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The effect of a nurse-directed intervention to reduce pain and improve behavioral and physical outcomes in patients with critically colonized/infected chronic leg ulcers. J Wound Ostomy Continence Nurs 2015; 41:111-21. [PMID: 24413659 DOI: 10.1097/won.0000000000000009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We compared a WOC nurse-directed, patient-centered intervention called MECALF (motivational enhancement and conditioning activity for leg function) compared to conditioning activities for lower leg function (CALF) alone. Outcomes were study feasibility, pain, motivation, self-efficacy, physical activity, leg strength, and range of motion. DESIGN Comparative study. SUBJECTS AND SETTING The sample was drawn from 2 wound centers in the Southeastern United States. Twenty-one patients (n = 12 MECALF site A and n = 9 CALF site B) with painful lower legs and critically colonized/infected wounds participated in the study. METHODS All patients received usual wound care per center protocol. The MECALF intervention was delivered by WOC nurses for 6 weeks at site A and a handout of CALF depicting the conditioning activities was provided by site staff (not WOC nurses) to patients at site B. We assessed study feasibility with postsurvey questionnaires given to WOC nurses (training usefulness, ease of use of ME with patients) and subjects (able to perform activities, use logs). Pre- and postintervention outcome data were collected by study staff using pain, motivation, and self-efficacy scales, functional measures of physical activity, and physical measures of strength and range of motion. RESULTS The study was found to be somewhat feasible by the WOC nurses and patients. WOC nurses had time management problems using MECALF during usual patient care. Patients reported that they were able to perform CALF. Overall pain was statistically significantly reduced (P = .046) in both groups of patients with painful critically colonized/infected leg ulcers measured at week 8, 2 weeks after the study period. The CALF group experienced a slightly greater reduction in pain intensity than did the MECALF group. No statistically significant differences between the groups were observed in behavioral outcomes for motivation (P = .641) and self-efficacy (P = .643), or for physical outcomes including overall ankle strength (P = .609) and ankle range of motion (P = .498). Functional and physical activity scores revealed no statistically significant differences in 3 measures, including Timed Up and Go test (P = .624), Timed Chair Standing Test (P = .686), or the Community Health Activities Model for Seniors (P = .803). CONCLUSION While somewhat feasible to implement in the wound care setting, no improvement in outcomes was observed with the addition of the WOC nurse-directed intervention. However, pain in the lower legs of patients with critically colonized/infected wounds in both groups improved after a 6-week behavioral/physical activity intervention. A larger trial is needed to further elucidate these findings.
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Hekler EB, Buman MP, Grieco L, Rosenberger M, Winter SJ, Haskell W, King AC. Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies. JMIR Mhealth Uhealth 2015; 3:e36. [PMID: 25881662 PMCID: PMC4414958 DOI: 10.2196/mhealth.3505] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/02/2014] [Accepted: 10/19/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach. OBJECTIVE The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults. METHODS A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph. RESULTS Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (ρ=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph's percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, ρ=.59, P<.001) between the raw ActiGraph counts/minute and the phone's raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, ρ=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=-26 min/day of sedentary behavior) and MVPA (mean difference=-1.3 min/day of MVPA) although there was large variation. CONCLUSIONS Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates.
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Affiliation(s)
- Eric B Hekler
- Arizona State University, School of Nutrition and Health Promotion, Phoenix, AZ, United States.
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Wild KV, Mattek N, Austin D, Kaye JA. "Are You Sure?": Lapses in Self-Reported Activities Among Healthy Older Adults Reporting Online. J Appl Gerontol 2015; 35:627-41. [PMID: 25669877 DOI: 10.1177/0733464815570667] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/21/2014] [Indexed: 11/17/2022] Open
Abstract
Accurate retrospective reporting of activities and symptoms has been shown to be problematic for older adults, yet standard clinical care relies on self-reports to aid in assessment and management. Our aim was to examine the relationship between self-report and sensor-based measures of activity. We administered an online activity survey to participants in our ongoing longitudinal study of in-home ubiquitous monitoring. We found a wide range of accuracies when comparing self-report with time-stamped sensor-based data. Of the 95 participants who completed the 2-hr activity log, nearly one quarter did not complete the task in a way that could potentially be compared with sensor data. Where comparisons were possible, agreement between self-reported and sensor-based activity was achieved by a minority of participants. The findings suggest that capture of real-time events with unobtrusive activity monitoring may be a more reliable approach to describing behavioral patterns and meaningful changes in older adults.
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Affiliation(s)
| | - Nora Mattek
- Oregon Health & Science University, Portland, USA
| | | | - Jeffrey A Kaye
- Oregon Health & Science University, Portland, USA Portland Veteran Affairs Medical Center, Portland, USA
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104
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Bann D, Hire D, Manini T, Cooper R, Botoseneanu A, McDermott MM, Pahor M, Glynn NW, Fielding R, King AC, Church T, Ambrosius WT, Gill T. Light Intensity physical activity and sedentary behavior in relation to body mass index and grip strength in older adults: cross-sectional findings from the Lifestyle Interventions and Independence for Elders (LIFE) study. PLoS One 2015; 10:e0116058. [PMID: 25647685 PMCID: PMC4315494 DOI: 10.1371/journal.pone.0116058] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/01/2014] [Indexed: 02/04/2023] Open
Abstract
Background Identifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time—assessed both objectively and by self-report—with body mass index (BMI) and grip strength in a large sample of older adults. Methods We used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3–7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression. Results Greater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength. Conclusions In this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.
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Affiliation(s)
- David Bann
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
- * E-mail:
| | - Don Hire
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Todd Manini
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, United States of America
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Anda Botoseneanu
- Department of Health Policy Studies and Institute of Gerontology, University of Michigan—Dearborn/Ann Arbor, Ann Arbor, Michigan, United States of America
| | - Mary M. McDermott
- Northwestern University, Feinberg School of Medicine, Chicago, United States of America
| | - Marco Pahor
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, United States of America
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, United States of America
| | - Roger Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States of America
| | - Abby C. King
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Timothy Church
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Walter T. Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Thomas Gill
- Yale School of Medicine, New Haven, Connecticut, United States of America
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105
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Blair CK, Morey MC, Desmond RA, Cohen HJ, Sloane R, Snyder DC, Demark-Wahnefried W. Light-intensity activity attenuates functional decline in older cancer survivors. Med Sci Sports Exerc 2015; 46:1375-83. [PMID: 24389524 DOI: 10.1249/mss.0000000000000241] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED While moderate- to vigorous-intensity physical activities (MVPA) confer the greatest health benefits, evidence suggests that light-intensity activities are also beneficial, particularly for older adults and individuals with moderate to severe comorbidities. PURPOSE To examine cross-sectional and longitudinal associations between light-intensity activity and physical function in older cancer survivors at increased risk for age- and treatment-related comorbidities, including accelerated functional decline. METHODS The analysis included data from 641 breast, prostate, and colorectal cancer survivors (54% female) age 65 yr and older who participated in a 1-yr home-based diet and exercise intervention designed to reduce the rate of physical function decline. ANCOVA was used to compare means of physical function across levels of PA intensity (low-light [LLPA]: 1.5-2.0 METs; high-light [HLPA]: 2.1-2.9 METs; MVPA: ≥3.0 METs). RESULTS In cross-sectional analyses, increasing tertiles of light-intensity activity were associated with higher scores for all three measures of physical function (all P values <0.005), after adjusting for age, sex, body mass index, comorbidity, symptoms, and MVPA. Associations were stronger for HLPA than for LLPA. Compared with survivors who had decreased MVPA or maintained stable MVPA and HLPA at the postintervention follow-up, those who had increased HLPA, but had decreased MVPA or maintained stable MVPA, reported higher physical function scores (LS means [95% confidence interval]: SF-36 Physical Function Subscale: -5.58 [-7.96 to -3.20] vs -2.54 [-5.83 to 0.75], P = 0.14; Basic Lower Extremity Function: -2.00 [-3.45 to -0.55] vs 0.28 [-1.72 to 2.28], P = 0.07; Advanced Lower Extremity Function: -2.58 [-4.00 to -1.15] vs 0.44 [-1.52 to 2.40], P = 0.01). CONCLUSIONS Our findings suggest that increasing light-intensity activities, especially HLPA, may be a viable approach to reducing the rate of physical function decline in individuals who are unable or reluctant to initiate or maintain adequate levels of moderate-intensity activities.
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Affiliation(s)
- Cindy K Blair
- 1Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN; 2Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC; 3Department of Medicine, Duke University Medical Center, Durham, NC; 4Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC; 5Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 6Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 7University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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106
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Copeland JL, Clarke J, Dogra S. Objectively measured and self-reported sedentary time in older Canadians. Prev Med Rep 2015; 2:90-5. [PMID: 26844055 PMCID: PMC4721336 DOI: 10.1016/j.pmedr.2015.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine objectively measured total and self-reported leisure sedentary time among older Canadians by work status. METHODS The analysis was based on 1729 older adults (60-79 years) from the 2007/09 and 2010/11 Canadian Health Measures Survey. Work status, functional limitations, smoking, and perceived health were assessed by self-report and waist circumference (WC) was measured. Total sedentary time (ST) and physical activity (PA) were objectively measured by accelerometer and leisure sedentary activities were assessed by questionnaire. RESULTS 93.6% of individuals were sedentary for 8 or more hours per day. Measured ST did not differ by work status, while self-reported leisure ST was higher in those not working compared to those working (239 vs. 207 minutes/day, p < 0.05). Correlates of measured ST were fair/poor perceived health (β: 28.76, p < 0.01), smoking (β: 17.12, p < 0.05), high-risk WC (β: 13.14, p < 0.05), and not meeting PA guidelines (β: 35.67, p < 0.001). For self-reported leisure ST, working status (β: 33.80, p < 0.001) and functional limitations (β: 16.31, p < 0.05) were significant correlates. CONCLUSIONS Older adults accumulate substantial ST regardless of their working status and ST is correlated with indicators of health risk. Older adults are an important target population for interventions to reduce ST.
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Affiliation(s)
- Jennifer L. Copeland
- Dept. of Kinesiology, University of Lethbridge, 4401 University Drive, Lethbridge AB T1K 3M4, Canada
- Corresponding author.
| | - Janine Clarke
- Canadian Health Measures Survey, Statistics Canada, 150 Tunney's Pasture Driveway, Ottawa, ON K1A 0T6, Canada
| | - Shilpa Dogra
- Faculty of Health Sciences, Kinesiology, University of Ontario Institute of Technology, Science Building, 2000 Simcoe St. N., Oshawa, ON L1H 7K4, Canada
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Astell AJ, Hwang F, Brown LJE, Timon C, Maclean LM, Smith T, Adlam T, Khadra H, Williams EA. Validation of the NANA (Novel Assessment of Nutrition and Ageing) touch screen system for use at home by older adults. Exp Gerontol 2014; 60:100-7. [PMID: 25456843 DOI: 10.1016/j.exger.2014.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 01/04/2023]
Abstract
Prospective measurement of nutrition, cognition, and physical activity in later life would facilitate early detection of detrimental change and early intervention but is hard to achieve in community settings. Technology can simplify the task and facilitate daily data collection. The Novel Assessment of Nutrition and Ageing (NANA) toolkit was developed to provide a holistic picture of an individual's function including diet, cognition and activity levels. This study aimed to validate the NANA toolkit for data collection in the community. Forty participants aged 65 years and over trialled the NANA toolkit in their homes for three 7-day periods at four-week intervals. Data collected using the NANA toolkit were compared with standard measures of diet (four-day food diary), cognitive ability (processing speed) and physical activity (self-report). Bland-Altman analysis of dietary intake (energy, carbohydrates, protein fat) found a good relationship with the food diary and cognitive processing speed and physical activity (hours) were significantly correlated with their standard counterparts. The NANA toolkit enables daily reporting of data that would otherwise be collected sporadically while reducing demands on participants; older adults can complete the daily reporting at home without a researcher being present; and it enables prospective investigation of several domains at once.
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Affiliation(s)
- A J Astell
- Ontario Shores Centre for Mental Health Sciences, Canada; University of Sheffield, UK.
| | | | | | - C Timon
- University College Dublin, Ireland
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The effects of a telehealth coping skills intervention on outcomes in chronic obstructive pulmonary disease: primary results from the INSPIRE-II study. Psychosom Med 2014; 76:581-92. [PMID: 25251888 PMCID: PMC4197099 DOI: 10.1097/psy.0000000000000101] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality and reduced quality of life (QoL). Novel interventions are needed to improve outcomes in COPD patients. The present study assessed the effects of a telephone-based coping skills intervention on psychological and somatic QoL and on the combined medical end point of COPD-related hospitalizations and all-cause mortality. METHODS We conducted a dual-site, randomized clinical trial with assessments at baseline and after 16 weeks of treatment. The study population comprised 326 outpatients with COPD aged 38 to 81 years, randomized to coping skills training (CST) or to COPD education (COPD-ED). Patients completed a battery of QoL instruments, pulmonary function tests, and functional measures and were followed up for up to 4.4 years to assess medical outcomes. RESULTS The CST group exhibited greater improvements in psychological QoL compared with controls (p = .001), including less depression (Cohen d = 0.22 [95% confidence interval, or CI = 0.08-0.36]) and anxiety (d = 0.17 [95% CI = 0.02-0.33]), and better overall mental health (d = 0.17 [95% CI = 0.03-0.32]), emotional role functioning (d = 0.29 [95% CI = 0.10-0.48]), vitality (d = 0.27 [95% CI = 0.11, 0.42]), and social functioning (d = 0.21 [95% CI = 0.03-0.38]). A significant baseline psychological QoL by treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared with COPD-ED. CST participants also exhibited greater improvements in somatic QoL (p = .042), including greater improvements in pulmonary QoL (d = 0.13 [95% CI = 0.01-0.24]), less fatigue (d = 0.34 [95% CI = 0.18-0.50]), and less shortness of breath (d = 0.11 [95% CI = -0.01 to 0.23]) and greater improvement in distance walked on the Six-Minute Walk test (d = 0.09 [95% CI = 0.01-0.16]). However, there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST (34 events) and COPD-ED (32 events; p = 0.430). CONCLUSIONS A telehealth CST intervention produced clinically meaningful improvements in QoL and functional capacity, but no overall improvement in risk of COPD-related hospitalization and all-cause mortality. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00736268.
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Pinto BM, Stein K, Dunsiger S. Peers promoting physical activity among breast cancer survivors: A randomized controlled trial. Health Psychol 2014; 34:463-72. [PMID: 25110844 DOI: 10.1037/hea0000120] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although studies have shown that physical activity (PA) can reduce some treatment-related side effects of breast cancer, there is a need to offer PA programs outside of research settings to reach more cancer survivors. We partnered with the American Cancer Society's Reach to Recovery (RTR) program to train their volunteers (breast cancer survivors) to deliver a 12-week PA intervention to other breast cancer survivors. METHOD We conducted a randomized controlled trial to compare the PA intervention delivered by RTR volunteers (PA plus RTR) with contact control (RTR control). Eighteen RTR volunteers/coaches (Mage = 54.9 years; Mtime since diagnosis = 7.0 years) delivered the contact control condition or the PA intervention. Seventy-six breast cancer survivors in New England (Mage = 55.6 years; Mtime since diagnosis = 1.1 years) were randomized to 1 of the 2 groups. At baseline, 12 weeks (postintervention), and at 24 weeks, participants wore an accelerometer for 7 days, were interviewed about their PA, and reported their motivational readiness for PA. RESULTS Adjusted, mixed-effects longitudinal regression models showed significant group differences favoring the PA plus RTR group in minutes of moderate to vigorous PA at 12 weeks (Mdifference = 103 min/week, p < .001) and at 24 weeks (Mdifference = 34.7 min/week, p = .03). Results were corroborated with significant group differences in accelerometer data favoring the PA plus RTR group at both time points. CONCLUSION Peer volunteers were able to significantly increase PA among cancer survivors relative to contact control. Partnerships with existing volunteer programs can help to widen the reach of behavioral interventions among cancer survivors. (PsycINFO Database Record
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Affiliation(s)
| | - Kevin Stein
- Behavioral Research Center, American Cancer Society
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital
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110
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Reliability and Validity of 2 Self-Report Measures to Assess Sedentary Behavior in Older Adults. J Phys Act Health 2014; 12:727-32. [PMID: 25110344 DOI: 10.1123/jpah.2013-0546] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of this study was to examine the reliability and validity of 2 currently available physical activity surveys for assessing time spent in sedentary behavior (SB) in older adults. METHODS Fifty-eight adults (≥65 years) completed the Yale Physical Activity Survey for Older Adults (YPAS) and Community Health Activities Model Program for Seniors (CHAMPS) before and after a 10-day period during which they wore an ActiGraph accelerometer (ACC). Intraclass correlation coefficients (ICC) examined test-retest reliability. Overall percent agreement and a kappa statistic examined YPAS validity. Lin's concordance correlation, Pearson correlation, and Bland-Altman analysis examined CHAMPS validity. RESULTS Both surveys had moderate test-retest reliability (ICC: YPAS = 0.59 (P < .001), CHAMPS = 0.64 (P < .001)) and significantly underestimated SB time. Agreement between YPAS and ACC was low (κ = -0.0003); however, there was a linear increase (P < .01) in ACC-derived SB time across YPAS response categories. There was poor agreement between ACC-derived SB and CHAMPS (Lin's r = .005; 95% CI, -0.010 to 0.020), and no linear trend across CHAMPS quartiles (P = .53). CONCLUSIONS Neither of the surveys should be used as the sole measure of SB in a study; though the YPAS has the ability to rank individuals, providing it with some merit for use in correlational SB research.
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111
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Van Cauwenberg J, Van Holle V, De Bourdeaudhuij I, Owen N, Deforche B. Older adults' reporting of specific sedentary behaviors: validity and reliability. BMC Public Health 2014; 14:734. [PMID: 25042423 PMCID: PMC4223385 DOI: 10.1186/1471-2458-14-734] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Previous questionnaires targeting older adults’ sedentary time have underestimated total sedentary time, possibly by not including all relevant specific sedentary behaviors. The current study aimed to investigate the criterion validity and test-retest reliability of a new questionnaire assessing a comprehensive set of sedentary behaviors. Additionally, we examined whether the criterion validity of the questionnaire differed according to age, gender and educational level. Methods A sample of home-dwelling Belgian older adults (>64 years, n = 508) completed a newly-developed questionnaire assessing twelve specific sedentary behaviors and wore an accelerometer for seven consecutive days as criterion measure. A subsample (n = 28) completed the questionnaire a second time to examine test-retest reliability. Data collection occurred between September 2010 and October 2012. Results Correlational analyses examining self-reported total sitting time and accelerometer-derived sedentary time yielded a Spearman’s ρ of 0.30. Using the Bland-Altman regression procedure, self-reported total sitting time underestimated accelerometer-derived sedentary time by -82 minutes/day for a participant with an average level of sedentary time (539 minutes/day). Corresponding 95% limits of agreement were wide (-364, 200 minutes/day). Better, but still not ideal, validity findings were observed in the younger, male and tertiary-educated subgroups. Acceptable test-retest reliability (ICC > 0.70) was found for total sitting time, TV viewing, computer use, and driving a car. Conclusion Validity for older adults’ self-reported total sitting time against accelerometer-derived sedentary time was not strong, but comparable to previous studies. However, underestimation of total sedentary time was lower compared to previous studies, possibly explained by the inclusion of additional specific sedentary behaviors. Further research is needed to develop self-report tools and objective criterion measures that accurately measure engagement in (specific) sedentary behavior(s) among different subgroups of the older population.
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Affiliation(s)
- Jelle Van Cauwenberg
- Department of Human Biometry and Biomechanics, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium.
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McMahon S, Vankipuram M, Hekler EB, Fleury J. Design and evaluation of theory-informed technology to augment a wellness motivation intervention. Transl Behav Med 2014; 4:95-107. [PMID: 24653780 DOI: 10.1007/s13142-013-0221-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Integrating mobile technology into health promotion strategies has the potential to support healthy behaviors. A new theory-informed app was designed to augment an intervention promoting wellness motivation in older adults with fall risk and low levels of physical activity. The app content was evaluated for clarity, homogeneity, and validity of motivational messages; both the app and device were evaluated for acceptability and usability. The initial evaluation included nine adults (mean age, 75); four of whom also assessed the app's sensing abilities in the field. As part of an intervention feasibility study, 14 older adults (mean age, 84) also provided a follow-up evaluation of app usability. Evaluation participants assessed the app as valid, usable, acceptable, and able to sense most reported free-living activities, and provided feedback for improving the app. Design processes illustrate methodologic and interpretive efforts to operationalize motivational content in a theory-informed app promoting change in physical activity behavior.
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Affiliation(s)
- Siobhan McMahon
- School of Nursing, University of Minnesota, Minneapolis, MN USA
| | - Mithra Vankipuram
- Hewlett-Packard Laboratories, 1501 Page Mill Road, Palo Alto, CA 94304-1126 USA
| | - Eric B Hekler
- School of Nutrition and Health Promotion, Arizona State University, 500 N. Third Street, Phoenix, AZ 85004 USA
| | - Julie Fleury
- College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004 USA
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Sabia S, van Hees VT, Shipley MJ, Trenell MI, Hagger-Johnson G, Elbaz A, Kivimaki M, Singh-Manoux A. Association between questionnaire- and accelerometer-assessed physical activity: the role of sociodemographic factors. Am J Epidemiol 2014; 179:781-90. [PMID: 24500862 PMCID: PMC3939851 DOI: 10.1093/aje/kwt330] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The correlation between objective and self-reported measures of physical activity varies between studies. We examined this association and whether it differed by demographic factors or socioeconomic status (SES). Data were from 3,975 Whitehall II (United Kingdom, 2012–2013) participants aged 60–83 years, who completed a physical activity questionnaire and wore an accelerometer on their wrist for 9 days. There was a moderate correlation between questionnaire- and accelerometer-assessed physical activity (Spearman's r = 0.33, 95% confidence interval: 0.30, 0.36). The correlations were higher in high-SES groups than in low-SES groups (P 's = 0.02), as defined by education (r = 0.38 vs. r = 0.30) or occupational position (r = 0.37 vs. r = 0.29), but did not differ by age, sex, or marital status. Of the self-reported physical activity, 68.3% came from mild activities, 25% from moderate activities, and only 6.7% from vigorous activities, but their correlations with accelerometer-assessed total physical activity were comparable (range of r 's, 0.21–0.25). Self-reported physical activity from more energetic activities was more strongly associated with accelerometer data (for sports, r = 0.22; for gardening, r = 0.16; for housework, r = 0.09). High-SES persons reported more energetic activities, producing stronger accelerometer associations in these groups. Future studies should identify the aspects of physical activity that are most critical for health; this involves better understanding of the instruments being used.
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Affiliation(s)
- Séverine Sabia
- Correspondence to Dr. Séverine Sabia, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom (e-mail: ); or Dr. Vincent T. van Hees, MoveLab—Physical Activity and Exercise Research, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom (e-mail: )
| | - Vincent T. van Hees
- Correspondence to Dr. Séverine Sabia, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom (e-mail: ); or Dr. Vincent T. van Hees, MoveLab—Physical Activity and Exercise Research, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom (e-mail: )
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114
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Shuval K, Kohl HW, Bernstein I, Cheng DL, Gabriel KP, Barlow CE, Yinghui L, DiPietro L. Sedentary behaviour and physical inactivity assessment in primary care: the Rapid Assessment Disuse Index (RADI) study. Br J Sports Med 2014; 48:250-5. [PMID: 24144532 PMCID: PMC4226341 DOI: 10.1136/bjsports-2013-092901] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The emerging evidence of the effects of sedentary time on health outcomes suggests a need to better measure this exposure. Healthcare settings, however, are not equipped with a tool that can quickly assess the sedentary habits of their patient population. The purpose of this study was to validate a tool for rapidly quantifying and tracking the sedentary time and low levels of daily lifestyle physical activity among primary care patients. METHODS The study examined the test-retest reliability and validity of the rapid assessment disuse index (RADI) among adult patients from a large primary care clinic. Patients completed RADI (comprised of 3 items: sitting, moving and stair climbing) twice, followed by accelerometer monitoring. Test-retest reliability was computed, and the correlation between survey responses and accelerometry was determined. A receiver operating characteristic curve was constructed and the area under the curve (AUC) was calculated. RESULTS RADI was temporally stable (intraclass correlation coefficients 0.79), and a higher score was significantly correlated with greater sedentary time (ρ=0.40; p<0.01), fewer sedentary to active transitions (ρ=-0.42; p<0.01), and less light-intensity physical activity (ρ=-0.40; p<0.01). The ability of RADI to detect patients with high levels of sedentary time was fair (AUC=0.72). CONCLUSIONS This brief assessment tool, designed to quickly identify patients with high levels of sitting and low daily physical activity, exhibits good reliability and moderate validity. RADI can assist in providing recommendations at the point of care pertaining to modifying sedentary behaviour.
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Affiliation(s)
- Kerem Shuval
- University of Texas, School of Public Health, Division of Epidemiology, Human Genetics and Environmental Sciences, Dallas and Austin, Texas, USA
- Harold C Simmons Cancer Center, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
- American Cancer Society, Atlanta, Georgia, USA
| | - Harold W Kohl
- University of Texas, School of Public Health, Division of Epidemiology, Human Genetics and Environmental Sciences, Dallas and Austin, Texas, USA
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin Texas USA
| | - Ira Bernstein
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Dun lei Cheng
- University of Texas, School of Public Health, Division of Biostatistics, Dallas, Texas, USA
| | - Kelley Pettee Gabriel
- University of Texas, School of Public Health, Division of Epidemiology, Human Genetics and Environmental Sciences, Dallas and Austin, Texas, USA
| | - Carolyn E Barlow
- University of Texas, School of Public Health, Division of Epidemiology, Human Genetics and Environmental Sciences, Dallas and Austin, Texas, USA
- Cooper Institute, Dallas, Texas, USA
| | - Liu Yinghui
- Division of General Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Loretta DiPietro
- George Washington University, Department of Exercise Science, School of Public Health and Health Services, Washington DC, USA
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115
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Buman MP, Winkler EAH, Kurka JM, Hekler EB, Baldwin CM, Owen N, Ainsworth BE, Healy GN, Gardiner PA. Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005-2006. Am J Epidemiol 2014; 179:323-34. [PMID: 24318278 DOI: 10.1093/aje/kwt292] [Citation(s) in RCA: 283] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sleep and sedentary and active behaviors are linked to cardiovascular disease risk biomarkers, and across a 24-hour day, increasing time in 1 behavior requires decreasing time in another. We explored associations of reallocating time to sleep, sedentary behavior, or active behaviors with biomarkers. Data (n = 2,185 full sample; n = 923 fasting subanalyses) from the cross-sectional 2005-2006 US National Health and Nutrition Examination Survey were analyzed. The amounts of time spent in sedentary behavior, light-intensity activity, and moderate-to-vigorous physical activity (MVPA) were derived from ActiGraph accelerometry (ActiGraph LLC, Pensacola, Florida), and respondents reported their sleep duration. Isotemporal substitution modeling indicated that, independent of potential confounders and time spent in other activities, beneficial associations (P < 0.05) with cardiovascular disease risk biomarkers were associated with the reallocation of 30 minutes/day of sedentary time with equal time of either sleep (2.2% lower insulin and 2.0% lower homeostasis model assessment of β-cell function), light-intensity activity (1.9% lower triglycerides, 2.4% lower insulin, and 2.2% lower homeostasis model assessment of β-cell function), or MVPA (2.4% smaller waist circumference, 4.4% higher high-density lipoprotein cholesterol, 8.5% lower triglycerides, 1.7% lower glucose, 10.7% lower insulin, and 9.7% higher homeostasis model assessment of insulin sensitivity. These findings provide evidence that MVPA may be the most potent health-enhancing, time-dependent behavior, with additional benefit conferred from light-intensity activities and sleep duration when reallocated from sedentary time.
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116
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Kerr J, Marshall SJ, Patterson RE, Marinac CR, Natarajan L, Rosenberg D, Wasilenko K, Crist K. Objectively measured physical activity is related to cognitive function in older adults. J Am Geriatr Soc 2014; 61:1927-31. [PMID: 24219194 DOI: 10.1111/jgs.12524] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the relationship between cognitive functioning and time spent at different intensities of physical activity (PA) in free-living older adults. DESIGN Cross sectional analyses. SETTING Continuing care retirement communities. PARTICIPANTS Older adults residing in seven continuing care retirement communities in San Diego County with an average age of 83; 70% were female, and 35% had a graduate-level education (N = 217). MEASUREMENTS PA was measured objectively using hip worn accelerometers with data aggregated to the minute level. Three cut points were used to assess low light-intensity PA (LLPA), high light-intensity PA (HLPA), and moderate- to vigorous-intensity PA (MVPA). The Trail Making Test (TMT) Parts A and B were completed, and time for each test (seconds) and time for Part B minus time for Part A (seconds) were used as measures of cognitive function. Variables were log-transformed and entered into linear regression models adjusting for demographic factors (age, education, sex) and other PA intensity variables. RESULTS LLPA was not related to any TMT test score. HLPA was significantly related to TMT A, B, and B minus A but only in unadjusted models. MVPA was related to TMT B and B minus A after adjusting for demographic variables. CONCLUSION There may be a dose response between PA intensity and cognitive functioning in older adults. The stronger findings supporting a relationship between MVPA and cognitive functioning are consistent with previous observational and intervention studies.
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Affiliation(s)
- Jacqueline Kerr
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California; Moores UCSD Cancer Center, University of California at San Diego, La Jolla, California
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Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis. Eur Rev Aging Phys Act 2013; 11:35-49. [PMID: 24765212 PMCID: PMC3990855 DOI: 10.1007/s11556-013-0132-x] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/23/2013] [Indexed: 12/27/2022] Open
Abstract
Accelerometers objectively monitor physical activity and sedentary patterns and are increasingly used in the research setting. It is important to maintain consistency in data analysis and reporting, therefore, we: (1) systematically identified studies using accelerometry (ActiGraph, Pensacola, FL, USA) to measure moderate-to-vigorous physical activity (MVPA) and sedentary time in older adults, and (2) based on the review findings, we used different cut-points obtained to analyze accelerometry data from a sample of community-dwelling older women. We identified 59 articles with cut-points ranging between 574 and 3,250 counts/min for MVPA and 50 and 500 counts/min for sedentary time. Using these cut-points and data from women (mean age, 70 years), the median MVPA minutes per day ranged between 4 and 80 min while percentage of sedentary time per day ranged between 62 % and 86 %. These data highlight (1) the importance of reporting detailed information on the analysis assumptions and (2) that results can differ greatly depending on analysis parameters.
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118
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Nathan A, Wood L, Giles-Corti B. Examining correlates of self-reported and objectively measured physical activity among retirement village residents. Australas J Ageing 2013; 33:250-6. [PMID: 24102853 DOI: 10.1111/ajag.12055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Physical activity (PA) patterns of retirement village residents were investigated using self-report and objective measures. METHODS Residents (n = 323) from retirement villages in Perth, Australia, were surveyed on PA behaviour and various demographic, residency, health-related and mobility factors. Most participants wore accelerometers for 7 days. Retirement village managers (n = 32) were surveyed on village descriptive characteristics, including the provision of amenities and facilities. Logistic regression models examined village and resident characteristics associated with PA. RESULTS Based on objective measurement, only 27.1% of participants were sufficiently active (n = 288). Walking was one of the most popular PA modes. Few village characteristics were associated with PA; however, villages located in more walkable neighbourhoods increased participants' odds of transport walking. Travelling outside the village daily also increased PA odds. CONCLUSIONS Most residents were insufficiently active to gain health benefits. Considering individual and environmental factors, within the retirement village and neighbourhood settings, and associations with PA, warrants attention.
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Affiliation(s)
- Andrea Nathan
- Centre for the Built Environment and Health, School of Population Health, University of Western Australia, Perth, Western Australia, Australia
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119
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King AC, Bickmore TW, Campero MI, Pruitt LA, Yin JL. Employing virtual advisors in preventive care for underserved communities: results from the COMPASS study. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1449-1464. [PMID: 23941610 PMCID: PMC7187757 DOI: 10.1080/10810730.2013.798374] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Electronically delivered health promotion programs that are aimed primarily at educated, health-literate individuals have proliferated, raising concerns that such trends could exacerbate health disparities in the United States and elsewhere. The efficacy of a culturally and linguistically adapted virtual advisor that provides tailored physical activity advice and support was tested in low-income older adults. Forty inactive adults (92.5% Latino) 55 years of age and older were randomized to a 4-month virtual advisor walking intervention or a waitlist control. Four-month increases in reported minutes of walking/week were greater in the virtual advisor arm (mean increase = 253.5 ± 248.7 minutes/week) relative to the control (mean increase = 26.8 ± 67.0 minutes/week; p = .0008). Walking increases in the virtual advisor arm were substantiated via objectively measured daily steps (slope analysis p = .002). All but one intervention participant continued some interaction with the virtual advisor in the 20-week poststudy period (mean number of poststudy sessions = 14.0 ± 20.5). The results indicate that a virtual advisor delivering culturally and linguistically adapted physical activity advice led to meaningful 4-month increases in walking relative to control among underserved older adults. This interactive technology, which requires minimal language and computer literacy, may help reduce health disparities by ensuring that all groups benefit from e-health opportunities.
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Affiliation(s)
- Abby C King
- a Division of Epidemiology, Department of Health Research and Policy, and Stanford Prevention Research Program, Department of Medicine , Stanford University School of Medicine , Stanford , California , USA
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120
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Visser M, Koster A. Development of a questionnaire to assess sedentary time in older persons--a comparative study using accelerometry. BMC Geriatr 2013; 13:80. [PMID: 23899190 PMCID: PMC3733654 DOI: 10.1186/1471-2318-13-80] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 07/22/2013] [Indexed: 01/27/2023] Open
Abstract
Background There is currently no validated questionnaire available to assess total sedentary time in older adults. Most studies only used TV viewing time as an indicator of sedentary time. The first aim of our study was to investigate the self-reported time spent by older persons on a set of sedentary activities, and to compare this with objective sedentary time measured by accelerometry. The second aim was to determine what set of self-reported sedentary activities should be used to validly rank people’s total sedentary time. Finally we tested the reliability of our newly developed questionnaire using the best performing set of sedentary activities. Methods The study sample included 83 men and women aged 65–92 y, a random sample of Longitudinal Aging Study Amsterdam participants, who completed a questionnaire including ten sedentary activities and wore an Actigraph GT3X accelerometer for 8 days. Spearman correlation coefficients were calculated to examine the association between self-reported time and objective sedentary time. The test-retest reliability was calculated using the intraclass correlation coefficient (ICC). Results Mean total self-reported sedentary time was 10.4 (SD 3.5) h/d and was not significantly different from mean total objective sedentary time (10.2 (1.2) h/d, p = 0.63). Total self-reported sedentary time on an average day (sum of ten activities) correlated moderately (Spearman’s r = 0.35, p < 0.01) with total objective sedentary time. The correlation improved when using the sum of six activities (r = 0.46, p < 0.01), and was much higher than when using TV watching only (r = 0.22, p = 0.05). The test-retest reliability of the sum of six sedentary activities was 0.71 (95% CI 0.57-0.81). Conclusions A questionnaire including six sedentary activities was moderately associated with accelerometry-derived sedentary time and can be used to reliably rank sedentary time in older persons.
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Vankipuram M, McMahon S, Fleury J. ReadySteady: app for accelerometer-based activity monitoring and wellness-motivation feedback system for older adults. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2012; 2012:931-9. [PMID: 23304368 PMCID: PMC3540520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Increased physical activity and exercise have been found to reduce falls and decrease mortality and age-related morbidity in older adults. However, a large percentage of this population fail to achieve the necessary levels of activity needed to support health living. In this work, we present a mobile app developed on the iOS platform that monitors activity levels using accelerometry. The data captured by the sensor is utilized to provide real-time motivational feedback to enable reinforcement of positive behaviors in older adults. Pilot experiments (conducted with younger adults) performed to assess validity of activity measurement showed that system accurately measures sedentary, light, moderate and vigorous activities in a controlled lab setting. Pilot tests (conducted with older adults) in the user setting showed that while the app is adept at capturing gross body activity (such as sitting, walking and jogging), additional sensors may be required to capture activities involving the extremities.
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Affiliation(s)
- Mithra Vankipuram
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
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122
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Hekler EB, Buman MP, Ahn D, Dunton G, Atienza AA, King AC. Are daily fluctuations in perceived environment associated with walking? Psychol Health 2012; 27:1009-20. [PMID: 22214492 DOI: 10.1080/08870446.2011.645213] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The physical environment is thought to influence walking; however, daily variations in perceived environment have received little attention. The current study sought to examine if key within-person factors (i.e., implementation intentions, social support, affect and self-efficacy) would be associated with walking and if perceived access to supportive environments (e.g., access to nice walking paths) and perceived environmental barriers (e.g., bad weather and safety issues) were uniquely associated with walking after controlling for other constructs. Participants (N = 14, 50.0% men, 78.6% White, M age = 59.4 ± 6.4) were in the intervention arm of an 8-week controlled trial promoting walking via personal digital assistants. Participants completed electronic surveys twice a day (total entries = 804) in which they reported brisk walking levels and psychosocial and environmental factors. Multilevel modelling was used to examine within-person variations in constructs as determinants of walking. Results suggested that daily variations in implementation intentions, social support and positive affect were positively associated with walking. Further, perceived access to supportive environments, though not perceived environmental barriers, was positively associated with walking after controlling for other constructs (p < 0.05). Future research should explore intervention components that target context-specific information about perceived access to supportive environments as part of a broader perspective on intervention development.
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Affiliation(s)
- Eric B Hekler
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
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123
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King AC, Sallis JF, Frank LD, Saelens BE, Cain K, Conway TL, Chapman JE, Ahn DK, Kerr J. Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults. Soc Sci Med 2011; 73:1525-33. [PMID: 21975025 DOI: 10.1016/j.socscimed.2011.08.032] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 07/23/2011] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
Abstract
While there is a growing literature on the relations between neighborhood design and health factors such as physical activity and obesity, less focus has been placed on older adults, who may be particularly vulnerable to environmental influences. This study evaluates the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. An observational design involving two time points six months apart was employed between 2005 and 2008. U.S. Census block groups in Seattle-King County, Washington and Baltimore, Maryland-Washington DC regions were selected via geographic information systems to maximize variability in walkability and income. Participants were 719 adults ages 66 years and older who were able to complete surveys in English and walk at least 10 feet continuously. Measurements included reported walking or bicycling for errands (i.e., transport activity) and other outdoor aerobic activities measured via the CHAMPS questionnaire: accelerometry-based moderate-to-vigorous physical activity; reported body mass index; and reported lower extremity mobility impairment measured via the Late-Life Function and Disability Instrument. Across regions, time, and neighborhood income, older adults living in more walkable neighborhoods had more transport activity and moderate-to- vigorous physical activity and lower body mass index relative to those living in less walkable neighborhoods. The most mobility-impaired adults living in more walkable neighborhoods reported transport activity levels that were similar to less mobility-impaired adults living in less walkable neighborhoods. The results add to the small literature aimed at understanding how neighborhood design may influence physical activity and related aspects of health linked with day-to-day function and independence as people age.
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Affiliation(s)
- Abby C King
- Division of Epidemiology, Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA 94305-5405, USA.
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