Meeting Exercise Recommendations Research Articles

The association of physical activity during pregnancy with birthweight extremes: A scoping review

ObjectivesBirthweight (BW) indicates newborn health and is a risk factor for development of chronic diseases later in life. The aim was to investigate whether or not prenatal physical activity (PA) influences BW extremes and how PA influences BW extremes in those diagnosed with pregnancy-related diseases. DesignWe performed a scoping review. MethodsSearches were completed on five databases and studies identified were uploaded to Covidence. ResultsAcross the five databases 3114 studies were identified and after screening, 69 of these studies were used for the final review. Of the 61 studies that considered low BW (LBW)/small for gestational age (SGA) infants, the majority of results (69 %) indicated that PA during pregnancy had no significant impact on LBW or SGA infants. In addition, 11 % of studies reported a significant decrease in the prevalence of LBW infants, however two studies (3 %) reported a significant increase in LBW or SGA infants, likely relating to individuals with high body mass index and poor adherence to PA. Of the 41 studies that did report LGA/macrosomia, 34 % reported that PA significantly reduced the prevalence of higher BW infants. One study reported the association between meeting exercise recommendations and reducing the odds of LGA infants in those with pregnancy-related diseases. ConclusionsWe provide evidence on the association of prenatal PA with BW extremes. It is suggested that prenatal PA does not increase the risk of delivering LBW/SGA infants and may reduce the prevalence of large BW infants. Further research is needed to confirm these relationships and explain their underlying mechanisms.

The Impact of COVID-19 Health and Safety Measures on the Self-Reported Exercise Behaviors and Mental Health of College Students.

The public-health restrictions (e.g., remote learning, restricted access to facilities and dining halls) put in place by colleges to reduce the spread of COVID-19 resulted in forced isolation and modifications to health-related behaviors. The restrictions and uncertainty associated with COVID-19 may have exacerbated the challenges of meeting exercise recommendations and mental-health concerns. The purpose of this study was to assess the impact of restrictions on students' exercise habits and their levels of anxiety, stress, and depression. Five-hundred and forty students completed a 29-question survey on individual demographics, living arrangements, exercise, sleep, diet, and mental health. Significant changes in weekly days of exercise and intensity were reported. Increases in anxiety, stress, and depression were reported. The two most frequently reported changes in exercise behavior were an increase in minutes of aerobic training (5%) and a combination of reduced minutes of aerobic and resistance training (3.9%), which could be reflective of an individual's ability and/or desire to maintain exercise behavior during the restrictions. Alternatively, for those students who reduced their exercise habits, aerobic training (11%) was the mode that suffered the most. Demographic factors such as ethnicity, regional residence, and gender were found to have significant effects on stress, anxiety, and depression. Amidst pandemics and future health emergencies, colleges should prioritize establishing opportunities for students to exercise, helping them meet physical activity recommendations and combat mental-health issues.

Women's heart clinics to prevent cardiovascular disease in women with pregnancy-related risk factors: a prospective study

Abstract Background A woman’s risk of cardiovascular disease (CVD) is substantially increased after a diagnosis of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), or have had a small for gestational age (SGA) baby. However, evidence for models of care that mitigate CVD risk in women with these pregnancy-related conditions is lacking. Purpose To assess the effectiveness of a Women’s Heart Clinic (WHC) on blood pressure (BP) and lipid control in women with past pregnancy-related cardiovascular risk factors. Method A six-month prospective cohort study of women aged 30-55 years with a past pregnancy diagnosis of HDP, GDM or an SGA baby. All women attended a multidisciplinary WHC comprising a cardiologist, a cardiac nurse, and a dietician, located in three cardiovascular healthcare service centers in Australia. Women were assessed at their first attendance of the WHC and at 6 months. The co-primary endpoints were: 1) BP<140/90mmHg or <130/80mmHg if diabetes mellitus and 2) total cholesterol to high density lipoprotein-cholesterol ratio (TC:HDL-C)<4.5. Results 156 women were recruited with a mean age of 41.0±4.2 years, 68.6% Caucasian, 20.5% South/East Asian and 80.5% university educated. Women were a mean of 3.9±2.9 years from last delivery with 23.1% past HDP only, 60.3% GDM only, 13.5% both HDP and GDM and, 3.2% with an SGA baby. All women attended a WHC at least once, with 69.5% reviewed by a dietician. The proportion meeting BP target increased (69.2% to 80.5%, p=0.004); with no significant change in women meeting lipid targets (80.6% to 83.7%, p=0.182). Women had significant reductions in mean systolic BP (-6.9mmHg, 95% confidence interval (CI): -9.1,-4.7, p<0.001), body mass index (-0.6kg/m2, CI: -0.8,-0.3, p<0.001), LDL-cholesterol (-4.2mg/dL, CI: -8.2,-0.2, p=0.042) and total cholesterol (-4.6mg/dL, CI: -9.1,-0.2, p=0.042). Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, p=0.012) and decreased fast food consumption (33.8% to 11.0%, P<0.001), with more women meeting exercise recommendations (84.0% to 92.9%, p=0.025). Conclusion Women at high risk for CVD due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors, after attending a Women’s Heart Clinic. This female-specific cardiovascular healthcare model has the potential to improve long-term CVD outcomes for women.Figure 1:Visual abstract

Associations between Symptoms and Exercise Barriers in Breast Cancer Survivors.

Despite exercise benefits for cancer survivor health, most breast cancer survivors do not meet exercise recommendations. Few studies have examined associations between psychosocial symptoms and exercise barriers in this population. To improve physician exercise counseling by identifying survivors with high barriers in a clinical setting, associations between breast cancer symptoms (fatigue, mood, sleep quality) and exercise barriers were investigated. Physically inactive survivors (N = 320; average age 55 ± 8 years, 81% White, 77% cancer stage I or II) completed a baseline survey for a randomized physical activity trial and secondary analyses were performed. Potential covariates, exercise barriers interference score, Fatigue Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index were assessed. Based on multiple linear regression analyses, only HADS Global (B = 0.463, p < 0.001) and number of comorbidities (B = 0.992, p = 0.01) were independently associated with total exercise barriers interference score, explaining 8.8% of the variance (R2 = 0.088, F(2,317) = 15.286, p < 0.001). The most frequent barriers to exercise for survivors above the HADS clinically important cut point included procrastination, routine, and self-discipline. These results indicate greater anxiety levels, depression levels, and comorbidities may be independently associated with specific exercise barriers. Health professionals should consider mood and comorbidities when evaluating survivors for exercise barriers, and tailoring exercise counseling.

Using the TIDieR checklist to describe development and integration of a web-based intervention promoting healthy eating and regular exercise among older cancer survivors.

To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the AiM, Plan, and act on LIFestYles (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.

Who We Are And What We Do: An Exploration Of Individual Differences For Exercise Behavior

BACKGROUND: Even with the well-known and well-advertised preventative and therapeutic benefits of regular exercise, only ~20-25% of adults self-report meeting exercise recommendations, and the prevalence decreases to ~10-15% when behavior is assessed using device-based recordings. With 75-90% of adults failing to engage in enough exercise to reap the health benefits, it is crucial to direct efforts towards understanding why individuals do or do not choose to engage in exercise behavior. PURPOSE: Determine the extent to which personality dispositions and exercise attitudes explain future exercise behavior. METHODS: Undergraduates (N=84, 20±2 yrs, 50 ♀, 73% regular exercisers) completed an online survey to assess Extraversion (E), Conscientiousness (C), and Neuroticism (N; via Big Five Inventory), as well as exercise attitudes (via Affective Exercise Experiences). 2-weeks following initial survey completion, participants completed a 7-day journal where exercise type, intensity, duration, and frequency were self-reported each day. Separate, stepwise regressions were performed to determine explained variance on average exercise intensity, average duration, and frequency. RESULTS: E, C, and N were not related to exercise intensity (rs = -0.15 - 0.00, Ps= .07-0.33), duration (rs = -0.14 - 0.02, Ps= 0.09-0.50), or frequency (rs = -0.16 - -0.04, Ps= 0.07-0.33) and were removed from subsequent regression models. Affective attitudes toward exercise explained significant variance in average exercise intensity (F(3,80)=7.85, P<0.001, R2adj =0.20) and exercise frequency (F(3,80)=2.91, P=0.040, R2adj =0.07), but did not explain variance in average exercise duration (F(3,80)=1.99, P=0.122, R2adj=0.04). CONCLUSION: While E, C, and N were not related to self-reported exercise behavior, attitudes towards exercise (e.g., belief exercise will bring pleasure, preference for exercise over sedentary behavior, feeling empowered by, or a sense of competence, with exercise) explained 23% and 7% variance in average exercise intensity and frequency (i.e., d·wk-1), respectively. This suggests affective attitudes play an important role in how vigorous an individual exercises as well as provides some explanation for how frequently someone will exercise, which may result in greater health benefits.

Abstract 5937: Are female cancer survivors meeting exercise recommendations for cancer survivorship: Evaluation of disparities by race/ethnicity and US nativity

Abstract Purpose: We examined disparities among female cancer survivors in associations between race/ethnicity, United Statues (US) nativity, and odds of meeting the American College of Sports Medicine (ACSM) weekly exercise recommendations for adult cancer survivors, determining if different by comorbidity and obesity status. Methods: We analyzed 2,044 adult females with a history of cancer 2+ years since initial cancer diagnosis from the National Health and Nutrition Examination Survey (NHANES 1999-2018). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for associations between race/ethnicity (non-Hispanic white [NHW], non-Hispanic Black [NHB], Hispanic/Mexican American, additional racial/ethnic groups), US nativity (US-born, foreign-born), and time of acculturation (US-born, foreign-born &amp;lt;15 years in US, foreign-born ≥15 years in US) and odds of meeting weekly exercise recommendations accounting for examination weights and covariates. Statistical interactions between stratifications (comorbidity status [none, at least one]; BMI [underweight/normal, overweight/obese]) were conducted. Results: Most were breast cancer survivors (33.8%), NHW (64.1%), born in the US (84.5%), overweight/obese (69.9%), and did not meet recommendations (66.5%). NHB survivors were significantly less likely to meet recommendations (aOR, 0.66, 95% CI, 0.47-0.92) than NHW survivors. Foreign-born women were 3.41 times more likely to meet recommendations (95% CI, 1.18-9.85) compared to US-born women. Survivors who were foreign-born and lived in the US for ≥15 years were significantly less likely to meet recommendations (aOR, 0.43, 95% CI, 0.21-0.87) compared to US natives. Comorbidity status significantly modified (p-interaction&amp;lt; 0.05) the associations between US nativity and time of acculturation and BMI modified the relationship between race/ethnicity and odds of meeting recommendations (p-interaction=0.013). NHB survivors who were underweight/normal weight were 2 times more likely (95% CI, 0.96-4.77) to meet recommendations while overweight/obese NHB survivors were significantly less likely (aOR, 0.27; 95% CI 0.13-0.56). Conclusion: Our study results confirm that racial/ethnic disparities exist in meeting exercise recommendations among NHB survivors, particularly those overweight/obese. Our findings provide new evidence for disparities in meeting exercise recommendations among female cancer survivors born outside of the US. While foreign-born survivors were more likely to meet recommendations, living in the US for 15+ years was significantly associated with reduced odds of meeting recommendations. Results can inform researchers and clinicians to better tailor lifestyle and exercise interventions for these women to identify barriers for improving adherence. Citation Format: Kate E. Dibble, Avonne E. Connor. Are female cancer survivors meeting exercise recommendations for cancer survivorship: Evaluation of disparities by race/ethnicity and US nativity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5937.

Prospective associations between multidimensional religiosity/spirituality and cardiovascular risk factors in the English longitudinal study of ageing

Abstract Background Religiosity/Spirituality (R/S) is usually associated with improved cardiovascular disease (CVD) outcomes. If such findings are genuine, they may be explained by the relationship between different R/S dimensions and CVD behavioural and biological risk factors. However, previous studies were mostly cross-sectional, used attendance as main R/S measure and dealt with cofounders inadequately. Hence, more longitudinal research is needed. Purpose This study explored whether multidimensional R/S predicted improvements in future CVD behavioural and physiological risk factors. Methods Participants were 6,844 adults aged 50+ from the English Longitudinal Study of Ageing. Smoking, exercising, drinking, eating fruits/vegetables and R/S were evaluated by self-report at waves 5 (2010/11) and 7 (2014/15). Physical examination and blood samples at waves 4 (2008/09) and 6 (2012/13) involved measurement of blood pressure (BP), body-mass index (BMI), C-reactive Protein (CRP), fibrinogen and HbA1c. Hierarchical multiple regressions controlled for age, gender, wealth, education and ethnicity. Models assessing biomarkers were further adjusted for the four health behaviours and BMI. Data on HbA1c, drinking and eating fruits/vegetables were log-transformed to ensure normal distribution. Results Greater reported spirituality (B=−0.018; CI: −0.035, −0.002; p=.029), praying/meditating daily (B=−0.017; CI: −0.033, −0.002; p=.025) and involvement in organised religion (B=−0.018; CI: −0.033, −0.003; p=0.017) were independently associated with lower fibrinogen at wave 6. Daily prayer/meditation also predicted a higher intake of fruits and vegetables at wave 7 (B=0.004; CI: 0.000, 0.008; p=0.049). However, frequent attendance (OR=0.846; CI: 0.730, 0.982; p=0.027), importance of faith (OR=0.935; CI: 0.879, 0.994; p=0.031) and religious purpose (OR=0.939; CI=0.884, 0.997; p=0.040) independently reduced the odds of meeting exercise recommendations at wave 7. Similarly, frequent attendance predicted higher HbA1c at wave 6 (B=0.002; CI: 0.000, 0.005; p=0.033). R/S was associated with lower systolic and diastolic BP, lower alcohol consumption and greater sedentary behaviour, but these relationships were explained by covariates. Smoking and CRP were unrelated to R/S. Conclusions We found that higher R/S offered partial future cardiovascular protection as it was independently associated with lower fibrinogen and greater intake of fruits and vegetables. However, somewhat unexpectedly, higher R/S also aggravated some CVD risk factors such as HbA1c and engagement in moderate/vigorous exercise. Besides, R/S was associated with lower BP and alcohol consumption at follow-up, but this relationship did not survive adjustment for covariates. Finally, we found no prospective association between R/S and smoking status and CRP. R/S is complicated, and further research should include measures of adverse aspects of religious involvement to clarify the drivers of these detrimental effects of R/S on CVD risk factors. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute on AgeingUK Government Departments

Behavioral impact of national health campaigns on healthy lifestyle practices among young adults in Singapore: a cross-sectional study

BackgroundNational health campaigns are often used to improve lifestyle behaviors in the general population. However, evidence specifically in the young adult population is scarce. Given the general deterioration of healthy lifestyle practices from adolescence to young adulthood, it is imperative to study this age group. This study aimed to investigate the behavioral impact of a national health campaign in Singapore on the lifestyle practices of young adults, and whether sex or full-time working and schooling status affected lifestyle practices.MethodsA total of 594 Singaporean respondents aged 18–39 years old were interviewed via a cross-sectional study in December 2019. Lifestyle practices assessed were diet, exercise, alcohol consumption, current tobacco use, and participation in health screening programs. Other factors investigated included exposure to the national health campaign “War on Diabetes” (WoD), sex, ethnicity, and working/schooling status. Multivariable modified Breslow-Cox proportional hazards models were used to estimate prevalence risk ratios (PRRs) as measures for the associations in this study, after adjusting for potential confounders.ResultsExposure to the WoD campaign had a significant association with meeting dietary recommendations (PRR = 1.6, 95% CI: 1.0–2.5, p = 0.037), participation in screening (PRR = 1.2, 95% CI: 1.0–1.5, p = 0.028), and current tobacco use (PRR = 0.5, 95% CI: 0.3–0.8, p = 0.003). Males were significantly more likely to meet exercise recommendations (PRR = 2.0, 95% CI: 1.5–2.7, p < 0.001), currently use tobacco (PRR = 3.9, 95% CI: 2.2–6.9, p < 0.001), and consume alcohol excessively (PRR = 1.5, 95% CI: 1.0–2.3, p = 0.046), as compared to females. Working young adults were significantly less likely to meet exercise recommendations (PRR = 0.7, 95% CI: 0.5–0.9, p = 0.019) but significantly more likely to be current tobacco users (PRR = 1.8, 95% CI: 1.1–3.1, p = 0.024), as compared to those who were in school.ConclusionsWhile this paper affirms that national health campaigns have significant beneficial associations in diet, health screenings and current tobacco use, policymakers should acknowledge that young adults are an age group with different influences that impact their healthy lifestyle habits. Specific interventions that target these subgroups may be required for better health outcomes. Future studies should evaluate other socio-environmental factors that could play a role in modifying the effect of health campaigns among young adults.

Wearable Exercise Technology and the Impact on College Women’s Physical Activity

ABSTRACT Increased exercise correlates with positive health outcomes in college women. Many women do not get the recommended physical activity during college. The purpose of this study was to analyze whether regular use of wearable exercise technology (i.e., smartphones, dedicated devices) during exercise was associated with increased exercise behaviors. The theoretical framework was Transtheoretical Model of Behavior Change. The participants were 289 undergraduate students, all women. The research design was a survey method using an online platform. The survey questionnaire was administered to identify motivational readiness (from never to regularly) for exercise and exercise technology use. Descriptive and inferential statistics (analysis of variance and Chi-Square) were used in analyzing the data. Of the 289 women participants, 80 were identified as meeting exercise recommendations, and 27 were regular users (6 months or longer) of exercise technology; of these 27, 23 were also regular exercisers. Chi-square tests identified a strong association between the most motivated group for regular exercise and for regular device use, suggesting that women who regularly used an exercise technology device were significantly more likely to be regularly exercising (Χ 2 (4) = 9.41, p = 0.05.).

Does "Sitting" Stand Alone? A Brief Report Evaluating the Effects of Prenatal Sedentary Time on Maternal and Newborn Anthropometric Outcomes.

Research on sedentary behavior and effects on maternal and newborn outcomes has been inconclusive. The objective of this report was to correlate sedentary time with maternal and fetal anthropometric measurements and compare the effect on sedentary time based on meeting prenatal activity guidelines. Healthy pregnant women (N = 61) in their second trimester (24-28wk gestation) provided 7-day accelerometry data. Outcomes, including neonatal weight, length, and body fat percentage, were collected 24 to 48hours after delivery. Placenta weight was measured immediately after delivery. Gestational weight gain was calculated by subtracting self-reported prepregnancy weight from measured weight at 38 weeks gestation. Correlations between sedentary time and outcomes were tested with Spearman and Pearson coefficient of correlations in all women separately and in accordance with the 2019 Canadian prenatal exercise guidelines. No significant associations were found between sedentary time and the selected outcomes, even when compared by prenatal exercise level. There was no difference in total time spent sedentary between active (576.7 [52.8]min) and inactive women (599.3 [51.6]min). Meeting exercise recommendations during pregnancy does not significantly decrease total sedentary time. Future studies should aim to evaluate the health effects of both decreasing sedentary time and meeting prenatal exercise guidelines.

Physical activity of Korean cancer survivors is associated with age and sex.

Background/AimsThis study aimed to assess adherence to physical activity guidelines in cancer survivors and to investigate related factors.MethodsThe cross-sectional data of 39,845 community-dwelling participants aged ≥ 20 years (1,254 cancer survivors) in the Korea National Health and Nutrition Examination Survey were analyzed. The age- and sex-stratified prevalence for meeting exercise guidelines was obtained. The correlates of meeting exercise recommendations were evaluated by using complex-sample logistic regression models.ResultsOverall, 36.2% and 20.5% of cancer survivors met the recommendations for aerobic and resistance exercises, respectively. Cancer survivors and noncancer controls had similar low adherence to exercise recommendations in most age and sex groups, except young female cancer survivors (20 to 49 years old) who showed higher engagement in aerobic exercise than female noncancer controls in the same age group. Old cancer survivors (≥ 65 years) were less likely to engage in recommended levels of aerobic exercise than young cancer survivors (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24 to 0.79). Female cancer survivors were less likely to meet resistance exercise guidelines than male cancer survivors (OR, 0.32; 95% CI, 0.21 to 0.50). In addition, cancer survivors with current smoking status and cardiovascular disease were less likely to meet aerobic exercise recommendations.ConclusionsThe prevalence of meeting exercise guidelines are low in Korean cancer survivors and varied by age and sex. Old age is associated with an insufficient level of aerobic exercise, and female sex is associated with low participation in resistance exercise.

Perspectives on the role of exercise in the treatment of pediatric type 1 diabetes.

Studies demonstrate that children with type 1 diabetes may not be meeting exercise recommendations. This, coupled with the lack of data on the determinants of exercise promotion in youth, may indicate a need for additional focus on exercise guidelines and promotion in youth with type 1 diabetes. The objective of this study is to understand provider perspectives regarding exercise promotion in children with type 1 diabetes. An online survey regarding perspectives on exercise was emailed to Pediatric Endocrine Society members. Of the 84 respondents, 85.5% believe counseling regarding exercise recommendations is a priority. However, 87.8% did not identify Office of Disease Prevention and Health Promotion (ODPHP) guidelines correctly and 79.3% did not identify American Diabetes Association (ADA) guidelines correctly. Providers who exercised regularly (P = .009) and providers who identified ODPHP guidelines correctly (P = .004) were more likely to identify ADA guidelines correctly. Providers who identified ADA guidelines correctly were 4.21 times (OR 4.21; 95% CI 1.30-13.7) more likely to make good recommendations and those who discussed recommendations at diagnosis were 6.10 times (OR 6.10; 95% CI 1.76-21.2) more likely to make good recommendations. To our knowledge, this study is the first to investigate provider perspectives of exercise promotion in children with type 1 diabetes. We found provider recommendations were not consistent with ADA exercise guidelines and most providers were not fully aware of the recommendations. Future research should address increasing provider education regarding exercise guidelines and developing exercise promotion tools.

Motivational Strategies to Prevent Frailty in Older Adults with Diabetes: A Focused Review.

The prevalence of diabetes among Americans aged 65 years and older is greater than 25%. Medical expenditures for persons with diabetes are more than twice as high as those for patients without diabetes. Diabetes in older adults often times coexists with frailty, resulting in reduced quality of life and increased health-care use. Many older adults with type 2 diabetes have mobility impairments and experience falls, which contributes to increased frailty. Exercise has a protective effect for frailty and falls, yet less than half of persons with diabetes exercise and approximately one-quarter meet exercise recommendations. In addition to exercise, nutrition may help reduce the risk for falls; however, nutritional interventions have not been tested as a fall-prevention intervention. According to a review, there is insufficient evidence to create nutritional guidelines specific for frail older adults with type 2 diabetes. There is a need to motivate and empower older adults with type 2 diabetes to make lifestyle changes to prevent frailty. The purpose of this review was to identify and integrate what is known and what still needs to be done for this population to be successful in making health behavior changes to reduce frailty. There is some evidence that motivational approaches have worked for older adults with various chronic disease conditions. However, studies applying motivational strategies are lacking for frail older adults with type 2 diabetes. A novel motivational approach was described; it combines aspects of the Health Belief Model and Motivational Interviewing. Intervention studies incorporating this model are needed to determine whether this client-driven strategy can help various racial/ethnic populations make the sustainable health behavior changes of increasing exercise and healthy eating while taking into consideration physiological, psychological, and economic barriers.

Sleep, Nutrition, Disordered Eating, Problematic Tobacco and Alcohol Use, and Exercise in College Students With and Without Diabetes.

The purpose of the current study was to examine the health behaviors of college students with diabetes and compare behaviors to college students without diabetes. This descriptive study used the American College Health Association-National College Health Assessment II and included 1,216 students between ages 18 and 24. Health behaviors related to sleep, nutrition, disordered eating, problematic tobacco and alcohol use, and exercise were examined. Students with diabetes (n = 528) reported a higher frequency of meeting exercise recommendations and less healthy behaviors related to nutrition and problematic tobacco and alcohol use. Both groups of students reported inadequate sleep. Students with diabetes reported more academic problems due to sleep difficulties, disordered eating, and problematic alcohol use. Health behaviors in both groups showed similar needs for improvement. Nurses are in a position to guide new, prospective, and continuing college students with diabetes in practicing behaviors associated with positive health outcomes. Opportunities for interventions are numerous. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 23-32.].

Ballroom dance for persons with multiple sclerosis: a pilot feasibility study

Purpose: The purpose of this study was to evaluate the exercise intensity and feasibility of recreational ballroom dance for persons with multiple sclerosis (MS).Methods: Seven persons with MS participated in 2 one-hour dance sessions per week for 6 weeks. Dance types included rumba, foxtrot, waltz, and push-pull. Six other persons with MS comprised a control group that did not dance. Heart rate and ratings of perceived exertion (RPE) were monitored during the sessions. Outcomes included: quality of life, fatigue, depression, self-efficacy, timed up and go, Berg Balance Scale, Dynamic Gait Index and the Multiple Sclerosis Functional Composite comprising 9-hole peg test, 25-ft walk test, and Paced Auditory Serial Addition Test (PASAT), a cognitive test.Results: Heart rates and RPE indicated that ballroom dance for persons with MS can provide a light to moderate exercise intensity. After the dance program, quality of life and PASAT improved as did the MS Functional Composite Score. No changes were noted in the control group.Conclusions: Recreational ballroom dance is feasible and can provide an exercise stimulus sufficient to help meet exercise recommendations for persons with multiple sclerosis as well as improve quality of life and cognition in persons with MS.Implications for rehabilitationExercise or physical activity is important for the health and wellness of persons with multiple sclerosis.Persons with multiple sclerosis often seek information about non-traditional low-impact physical activity.In a small controlled sample, partnered recreational ballroom or social dance for persons with multiple sclerosis has been shown to be feasible and of recommended exercise intensity.Further, partnered recreational ballroom dance for persons with multiple sclerosis can improve measures of quality of life and cognitive function.

A prospective study examining the influence of cardiac rehabilitation on the sedentary time of highly sedentary, physically inactive patients

ObjectivesProlonged sedentary time is recognized as a distinct health risk, and mortality risks are expected to be greatest for individuals with low exercise levels. It is unknown whether participation in exercise-based cardiac rehabilitation (CR) programs influences sedentary behaviour particularly among those patients expected to be at greatest mortality risk. This study examined the influence of CR participation on sedentary behaviour and identified the proportion and characteristics (socio-demographic and clinical) of patients who do not meet exercise recommendations and have prolonged sedentary times. MethodsA prospective study was conducted among patients of an exercise-based CR program and assessments performed at baseline and 3 months. Physical activity and sedentary behaviour information were collected by self-report, and convergent validity was examined on an accelerometer-wearing subsample. ResultsOf 468 CR patients approached, 130 participants were recruited with an average sedentary time of 8hours/day. Sedentary behaviour remained consistent at follow-up (relative change= −2.4%, P=0.07) notwithstanding a greater proportion meeting exercise recommendations (relative change= 57.4%). 19.2% of participants were classified to have prolonged sedentary time and not meet exercise recommendations at baseline. No significant differences were found between the characteristics of high-risk individuals and lower risk subgroups. Findings were consistent among the accelerometer-derived subgroup and the overall sample despite poor to moderate convergent validity. ConclusionsThese results suggest that the exercise-focus of CR may not reduce sedentary behaviours. Future studies are needed to determine whether sedentary behaviour-specific reduction strategies are more effective than traditional exercise-based strategies and lead to meaningful improvements in clinical outcomes.

Do physical activity levels in the cancer population recover without intervention? An observational study

Background: National UK directives expect physical activity (PA) to be included in cancer patients’ management due to recognition of its wide-ranging benefit. Local implementation is inconsistent and remains a challenge.Nationally, only 29% of females and 39% of males in England met American College of Sports Medicine (ACSM) exercise recommendations. Those receiving cancer treatments may be less likely to meet exercise recommendations at the completion of primary cancer treatment. Purpose: To evaluate PA levels in a representative sample of cancer survivors post primary treatment (end-of-treatment: EOT) and 4 months post EOT as part of determining their natural recovery trajectory to inform future development of services. Methods:A consecutive, representative sample of 76 survivors with breast, prostate, gynaecological, colorectal and lymphoma cancer (mean age 64.7 years, SD= 11.67) diagnosed and treated at a regional cancer centre in London, UK were measured between November 2012 and March 2013 at EOT. The short form International Physical Activity Questionnaire (IPAQ-SF) was our primary measure of patient self-reported PA levels. Patient demographics and characteristics represented secondary measures. Results: IPAQ-SF scores revealed 85% (n= 71) met exercise recommendations at EOT when translated to the ACSM recommendations.At 4months therewas no proportional difference (n= 53, 85%). There were no statistically significant associations between PA change and gender or tumour type. Overall, our results showed an unexpected over-reporting of recommended PA levels both at EOT and 4 months post EOT compared with the unimpaired population. Conclusion(s):Our results show that self reported PA levels do not change 4 months after EOT. The validity of the IPAQ-SF in translating PA with respect to exercise recommendations in cancer survivors is questionable. This may be secondary to erroneous reporting of low level activity included e.g. walking which may have inflated PA levels. There remains debate about operationalizing PA and other functional activities in this representative sample. Implications:Our data indicates that the use of the IPAQSF should be carefully considered in reportingPA levels in the context of recommended PA levels in the cancer population at the end of primary treatment. There is an urgent need for the professional community to reach consensus on what does and does not constitute PA in impaired populations.

Exercise Adherence Among Pregnant Women

Epidemiological data indicate that the prevalence of pregnant women meeting exercise recommendations is lower than nonpregnant women and randomized controlled trials of exercise in this population have reported poor levels of adherence to the interventions. PURPOSE: To identify predictors of exercise levels among pregnant women. METHODS: Pregnant women without medical contraindications to exercise (n=27) were surveyed to assess their current exercise levels, exercise attitudes, social support for exercise, and demographic characteristics. Preliminary analyses of this ongoing study involved Oaxaca-Blinder decompositions and ordinary least squares regression in Stata 11 and SPSS 22, respectively. RESULTS: Oaxaca-Blinder decomposition analyses indicated a trend for higher exercise levels for women with at least some college compared to high school or less (15.8 vs. 8.5 MET-hours/week, p=0.24) and for high compared to low income women (19.0 vs. 9.6 MET-hours/week, p=0.39). Less than 10% of any difference in exercise between high and low educated women is due to differences in exercise attitudes and most is due to the differences in the coefficients for exercise attitudes (β=0.877, p=0.114 and β=0.714, p=0.030, respectively). About half of any difference in exercise between high and low income women is due to differences in exercise attitudes and the other half is due to the differences in the coefficients (β=1.596, p=0.192 and β=0.518, p=0.024, respectively). Family social support for exercise is positively related to exercise levels (β=0.542, p=0.036), but is not statistically significant when controlling for education or income. Family social support for exercise interacts with education (β =0.386, p=0.013) and income (β=0.198, p=0.017). CONCLUSION: It may benefit future exercise interventions to target pregnant women’s attitudes towards exercise to increase their adherence, particularly those with low incomes. However, disparities in exercise will only decrease so much by increasing positive attitudes towards exercise. Interventions should also examine structural factors that impede women’s abilities to comply with exercise programs. Future clinical trials may also benefit from including family members in the exercise intervention. The first author is supported by NIH Grant T32 HL105349.

Prediction of adaptive self-regulatory responses to arthritis pain anxiety in exercising adults: does pain acceptance matter?

Exercising for ≥ 150 min/week is a recommended strategy for self-managing arthritis. However, exercise nonadherence is a problem. Arthritis pain anxiety may interfere with regular exercise. According to the fear-avoidance model, individuals may confront their pain anxiety by using adaptive self-regulatory responses (eg, changing exercise type or duration). Furthermore, the anxiety-self-regulatory responses relationship may vary as a function of individuals' pain acceptance levels. To investigate pain acceptance as a moderator of the pain anxiety-adaptive self-regulatory responses relationship. The secondary objective was to examine whether groups of patients who differed in meeting exercise recommendations also differed in pain-related and self-regulatory responses. Adults (mean [± SD] age 49.75 ± 13.88 years) with medically diagnosed arthritis completed online measures of arthritis pain-related variables and self-regulatory responses at baseline, and exercise participation two weeks later. Individuals meeting (n=87) and not meeting (n=49) exercise recommendations were identified. Hierarchical multiple regression analysis revealed that pain acceptance moderated the anxiety-adaptive self-regulatory responses relationship. When pain anxiety was lower, greater pain acceptance was associated with less frequent use of adaptive responses. When anxiety was higher, adaptive responses were used regardless of pain acceptance level. MANOVA findings revealed that participants meeting the recommended exercise dose reported significantly lower pain and pain anxiety, and greater pain acceptance (P<0.05) than those not meeting the dose. Greater pain acceptance may help individuals to focus their efforts to adapt to their pain anxiety only when it is higher, leaving self-regulatory capacity to cope with additional challenges to exercise adherence (eg, busy schedule).