Patterns and correlates of physical activity among US women 40 years and older

Physical activity and resting metabolic rate

The direct effects of physical activity interventions on energy expenditure are relatively small when placed in the context of total daily energy demands. Hence, the suggestion has been made that exercise produces energetic benefits in other components of the daily energy budget, thus generating a net effect on energy balance much greater than the direct energy cost of the exercise alone. Resting metabolic rate (RMR) is the largest component of the daily energy budget in most human societies and, therefore, any increases in RMR in response to exercise interventions are potentially of great importance. Animal studies have generally shown that single exercise events and longer-term training produce increases in RMR. This effect is observed in longer-term interventions despite parallel decreases in body mass and fat mass. Flight is an exception, as both single flights and long-term flight training induce reductions in RMR. Studies in animals that measure the effect of voluntary exercise regimens on RMR are less commonly performed and do not show the same response as that to forced exercise. In particular, they indicate that exercise does not induce elevations in RMR. Many studies of human subjects indicate a short-term elevation in RMR in response to single exercise events (generally termed the excess post-exercise O2 consumption; EPOC). This EPOC appears to have two phases, one lasting < 2 h and a smaller much more prolonged effect lasting up to 48 h. Many studies have shown that long-term training increases RMR, but many other studies have failed to find such effects. Data concerning long-term effects of training are potentially confounded by some studies not leaving sufficient time after the last exercise bout for the termination of the long-term EPOC. Long-term effects of training include increases in RMR due to increases in lean muscle mass. Extreme interventions, however, may induce reductions in RMR, in spite of the increased lean tissue mass, similar to the changes observed in animals in response to flight.

Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures

Research in transportation, urban design, and planning has examined associations between physical environment variables and individuals' walking and cycling for transport. Constructs, methods, and findings from these fields can be applied by physical activity and health researchers to improve understanding of environmental influences on physical activity. In this review, neighborhood environment characteristics proposed to be relevant to walking/cycling for transport are defined, including population density, connectivity, and land use mix. Neighborhood comparison and correlational studies with nonmotorized transport outcomes are considered, with evidence suggesting that residents from communities with higher density, greater connectivity, and more land use mix report higher rates of walking/cycling for utilitarian purposes than low-density, poorly connected, and single land use neighborhoods. Environmental variables appear to add to variance accounted for beyond sociodemographic predictors of walking/cycling for transport. Implications of the transportation literature for physical activity and related research are outlined. Future research directions are detailed for physical activity research to further examine the impact of neighborhood and other physical environment factors on physical activity and the potential interactive effects of psychosocial and environmental variables. The transportation, urban design, and planning literatures provide a valuable starting point for multidisciplinary research on environmental contributions to physical activity levels in the population.

Why is poverty unhealthy? Social and physical mediators

Socioeconomic status is associated with mortality, yet does not fully explain health disparities. This study analyzed data from the Project on Human Development in Chicago Neighborhoods (PHDCN), in the USA, to identify neighborhood-level factors associated with premature mortality. 1990 US Census data and mortality data from Chicago were merged with data from PHDCN, a study of 8782 residents in 343 Chicago neighborhoods. We performed a multivariate analysis to determine the association between premature mortality and concentrated disadvantage, residential stability, immigrant concentration, "collective efficacy" (a measure of willingness to help out for the common good), and "broken windows" (boarded up stores and homes, litter, and graffiti). Both collective efficacy and broken windows appeared to mediate the effect of concentrated disadvantage on all-cause premature mortality and mortality from cardiovascular disease and homicide, but there was also an interaction between broken windows and collective efficacy. Non-income characteristics associated with poverty should be further investigated. Interventions to determine whether these factors are causally related to health are needed.

Local ordinances that promote physical activity: a survey of municipal policies

In this Utah-based study, we sought to identify the types of municipal employees responsible for physical activity policies, identify municipal ordinances that may influence physical activity, and determine local governments' intentions to implement policies. In 2001, we mailed a survey to all of the state's municipalities with the goal of measuring 6 physical activity domains: sidewalks, bicycle lanes, shared-use paths, work sites, greenways, and recreational facilities. Data from 74 municipalities revealed that planners made up a small proportion of municipal staff. Relative to cities experiencing slow or medium growth, high growth cities reported more ordinances encouraging physical activity. Physical activity policies can be monitored across municipalities. Moreover, evidence-based public health practice provides direction for limited staff and funding resources.

Managing cardiovascular risk reduction in elderly adults. By promoting and monitoring healthy lifestyle changes, health care providers can help older adults improve their cardiovascular health

Primary care practitioners must explore the most effective techniques for promoting cardiovascular risk reduction in older adults. Managing lifestyle modification risk factors, such as smoking cessation, obesity, sedentary lifestyle, and nutrition is discussed in this article. Other risk factor modification efforts, often not highlighted, include managing homocysteinemia, and sedentary behavior. These factors are presented as equally important modifiable coronary heart disease risks.

Occupational physical activity in the atherosclerosis risk in communities study

PURPOSE

Accumulation of physical activity throughout the day is recommended to reduce health risks and enhance quality of life. Yet, many epidemiologic studies measure leisure activity only, without assessment of occupational activity. The purposes of this study were to describe occupational activity and to quantify the association between occupational and leisure activity in 2991 African American and 8566 White middle-aged adults.

METHODS

Physical activity was measured by the Baecke questionnaire in 1987-89 for participants 45 to 64 years of age in the Atherosclerosis Risk in Communities Study.

RESULTS

Reported occupational activity was greater among African American men and women compared to White men and women. Leisure activity was greater among White men and women compared to African American men and women. Work indices (range-1 (low) to 5 (high)) were highest among African American women (2.78) and men (2.72), followed by White men (2.55) and women (2.45), adjusted for age, study center, body mass index, and perceived health status. Those with the highest occupational activity had lower participation in any sport or exercise than those with lower occupational activity across race-gender groups.

CONCLUSIONS

This data suggests that studies relying solely on leisure activity may miss important information provided by occupational physical activity.

Physical activity beliefs, behaviors, and cardiovascular fitness of Mexican immigrant women

This descriptive study examined physical activity beliefs, behaviors, and cardiovascular fitness of a convenience sample of 51 married Mexican immigrant women (MIW) with children in Northern California. Standardized tools/procedures were used to measure the variables of interest and to determine cardiovascular fitness levels. The majority (78%) was not involved in regular physical activity and had below average or poor cardiovascular fitness (76%). However, 93% had a positive attitude, were well-informed of the benefits, and perceived physical activity to be a health-promoting behavior. Cultural values and beliefs about physical activity, gender roles, and social and physiological factors were described as barriers to women's intention to engage in physical activity.

Environmental, policy, and cultural factors related to physical activity in sedentary American Indian women

Focus group interviews were conducted to explore sociocultural, environmental, and policy-related determinants of physical activity among sedentary American Indian women. Thirty women aged 20 to 50 years (mean = 37.4 +/- 10.6 years) participated. Three sessions were conducted with women aged 20 to 34 years and three with women aged 35 to 50 to evaluate response differences by age. Because no obvious age differences were observed, data were pooled. Barriers to physical activity included inadequate support for household and child care responsibilities and difficulties balancing home-related and societal expectations with physical activity. In addition, women reported little support from their communities and work sites to be physically active. Environmental barriers included lack of safe outdoor areas and accessible walking trails. Weather and stray dogs were also commonly mentioned. Sociocultural barriers included giving family obligations priority above all other things, being expected to eat large portions of high-fat foods, and failing to follow a traditionally active lifestyle. Enablers of physical activity included support from family and coworkers and participation in traditional community events. Suggested intervention approaches included accessible and affordable programs and facilities, community emphasis on physical activity, and programs that incorporated the needs of larger women and of families. Participants emphasized a preference for programs that were compatible with the role expectations of their families and communities, and they expressed the desire for acceptance and encouragement to be physically active from the family, the community, the worksite, and their tribal leaders.

Environmental, policy, and cultural factors related to physical activity among rural, African American women

Sixty-one African American women (ages 20-50 years) from a rural community in Alabama participated in six focus groups. Barriers to and enablers of physical activity were identified and grouped into personal, environmental (social and physical), policy, and cultural themes for qualitative analyses. Personal factors included motivation, perceived health, feeling tired, and lack of time; social environmental factors included support from friends, family, and issues related to child care; physical environmental factors included weather, access to facilities, availability of sidewalks or other places to walk; policy factors included personal safety concerns (loose dogs, traffic, etc.) and inflexible work environments. Some, but not all, women perceived cultural differences as a factor affecting physical activity levels. Differences in socioeconomic levels and time demands among women of different cultures were identified as factors that may influence physical activity. Participants provided suggestions for community-based physical activity interventions using an environmental approach.

Environmental, policy, and cultural factors related to physical activity in a diverse sample of women: the Women's Cardiovascular Health Network Project--introduction and methodology

Ethnic minority and low-income populations have some of the highest rates of cardiovascular disease (CVD) and the highest rates of physical inactivity, an independent risk factor for CVD. Ethnic minority and low-income women are especially at risk. Because programs designed to increase physical activity have the potential to reduce CVD rates in specific populations, research in this area is expanding. As part of the Women's Cardiovascular Health Network funded by the Centers for Disease Control and Prevention, the goal of this multi-site project is to identify factors, particularly environmental, policy, and cultural factors, that may influence physical activity among ethnic minority and low-income women ages 20-50 years. To achieve this goal, 42 focus groups were conducted in various locations throughout the United States with African American, American Indian, Latina and White women. Groups represented both urban and rural living environments. This article explains the basis for this project and the methodology used. Other articles in this series explain the results from the focus groups in detail.

Correlates of adults' participation in physical activity: review and update

PURPOSE

To review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults.

METHODS

Systematic review of the peer-reviewed literature to identify papers published between 1998 and 2000 with PA (and including exercise and exercise adherence). Qualitative reports or case studies were not included.

RESULTS

Thirty-eight new studies were located. Most confirmed the existence of factors already known to be correlates of PA. Changes in status were noted in relation to the influence of marital status, obesity, smoking, lack of time, past exercise behavior, and eight environmental variables. New studies were located which focused on previously understudied population groups such as minorities, middle and older aged adults, and the disabled.

CONCLUSION

The newly reported studies tend to take a broader "ecological" approach to understanding the correlates of PA and are more focused on environmental factors. There remains a need to better understand environmental influences and the factors that influence different types of PA. As most of the work in this field still relies on cross-sectional studies, longitudinal and intervention studies will be required if causal relationships are to be inferred.

Sex differences in claudication pain in subjects with peripheral arterial disease

PURPOSES

To compare the claudication distances between men and women patients with peripheral arterial disease (PAD), and to determine whether sex differences in claudication pain persisted after controlling for potential confounders such as demographic, functional, and physiological measures.

METHODS

A total of 488 men and 72 women functionally limited by intermittent claudication were evaluated. Patients were characterized on PAD-specific measures consisting of ankle/brachial index (ABI) and treadmill claudication distances, physical function measures consisting of ambulatory function, monitored physical activity, balance, and strength, and demographic measures obtained during a medical history.

RESULTS

Initial claudication distance (ICD) was 33% shorter ( = 0.024) in women than in men (126 +/- 22 vs 189 +/- 13 m; mean +/- SEM), and absolute claudication distance (ACD) was 23% shorter ( = 0.022) in women (313 +/- 43 vs 407 +/- 18 m). These differences were present despite similar ( = 0.440) ABI values between women (0.63 +/- 0.02) and men (0.62 +/- 0.01). Peak oxygen uptake ( = 0.043) and self-perceived stair climbing ability ( = 0.020) were different between men and women, and were independently related to ICD (multiple R = 0.57, < 0.001) and to ACD (multiple R = 0.71, < 0.001). The sex differences in ICD ( = 0.524) and ACD ( = 0.722) were no longer present after controlling for peak oxygen uptake and self-perceived stair climbing ability.

CONCLUSION

Shorter treadmill claudication distances in women with PAD were explained by their lower cardiopulmonary fitness and poorer self-perceived ability to climb stairs than compared with men. Therefore, women with intermittent claudication represent a subgroup of PAD patients who should receive high priority for exercise rehabilitation to improve physical function.

Counseling middle-aged women about physical activity using the stages of change

PURPOSE

To discuss application of the Stages of Change theoretical framework and provide clinical tips on exercise adherence among midlife women. Included is a checklist to assist the nurse practitioner (NP) in effectively delivering the message.

DATA SOURCES

Review of the current scientific literature on exercise adherence and the Stages of Change model.

CONCLUSIONS

Middle-aged women comprise a unique population. Determining the woman's readiness for change using the Stages of Change model, NPs can routinely include appropriate exercise recommendations in their practices.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are in a unique position to promote healthy behaviors by counseling women in midlife about adopting an active lifestyle. Exercise counseling is an essential component of healthcare, especially among middle-aged women who are experiencing physical, emotional, and social changes.

Perspectives of pregnant and postpartum latino women on diabetes, physical activity, and health

Impaired glucose tolerance and diabetes are prevalent among Latino women of childbearing age. Physical activity during and after pregnancy may contribute to weight control and improved metabolic status, but recommended activities may not be perceived as appropriate or feasible. To plan realistic and acceptable interventions, pregnant and postpartum Latino women in Detroit met in a focus group series to discuss their beliefs about diabetes and factors influencing their participation in regular physical activity during pregnancy and postpartum. Women believed that diabetes was primarily related to heredity and diet but not to physical activity. Exercise was believed to reduce stress and improve general health. Women suggested an organized group intervention, in a respected location, that offered safe physical activities within the context of a variety of activities for women and children. This strategy reduced concerns about safety and social acceptability while addressing their primary interest in social support.

Physical activity in free-living, overweight white and black women: divergent responses by race to diet-induced weight loss

BACKGROUND

Black women are at greater risk of obesity than are white women, perhaps because of their lower levels of physical activity.

OBJECTIVE

We compared free-living activity energy expenditure (AEE) in sedentary white and black women (in overweight and normal-weight states) and in never-overweight control subjects.

DESIGN

Subjects included 46 women (23 white, 23 black) studied while overweight and after reaching a normal weight and 38 female control subjects (23 white, 15 black). Diet, without exercise training, resulted in a mean weight loss of 13 kg and a body mass index (in kg/m(2)) < 25. Body composition, sleeping energy expenditure, free-living total energy expenditure, and the energy cost of activity and aerobic capacity were assessed before and after weight loss under 4-wk, diet-controlled, weight-stable conditions and in the control subjects. AEE was defined as above-sleep energy expenditure.

RESULTS

No significant racial differences in body composition, before or after weight loss, were found. After weight loss, AEE and aerobic capacity increased in the white women and decreased in the black women (P < 0.05 and P < 0.02, respectively). After weight loss, but not before, the white women had a significantly higher mean AEE than did the black women (2448 +/- 979 and 1728 +/- 1373 kJ/d, respectively; P < 0.05), approximating AEEs in the white (2314 +/- 1105) and black (2310 +/- 1251) control subjects.

CONCLUSIONS

Relative to the responses of the white women to diet-induced weight loss, the black women became less fit and less physically active. Induction of a normal body weight in overweight black women appeared to produce a more obesity-prone state, favoring weight relapse.

Intervention-related cognitive versus social mediators of exercise adherence in the elderly

CONTEXT

Participation in regular physical activity is recognized as one of the most important health behaviors associated with the prevention of chronic disease and the promotion of health and well-being among the elderly. Although a number of cross-sectional studies have reported predictors of physical activity participation, few studies have assessed changes in intervention-related mediators associated with physical activity adherence in the elderly.

OBJECTIVE

The purpose of this study was to compare the relative abilities of cognitive mediating variables (i.e., self-efficacy beliefs and outcome expectancies/realizations) versus a social mediating variable (i.e., exercise-related social support) to examine mediators of a telephone-based, exercise-counseling intervention on exercise adherence during months 7 to 12 of an exercise intervention.

METHOD

Participants were 103 community-dwelling, healthy, sedentary, older adults (67 women and 36 men). Self-efficacy for exercise, outcome expectancies/realizations, and social support for exercise were assessed at baseline, 6 months, and 12 months. Participants received telephone-based exercise counseling to promote exercise adherence during the course of two 12-month exercise programs (i.e., aerobic/strength or flexibility exercises).

RESULTS

Changes in cognitive mediators (i.e., self-efficacy and fitness outcome realizations) were associated with 7- to 12-month exercise adherence while exercise-related social support was not.

CONCLUSION

Attention should be given to increasing confidence in the elderly to overcome barriers to exercise and achieve relevant fitness outcomes in exercise programs.

Ethnic differences in exercise among adults with diabetes

The purposes of this secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) III Household Adult Data File (1988-1994) were to describe and compare exercise practices and preferences of adult Caucasians, African Americans, and Hispanics with diabetes and to relate that information to diabetes treatment modalities. The research questions were: (a) What proportion of ethnically diverse adults with diabetes do and do not exercise? (b) What are the preferred types of exercise by ethnicity, gender, and age? and (c) What are the relationships among exercise participation, exercise preference, and treatment of diabetes by ethnic group? More than one third of the total sample reported no exercise within the last month. There were no significant differences in amount of exercise by ethnic group. Gardening and walking were the preferred forms of exercise across age, gender, ethnicity, and treatment.

Agreement between participant-rated and compendium-coded intensity of daily activities in a triethnic sample of women ages 40 years and older

Participant-rated and compendium-coded intensity of daily physical activities were compared in 148 African American, 144 Native American, 51 non-Hispanic White women ages 40 to 91 years who completed 4 days of activity records. For compendium-coded intensity, reported activities were classified as light (< 3 metabolic equivalents [METS]), moderate (3-6 METS), or vigorous (> 6 METS) using the Compendium of Physical Activities (1), whereas these categories were self-assigned for participant-rated intensity. Minutes per day (min/d) spent in activities at each intensity level were computed. Relative to compendium-coded min/d, participants reported significantly greater time spent in light (+10 min/d; p < .01) and vigorous (+17 min/d; p < .001) activities, and less time spent in moderate activities (-27 min/d; p <.001). Similarly, compendium-coded estimates yielded higher rates ofparticipants meeting Centersfor Disease Control and Prevention-American College of Sports Medicine and Surgeon General recommendations than participant-rated estimates (11-18% differences) but substantially lower rates meeting American College of Sports Medicine vigorous recommendations (22% difference). Further, 247 greater kilocalories per day were estimated based on compendium-coded intensity. Kilocalories per day estimates based on compendium codings were more highly associated with pedometer counts than those based on participant ratings (p < .05). Studypatterns were generally seen across all sample subgroups. Discrepancies between participant and compendium estimates are likely to be most meaningful in studies estimating energy expenditure as it relates to health outcomes and in studies estimating vigorous activities.

Correlates of physical activity among women from diverse racial/ethnic groups

OBJECTIVE

Women have lower rates of participation in leisure time physical activity than men and have been studied to a lesser extent than men. Because physical activity plays a vital role in overall health, it is important to identify factors than can help increase physical activity rates for women.

METHODS

Defining and understanding correlates of physical activity is critical for at-risk populations and for planning effective interventions. This paper reviews research conducted in the past two decades on correlates of physical activity in women. An ecological model with an added physical environment component was used to organize the correlates. Studies conducted among adult white, black, American Indian, Asian, and Hispanic women are included. A total of 91 studies were reviewed. Many studies included white women, fewer studies included black and Hispanic women, and even fewer included American Indian women, and only 3 studies included Asian women.

RESULTS

The correlates most studied are sociodemographic variables, with nonwhite race, lower educational levels, and older age most consistently associated with lower levels of physical activity. Few studies focused on environmental and policy correlates. Social support was an overwhelmingly positive determinant of physical activity for all groups of women.

CONCLUSIONS

Based on these findings, we recommend that future research include more diverse groups of women and evaluate modifiable factors, such as psychological, interpersonal, and environmental correlates. Future research also should include more intervention and longitudinal studies.

Exercise as a gateway behavior for healthful eating among older adults: an exploratory study

CONTEXT

The relationship between eating and exercise behavior change may influence effectiveness of interventions for older adults.

OBJECTIVE

To determine whether exercise is a potential gateway behavior for healthful eating behavior among older adults.

DESIGN

The Transtheoretical Model was applied to eating and exercise behaviors through the administration of a cross-sectional survey.

SETTING/PARTICIPANTS

205 older adults (the majority were white women) participating in congregate dining programs in a large Midwestern city.

VARIABLES MEASURED

Perceived benefits and barriers, self-efficacy, and stage of change related to exercise and eating habits.

ANALYSIS

Differences in responses to survey items based on stage of change were determined by analysis of variance, P <.05.

RESULTS

Subjects in later stages for exercise behavior were also likely to be in later stages for eating adequate servings of fruit and dairy products but not for vegetables and avoiding fat.

CONCLUSIONS AND IMPLICATIONS

Exercise is a potential gateway behavior for some dietary behaviors for older adults, justifying further controlled, longitudinal research.

Changes and tracking of physical activity across seven years in Mexican-American and European-American mothers

Longitudinal changes in physical activity among 129 Mexican-American (mean age 30.8; SD = 5.6) and 97 European-American (mean age 31.2; SD = 5.4) women were studied. Two physical activity recall interviews were administered at baseline and 7 years later. At baseline, European-American women reported more vigorous leisure activity (p < .005) than Mexican-Americans, and Mexican-Americans reported more moderate work activity (p < .02) than European-Americans. Virtually all components of physical activity increased significantly over the 7 years. Pearson tracking correlations for total energy expenditure were about r = 0.30. The finding that both groups increased physical activity overtime was unexpected and was unrelated to a reduction in the number of preschool children in the homes over time.

Risk factors for exposure to environmental tobacco smoke among ethnically diverse women in the United States

The likelihood of exposure to environmental tobacco smoke (ETS) has been shown to vary across sociodemographic characteristics, health behaviors, and the type of smoking restrictions at work. Women may be particularly at risk. The purpose of our study was to assess differences in the likelihood of exposure to ETS at home and at work among an ethnically diverse sample of women age 40 and older in the United States. We used data from the U.S. Women's Determinants Study and restricted the sample to include only nonsmoking women (n = 2326). Unadjusted and adjusted odds ratios (aOR) for exposure to ETS by sociodemographic characteristics, health risk behaviors, and the type of workplace smoking policy were calculated using logistic regression. Exposure to ETS at home was associated with being American Indian/Alaska Native (aOR 1.5, 95% CI 1.0, 2.6), age 40-44 (aOR 1.6, 95% CI 1.0, 2.6) and 45-54 (aOR 1.8, 95% CI 1.2, 2.6), having eighth grade (aOR 2.1, 95% CI 1.3, 3.6) or high school education (aOR 2.2, 95% CI 1.4, 3.3), inadequate fruit and vegetable consumption (aOR 1.5, 95% CI 1.0, 2.1), and not getting screened for breast cancer (aOR 1.5, 95% CI 1.1, 2.0). Women who did not have regular breast (aOR 1.3, 95% CI 1.9, 1.9) and cervical (aOR 2.0, 95% CI 1.5, 5.3) cancer screening were more likely to be exposed to ETS at work. Exposure to ETS at work was higher among women with some high school education (aOR 2.8, 95% CI 1.5, 5.3) and high school graduates (aOR 3.1, 95% CI 1.9, 5.1) and substantially higher for women who worked where smoking was allowed in some (aOR 15.1, 95% CI 10.2, 22.4) or all (aOR 44.8, 95% CI 19.6, 102.4) work areas. Larger effect sizes were observed for the relationship between selected risk factors and ETS exposure at work than for ETS exposure at home. Among individual risk factors, lower education level was most strongly related to ETS exposure at work. The likelihood of being exposed to ETS at work was highest for women whose workplace smoking policies allowed smoking in some or all work areas.

Environmental and policy determinants of physical activity in the United States

OBJECTIVES

This study examined (1) descriptive patterns in perceived environmental and policy determinants of physical activity and (2) associations between these factors and behavior.

METHODS

A cross-sectional study was conducted from 1999 to 2000 among US adults; individuals at lower income levels were oversampled.

RESULTS

Availability of areas for physical activity was generally higher among men than among women. The 4 most commonly reported personal barriers were lack of time, feeling too tired, obtaining enough exercise at one's job, and no motivation to exercise. Neighborhood characteristics, including the presence of sidewalks, enjoyable scenery, heavy traffic, and hills, were positively associated with physical activity. There was a high level of support for health policy-related measures. Up to one third of individuals who had used environmental supports reported an increase in physical activity.

CONCLUSIONS

An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions.

Attitudes and beliefs about exercise among elderly African Americans in an urban community

Older African Americans are less likely to exercise compared with their white counterparts. Few studies have examined the facilitating factors and barriers to exercise among older African Americans living in urban communities. This study represented the first phase of a program to develop an exercise intervention in an urban community. Qualitative research was conducted to identify culturally determined attitudes that could be useful in designing an effective exercise program. Five focus groups involving 38 persons from a variety of settings were facilitated by trained professionals. Transcripts were analyzed to identify themes and contrasts among group participants. Contrary to the expectations of the investigative team, focus-group participants: (1) uniformly preferred group exercises compared with exercising at home, (2) rejected walking as a feasible option because of safety concerns, and (3) expressed limited interest in using weights or Eastern exercises such as Tai Chi. Concepts and goals of exercise differed according to the physical capabilities of the participants. The analysis of these focus-group discussions provided valuable insights with regard to the development of our community-based exercise-intervention protocol. These findings may be important in designing effective exercise programs for older African Americans in urban settings.

Physical activity in first-degree relatives of breast cancer patients

This study sought to evaluate physical activity in women at moderate risk for breast cancer, the correlates of engaging in regular physical activity, and whether physical activity relates to psychological well-being. The results revealed that 55% of women were regularly active. Logistic regression models indicated that positive affect was associated with increased and negative affect was associated with decreased overall and leisure activity. Older, married, and employed women were more likely to engage in household/occupational activity, whereas women who perceived their risk for breast cancer as high were less likely. More educated women and those with higher perceived risk were more likely to engage in leisure activity, and married women were less likely. These results suggest a need to increase activity levels in women at moderate risk for breast cancer, provide variables upon which interventions can be tailored to promote activity, and point to psychological benefits of activity in this population.

Predictors of older primary care patients' participation in a submaximal exercise test and a supervised, low-impact exercise class

OBJECTIVES

This study is an investigation of physical activity promotion among a nonvolunteer sample of community-dwelling, older, urban primary care patients. Our primary interest was in the rates of exercise test and class participation. Of secondary interest were the medical record and baseline survey predictors of test and class participation.

METHODS

The first 500 nonterminally ill women ages 50 years or more with a visit at one of two predominantly African-American, inner-city primary care clinics received a physician screen, a referral to a submaximal exercise test, and, subsequently, a free, supervised exercise program located in a nearby community center.

RESULTS

Eighty-one percent were eligible for the exercise test per provider screen. Of these, 29% completed the exercise test and 28% attended at least one exercise class. After 1 year, 9.2% were attending the exercise classes. Higher exercise outcome expectations, not smoking, and clinic site were associated with exercise test and class participation.

CONCLUSIONS

Providing free, traditional exercise classes and a primary care referral to the classes resulted in limited physical activity participation among older, urban primary care patients. More development and testing of physical activity promotion programs are needed in this population.

Demographic and psychosocial correlates of physical activity in late life

INTRODUCTION

According to the Centers for Disease Control and Prevention and the World Health Organization, increasing physical activity may help prolong health and preserve the quality of life in late adulthood. Physical activity has taken center stage as the behavior most likely to alter health. However, there is little recent population-wide information about the demographic and psychosocial correlates of physical activity in the elderly population. The purpose of the study was to identify the factors associated with older adults' frequency of physical activity. The study may have implications for preventive interventions.

METHODS

Data for 12,611 community-dwelling people aged > or = 65 from the 1996-1997 Canadian National Population Health Survey were examined. Predictors of frequent versus infrequent self-reported physical activity lasting > 15 minutes were examined using logistic regression analyses. The predictor variables included geographic location, psychological distress (Generalized Distress Scale), demographic factors (age, gender, educational level, and marital status), perceived social support, chronic medical conditions, physical limitations due to injury, functional limitations, smoking behavior, and body mass index (BMI).

RESULTS

Gender (male); younger age; higher levels of education; being unmarried; absence of chronic conditions, injuries, and functional limitations; lower BMI; social support (females); nonsmoking; region; and lower levels of psychological distress were associated with frequent physical activity in late life. Older adults in western Canadian provinces were more active than those in eastern provinces.

CONCLUSIONS

The results will be useful for the design of interventions aimed at improving older adults' health behavior and other health and functional outcomes, especially for subgroups in particular need. Recommendations for further longitudinal research are presented.

Physician advice and support for physical activity: results from a national survey

BACKGROUND

It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey.

METHODS

A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues.

RESULTS

Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor.

CONCLUSIONS

Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.

Quantifying energy expenditure and physical activity in the context of dose response

PURPOSE

Methods for assessing physical activity (PA) and energy expenditure (EE) were reviewed to identify potential limitations to evaluating and interpreting dose-response relationships between PA and health-related outcomes and to suggest future research directions in this area.

METHODS

Literature describing PA and EE assessment methodology was reviewed according to the reported validity, reliability, and feasibility of the measurement in epidemiologic studies. A summary of this review is presented for techniques applicable to studying PA or EE among free-living individuals.

RESULTS

Several methods with varying degrees of precision and feasibility have been used to assess PA and EE in free-living populations. Lack of a gold standard field measure of PA may explain some of the variability in precision among these methods. The most accurate field measure of EE appears to be doubly labeled water; however, this approach has limited feasibility in terms of cost and use in studies of total EE only. Electronic motion sensors and physiologic measures related with EE are limited in their ability to discriminate specific types of PA and by inconvenient measurement procedures. Self-reported PA records and surveys are low-cost, relatively unobtrusive methods of assessing PA and EE in field settings and vary in terms of their format, mode of administration, and degree of detailing habitual PA levels. Disparity in the metric used to quantify PA and EE exists within the current literature, which limits the interpretation and comparison of observed dose-response relationships.

CONCLUSIONS

Efforts to develop equated methods of assessing PA and EE in free-living populations are needed before a systematic evaluation and interpretation of dose-response characteristics between PA and specific health-related parameters can be undertaken.

Immigration and leisure-time physical inactivity: a population-based study

OBJECTIVE

To investigate the relationship between migration status and sedentary leisure-time physical activity status in the city of Malmö, Sweden.

METHODS

The public health survey in 1994 is a cross-sectional study. A total of 5,600 individuals aged 20-80 completed a postal questionnaire. The response rate was 71%. The population was categorized according to country of birth. Multivariate analysis was performed using a logistic regression model to investigate the importance of possible confounders for the differences in sedentary leisure-time physical activity status.

RESULTS

The prevalence of a sedentary leisure-time physical activity status was 18.1% among men and 26.7% among women. The odds ratio of a sedentary leisure-time physical activity status was significantly higher among men born in Arabic-speaking countries, in All other countries, and among women born in Yugoslavia, Poland, Arabic-speaking countries, and the category all other countries', compared to the reference group born in Sweden. The multivariate analysis including age, sex, and education did not alter these results.

CONCLUSION

There were significant ethnic differences in leisure-time physical activity status. This is a CVD risk factor that could be affected by intervention programs aimed at specific ethnic subgroups of the population.

African-American women have higher initial HbA1c levels in diabetic pregnancy

OBJECTIVE

African-American women with diabetes are at greater risk for poor glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care.

RESEARCH DESIGN AND METHODS

HbA1c levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbA1c levels above the median for the group.

RESULTS

The median HbA1c level for the group was 8%. HbA1c levels were 8.7 +/- 2.0% in African-Americans and 7.7 +/- 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbA1c when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity, insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbA1c was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001).

CONCLUSIONS

We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.

Knowledge, beliefs, and risk factors for osteoporosis among African-American and Hispanic women

The purpose of this work was to develop and conduct a needs and risk instrument to assess knowledge of osteoporosis risk factors, identify beliefs and attitudes about this disease, and delineate the presence and/or absence of healthy behaviors associated with osteoporosis among African American and Hispanic women. The survey findings suggest that African-American and Hispanic women are not well-versed in behaviors that would promote and maintain optimal bone mass. Consequently, they are not practicing appropriate lifestyle and dietary habits to decrease their risk of osteoporosis. Such behaviors include inadequate physical activity, inadequate calcium intake, cigarette smoking, and long-term steroid use. Less than 10% of women in the study were getting adequate daily dietary calcium intake, with only 13% taking daily calcium supplements to augment this deficit and less than one-half of women exercising at a minimal level (20 minutes/3 times a week). Women in this study also had limited knowledge about osteoporosis, perceived this condition to be less of a health threat as compared to breast cancer, heart disease, diabetes, and Alzheimer's disease, and very few had the perception that being Hispanic or African American was a factor to consider in assessing their risk of osteoporosis. Our findings suggest that osteoporosis education and prevention initiatives are needed, specifically for African-American and Hispanic women, to promote healthy behaviors, identify women at-risk, and encourage early diagnosis and treatment.

Occupation, hours worked, and leisure-time physical activity

BACKGROUND

International research indicates that blue-collar employees typically exhibit lower rates of leisure-time physical activity. While "lack of time" and "work demands" are commonly reported barriers to activity, the extent to which time-at-work mediates the relationship between occupation and leisure-time physical activity is unclear. This study investigated the association between occupation, time spent in paid employment, and participation in leisure-time physical activity.

METHODS

This was a secondary analysis of cross-sectional data from the 1995 Australian Health Survey, focusing on employed persons ages 18-64 years (n = 24, 454). Occupation was coded as per the Australian Standard Classification of Occupations and collapsed into three categories (professional, white-collar, blue-collar). Hours worked was categorized into eight levels, ranging from 1-14 to more than 50 h per week. Participation in leisure-time physical activity was categorized as either insufficient or sufficient for health, consistent with recommended levels of energy expenditure (1600 METS-min/fortnight). The relationship between occupation, hours worked, and leisure-time physical activity was examined using logistic regression. Analyses were conducted separately for male and female, and the results are presented as a series of models that successively adjust for a range of potential covariates: age, living arrangement, smoking status, body mass index, and self-reported health.

RESULTS

Individuals in blue-collar occupations were approximately 50% more likely to be classified as insufficiently active. This occupational variability in leisure-time physical activity was not explained by hours worked. There was a suggested relationship between hours worked and leisure-time physical activity; however, this differed between men and women, and was difficult to interpret.

CONCLUSIONS

Occupational variability in leisure-time physical activity cannot be explained by hours worked. Therefore, reports that work constitutes a barrier to participation should be explored further. Identification of the factors contributing to occupational variability in leisure-time physical activity will add to our understanding of why population subgroups differ in their health risk profiles, and assist in the development of health promotion strategies to reduce rates of sedentariness and health inequalities.

Measuring physical activity with the behavioral risk factor surveillance system

PURPOSE AND METHODS

Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity.

RESULTS

Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)).

CONCLUSIONS

Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.

Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States

STUDY OBJECTIVE

Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA.

DESIGN

A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques.

PARTICIPANTS

Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study.

MAIN RESULTS

Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09).

CONCLUSIONS

Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women

Personal, program-based, and environmental barriers to physical activity were explored among a U.S. population-derived sample of 2,912 women 40 years of age and older. Factors significantly associated with inactivity included American Indian ethnicity, older age, less education, lack of energy, lack of hills in one's neighborhood, absence of enjoyable scenery, and infrequent observation of others exercising in one's neighborhood. For all ethnic subgroups, caregiving duties and lacking energy to exercise ranked among the top 4 most frequently reported barriers. Approximately 62% of respondents rated exercise on one's own with instruction as more appealing than undertaking exercise in an instructor-led group, regardless of ethnicity or current physical activity levels. The results underscore the importance of a multifaceted approach to understanding physical activity determinants in this understudied, high-risk population segment.