A Group-Mediated Cognitive-Behavioral intervention for Increasing Adherence to Physical Activity in Older Adults

The effect of walking intervention on blood pressure control: a systematic review

BACKGROUND

Hypertension is a major public health problem and a key risk factor of cardiovascular diseases. Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. However the optimal characteristics for a physical activity programme remain open to debate. Walking is recommended by healthcare professionals as a form of exercise for controlling hypertension and nurses find it difficult to provide advice about this form of physical activity. Studies testing the effect of walking on blood pressure have produced inconsistent findings.

OBJECTIVES

To systematically review the evidence for the effectiveness of walking intervention on blood pressure.

METHODS

A systematic search of the literature was conducted using a range of electronic and evidence-based databases to identify studies. Criteria for study inclusion were a randomised controlled trial design with a non-intervention control group; study samples were aged 16 years and over; the intervention was predominantly focused on walking and blood pressure was an outcome. Data extraction and quality appraisal were carried out independently by two reviewers; a third reviewer was consulted when needed.

RESULTS

A total of 27 randomised controlled trials were included and nine of the 27 trials found an effect of walking intervention on blood pressure control. Walking intervention tends to be effective from studies with larger sample size. A beneficial effect of walking on blood pressure tended to employ moderate to high-intensity walking and a longer intervention period than those trials not showing the effect.

CONCLUSIONS

The results of this review provide evidence of the beneficial effects of walking on lowering blood pressure. Recommendations on lowering blood pressure with a walking activity should address the issue of walking intensity to achieve a beneficial effect on lowering blood pressure. Future research investigating the effect of walking intensity on blood pressure levels and rigorous design of walking interventions to achieve better adherence and methodological quality is required.

A lifestyle activity intervention in patients with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients have lower levels of physical activity compared to age-matched controls, and they limit physical activities requiring normal exertion. Our purpose was to compare the effectiveness of a traditional exercise therapy (TET) program with a behavioral lifestyle activity program (LAP) in promoting physical activity.

METHODS

Moderate physical activity (kcal/week) was assessed in 176 COPD patients using the Community Health Activities Model for Seniors questionnaire. Patients were randomized to either a three month TET program that meet thrice weekly or a LAP. The LAP was designed to teach behavioral skills that encouraged the daily accumulation of self-selected physical activities of at least moderate intensity. Interventionist contact was similar (36 h) between the two groups. Patients were assessed at baseline and 3, 6 and 12 months.

RESULTS

Compared to baseline values, self-reported moderate physical activity increased three months post-randomization with no significant difference (p = 0.99) found between the TET (2501 +/- 197 kcal/week) and the LAP (2498 +/- 211 kcal/week). At 6 and 12 months post-randomization, there were no significant differences (p = 0.37 and 0.69, respectively) in self-reported levels of moderate physical activity between the TET (2210 +/- 187 and 2213 +/- 218 kcal/week, respectively) and the LAP (2456 +/- 198 and 2342 +/- 232 kcal/week, respectively).

CONCLUSION

Although there was no difference between treatment groups, the TET and the LAP were both effective at in increasing moderate levels of physical activity at 3 months and maintaining moderate physical activity levels 12 months post-randomization. This clinical trial is registered with ClinicalTrials.gov. Its identifier is NCT00328484.

The impact of a student-led pedometer intervention incorporating cognitive-behavioral strategies on step count and self-efficacy

This study evaluated the effectiveness of a student-led physical activity intervention that incorporated pedometers and cognitive-behavioral strategies. Undergraduate students (N=117) enrolled in upper division exercise and sport science courses recruited participants. Participants in the cognitive-behavioral intervention condition received weekly mentoring from students on strategies to foster self-regulation, whereas those in a minimal intervention control condition (i.e., pedometer and self-monitoring) did not. All volunteers wore a pedometer for 6 weeks, maintained a step-count log, and completed physical activity and barrier self-efficacy measures pre- and postintervention. Repeated measures analysis of variance revealed that intervention condition participants increased their steps more so than those in the control condition, F(5, 570) = 10.1, p < .0001, starting at Week 3, with effect sizes in the moderate range. Intervention condition participants also reported increased physical activity self-efficacy, whereas those in the control condition did not, F(1, 77) = 5.6, p < .03, Cohen d = .47. There were no significant changes in barrier self-efficacy for either group. Overall, these findings suggest a student-led cognitive-behavioral pedometer intervention results in more favorable changes in step counts and physical activity self-efficacy than simply wearing a pedometer and self-monitoring step counts.

Lifestyle modification and metformin as long-term treatment options for obese adolescents: study protocol

BACKGROUND

Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life). The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program.

METHODS/DESIGN

The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years) and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial well-being (e.g., quality of life). It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2 diabetes and cardiovascular disease. These improvements are expected to be maintained over the 2-year program.

DISCUSSION

The findings from this study will advance the knowledge regarding the long-term efficacy and sustainability of interventions for childhood obesity.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT00934570.

The use of group dynamics strategies to enhance cohesion in a lifestyle intervention program for obese children

Background

Most research pertaining to childhood obesity has assessed the effectiveness of preventative interventions, while relatively little has been done to advance knowledge in the treatment of obesity. Thus, a 4-week family- and group-based intervention utilizing group dynamics strategies designed to increase cohesion was implemented to influence the lifestyles and physical activity levels of obese children.

Methods/Design

This paper provides an overview of the rationale for and implementation of the intervention for obese children and their families. Objectives of the intervention included the modification of health behaviors and cohesion levels through the use of group dynamics strategies. To date, a total of 15 children (7 boys and 8 girls, mean age = 10.5) and their families have completed the intervention (during the month of August 2008). Physiological and psychological outcomes were assessed throughout the 4-week intervention and at 3-, 6-, and 12-month follow-up periods.

Discussion

It is believed that the information provided will help researchers and health professionals develop similar obesity treatment interventions through the use of evidence-based group dynamics strategies. There is also a need for continued research in this area, and it is our hope that the Children's Health and Activity Modification Program (C.H.A.M.P.) will provide a strong base from which others may build.

Fidelity to Theory in PA Intervention Research

Research using theory-based interventions to promote regular physical activity (PA) has increased substantially over the past decade. The purpose of this article is to provide a review and summary of PA intervention research specific to fidelity to intervention theory, providing an overview of the concept of fidelity to intervention theory, defining the evaluative components of fidelity: (a) conceptualization of the problem, (b) operationalization of the theory, (c) specification of mediating processes, and (d) specification of outcome variables. Using journal scans and computerized literature database searches, the authors identified 470 PA activity intervention studies that incorporated a theoretical perspective. A validity framework explicated by was used to summarize intervention research in light of fidelity to intervention theory. In all, 15 intervention studies met the inclusion criteria and were incorporated into the review. Theoretical models for health behavior change, including social cognitive theory (SCT), cognitive behavioral theory (CBT), the transtheoretical model (TTM, the TTM combined with SCT), the reversal theory (theory of psychological reversals), and the disconnected values theory, were used as a basis for intervention design and evaluation.

Determining the impact of Walk Kansas: applying a team-building approach to community physical activity promotion

BACKGROUND

Research and practice partnerships have the potential to enhance the translation of research findings into practice.

PURPOSE

This paper describes such a partnership in the development of Walk Kansas (WK) and highlights individual and organizational level outcomes.

METHOD

Phase 1 examined: (a) the reach of WK, (b) physical activity changes, and (c) maintenance of physical activity changes 6 months after the program was completed. Phase 2 explored WK adoption and sustainability over 5 years.

RESULTS

WK attracted a large number of participants who were more likely to be female, more active, and older than the adult population within the counties where they resided. Inactive or insufficiently active participants at baseline experienced significant increases in both moderate (p < 0.001) and vigorous (p < 0.001) physical activity. A random selection of participants who were assessed 6 months post-program did not demonstrate a significant decrease in moderate or vigorous activity between program completion and 6-month follow-up. The number of counties adopting the program increased across years, peaking at 97 in 2006 and demonstrated the sustainability of the WK over 5 years.

CONCLUSIONS

WK is effective, has a broad reach, and enables participants to maintain increased activity. It also shows promise for broad adoption and sustainability.

Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper

BACKGROUND

Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity.

AIM

This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people.

CONCLUSION

A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.

Helping clients think through their causal models: application to counseling clients to exercise

This article presents a model for therapy using active investigation of causal attributions made by the client. Causal attributions guide behavior. Often wrong attributions (excuses) force the individual to waste effort and time in making changes that do not lead to desired behavior. Many focus on their motivation and not external causes of their behavior. As a consequence, they relapse into old habits when their motivation waivers. Others gather information that is not causally linked to their behavior, and therefore of little use in understanding the mechanism for change. The role of clinician is envisioned as being to guide the clients to seek causal explanations for their behavior, to correct false attributions, and to help the clients use the causal mechanisms they have found to change their behavior. In theory, at least, it is expected that when causes of the unhealthy behavior are removed, lasting change will occur and the client is less likely to go through cycles of improvement and relapse. This article shows how the clinician can conduct causal analysis of the client's behavior. This model for therapy is in the tradition of solution-focused approaches to helping individuals make psychological and behavioral changes. A case example is also presented, where the client is trying to increase his or her exercise patterns.

Cognitive-behavioral therapy, exercise, and older adults' quality of life

This study examined health-related quality of life (HRQL) at baseline and 6, 9, and 12 months after initiating exercise training in three groups of older adults. The conditions were cognitive-behavioral therapy, attention-control health promotion education, and a control group. Participants (N = 332) were mainly women (n = 252, 75.9%) with a mean age of 71.8 (SD = 5.1) years. Therapy participants were trained to modify their negative interpretations of exercise. Participants in the education group received information unrelated to exercise. After controlling for exercise behavior over time, the therapy group reported lower general health, more role limitations because of emotional problems, and somewhat less vitality than the control group did. The education group also reported lower general health and vitality than the control group did. Social interaction and discussion may heighten participants' awareness of these health aspects and influence their appraisal of HRQL. Findings demonstrate the complexities of HRQL and the challenge in developing effective methods for helping older adults adopt and maintain an active lifestyle.

Construction of group exercise sessions in geriatric inpatient rehabilitation

There is little knowledge about the ways geriatric physiotherapy is being carried out in practice and about the situational construction of formal policies for promoting physical activity. This article examines how professional physiotherapists and frail community-dwelling older adults as their clients use talk and action to construct a group exercise session in an inpatient rehabilitation setting in Finland. The analysis of 7 group exercise sessions with a total of 52 clients and 9 professional physiotherapists revealed 3 different practitioner approaches, which served different functions in older adults' empowerment and lifestyle activity change. The highly structured approach favored taciturn physical performances completed independently and successfully by frail older adults. The guided exercise approach with individualized guidance encouraged occasional coconstruction of shared understanding of learning the exercises. The circuit training approach facilitated occasional self-regulation by the clients. The results of this study indicate that a combination of different approaches is required to address the multifaceted needs of heterogeneous frail older adults.

Older adults' exercise behavior: roles of selected constructs of social-cognitive theory

Exercise is consistently related to physical and psychological health benefits in older adults. Bandura's social-cognitive theory (SCT) is one theoretical perspective on understanding and predicting exercise behavior. Thus, the authors examined whether three SCT variables-self-efficacy, self-regulation, and outcome-expectancy value-predicted older adults' (N = 98) exercise behavior. Bivariate analyses revealed that regular exercise was associated with being male, White, and married; having higher income, education, and self-efficacy; using self-regulation skills; and having favorable outcome-expectancy values (p < .05). In a simultaneous multivariate model, however, self-regulation (p = .0097) was the only variable independently associated with regular exercise. Thus, exercise interventions targeting older adults should include components aimed at increasing the use of self-regulation strategies.

Get moving! Physical activity counseling in primary care

PURPOSE

The purpose of this article is to present strategies to improve the effectiveness of physical activity counseling for adults in primary care settings. Adoption of physical activity can be part of a healthy lifestyle to prevent or manage many chronic and debilitating conditions, including cardiovascular disease, diabetes, hypertension, and obesity.

DATA SOURCES

Original research articles reporting results from descriptive studies and clinical trials testing the effectiveness of physical activity counseling in primary care. Journal articles and Web sites are cited as patient and professional resources.

CONCLUSIONS

Despite conflicting research findings on the effectiveness of physical activity counseling in primary care, the importance of an active lifestyle in promoting health and well-being is well known. Yet, only one third of all Americans attain adequate daily physical activity. Implementing physical activity counseling in primary care is one method to promote active lifestyles. Some strategies to promote physical activity counseling in primary care settings are identified, including use of the Five A's approach and printed materials. Suggestions to manage the barriers primary care providers experience with physical activity counseling include brief counseling sessions involving all members of the health team.

IMPLICATIONS FOR PRACTICE

The implementation of a brief physical activity counseling intervention in primary care settings is presented as a promising method to promote physical activity in adults. Nurse practitioners can deliver this counseling in a succinct, well-planned session to promote physical activity and reduce the potential devastating consequences associated with a sedentary lifestyle.

Health-related quality of life in older adults at risk for disability

BACKGROUND

The number of older adults living in the United States continues to increase, and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability. The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study.

METHODS

The Lifestyle Interventions and Independence for Elders-Pilot study (LIFE-P) was a randomized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability. Baseline data (collected in April-December 2004, analyzed in 2006) included demographics, medical history, the Quality of Well-Being Scale (QWB-SA), a timed 400-m walk, and the Short Physical Performance Battery (SPPB). Descriptive health-related quality of life (HRQOL) data are presented. Hierarchical linear regression models were used to examine correlates of HRQOL.

RESULTS

The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 (death) to 1.0 (asymptomatic, optimal functioning). The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults. The variables associated with lower HRQOL included white ethnicity, more comorbid conditions, slower 400-m walk times, and lower SPPB balance and chair stand scores.

CONCLUSIONS

Older adults who are at risk for disability had reduced HRQOL. Surprisingly, however, mobility was a stronger correlate of HRQOL than an index of comorbidity, suggesting that interventions addressing mobility limitations may provide significant health benefits to this population.

Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial

OBJECTIVE

To study the effect of a community-based walking intervention on blood pressure among older people.

METHOD

The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure.

RESULTS

At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19).

CONCLUSIONS

Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.

Physical Activity Behavior, Motivational Readiness and Self-Efficacy among Ontarians with Cardiovascular Disease and Diabetes

This cross-sectional study examined physical activity and its correlates among 355 diabetes, 144 cardiovascular disease, 75 diabetes and cardiovascular disease, and 390 residents with cardiovascular risk factors. Community residents (N=2566) were screened by telephone, and 964 participants completed a self-report survey. Non-diabetes participants participated in a greater range of physical activities (p<.001), more frequently (p=.013). Diabetes participants had lower physical activity readiness and efficacy (ps<.009). In a regression model (p<.001), region and disease, work, marital and smoking status were significant correlates of physical activity frequency. Interventions which increase motivational readiness and efficacy among diabetics are required to prevent and delay complications, particularly in regions with environmental barriers such as cold weather and homogeneous, low-density land use.

Translating effective clinic-based physical activity interventions into practice

An increasing number of studies report on the efficacy of physical activity interventions conducted in, or in conjunction with, clinical settings. This article reviews the status of the literature with regard to translation to practice and describes methods that will heighten the likelihood of translation. In general, few physical activity programs have been designed for translation, and the diffusion models underlying most reported programs have relied on an assumption of linear diffusion into practice. However, recent developments are encouraging and examples are provided of programs that utilize relationship or systems approaches to translation.

Functional Health: Innovations in Research on Physical Activity with Older Adults

PURPOSE

This symposium was structured to provide two keynote addresses and recent innovations on the topic of physical activity interventions.

OVERVIEW

In the first paper, Drs. W. Jack Rejeski and Lawrence R. Brawley combine the content of their two keynotes into a single integrative review. This paper is then followed by four studies that build on and extend the research reviewed in their keynotes. The first is a study that examines the measurement properties of a scale designed to assess older adults' desire for physical competence. The second is an experiment that tests the efficacy of a brief intervention for increasing older adults' motives to attend educational sessions on physical activity in the context of assisted living. The third involves a pilot study in older adults that explores the feasibility and efficacy of using a group-mediated intervention for psychological empowerment in conjunction with more traditional methods of strength training. The fourth examines an innovative intervention that was designed to link the abilities acquired during strength training to older adults' performance of activities of daily living.

CONCLUSIONS

Physical activity interventions should be designed to promote collaborative relationships between interventionists and participants. Older adults bring with them symptoms, emotions, motives, and beliefs that are as important to adherence and to the outcomes of interventions as the physical training regimen itself. Furthermore, from the perspective of both behavior change and physical training, the design of physical activity programs for older adults should pay close attention to intended objectives.

Cognitive behavioral therapy to promote exercise behavior in older adults: implications for physical therapists

Although exercise has both physical and psychological benefits, most older adults do not exercise on a regular basis. Physical therapists need to explore ways to encourage sustained commitment. This article proposes that cognitive factors contribute to older adults inactivity and that the self regulation of exercise maintenance model is a means of promoting exercise. Cognitive behavioral therapy (CBT), an intervention guided by the self-regulation model, is presented as a practical way to help older adults see how thoughts guide their exercise behavior. The article concludes with a hypothetical case in which principles of CBT are used to promote exercise with older adults.

Evidence-based care for the elderly with isolated systolic hypertension

This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non-compliance with therapeutic regimens.

Participatory Research to Promote Physical Activity at Congregate-Meal Sites

The purpose of this study was to determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site-manager interviews and site visits to determine organizational feasibility. Study 3, a controlled pilot study, randomized meal sites to a 12-week group-based social-cognitive (GBSC) intervention or a standard-care control. Studies 1 and 2 indicated that most meal-site users would participate in an on-site PA program, and meal sites had well-suited physical resources and strong organizational support for this type of program. In Study 3, GBSC participants increased their weekly PA over those in the control condition (p < .05, ES = .79). Results indicated that changes in task cohesion might have mediated intervention effectiveness. These studies demonstrate that a PA program offered in this venue is feasible, is effective in promoting PA, and could have a strong public health impact.

Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation

BACKGROUND

Regular physical activity has been consistently related to improvements in health- related quality of life (HRQL) in older adults. Nevertheless, systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse.

PURPOSE

The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program (GMCB) to a traditional cardiac rehabilitation program (CRP) with regard to changes in HRQL in a community-dwelling sample of older adults.

METHODS

This randomized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms. Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 (SF-36) from the Medical Outcomes Study.

RESULTS

Mixed-model analyses yielded significant Baseline x Gender x Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36. Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment.

CONCLUSIONS

Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment, gender, and initial mental health status. Results are discussed in terms of the implications for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL.

The relationships between delivery agents' physical activity level and the likelihood of implementing a physical activity program

PURPOSE

To determine the relationships between delivery agents'physical activity characteristics and subsequent adoption of a physical activity promotion program for community implementation.

METHODS

Agents responsible for county health promotion in Kansas (n = 91; 94.5% women; mean age = 43.0 +/- 11) completed interviews that assessed physical activity self-efficacy, value, and participation. Subsequent implementation of a physical activity program was monitored. The response rate was 100%.

RESULTS

Fifty-five percent of the agents met Centers for Disease Control and Prevention (CDC) recommendations for physical activity, 35% were active but did not meet CDC recommendations, and 10% were inactive. On the basis of logistic regression analysis (Wald statistic = 7.63; p < .05), agents who met recommendations were more likely to adopt the program for their county (69%) than were agents who were less active (41%) and inactive (11%).

DISCUSSION

The data suggest that increasing the proportion of delivery agents who meet the CDC recommendations for physical activity could be related with a higher proportion of communities implementing physical activity programs.

Integrative review of physical activity intervention research with aging adults

This paper reviews randomized, controlled trials (RCTs) that have attempted to increase physical activity behavior by aging adults. A systematic review was necessary because numerous studies target older adults, and previous reviews have addressed a limited range of primary studies. Computerized database, ancestry, and extensive search strategies by authors of research reported in English between 1960 and 2000 located diverse intervention trials. RCTs reporting endurance physical activity or exercise behavioral outcomes for at least five subjects were included. Integrative review methods were used to summarize extant research. Forty-two studies were retrieved. Seventeen RCTs with 6,391 subjects were reviewed. A wide variety of intervention strategies were reported. The most common interventions were self-monitoring, general health education, goal setting, supervised center-based exercise, problem solving, feedback, reinforcement, and relapse prevention education. Few studies individually adapted motivational interventions, used mediated intervention delivery, or integrated multiple theoretical frameworks into the intervention. Links between individual intervention components and effectiveness were not clear. Common methodological weaknesses included small samples, untested outcome measures, and time-limited longitudinal designs. Significant numbers of aging adults increased their physical activity in response to experimental interventions. The amount of increased activity rarely equaled accepted behavior standards to achieve positive health outcomes. Further work is essential to identify successful strategies to increase activity by larger numbers of elders and to accelerate the increase in activity by those who change activity behaviors. Sex and ethnic differences need further investigation. There is a vital need for rigorously designed studies to contribute to this science.

Older adults with chronic disease: benefits of group-mediated counseling in the promotion of physically active lifestyles

In this 12-month trial standard exercise training was compared with a group-mediated cognitive-behavioral (GMCB) intervention with respect to effects on long-term adherence and change in physical function of older adults who were either at risk for or had cardiovascular disease. Participants (147 older men and women) were randomized to the 2 treatments. Outcomes included self-reportedphysical activity, fitness, and self-efficacy. The GMCB treatment produced greater improvements on all outcomes than did standard exercise therapy. Regardless of treatment assignment, men had more favorable change on the study outcomes than did women. Analysis of a self-regulatory process measure in the GMCB group revealed that change in barriers efficacy was related to change in physical activity and fitness. Results suggest that teaching older adults to integrate physical activity into their lives via GMCB leads to better long-term outcomes than standardized exercise therapy.

Older adults in cardiac rehabilitation: a new strategy for enhancing physical function

PURPOSE

This study contrasted the effect of a group-mediated cognitive-behavioral intervention (GMCB) versus traditional cardiac rehabilitation (CRP) upon changes in objective and self-reported physical function of older adults [mean (SD) age of 64.7 (7.5) yr] after 3 months of exercise therapy.

METHODS

This randomized clinical trial enrolled 147 participants who were eligible for inclusion into cardiac rehabilitation. Baseline to 3-month changes in self-reported and performance related measures of physical function were assessed using a physical functioning questionnaire, a 6-min walk test, and measured MET levels.

RESULTS

Paired t-tests revealed that participants made improvements in all measures across the first 3 months of the study, irrespective of group treatment (P < 0.001). General linear models including effects for baseline levels of physical function, treatment, and gender revealed that lower functioning men in the GMCB treatment made greater improvements than any other subgroup on the two performance outcomes: 6-min walk and measured MET levels (P < 0.01). Gender did not moderate change in self-reported level of physical function (P > 0.05); however, the lower functioning participants in the GMCB intervention experienced greater improvements in self-reported physical function than those in CRP (P < 0.05).

CONCLUSIONS

Exercise therapy is a valuable intervention for improving physical function of older adults with cardiovascular disease (CVD) and those at increased risk for CVD. Baseline level of physical function and gender are important variables to consider when studying the relationship between exercise therapy and improvements in physical function.

Aging and physical disability: on integrating group and individual counseling with the promotion of physical activity

This review examines selected conceptual models on physical disability that have been commonly employed in the study of chronic disease and aging, and suggests including self-efficacy beliefs and physical symptoms into the main pathway of the disablement process. The resulting model of disability has direct implications for integrating group and individual counseling into exercise prescription.

Interventions to promote physical activity by older adults

Physical inactivity has been established to be an independent risk factor for a range of chronic diseases and conditions that threaten the health of the nation. However, only a minority of the population is currently meeting the recommended levels of regular physical activity, which have been linked with important health and quality-of-life benefits. Older adults are at particular risk for leading sedentary lifestyles. This article provides an overview of factors associated with physical activity for older adults and also describes potentially promising interventions for promoting regular physical activity in this growing population segment. Examples of interventions undertaken at personal and interpersonal as well as broader levels of analysis (e.g., environmental) are provided. Major issues currently facing the field are discussed, including the ongoing challenge of developing assessment tools that are sensitive to the more moderate-intensity physical activities favored by older adults and the formidable task of combining clinical approaches with environmental and policy strategies aimed at combating this public health problem.