Leisure-time physical exercise: prevalence, attitudinal correlates, and behavioral correlates among young Europeans from 21 countries

Lay explanations for Kentucky's "Coronary Valley"

Kentucky and its neighboring states have some of the highest coronary heart disease (CHD) mortality rates in the United States, leading researchers to nickname the region "Coronary Valley." Currently, little is known about factors that account for "Coronary Valley"; however, understanding lay perspectives on CHD risk factors may provide insights into this high prevalence of CHD and may guide prevention efforts. In December 1999, a statewide telephone survey was administered to a random sample of Kentucky residents to elicit lay explanations for the high rates of CHD. Standard protocol for descriptive statistics was undertaken. Respondents (N = 624) identified most of the biomedically acknowledged risk factors, with an overwhelming majority acknowledging that high rates of smoking and poor diets contribute to CHD. Older respondents and those who reported having heart disease were more likely than others to identify factors beyond their control, including stress and pollution (p < .0005 and p < .00 1, respectively). After controlling for the presence of heart disease, age differences remained significant only among those who reported no heart disease. Education had marginal significance (p = .027) on explanations for CHD, while gender, racial or ethnic background, and type of community residence had no significant effects. Since most Kentuckians are aware of traditional risk factors underlying CHD, prevention efforts should be directed at removing structural and information barriers to behavior change (e.g., by providing smoking cessation programs) rather than limiting prevention efforts to traditional health education approaches (i.e., increasing knowledge of CHD risk factors).

Relative contribution of psychosocial variables to the explanation of physical activity in three population-based adult samples

BACKGROUND

Despite large differences in physical activity by demographic subgroup, few studies have identified correlates for specific age and sex groups. The present study quantified the unique variance accounted for in each subgroup by the main psychosocial variables.

METHODS

Three random samples, ages 16-25, 35-45, and 50-65, with a total of 2,390 Belgian subjects, completed psychosocial questionnaires and were interviewed at home.

RESULTS

Social influences, self-efficacy, perceived benefits, and perceived barriers varied in importance by age and sex groups. Social variables provided the most unique information about physical activity for all age and sex groups, except older females. Competition was a significant perceived benefit only for young men, whereas health was the most significant perceived benefit for young women. Among older women and men, health concerns were significant perceived barriers to participation in physical activity.

CONCLUSIONS

The present results provide hypotheses about mediators of physical activity that can be applied in interventions tailored to the needs of various subgroups.

Gender bias in the assessment of physical activity in population studies

OBJECTIVES

Despite their generally more health promoting behaviours, women are found to participate less in physical activity than men. This study explores possible gender bias in measurement of physical activity in population studies.

METHODS

Data collected by telephone (CATI) from the Berne Lifestyle Panel in 1996 is utilised. A representative samples of the population of the city of Berne comprised N = 1119 cases. Gender differences are assessed for the weekly frequency of three measurements of physical activities.

RESULTS

An indicator of sport and exercise showed higher physical activity among men, while the indicator of habitual physical activity showed higher rates of daily walking and biking among women. A combined indicator of general physical activity showed no significant gender differences.

CONCLUSIONS

The results provide empirical evidence on potential risk of underestimation of physical activity among women and of misclassification with respect to high or low risk behaviour patterns.

Exercise attitudes and behaviors among persons in treatment for alcohol use disorders

The present study investigated self-reported exercise behaviors and exercise-related attitudes in a sample (N = 105) of adults in treatment for alcohol use disorders (AUD) (abuse or dependence). Slightly less than half (47%) of participants reported engaging in regular physical exercise (3 times per week or more). Level of alcohol dependence was not significantly associated with level of physical exercise activity. Level of nicotine dependence was significantly and negatively associated with physical activity level. Nicotine dependence and level of depressive symptoms were both significantly negatively associated with self-efficacy for physical exercise (SPE). Exercise self-efficacy mediated the relationship between nicotine dependence and physical activity level. Tension and stress reduction were among the most strongly endorsed of the perceived benefits of physical activity. Other perceived benefits included more positive outlook and increased self-esteem. Financial costs associated with exercise, lack of motivation, and time constraints were among the most common perceived barriers to exercise in this sample. Together, these preliminary data indicate that exercise-based interventions are may be well-received by those early in recovery from AUDs.

Older people's knowledge and practice about lifestyle behaviors that may prevent vascular dementia

This study examined the relationship between knowledge and practice of healthy lifestyle behaviors in the prevention of vascular dementia. Data presented here are derived from a convenience sample of 296 participants recruited through senior citizen agencies in Australia. Lifestyle was measured using the Health-promoting Lifestyle Profile (HPLP). Seven knowledge subscales were developed, consistent with the HPLP. Data were analyzed using multiple regression analysis. Correlations among the lifestyle and knowledge indicated statistically significant results. However, the strength of these associations was generally weak. Multivariate analysis found that six variables explained 20% of the variance in the lifestyle score. These included: knowledge of interpersonal relations, knowledge of physical activity, medical knowledge, medical history, self-assessment of general health, and use of alcohol. The results indicate that knowledge, by itself, does not necessarily ensure that people engage in self-practising healthy lifestyle behaviors, and those who experience illness and, perhaps exposure to risk factors, had higher HPLP scores. Recommendations for how older people can be supported to reduce some of the attitudinal barriers that reduce healthy lifestyle behaviors are discussed.

Social support and health behavior in hostile black and white men and women in CARDIA. Coronary Artery Risk Development in Young Adults

OBJECTIVE

These cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and women, such that the higher the hostility, the worse the health behavior profile. The current study investigated whether high social support was associated with better health behavior than low social support in individuals with high hostility scores.

METHODS

The subjects were 5115 healthy black and white men and women ranging in age from 18 to 30 years. The hypothesis was that the association between hostility and certain adverse health behaviors would be diminished in the presence of high social support. Race-gender specific median cutpoints of the Cook-Medley Hostility scale and an index of social support defined levels of high and low hostility and social support.

RESULTS

After controlling for age and body mass index (BMI), support was positively associated with more exercise in all groups except black women, but when coupled with high hostility, this positive association between support and exercise remained only in men. White women with high support were less often smokers but this association did not hold when examined only in the high-hostile group. Black men and white women with high support in the presence of high hostility consumed more alcohol, but the amount was moderate.

CONCLUSIONS

We conclude that social support in the presence of high hostility only sometimes reduces the association of hostility to adverse health behaviors and that these effects are complex. Additional research investigating types of social support on health behavior in different race-gender groups is advocated.

Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory

Until recently, claims for the psychological benefits of physical exercise have tended to precede supportive evidence. Acutely, emotional effects of exercise remain confusing, both positive and negative effects being reported. Results of cross-sectional and longitudinal studies are more consistent in indicating that aerobic exercise training has antidepressant and anxiolytic effects and protects against harmful consequences of stress. Details of each of these effects remain unclear. Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder, and clinical applications remain to be exploited. Cross-sectional studies link exercise habits to protection from harmful effects of stress on physical and mental health, but causality is not clear. Nevertheless, the pattern of evidence suggests the theory that exercise training recruits a process which confers enduring resilience to stress. This view allows the effects of exercise to be understood in terms of existing psychobiological knowledge, and it can thereby provide the theoretical base that is needed to guide future research in this area. Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. It also offers a specific psychological treatment that may be particularly effective for patients for whom more conventional psychological interventions are less acceptable.

The importance of the social environment for physically active lifestyle--results from an international study

Physically active lifestyles are regularly associated with improved health and quality of life. Differences in lifestyles in society can partly be understood through the differences in the social and physical environment. This study examines the relationships between reported physical activity, and the extent of perceived support for physical activity in the physical and policy environment (e.g. facilities, programmes and other opportunities), and in the social environment. The data for the study come from a cross-cultural health policy study called MAREPS. In total, 3342 adults, 18 years or older, from six countries (Belgium, Finland, Germany, The Netherlands, Spain, Switzerland) were interviewed via telephone. Respondents were categorised as active or inactive according to self-reported physical activity. Social environmental factors and physical and policy environmental factors were also assessed. The analysis of the data was informed by social cognitive theory, although the study was not originally designed for this purpose. Sixty-eight percent of females and 70% of males were active. The proportions of active and inactive varied by countries to a great extent. The strongest independent predictor of being physically active was social environment. Those who perceived low social support from their personal environment (i.e. family, friends, school and workplace) were more than twice as likely to be sedentary compared to those who reported high social support from their personal environment. Specific knowledge of the programmes and actions for physical activity and sport was also a strong predictor of being active. A supportive physical and policy environment was not associated with participation in physical activity as strongly as had been anticipated. The variation between countries was stronger predictor of being active than the physical and policy environment variables. This study generates the hypotheses and raises the questions that in a preliminary way, there appears to be some relationships between aspects of physical and social environment and physical activity participation. However, future research is needed to refine and clarify this.

Depressive symptoms, health promotion, and health risk behaviors

OBJECTIVES

To assess the relationships between history of depressive symptoms and smoking, alcohol consumption, dietary changes, attempts to lose weight or increase exercise, use of health services, and the likelihood of receiving influenza and pneumonia vaccinations, mammograms, and Pap tests.

METHODS

A survey of randomly sampled members of a large health maintenance organization (n = 5841).

RESULTS

Individuals with past depressive symptoms were more likely to smoke cigarettes (despite making more attempts to quit smoking); to drink more alcohol; to attempt to lose weight, increase exercise, reduce fat intake, increase fiber intake; and, for women, to have a mammogram.

CONCLUSIONS

Individuals with histories of depressive symptoms engage in more positive and negative health behaviors. Additionally, their increased service use provides opportunities to achieve positive health changes and improve treatment outcomes.

Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care

BACKGROUND

Increasing regular physical activity in adults at elevated risk of cardiovascular disease is an important target for preventive medicine. This study evaluated demographic, social and cognitive predictors of self-reported changes in physical activity after 4 and 12 months in a randomized trial of behavioral counseling in primary care.

METHOD

Data were analyzed from 234 male and 271 female sedentary patients with a body mass index of 25-35 (age 49.1 years, SD 11.2 years), who had been counseled by nurses in general practice using stage-matched behavioral methods or standard health promotion and who were reassessed after 4 months. A total of 187 men and 231 women were reassessed after 12 months.

RESULTS

Physical activity at baseline was associated with educational status, having a partner who exercised, perceived barriers, and self-efficacy. Changes over 4 months were greater with behavioral counseling, in non-smokers and in patients with higher ratings of motivation to change and self-efficacy at baseline. Changes over 12 months were greater with behavioral counseling and were predicted in the behavioral group by social support variables, perceived benefits, and barriers. Stage of readiness to change predicted increased activity at 4 but not 12 months.

CONCLUSIONS

Social support and cognitive variables predict increased physical activity following counseling in primary care of sedentary overweight adults. Different factors are relevant to short- and long-term modifications in behavior.

Patterns of health-related behaviour and their cross-cultural validity--a comparative study on two populations of young people

The study aimed at exploring health-related behaviour patterns among young people. The approach was cross-cultural and the study was focused on identifying culturally valid behaviour patterns in two countries, Finland (F) and Switzerland (CH). Data came from two surveys and included 16- and 18-year-old respondents (F: study year 1993, n = 280, CH: study year 1992/3, n = 272). Three intake behaviours--eating, drinking and smoking--were analysed by means of cluster and logistic regression analyses. Three cross-culturally valid behaviour clusters emerged: a healthy, an unhealthy and a mixed pattern where unhealthy eating behaviours were combined with non-smoking and low alcohol use. The determinants of the patterns were tested by comparing the two countries in relation to the socio-demographic characteristics of the young people that belonged in the same cluster. In both countries the structure of the determinants was almost identically indicating high cross-cultural stability. The study suggests that among young people of this age there is clear and cross-culturally consistent patterning of health-related behaviours.

Alexithymia and health behaviors in healthy male volunteers

The association between alexithymia and maladaptive health behaviors was evaluated in 118 young, healthy men, aged 18-45 years. Subjects completed the Toronto Alexithymia Scale (TAS-26), and a health behaviors questionnaire, measuring alcohol and drug use, sedentary lifestyle, poor nutritional consumption, and risky sexual practices. In forced hierarchical regression analyses, the association between alexithymia and health behaviors was evaluated after adjusting for age, body mass index, social support, ambivalence over expression of emotion, and the expression of emotion. Results indicated that: (1) the TAS-26 and difficulty identifying feelings was associated with poor nutritional consumption; (2) difficulty identifying feelings was associated with greater alcohol and drug use; and (3) difficulty communicating feelings was associated with a more sedentary lifestyle. There was no association between risky sexual practices and alexithymia. These results suggest that, in young men, difficulties with identifying emotions and communicating emotions are associated with maladaptive nutritional habits, a sedentary lifestyle, and substance abuse, even after adjusting for other psychosocial and demographic variables. Such maladaptive health behaviors may help explain the association between alexithymia and premature mortality.

The Berne-Munich Lifestyle Panel. Background and baseline results from a longitudinal health lifestyle survey

The Berne-Munich Lifestyle Panel (BMLP) studies health relevant lifestyles among some 2000 adults in Switzerland and Germany. This paper introduces the theoretical background and empirical concept of the BMLP. Sociological theory provided the guidelines for the development of an empirical model that measures structures and dynamics of health lifestyles. Health lifestyles are explained as the product of the complex interplay between health related behaviours, orientations and social resources. Residents of Berne (Switzerland) and Munich (Germany) in the age between 55 and 65 years were contacted in 12 months periods and interviewed by telephone (CATI). The questionnaire comprised some 200 questions on selected aspects of health lifestyles and health status. Interviews were conducted in two waves in Munich (1996 and 1997) and three waves in Berne (1996/97/98). The paper reports findings from baseline data analysis and explores cultural differentiations with respect to the distribution of 1. health relevant behaviours, orientations and social resources, 2. triggers of lifestyle change (life events), 3. mediating factors (Health Locus of Control, Sense of Coherence). Initial results from the search for patterns of health behaviours are also reported. The findings show considerable differences but also impressive similarities in health lifestyle elements across the two samples. There is also preliminary evidence for meaningful patterns of health behaviours in the cohort under investigation. Moreover, the findings clearly demonstrate the need for a gender specific approach in the analysis of cultural differences in health behaviours and lifestyles.

Regional, demographic and national influences on attitudes and beliefs with regard to physical activity, body weight and health in a nationally representative sample in the European Union

INTRODUCTION

Although the benefits of physical activity regarding body-weight gain and health in general are now widely accepted, physical activity levels remain low among citizens in the western world. This could be attributed to certain attitudes and beliefs about physical activity. Identifying and understanding these parameters would be the first step in an attempt to increase the levels of physical activity in populations generally characterized as having a sedentary lifestyle.

OBJECTIVE

The aim of the present study was to identify the attitudes and beliefs regarding physical activity, body weight and health in a nationally representative sample in the EU and in particular to explore the demographic and national (cultural) influences on attitudes towards physical activity.

DESIGN

In each member state of the EU, approximately 1000 adults aged 15 years and over, were selected to complete an interviewer-assisted face-to-face questionnaire. Overall, a sample of 15,239 individuals in the EU participated in the study. Subject selection was quota-controlled to ensure samples in each country were nationally representative.

RESULTS

On a European level wide variations were observed regarding the levels, beliefs and attitudes towards physical activity. More positive beliefs were observed among Finns, while less positive beliefs were observed among southern Europeans. A similar pattern was observed for attitudes, with the Portuguese having the highest percentage feeling that they do not need to be more physically active than they already are. However, most southern Europeans felt that a campaign would encourage them to become more active than they already are. On a demographic level, the youngest, more educated and most physically active subjects had more positive attitudes and beliefs towards physical activity and the health benefits derived from it; while for the overweight, beliefs and attitudes toward physical activity were related primarily to the benefits related to weight control.

CONCLUSIONS

Lower levels of physical activity, an unwillingness to become active among non-participants and confusion regarding the weight gain benefits and general health benefits of exercise were reported more frequently among southern Europeans and older and less educated subjects. The Finns scored highest in all these parameters, possibly due to the programmes implemented and the beliefs and behaviour changes observed in this country during the last few years. The actions taken in Finland and their benefits could be employed appropriately in the other European states.

Variables independently associated with self-reported obesity in the European Union

OBJECTIVE

The rapid increase in obesity rates over recent years suggest that cultural and societal influences are affecting the adjustment in the energy balance equation in addition to other physiopathological or genetic determinants. Therefore, a pan-EU study was carried out to explore the influence of sociodemographic factors as well as some attitudes (smoking and exercise) on the prevalence of obesity in the adult population of all 15 member states of the EU.

DESIGN

Overall, a sample of 15,239 individuals aged 15 years and upwards in the EU completed the questionnaire. Subject selection was quota-controlled to make the sample nationally representative following a multistage stratified cluster sampling. Self-reported height and weight were used to calculate body mass index (BMI).

RESULTS

From the EU average results, it can be seen that only about half of the EU population (48%) is within the normal weight range, while the obesity (BMI > or = 30 kg m(-2)) prevalence was about 10% in the EU and the overweight prevalence was 36.6% and 25.6% among men and women, respectively. UK subjects had the highest prevalence of obesity (12%), while Italians, French and Swedes had the lowest levels of obesity (about 7%). Concerning age and social class interactions, logistic regression analysis showed that high social class and younger individuals in all groups had a lower odds ratio for obesity prevalence. People with a higher level of education are less likely to be obese, while the interaction between educational levels and obesity was different for men and women. A low participation in various leisure-time physical activities, the lack of interest (precontemplation) in being involved in exercise/physical activity and the increasing number of hours sitting down at work appear to be predictors of obesity. Single individuals were less prone to become obese than couples or widowed/divorced people. Finally, smoking status was statistically linked to the prevalence of obesity, since non-smokers or ex-smokers for more than 1 year presented a higher tendency for a BMI > 30.

CONCLUSIONS

This survey confirms that a priority area for health intervention aimed at preventing the development of obesity should be to increase levels of physical activity, although the approach will depend on the population, especially with respect to educational and socioeconomic aspects.

Physical activity levels and body weight in a nationally representative sample in the European Union

OBJECTIVES

The main objectives of this pan-European study were: (1) to identify different types of physical activity and the time devoted to them, (2) to assess physical activity/inactivity at work and in leisure time, and (3) to determine self-reported body weight and height.

DESIGN AND SUBJECTS

In each member state of the EU, approximately 1000 adults, aged 15 years or more, were selected to participate in an interview-assisted face-to-face questionnaire on physical activity and body weight. In each country, sample selection was quota-controlled to ensure national representativeness. Overall, 15,239 subjects in the EU completed the study.

RESULTS

On average in the EU, nearly three-quarters of the population participate in some kind of activity. In general, the highest proportions of participants were found in the Nordic countries and the lowest in the southern ones. At the European level, the five most common activities include walking, gardening, cycling, keep fit and swimming. Higher participation rates were found among men, younger subjects and those with a higher level of education. The majority of Europeans fall within the normal body mass index (BMI) range but more than one-third are overweight (31%) or obese (10%) and 11% have a BMI below 20.

CONCLUSIONS

Several risk groups related to physical activity emerge from this survey: women, those with a lower level of education, older subjects, the overweight/obese and the underweight. Programmes to promote physical activity need to be tailored to the different groups identified in each country/region in order to increase adherence of non-participants and for the maintenance of those already engaged in activities.