Greater Increases In Physical Activity Research Articles

Prospective associations between changes in physical activity and sedentary time and subsequent lean muscle mass in older English adults: the EPIC-Norfolk cohort study

BackgroundThe longitudinal associations between physical behaviours and lean muscle mass indices need to be better understood to aid healthy ageing intervention development.MethodsWe assessed physical behaviours (total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, total sedentary time and prolonged sedentary bout time) for 7 days using hip-worn accelerometers. We also assessed domain-specific physical behaviours (walking, cycling, gardening and housework time) with self-report questionnaires at baseline (2006–2011) and follow-up (2012–2016) in the European Prospective Investigation into Cancer (EPIC)-Norfolk study. We assessed body composition using dual-energy X-ray absorptiometry (DEXA) at follow-up in 1535 participants (≥ 60 years at baseline). From this, we derived appendicular lean muscle mass (ALM) indices (% relative ALM = (ALM/total body weight)*100), body mass index (BMI)-scaled ALM (ALM/BMI, kg/kg/m2) and height-scaled ALM (ALM/height2, kg/m2)). We evaluated the prospective associations of both baseline and change in physical behaviours with follow-up muscle mass indices using multivariable linear regression.ResultsOver 5.5 years (SD 14.8) follow-up, higher baseline accelerometer-measured physical activity and lower sedentary time were associated with higher subsequent relative ALM and BMI-scaled ALM, but not height-scaled ALM (e.g. 0.02% higher subsequent relative ALM per minute/day of baseline MVPA for men). Greater increases in physical activity and greater declines in sedentary time variables were associated with higher subsequent relative ALM and BMI-scaled ALM, but not height-scaled ALM (e.g. 0.001 kg/kg/m2 subsequent BMI-scaled ALM and 0.04% subsequent relative ALM per min/day/year increases in LPA over follow-up; 0.001 kg/kg/m2 subsequent BMI-scaled ALM and -0.03% subsequent relative ALM per min/day/year less of total sedentary time over follow-up).Greater increases in women’s cycling and gardening over follow-up were associated with greater subsequent relative ALM (cycling 0.9% per hour/week/year; gardening 0.2% per hour/week/year) and BMI-scaled ALM (cycling 0.03 kg/kg/m2 per hour/week/year; gardening 0.004 kg/kg/m2 per hour/week/year).ConclusionPhysical behaviours across all intensities, and in women more specifically cycling and gardening, may help prevent age-related declines in muscle mass.

Physical activity and weight loss in a pragmatic weight loss trial.

The purpose of this study was to determine the association between changes in physical activity and changes in body weight in a cluster-randomized weight loss trial conducted in an underserved population in Louisiana. This study reports analyses conducted in the intervention group only, which was a 24-month multi-component weight loss program delivered by health coaches embedded in primary care clinics. Physical activity was assessed at baseline and at 6, 12, and 24 months of follow-up and changes in body weight were expressed as percent weight change from baseline. Among the sample of 402 patients, percent changes in body weight (mean ± SE) across increasing tertiles of changes in walking between baseline and 24 months were -3.2 ± 1.0%, -5.5 ± 0.9%, and -7.3 ± 0.9%, respectively (p = 0.001). Changes in body weight across increasing tertiles of changes in moderate-to-vigorous-intensity activity between baseline and 24 months were -4.3 ± 1.0%, -5.0 ± 0.9%, and -7.0 ± 0.9%, respectively (p = 0.04). In conclusion, this multi-component intervention resulted in clinically significant weight loss, and greater increases in physical activity over the intervention period were associated with greater percent reductions in body weight. These results are consistent with those from other studies conducted primarily in non-underserved populations.

A Randomized Controlled Trial of a Positive Family Holistic Health Intervention for Probationers in Hong Kong: A Mixed-Method Study.

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers.Methods: Probationers under the care of the Hong Kong Social Welfare Department were randomized into a care-as-usual control group (CAU), a brief intervention group (BI) receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise (simple and easy-to-do lifestyle-integrated physical activity) and positive psychology themes of “Praise and Gratitude” in the existing probation service], or a combined intervention group (CI) receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used.Results: 318 probationers (51% male) were randomized into CAU (n = 105), BI (n = 108), or CI (n = 105) group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes (Cohen’s d: 0.19–0.41). BI and CI showed further improved physical activity, family communication and family well-being (Cohen’s d: 0.37–0.70). Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size (Cohen’s d: 0.43). CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes (Cohen’s d: 0.38–0.58). Qualitative feedbacks corroborated the quantitative findings.Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service.Trial Registration: The research protocol was registered at the National Institutes of Health (identifier: NCT02770898).

The roles of motivational interviewing and self-efficacy on outcomes and cost-effectiveness of a community-based exercise intervention for inactive middle-older aged adults.

Increasing physical activity (PA) among inactive middle-older aged adults in rural communities is challenging. This study investigates the efficacy of a PA intervention supporting inactive adults in rural/semirural communities. Inactive participants enrolled on either a single signposting session (n=427) or a multisession pathway combining signposting with motivational interviewing (MI; n=478). Pre-post outcomes data assessed activity levels (International Physical Activity Questionnaire-Short Form; Single Item Sport England Measure), self-efficacy (New General Self-Efficacy scale [NGSE]) and well-being (five-item World Health Organization Well-Being Index [WHO-5]). Measures were repeated at longitudinal time points (26, 52weeks) for the MI pathway. Outcomes were contrasted with results from an unmatched comparison group receiving treatment as usual (TAU). Cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) were estimated for short (5years), medium (10years) and long (25years) time horizons. Both pathways significantly increased participants' PA. The MI pathway resulted in significantly greater increases in PA than signposting-only and TAU. Improvements in psychological outcomes (NGSE; WHO-5) were significantly greater in the MI pathway than TAU. Longitudinal results indicated MI pathway participants sustained increases in light-intensity PA at 52weeks (p<0.001; =0.16). Regression analyses found baseline self-efficacy predicted increased PA at 52weeks, while baseline well-being did not. The relationship between self-efficacy and PA increased successively across time points. However, magnitude of participants' increased self-efficacy did not predict PA at any time point. Both pathways were cost-effective and cost -saving for participants aged ≥61years from the short time horizon, with the MI pathway having greater ROI estimates. Overall, MI increased efficacy of a signposting PA intervention and was cost-saving for older adults.

Targeting self-control as a behavior change mechanism to increase physical activity: Study protocol of a randomized controlled trial

Despite the highly publicized beneficial effects of physical activity, 51.1% of middle-aged US adults do not achieve the recommended minimum of aerobic physical activity needed to maintain health. A sedentary lifestyle can be attributed in part to a lack of self-control and there is some evidence that self-control strategies can be improved with targeted interventions. The overall aim of this study is to test self-control as a behavior change mechanism for physical activity and to investigate whether a smartphone-based self-control intervention can increase physical activity among sedentary middle-aged adults. This protocol describes the design of a randomized controlled trial with two experimental conditions: The self-control treatment group and the control group. Both groups track their daily physical activity using a Fitbit step counter for eight weeks. Additionally, the self-control intervention group receives a 7-week smartphone-based self-control intervention to learn strategies how to potentiate desirable impulses or weaken undesirable ones. It is expected that the self-control treatment group will show greater increases in physical activity and that changes last longer compared to the control group. All participants will be assessed at pretest (baseline), at the end of each week (weeks 1–7), at posttest (week 8), and at follow-up (week 12). If this self-control intervention proves effective, this digital approach would represent a low-threshold and cost-effective approach to increasing physical activity. Such an intervention could be delivered to a large number of people to improve their health outcomes in the long run.Trial Registration:ClinicalTrials.gov: NCT04522141

A Randomized Controlled Trial Comparing Two Different Approaches To Prescribe Exercise

The Physical Activity Guidelines for Americans (PAG) recommend 150min/wk of moderate intensity aerobic physical activity (PA) plus 2days of muscle strengthening PA for health. Yet, 26% of Americans and 36% of college students perform no leisure time PA, stressing the need to increase PA in these populations. PURPOSE: We conducted a randomized controlled trial (RCT) comparing two different exercise prescription (ExRx) approaches to increase PA among college students. The purpose of this interim analysis was to assess differences in the Transtheoretical Model stage of change (SOC) and drop-out (DO) rates at the 6wk mid-point (6W) of the RCT compared to baseline (BL) between the two ExRx approaches. METHODS: 60 sedentary, healthy college students >18yr were randomized to two groups: ExRx #1 emphasized meeting the PAG via the Frequency, Intensity, Time, and Type or FITT principle of ExRx; and ExRx #2 emphasized that all PA counts. Both ExRx approaches progressed students from being sedentary to meeting weekly PA goals over the 12wk PA intervention. The primary RCT outcome was the change in PA volume at 12wk, assessed via accelerometer and the Paffenbarger PA Questionnaire. At BL and 6W students completed the SOC to measure PA action transitions over time. Height (cm) and weight (kg) were measured to calculate the body mass index (BMI) at BL. DO was calculated as those who ceased participation at 6W divided by the total randomized sample x100. RMANOVA tested if SOC differed over time by group and Chi-Square tested if DO differed between groups. RESULTS: Subjects (n=32) were sedentary, overweight (BMI=26.0+4.2 m2/kg), healthy college students (24.7+5.2yo) with no differences in BL characteristics between ExRx groups or DO and completers (>0.05). At 6W DO was 28.1% for the total sample with no differences between ExRx groups (p>0.05). At 6W SOC increased from BL in both ExRx groups (p<0.001), but to a greater level in ExRx #1 of 3.6+1.2 indicating progression from the contemplation to action stage than ExRx #2 of 2.7+1.0 indicating progression from the contemplation to preparation stage (p=.045). DISCUSSION: Improvements in SOC suggest PA increased with both ExRx approaches at 6W. Whether these SOC improvements persist at 12wk and translate into greater increases in PA and lower DO remains to be determined.

Caregiver Psychological Distress: Longitudinal Relationships With Physical Activity and Diet.

Given limited longitudinal research with caregivers (CGs, n = 122) of spouses with Alzheimer disease, and demographically matched noncaregivers (NCGs, n = 117), we compared these groups on psychological distress (anxiety, depression), burden, and health behaviors over 2 years. Analyses examined group differences in relationships of micronutrient recommended daily allowances (RDAs) and physical activity considering hours of care, psychological distress, and burden. Participants were measured and assessed on whether they met micronutrient intake and physical activity totaled over an average week. Regression analyses showed a total effect whereby NCGs had greater increases in meeting micronutrient allowances (RDAs) than CGs (b = 10.91, standard error [SE] = 4.74, 95% confidence interval [CI]: 1.56-20.26). Additionally, over time, NCGs had greater increases in physical activity, which was mediated by hours of care (b = 0.149, SE = 0.060, 95% CI: 0.034-0.270). These results suggest CGs may lack proper nutrients, and care hours may influence their health behaviors.

Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD.

This study explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial.A 12-week, four-group, randomised, partially double-blind, placebo-controlled, parallel-group trial of SMBM in addition to tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, tiotropium/olodaterol 5/5 µg plus ExT, or placebo was conducted in 304 patients. Outcomes included anxiety (Hospital Anxiety and Depression Scale (HADS)-A), depression (HADS-D and Patient-Health Questionnaire (PHQ)-9) and cognitive function (Montreal Cognitive Assessment (MoCA)).All outcomes showed statistically and clinically significant improvements after 12 weeks independent of treatment group. However, greater improvements in HADS-A and MoCA were seen in patients who exhibited greater increases in physical activity and exercise capacity, respectively, whereas greater improvements in HADS-D and PHQ-9 were seen in patients who exhibited increases in either physical activity or exercise capacity.The results indicate that SMBM with/without bronchodilators or ExT was associated with improved psychological and cognitive functioning. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD.

Motivational Interviewing to Increase Physical Activity in Persons with Parkinson's Disease

To investigate which intervention leads to greater increase in physical activity in persons with Parkinson's disease (PD) over three months.

Exercise is Medicine ®: Physical Activity Prescriptions and Behavior During Pregnancy

Physical activity (PA) is beneficial to the health of both pregnant mother and unborn child, particularly when current PA guidelines are met (e.g., 150 min/week of moderate-intensity PA). The impact of PA prescriptions given by prenatal physicians, following the Exercise is Medicine® program, is currently unclear. PURPOSE: This study examined the relationship between healthcare provider PA prescriptions given at two prenatal healthcare visits and subsequent PA behavior of pregnant women. METHODS: Prenatal healthcare providers in Cabarrus County, North Carolina assessed physical activity days/week and minutes/day among all prenatal patients (N=965) at two prenatal visits (V1: 20 weeks gestation; V2: 28 weeks gestation). Minutes/week of physical activity were calculated, and providers were trained to provide physical activity prescriptions if the patient was not meeting current guidelines. Wilcoxon-Mann-Whitney tests were used to determine the association between healthcare provider PA prescription and self-reported physical activity from V1 to V2. RESULTS: The frequency of PA assessment at visits decreased as pregnancy progressed (V1=82.1%; V2=45.9%). Median PA minutes reported increased from V1 (25.0 min/wk) to V2 (60.0 min/wk). Likewise, the percentage of pregnant women receiving a PA prescription decreased from visit to visit (V1=68.6%; V2=56.3%). Women who received a PA prescription reported a greater increase in PA from V1 to V2 (117 min/wk) compared to women who did not receive a PA prescription (72 min/wk) (p<0.001). However, only 18.1% of PA prescriptions were consistent with current PA guidelines at prenatal visits. CONCLUSIONS: PA among pregnant women appears positively influenced by PA prescriptions provided by healthcare providers. Further training of healthcare providers is needed to increase the prevalence of prenatal exercise prescriptions consistent with PA guidelines.

Physical activity among Norwegian preschoolers varies by sex, age, and season.

Knowledge of physical activity (PA) in preschool populations is important for public health promotion. We investigated levels of PA in a large sample of Norwegian preschoolers and explored variations and development in PA by sex, age, and season. Physical activity levels of 1154 children (mean age 4.7years, 52% boys) were measured by accelerometry (ActiGraph GT3X+) for 14 consecutive days between autumn 2015 and summer 2016. Additionally, 330 children provided up to 3 repeated measurements of PA across seasons. A linear mixed model was applied to analyze associations and interactions of total PA (cpm), light PA (LPA), moderate PA (MPA), vigorous PA (VPA), moderate-to-vigorous PA (MVPA), sedentary time (SED), sex, age, and season. Boys and girls spent mean (standard deviation) 72 (21) and 59 (18) min/d in MVPA and had a total PA of 790 (202) and 714 (192) cpm/d, respectively. Boys had higher PA levels than girls, PA increased with age, and PA was higher during spring/summer than autumn/winter (P<0.001). Boys had a greater increase in PA by age than girls (P<0.05), mainly due to increased MVPA during spring/summer (p for sex×age×season=0.009). Boys were consistently more active and less sedentary than girls, and PA increased with age for both sexes. Boys exhibited a greater increase than girls in PA by age, and PA differed across seasons, with higher levels of MVPA during spring/summer. Differences in MVPA between boys and girls, among age groups, and among seasons seem to be interrelated, indicating that many factors influence preschoolers' PA.

Weight-related quality of life and temperament as predictors and moderators of outcomes among treatment-seeking, low-income, ethnically diverse children with obesity.

Within any childhood obesity treatment program, some children have better outcomes than others. Little is known about predictors or moderators of more positive outcomes. We aimed to identify whether child temperament and weight-related quality of life predict or moderate childhood obesity treatment outcomes at 6 months. From 2015 to 2016, children (n = 97) ages 5-11 years old with obesity were randomized to a clinic-community (Bull City Fit) or a clinic-only treatment program. Linear regression was used to explore whether dimensions of child temperament and weight-related quality of life predicted or moderated 6-month anthropometric and physical activity outcomes. Children who had more social avoidance due to their weight at baseline had significantly better improvements in body fat percent in the clinic-community model compared with the clinic-only model at 6 months. Across programs, better baseline social quality of life predicted greater increases in waist circumference; conversely, better physical quality of life predicted a decrease in percent of the 95th percentile. Also, children with longer attention spans had greater increases in physical activity. Our findings suggest that children who have social avoidance due to their weight may benefit most from comprehensive clinic-community treatment. Weight-related quality of life may influence outcomes across all treatments, and practitioners need to carefully counsel children experiencing weight negatively.

A Multi-Week Assessment of a Mobile Exergame Intervention in an Elementary School.

Exergaming is potentially useful to promote physical activity in children; however, long-term effectiveness is unclear. MobileKids Monster Manor (MKMM) is a mobile exergame developed with the help of young advisors. The game wirelessly transmits physical activity data from an accelerometer to a mobile device. Players' steps are redeemed for in-game rewards, for example, new characters. First, to evaluate whether increased physical activity previously observed in a 1-week intervention is sustained over a 2-week intervention and 1-week follow-up, and second, to compare impact in schools within different socioeconomic environments. Thirty-seven elementary school students participated in a 4-week randomized controlled study (1-week baseline; 2-week intervention [with only the Game group receiving MKMM]; and 1-week follow-up). All participants wore a Tractivity® accelerometer throughout. Linear mixed models were applied to assess sustainability; a second 42-children-based dataset and age-/sex-adjusted linear regression models were used to compare effect across socioeconomic environments. In the first week of intervention, the Game group compared to the Control group showed a greater increase in physical activity (of 1,758 steps/day [95% confidence interval, CI = 133-3,385] and 31 active minutes/day [95% CI = 4-59]), relative to baseline (13,986 steps/day; 231 active minutes/day). However, this was not sustained in the second intervention week or follow-up. The school within a lower socioeconomic status environment showed lower baseline activity and the 1-week intervention resulted in a greater increase relative to baseline (3,633 steps/day more [95% CI = 1,281-5,985]). MKMM could be a useful short-term physical activity promotion tool; however, effectiveness may decrease as novelty diminishes.

Long Term Effect of Intensive Lifestyle Intervention on Cerebral Blood Flow.

To determine whether long-term behavioral intervention targeting weight loss through increased physical activity and reduced caloric intake would alter cerebral blood flow (CBF) in individuals with type 2 diabetes mellitus. Postrandomization assessment of CBF. Action for Health in Diabetes multicenter randomized controlled clinical trial. Individuals with type 2 diabetes mellitus who were overweight or obese and aged 45 to 76 (N = 310). A multidomain intensive lifestyle intervention (ILI) to induce weight loss and increase physical activity for 8 to 11 years or diabetes support and education (DSE), a control condition. Participants underwent cognitive assessment and standardized brain magnetic resonance imaging (MRI) (3.0 Tesla) to assess CBF an average of 10.4 years after randomization. Weight changes from baseline to time of MRI averaged -6.2% for ILI and -2.8% for DSE (P < .001), and increases in self-reported moderate or intense physical activity averaged 444.3 kcal/wk for ILI and 114.8 kcal/wk for DSE (P = .03). Overall mean CBF was 6% greater for ILI than DSE (P = .04), with the largest mean differences between ILI and DSE in the limbic region (3.39 mL/100 g per minute, 95% confidence interval (CI) = 0.07-6.70 mL/100 g per minute) and occipital lobes (3.52 mL/100 g per minute, 95% CI = 0.20-6.84 mL/100 g per minute). In ILI, greater CBF was associated with greater decreases in weight and greater increases in physical activity. The relationship between CBF and scores on a composite measure of cognitive function varied between intervention groups (P = .02). Long-term weight loss intervention in overweight and obese adults with type 2 diabetes mellitus is associated with greater CBF.

A Bit of Fit: Minimalist Intervention in Adolescents Based on a Physical Activity Tracker.

BackgroundOnly 5% of Canadian youth meet the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day, with leisure time being increasingly allocated to technology usage. Direct-to-consumer mHealth devices that promote physical activity, such as wrist-worn physical activity trackers, have features with potential appeal to youth.ObjectiveThe primary purpose of this study was to determine whether a minimalist physical activity tracker-based intervention would lead to an increase in physical activity in young adolescents. A secondary aim of this study was to assess change in physical activity across a 7-week intervention, as measured by the tracker.MethodsUsing a quasi-experimental crossover design, two groups of 23 young adolescents (aged 13-14 years) were randomly assigned to immediate intervention or delayed intervention. The intervention consisted of wearing a Fitbit-Charge-HR physical activity tracker over a 7-week period. Actical accelerometers were used to measure participants’ levels of MVPA before and at the end of intervention periods for each group. Covariates such as age, sex, stage of change for physical activity behavior, and goal commitment were also measured.ResultsThere was an increase in physical activity over the course of the study period, though it was not related to overall physical activity tracker use. An intervention response did, however, occur in a subset of participants. Specifically, exposure to the physical activity tracker was associated with an average daily increase in MVPA by more than 15 minutes (P=.01) among participants who reported being in the action and maintenance stages of behavior change in relation to participation in physical activity. Participants in the precontemplation, contemplation, and preparation stages of behavior change had no change in their level of MVPA (P=.81).ConclusionsThese results suggest that physical activity trackers may elicit improved physical activity related behavior in young adolescents demonstrating a readiness to be active. Future studies should seek to investigate if integrating physical activity trackers as part of more intensive interventions leads to greater increases in physical activity across different levels of stages of behavior change and if these changes can be sustained over longer periods of time.

Effects of Instructional Physical Activity Courses on Overall Physical Activity and Mood in University Students

ABSTRACTPurpose: The aim of this research was to assess the association between university-based instructional physical activity (PA) courses and changes in overall PA levels and negative mood and their interrelations. The study also sought to determine the amount of change in PA required to significantly improve mood in course enrollees. Method: Participants were university students initially completing PA below the level recommended for health who were either presently enrolled in an elective instructional PA course (treatment group, n = 52, 69% female) or not presently enrolled in such a course (comparison group, n = 32, 69% female). Validated surveys assessed volumes of PA completed per week and overall negative mood from baseline to course end. Mediation analyses assessed group effects on mood through PA changes and reciprocal relations between PA and mood changes. Results: There was a significantly greater increase in PA and significantly more reduction in negative mood in the treatment group. Change in PA completely mediated the relationship between group and change in negative mood, and change in mood completely mediated the relationship between group and PA. These findings indicated a reciprocal, mutually reinforcing relationship between changes in PA and mood. An increase in PA of at least 2 days/week was associated with a significant reduction in negative mood, with no greater effect for more increase. Conclusions: Results provided an improved understanding of the effects of university-based instructional PA courses and how they might be leveraged to improve students’ mental health and possibly contribute to their academic success.

Effect of Theory-Based Training Intervention on Physical Activity and Blood Pressure in Hypertensive Patients: A Randomized Control Trial

Background: Adherence to regular physical activity (PA) remains a challenge for hypertensive (HTN) patients. The present study was aimed at assessing the effectiveness of theory-based training intervention on PA and blood pressure in HTN patients. Methods: The randomized control trial conducted at the healthy heart house in Shiraz, Iran, from January 2015 to January 2016 on 78 HTN patients (39 experimental group (EG) and 39 control group (CG). The exercise program for the EG included 30 minutes of fast walking at 40% to 60% of maximum heart rate reserve 5 days a week for 3 months. The study outcomes included PA stages of change, exercise self-efficacy (ESE), decisional balance, PA and 24-hour ambulatory blood pressure (ABP) and were measured at the onset and at three months post-intervention. Results: Between baseline and three months post-intervention, a greater increase in PA was observed in the EG than in the CG, giving a mean difference of 872.50 metabolic equivalent (MET), p = 0.004. The mean change from baseline to three months post-intervention in 24-hour systolic and diastolic ABP were significant between the EG and CG (mean difference -9.48 mmHg, P = 0.007 and -4.51 mmHg, P = 0.010 respectively). In the EG, 35 subjects (89.7%) and in the CG, 8 subjects (20.5%) entered the stage of action. The mean change from baseline to three month post intervention in ESE and decisional balance was significant between the EG than the CG (mean difference = 20.20, P = 0.001 and 0.50, P = 0.024 respectively). Conclusions: Among HTN patients, a three-month Theory-based training intervention used was effective in increasing PA and reducing 24 hour ABP.

Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults

BackgroundFew studies have been conducted in rural areas assessing the influence of community-level environmental factors on residents’ success improving lifestyle behaviors. ObjectiveOur aim was to examine whether 6-month changes in diet, physical activity, and weight were moderated by the food and physical activity environment in a rural adult population receiving an intervention designed to improve diet and physical activity. DesignWe examined associations between self-reported and objectively measured changes in diet, physical activity, and weight, and perceived and objectively measured food and physical activity environments. Participants were followed for 6 months. Participants/settingParticipants were enrolled in the Heart Healthy Lenoir Project, a lifestyle intervention study conducted in Lenoir County, located in rural southeastern North Carolina. Sample sizes ranged from 132 to 249, depending on the availability of the data. InterventionParticipants received four counseling sessions that focused on healthy eating (adapted Mediterranean diet pattern) and increasing physical activity. Potential moderating factorsDensity of and distance to food and physical activity venues, modified food environment index, Walk Score, crime, and perceived nutrition and physical activity neighborhood barriers were the potential mediating factors. Outcome measuresDiet quality, physical activity, and weight loss were the outcomes measured. Statistical analysesStatistical analyses included correlation and linear regression and controlling for potential confounders (baseline values of the dependent variables, age, race, education, and sex). ResultsIn adjusted analysis, there was an inverse association between weight change and the food environment, suggesting that participants who lived in a less-healthy food environment lost more weight during the 6-month intervention period (P=0.01). Also, there was a positive association between self-reported physical activity and distance to private gyms (P=0.04) and an inverse association between private gym density and pedometer-measured steps (P=0.03), indicating that those who lived farther from gyms and in areas with lower density of gyms had greater increases in physical activity and steps, respectively. ConclusionsContrary to our hypotheses, results indicated that those living in less-favorable food and physical activity environments had greater improvements in diet, physical activity, and weight, compared to those living in more favorable environments. Additional research should be undertaken to address these paradoxical findings and, if confirmed, to better understand them.

Effects of Peer Mentoring Program on the Health Conservation in Elderly Women with Osteoarthritis

Purpose: The purpose of this study was to investigate the effects of peer mentoring program on physical activity, knee joint function, self-care agency and social support, which are health conservation elements in elderly women with osteoarthritis. Methods: This study used a quasi-experimental research design. It is a pretest-and-post 1, post 2 test design of a non-equivalent control group. The subjects were elderly women aged over 65 who were diagnosed with osteoarthritis. A total of 60 patients (experimental group 30, control group 30) who registered with the Senior Welfare Center in City G and in Region D participated in this study. The data were collected from June 29th to September 4th, 2015. The collected data were analyzed with x2 test, Fisher''s exact test, independent t-test and repeated measurement ANOVA. Results: The experimental group showed a greater increase in physical activity, knee joint function, self-care agency and social support than the control group. Conclusion: The results indicated that the peer mentoring program is effective in increasing physical activity, knee joint function, self-care agency and social support of elderly women with osteoarthritis.

Effect of School-based Wellness Intervention in 7th Graders on Stage of Change for Lifestyle Behaviors: The MATCH Program

Objective: For the MATCH intervention, assess concurrent validity of a single item Stage of Change (SOC) measure and association with effectiveness. Methods: Observational pre, post intervention study in 17 schools in North and South Carolina. Subjects included 908 youth with all measures (908/1,468=62%) who participated in an interdisciplinary seventh grade wellness program called Motivating Adolescents with Technology to Choose Health (MATCH). Measures included: Pre and Post-MATCH self-reported SOC, frequency of fruit and vegetable intake (F/V) and Physical Activity (PA) and measured Body Mass Index z-score (zBMI). Concurrent validity was assessed using Wilcoxon rank tests (pre-action vs. action SOC category for F/V and PA at pre- and post-MATCH) and Spearman correlations (between change in SOC, F/V and PA). Change in SOC category distribution was assessed with McNemar’s test; association between change in SOC and change in zBMI was investigated with multiple regression. Results: Both PA and F/V were found to be statistically significantly higher for students in the action SOC category (p<0.0001). Greater increase in SOC was weakly associated with a greater increase in PA (correlation 0.1069, p=0.0013). Participation demonstrated a shift in SOC post-MATCH (% in “action” SOC 47% pre, 53% post; p=0.003). ZBMI decreased significantly from pre- to post-MATCH (p<0.0001). A significant association existed between baseline SOC and change in zBMI: students with higher baseline SOC tended to have more decrease/less increase in zBMI (all overweight subgroup, b=-0.040, p=0.0108). Limitations: lack of a control group, survey questions not validated for individual behavior change. Conclusion: The SOC measure appears to be valid. Participation in MATCH may improve SOC and baseline SOC may predict increased effectiveness; however this result must be considered cautiously in this observational study.