluate FitEx through the RE-AIM (reach, effect, adoption, implementation, maintenance) Framework, with a primary focus on reach and effectiveness (individual-level dimensions). Through a pragmatic, natural experiment, the impact of FitEx was assessed from 2015 to 2020. Reach was operationalized as the number and characteristics of eligible community members who participated. Effectiveness was operationalized as changes in physical activity levels. From 2015 to 2020, there were 1995 FitEx participants (274 ± 233 participants per year) who were 45.22 ± 14.13 years of age, predominantly female (83%) and White (78%). At the start of the program, 33% met physical activity guidelines and during the program 58% met guidelines (X2(1, 1648) = 1.6; P < .0). The reach and effectiveness of FitEx are comparable to-and in some cases, greater than-similar community-based walking programs. FitEx consistently reached middle-aged insufficiently active adults. Future work is needed to reach a more diverse population, establish objectively measured impacts, and establish a process to scale FitEx across the nation.

Mechanical adaptations in walking using carbon fiber ankle foot orthoses for patients with peripheral artery disease

BackgroundThe effectiveness of community-based walking programs for patients with peripheral artery disease (PAD) can be limited by calf claudication during exercise. Recent evidence finds adding carbon fiber ankle foot orthoses (AFO) to a walking program can result in improvements in patient mobility and delay claudication onset when walking. Research questionHow may carbon fiber AFO alter ankle walking mechanics and corresponding triceps surae muscle recruitment in a manner that could improve patient mobility? MethodsIn this repeated measures cohort study, fifteen patients with PAD were fit with bilateral AFO before completing self-paced gait analysis including electromyography. Patients were then given standard advice to walk at home using the devices for 12 weeks. Twelve patients completed follow-up testing. ResultsThere were no significant interactions between main effects for any variable of interest (p ≥ 0.189). Further, there were no within-subjects main effects for testing time for self-selected gait speed or any of the kinetic or kinematic variables (p ≥ 0.435). There were significant main effects for AFO use with reductions in dorsi flexion (p < 0.001), plantar flexion at toe off (p < 0.001), ankle plantar flexor moment (p = 0.037), and ankle plantar flexor power (p < 0.001). Triceps surae recruitment did not change between AFO conditions (p > 0.05). SignificanceAdding carbon fiber AFO limits peak ankle motion and joint power during self-paced walking for people with PAD while maintaining their walking speed. These gait adaptions were maintained over our 12 weeks of walking practice time. A resulting decrease in plantar flexor power while maintaining gait speed may provide the mechanism by which AFO can delay claudication onset which are major barrier to PAD walking programs. Calf muscle recruitment was maintained when adding the AFO which suggests sufficient muscle exertion could exist to maintain muscle integrity with sustained AFO use.

Barriers and Motivators to Physical Activity Prior to Starting a Community-Based Walking Program.

Despite the clear benefits of an active lifestyle, most American adults fail to meet physical activity (PA) guidelines. Because of its safety and ease, walking is a promising population-level strategy to increase PA. There is a need to further understand why adults do and do not participate in walking. This study provides a broader understanding of barriers and motivators of walking prior to starting a walking program. Four years of baseline data from a community-based walking program were analyzed (n = 1491). Descriptive statistics summarized participant characteristics, barriers, reinforcements, and current PA. Chi-square tests were used to assess differences in the barrier and reinforcement responses between participant’s PA level and age categories. Open-ended responses were analyzed using thematic analysis. On average, participants were white (96%), middle-aged (52 ± 13 years old) females (92%). Poor weather and time were frequently reported barriers to walking. Open-ended responses (n = 141) identified additional barriers of lack of motivation (n = 37), joint issues (n = 29), fatigue (n = 24), safety or lack of environmental supports (n = 17), family or work demands (n = 15), and lacking a walking partner (n = 9). Good weather, health, and weight loss were frequently reported motivators. Additional motivators (n = 282) identified included stress relief and mental health (n = 82), social time (n = 70), dog care (n = 41), other health benefits (n = 38), connect with nature (n = 19), enjoyment (14), occupation (n = 11), and environmental and community supports (n = 6). Findings highlight the importance of understanding participant barriers and motivators for PA before starting a program. Future research should examine how reported barriers and motivators are related to program completion and adherence. Tailoring community-based programs to address specific barriers and motivators may enable more participants to effectively change and maintain PA.

Exploring cancer survivors' experiences in a group-based walking program before and during the COVID-19 pandemic: a qualitative study.

PurposePhysical activity (PA) can help reduce side effects related to cancer whilst promoting quality of life. This qualitative study explored cancer survivors’ experiences in an 8-week group-based walking program with behavioural support that was delivered within the community to highlight factors central to successful adoption and sustainability of such programs.MethodsEleven cancer survivors who took part in the program before (n = 7) or during (n = 4) the COVID-19 pandemic were interviewed and asked to discuss their PA behaviour, motivation to join and complete the program, and experienced benefits and barriers, as well as offer feedback that could be incorporated into future programs. Interview transcripts were thematically analysed using a hybrid deductive-inductive approach.ResultsParticipants’ experiences were summarised into six themes: (1) PA behaviour and motivation were enhanced, (2) seeking accountability to take steps for better health, (3) mutual support encourages in-group bonding, (4) placing value on building PA confidence, (5) the impact of the COVID-19 pandemic and (6) recommendations for future programs. By receiving social and behavioural support, and thus experiencing increased PA confidence, participants felt the program supported their PA behaviour. However, key differences were evident for participants attending the program during the pandemic.ConclusionsExploring strategies that foster a communal focus amongst participants within community-based walking programs may be beneficial. Moreover, findings underscore the value of offering PA programming (walking or otherwise) with behavioural support during a pandemic with appropriate safety measures, though social relationships may not be fully fostered.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-021-06529-7.

Building Roads Together: a peer-led, community-based walking and rolling peer support program for inclusion and mental health

The program founder selected Regent Park for Building Roads Together© pilot program implementation because it is one of 31 neighbourhoods identified by the City of Toronto as a Neighbourhood Improvement Area based on a low Neighbourhood Equity Benchmark score indicating that it faces serious inequities requiring immediate action. In addition, Regent Parkhas a higher than average proportion of residents who are recent immigrants, and is Canada's first social housing development undergoing a 25-year process of transformation to a mixed-income community. Community partners confirmed that Building Roads Together responded to community needs and complemented existing programs and supports. Building Roads Together is an award-winning community-based peer support walking and rolling program designed to promote inclusion and reduce health inequities. Strong bodies of evidence demonstrate that peer support, walking, and exposure to green space, each on their own or in combination, reduce social isolation and improve health and mental health. The program founder designed Building Roads Together based on this research evidence; a needs assessment including interviews, focus groups, and meetings; and her lived experience. The needs assessment informed program design, including name, goals, approach, and curriculum. Building Roads Together includes the following phases: (1) Community engagement; (2) Partnership development; (3) Neighbourhood-based Walk the Talk Advisory Groups; (4) Peer Walking/Rolling Group Leadership Training; (5) Mentoring/Support; (6) Peer Walking/Rolling Groups. The training curriculum combines peer leadership, inclusion, and communication skills; practical skills required to create and manage a walking group; and information about urban green space. In partnership with the Centre for Learning & Development Toronto and theRegent Park Community Health Centre, the program founder trained 42 peer walking group leaders and mentored multiple walking groups.

Patient perspectives of ankle-foot orthoses for walking ability in peripheral artery disease: A qualitative study

Calf claudication associated with peripheral artery disease results in limited walking ability and diminished quality of life. Ankle-foot orthoses (AFO) have been used to mitigate calf pain during community-based walking exercise, yet little is known about patients' perspectives of this novel device. The purpose of this qualitative study was to determine the personal impact AFO had on patients who used them. Ten patients with calf claudication who previously completed a 12-week unstructured community-based walking program supplemented by AFO participated in a semi-structured recorded focus group. After data saturation was achieved, transcripts were coded and analyzed, and 2 primary themes emerged from the focus groups: 1) positive functional impact of AFO on walking ability and quality of life and 2) self-selected AFO usage patterns. Six subthemes included 1) positive ambulatory changes from using AFO, 2) sustained ambulatory improvements without AFO, 3) positive psychosocial impact, 4) optimal conditions for AFO usage, 5) optimal ambulatory surfaces when using AFO, and 6) challenges with comorbidities. The AFO were influential in decreasing claudication symptoms, improving walking capacity, and enhancing participation in meaningful daily and recreational activities. This study explores experiential knowledge of patients with calf claudication describing AFO as an effective tool to enhance unstructured walking programs. Further trials are needed to optimize device design and effectiveness in varying walking environments.

Implementation of a Community Walking Program (Walk On!) for Functionally-Limited Older Adults.

Walking interventions improve physical function, reduce fall risk, and prevent mobility disability-even in those with compromised walking ability. However, most prior studies have been conducted in controlled research settings, with no dissemination of an evidence-based walking program for older adults who have mobility limitations and/or are socially isolated. This study reports data on the feasibility and acceptability of a community-based walking program (Walk On!) for older adults who are functionally limited, and assesses changes in physical function among attendees. The program sessions focused on long-distance walking, and took place for one-hour, for two days/week, and for 12 weeks at a time. Pilot implementation study. Local church in Winston-Salem, NC. 49 program participants; Measurements: Physical function battery and satisfaction survey data, as well as formative evaluation data from six attendees of a focus group, are reported. The majority of the participants were >75 years (71%), female (65%), and presented with low levels of physical function (usual gait speed=0.79±0.16; 30.6% used an assistive device). Satisfaction with the program was high (100% would recommend it to others) and focus group results were overwhelmingly positive. Mean attendance to scheduled sessions was 77%±21%, and 63% of participants attended at least 75% of scheduled sessions (n=8 attended 100%). On average, participants improved their 6-min walk distance by 8.9%, their SPPB score by 15.4%, their timed-up-go time by 9.0%, and their usual gait speed by 11.4%. The results of the initial evaluation of Walk On! show high feasibility and acceptability of the program, as well as efficacy for improving physical function. Further research is needed to evaluate a delivery method for wider implementation of the program and to definitively test its effectiveness for improving function and other health benefits.

The effects of a community-based walking program on walking ability and fall-related self-efficacy of chronic stroke patients.

The objectives of this study were to evaluate the effects of community-based walking training (CWT) on the walking ability and fall-related self-efficacy of chronic stroke patients and compare the effects of CWT to the conventional walking programs in stroke patients. Previous studies focused on walking speed, walking endurance, and balance. However, no studies have examined the changes in fall-related self-efficacy after CWT. In order to achieve purpose of this study, 45 chronic stroke patients, who were hospitalized at National Rehabilitation Center, were randomly divided into the CWT group (CWTG, n=15), the treadmill walking training group (TWTG, n=15), and the control group (CG, n=15). The treatment was conducted 3 times per week (30 min each) for 4 weeks. CWT was carried out by gradually increasing the difficulty level in various environments outside the hospital room. The results revealed that the CWTG was more effective in enhancing the walking ability and fall-related self-efficacy than the TWTG and the CG. These findings demonstrated that the CWTG increased the walking ability and fall-related self-efficacy of chronic stroke patients. Therefore, we suggest that adding CWT to standard rehabilitation might be an effective method for improving walking ability and fall-related self-efficacy in chronic stroke patients.

Development of a Logic Model for a Community-Based Walking Program for Mothers

ABSTRACT Despite the evidence demonstrating the importance of physical activity, approximately 50% of US women meet aerobic national physical activity guidelines. There is often a disconnect between successful evidence-based physical activity programs and the translation/dissemination of these programs into community settings; this might be overcome through use of program theory and evaluation. The purpose of this study was to discuss the development of a logic model for a community-based walking program for mothers by providing background on the population and describing program theory, the process of developing the logic model, and logic model components. Participants (N = 86) were mothers (18–64 yr) with a child 26 yr or younger living in her household. Process evaluations, observational, and focus group data were used in a content analysis to determine major themes, informing the logic model. Findings revealed a set of resources needed to complete program activities. These activities led to short- and long-term outcomes. The overarching goal of the program is to improve the overall health status of families and communities. This logic model may have significant public health effect because it can serve as a framework for other communities wanting to develop, implement, and evaluate a walking program for mothers. To the authors' knowledge, this logic model is the first of its kind and may be used by public health practitioners and communities to promote physical activity, specifically walking, in an underserved population.

Development and implementation of a community-based pole walking program for older adults

ABSTRACTBackground: To address the problem of physical inactivity among older adults and the desire of community-based groups to have access to innovative physical activity programs, a pole walking program was developed specifically for older adults living at home who visit community organizations. Methods: The Walking with Poles Program (WWPP) is based on a six-stage approach involving: (1) definition, (2) conceptualization, (3) creation and validation, (4) pilot test, (5) generalization, and (6) consolidation. Reach, dose delivered, and dose received of program implementation were documented. Results: To date, the five stages of this co-construction project have been successfully operationalized through the WWPP. The program was implemented by seven community organizations. It reached 76 older adults whose characteristics are typical of this type of community-based group physical activity program. For instructors, implementing the promotional activities was the most difficult part of the WWPP. Overall, the program was well received by the participants, instructors, and the organization managers. Conclusion: This approach ensured the rigor, relevance, and feasibility of the WWPP.

How to get a nation walking: reach, retention, participant characteristics and program implications of Heart Foundation Walking, a nationwide Australian community-based walking program

BackgroundCommunity-based walking programs represent a low-cost, accessible approach to increasing physical activity among inactive adults. However, recruiting participants from vulnerable and hard-to-reach groups remains a challenge. This study examined the reach, retention, sociodemographic and health characteristics, physical activity levels and motivators of participants in Heart Foundation Walking, a nationwide Australian community-based walking program.MethodsDescriptive cross-sectional analyses were undertaken with data from 22,416 participants aged 15+ years in the Heart Foundation Walking registration database in December 2015, and from four surveys of participants in 2010 (n = 2400), 2011 (n = 3274), 2012 (n = 4158) and 2015 (n = 1890).ResultsHeart Foundation Walking reached participants in every geographic region of Australia, including remote and sparsely populated regions, and engaged sizeable proportions of the following at-risk participants: older than 60 years (>70%); with very low incomes (17–25%); who were overweight or obese (around 60%); and with one or more chronic disease or disease risk factors (57–81%). For all demographic groups, one-year retention rates were at least 75%. Seventy percent of participants met physical activity recommendations. Over 75% reported joining the program for health and fitness reasons while the most cited motivator for continuing was the social aspect (57–73%).ConclusionsVolunteer-run, group-based walking programs can have substantial reach and retention, in particular among those at risk for physical inactivity. The provision of opportunities for social interaction appears to be a key program element in promoting long-term participation, including among high-risk groups.

Mechanical Adaptations In Walking Performance Using Ankle Foot Orthoses For Patients With Peripheral Artery Disease

PURPOSE: Part of the limited success of community-based walking programs for people with peripheral artery disease (PAD) and intermittent claudication (IC) in the calf is a lack of strategies to manage pain during exercise. Carbon fiber ankle foot orthoses (AFO) could delay the onset of IC as they store elastic energy during stance that assists the calf muscles during gait propulsion. Clinical dogma may limit AFO implementation as many practitioners believe that AFO will reduce muscle recruitment during gait with a decline in function over time. Our purpose was to determine the gait adaptions in ankle mechanics, walking speed, and calf muscle recruitment when using AFOs to supplement a community walking program. METHODS: Fifteen patients with PAD (Age=67±12 yrs) were fitted with bilateral AFO. An initial 3D gait analysis with plantar flexor electromyography data was completed 1 week after fitting. We used a within-session comparison of walking with/without the AFO. Patients were then given standard advise to walk at home using the devices ad libitum for 12 weeks. Twelve patients completed follow up testing after 12 weeks. Differences between conditions and test times were analyzed using paired t-tests. RESULTS: The AFO reduced peak ankle plantar flexion power during the propulsion phase of walking at initial testing (mean±SE with AFO=1.5 ± 0.2 W · kg-1, without AFO=2.6 ± 0.3, p < 0.001). Reduced propulsion power was coupled with 4.5° less dorsiflexion during the terminal phase of stance (with AFO=8.6 ± 0.7°, without AFO=13.6 ± 0.9°, p < 0.001). Peak ankle plantar flexion moment and calf muscle recruitment did not change between conditions (p>0.05). The same pattern of results occurred at 12 weeks with no change in the variables over time (p>0.05). Gait speed was constant between conditions and over time (p>0.05; pooled initial=1.09 m · sec-1, pooled 12 weeks=1.06 m · sec-1). CONCLUSIONS: Maintenance of calf muscle recruitment when using the AFO was an unexpected, but favorable finding that contradicts conventional wisdom. Patients maintained normal values of ankle motion using AFO and sustained their gait velocity over time. The AFO reduces power demands on the calf muscle which has potential to reduce IC while still maintaining muscle integrity and walking function. Funding: Pilot and Mini-grants from NIH NIGMS 5U54GM104944.

An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial.

Knee osteoarthritis is a common joint problem leading to an increase of pain and a loss of function in older individuals. The main objective of this study was to evaluate if a participant who was randomly assigned to his preferred group improved his adherence to an effective walking program compared to a participant who did not receive his preferred group. This was a 9-month pilot randomized clinical trial, based on a patient treatment preferences design. The 69 eligible participants had a diagnosis of knee osteoarthritis. Participants were randomized to one of two groups: a supervised community-based or unsupervised walking program, based on the Ottawa Panel guidelines. At 6months, participants who expressed a preference, either for the supervised or unsupervised program, and who were assigned to their preferred choice of program showed significantly higher adherence to walking sessions (supervised 60.7±12.3%, P<0.0001; unsupervised 43.1±12.1%, P=0.03), compared to the participants who did not obtain their preferred choice of program. After 9months, significant improvements were shown according to the level of stiffness evaluated with the WOMAC (P=0.01) and the functional status assessed with the Timed Up and GO Test (P=0.04), among the adherent participants who obtained their preference, as compared to those who did not receive their preference. We show this approach promotes long-term adherence to a community-based walking program, while ensuring the maintenance of clinical benefits of walking, among older adults susceptible to avoid or not properly engage in physical activity.

Development and Evaluation of the Walk for Health Program: A Physical Activity Intervention for Adults with Visual Impairments

Background Although the pervasive comorbidity documented in adults with visual impairments may be linked to physical inactivity, little is known regarding the extent to which mobility and health status can be improved in this population. The aim of this preliminary study was to develop and implement an adaptive, community-based walking program for adults with visual impairments and to evaluate its impact on daily step activity, cardiovascular health, body composition, and lipid function. Methods During an 8-week period, 17 adults (age = 47.3 ± 12.3 years) with visual impairments were prompted at biweekly intervals (weeks 1, 3, 5) to increase their daily step activity by 1,000 steps per day and maintain these gains during weeks 2, 4, and 6. Participants were asked to sustain walking levels achieved by week 6 during the final 2 weeks of the program. Results Following the walking intervention, participants displayed a 78% increase in daily step activity (p &lt; .01), but no improvements in cardiovascular health, body composition, or lipid function were observed. Conclusion Daily step activity was improved after completion of the walking program, but markers of health-related fitness remained unchanged. Future studies should be conducted to quantify the volume of physical activity required to improve the health status of persons with visual impairments.

Underserved community-based walking program for breast cancer survivors.

e288 Background: Advancements in early detection and new treatment options have improved outcomes for breast cancer survivors (BCS). With increased survivorship, improving quality of life (QOL) may be a challenge for some women. Exercise improves QOL for BCS and decreases recurrence, but, despite this many women do not routinely exercise. Underserved areas are at particular risk. Few studies have examined factors influencing exercise initiation and maintenance in underserved areas among minority overweight women. The purpose of this mixed methods study was to examine physiological outcomes and motivational factors in a community-based goal oriented walking program for BCS. Methods: A convenience sample of female BCS was recruited from an inner-city community center 12-week walking program. Women participated in physiological testing and focus groups before and after the program. Data was collected regarding strength, fitness, quality of life, and motivation of the women. Quantitative data was analyzed with paired t-tests. Two researchers independently analyzed focus groups’ transcriptions and like statements and phrases were coded. Themes emerged after discussions between the researchers. Results: The 13 participants [overweight BMI (n = 2), and obese BMI (n = 11)] had a mean survivorship of 5.4 years (range .25-14.5) years. Only 7 participants completed both pre and post physiological testing. Functional endurance significantly improved as indicated by the 6 Minute Walk Test (pre = 503(56), post = 570 (63) meters, mean(sd)), p = 0.02). While overall QOL did not improve, functional well-being showed significant improvement. Two focus group sessions were held at the beginning (n = 13) and end (n = 11) of the program. Themes emerged identifying 1) Treatment Weight Gain, 2) Familial Support, 3) Not Wanting to Go it Alone, 4) The Team Made the Difference Conclusions: Female BCS spoke of interpersonal and environmental factors involved in the decision to engage and maintain exercise with the walking program. Further research is needed to examine exercise motivation in underserved, overweight and obese breast cancer survivors.

Factors influencing adherence among older people with osteoarthritis.

This study aims to identify potential factors that could affect adherence and influence the implementation of an evidence-based structured walking program, among older adults diagnosed with knee osteoarthritis. A total of 69 participants with mild to moderate osteoarthritis of the knee fulfilled an online survey on potential factors that could affect their adherence to an evidence-based structured walking program. Adherence with regard to the influencing factors was explored using a logistic regression model. Results tend to show higher odds of adhering to the evidence-based walking program if the participants were supervised (more than 2.9 times as high), supported by family/friends (more than 3.7 times as high), and not influenced by emotional involvement (more than 11 times as high). The odds of adhering were 3.6 times lower for participants who indicated a change in their medication intake and 3.1 times lower for individuals who considered themselves as less physically active (95% confidence interval (CI)). Our exploratory findings identified and defined potential adherence factors that could guide health professionals in their practice to better identify positive influences and obstacles to treatment adherence, which would lead to the adoption of a more patient-centered approach. A large-scale study is required to clearly delineate the key factors that would influence adherence. We addressed a new knowledge gap by identifying the main strategies to promote the long-term adherence of community-based walking program.

Increasing collective efficacy for physical activity: Design and rationale of Moms UNITE for Health

BackgroundMothers are a population that engages in low levels of physical activity due to unique barriers to physical activity. As such, there is a need to develop and implement physical activity interventions for mothers that can be delivered in community settings. The objective of this article is to describe the Moms UNITE (Using Networks to Increase Togetherness and Efficacy) for Health walking intervention. This intervention, based on social cognitive theory, is designed to compare a collective efficacy enhanced intervention to a standard intervention for increasing physical activity and secondary outcomes. MethodsIn this 6-week, randomized controlled trial, mothers will be assigned to either the standard or intervention (collective efficacy) group. Both groups will receive the same walking intervention and an evidence-based health education program. Strategies and messages focusing on building collective efficacy will be used in the intervention group. Data will be collected at baseline, post-intervention, and follow-up (after a 3month no-intervention period) using a mixed methods approach. ResultsQuantitative data will include anthropometric measurements, objective physical activity, and questionnaires assessing self- and collective-efficacy. Post-intervention focus groups and weekly process evaluation surveys will describe participants' experiences within the program. ConclusionsThis paper will serve as a theoretical framework for researchers and public health practitioners to develop and implement community-based walking programs for mothers.