Health cognitions mediate physical (in)activity and walking in midlife women

Menopause as a window of opportunity: the benefits of designing more effective theory-driven behaviour change interventions to promote healthier lifestyle choices at midlife

Menopause is a natural developmental phase that all women go through from their early forties to mid-fifties, marking the transition from the reproductive to the non-reproductive years. This is characterised as the permanent cessation of menses due to progressive ovarian failure. Each woman's experience of the menopause is unique. Biopsychosocial changes occur during this time with some symptoms affecting up to 80 % of women and lasting for 4-5 years from the peri- to post-menopause. Reduced oestrogen may predispose some women to health issues following menopause, such as heart disease, diabetes, stroke and cognitive decline. It is vital to understand how to promote health and well-being to reduce the risk of developing chronic conditions in later life. Increased symptoms and concerns about health during the menopausal transition can be cues to action for some women to actively maintain their health. Menopause represents a window of opportunity to promote health, and to support women to make healthier lifestyle choices, part of the National Institute for Clinical Excellence guidelines for menopause management. Identifying appropriate strategies to change behaviour is less clear. Theories of behaviour change can provide frameworks to gain more insight into the facilitators and barriers to behaviour and can inform the researcher on what needs to change. This information can be used to inform the design, content, implementation and evaluation of a lifestyle intervention. This review paper will explore the impact of menopause on health and well-being generally, and the benefits of designing more effective theory-driven behaviour change interventions for menopause.

Social capital and health beliefs: Exploring the effect of bridging and bonding social capital on health locus of control among women in Dhaka

This cross-sectional study examined if social capital affects women's health attributions. The study used the Internet Social Capital Scale (ISCS) and Multidimensional Health Locus of Control (MHLC) Scale to measure Social Capital and Health Locus of Control. A predefined 38-item questionnaire was used to survey 485 purposively selected women. A bidirectional reciprocal structural equation model was used to measure the covariance between Social Capital and Health Locus of Control. We hypothesized that women with strong social capital, particularly those rich in bridging ties, would exhibit a greater sense of agency and empowerment over their health, attributing their health outcomes less to internal factors like fate and more to external influences like powerful others and broader social support. However, we found that when women have higher social capital, their external health locus of control increases. Bridging and bonding social capital lower women's internal health control, but bridging social capital leads to higher attributes to powerful others. Likewise, we expected women with more social capital would exhibit a lower perception of uncontrollability over their health, but is not the case. The findings underscore the necessity for women to have more social capital.

Attitudes, Barriers, and Motivators Toward Daily Walking and a Mobile App to Increase Walking Among Women: Web-Based Anonymous Survey

BACKGROUND

There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking.

OBJECTIVE

This study explores the relationship between age and women's self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women.

METHODS

A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women's perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments.

RESULTS

Significant barriers to daily walking were observed in the 21-49-year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49-year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75-year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women's walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart.

CONCLUSIONS

Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women's ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages.

Ecological Momentary Assessment of Associations Between Social Interactions and Physical Activity Outcomes Among Women in Midlife With CVD Risk Conditions

BACKGROUND

Risk for cardiovascular disease is particularly high among women in midlife (ages 40-60). Moderate-to-vigorous-intensity physical activity (PA) can protect against risk during this time, and research is needed to understand contributors to PA motivation and behavior in daily life.

PURPOSE

This study used ecological momentary assessment to examine: (a) within-person associations between social interactions (both quantity and quality) and PA outcomes (motivation and behavior) among women in midlife, and (b) variability in within-person associations across days.

METHODS

Women ages 40-60 with one or more cardiovascular disease risk conditions (e.g., hypertension; n = 75; MAge = 51.6 years, MBMI = 34.0 kg/m2) wore waistband accelerometers and completed five surveys per day for 10 days.

RESULTS

Controlling for social interactions overall, at times when women reported a higher number of positive interactions, they reported higher PA motivation; this association was negative for both the number and valence of negative interactions. At times when women experienced a higher number of interactions overall, they engaged in fewer subsequent minutes of moderate-to-vigorous-intensity PA, though reports of positive and negative interactions were not associated with moderate-to-vigorous-intensity PA behavior. Importantly, the direction of these within-person associations differed between days of observation (positive associations on ~50% of days and negative associations on ~50% of days).

CONCLUSIONS

Findings show that social interactions influence PA motivation and behavior among women in midlife but that these influences are inconsistent, suggesting the need for careful consideration of how to engage social interactions to promote PA in this group.

The impact of physical activity on psychological well-being in women aged 45-55 years during the Covid pandemic: A mixed-methods investigation

Evidence suggests that being physically active may improve quality of life through the menopausal transition. This study is one of the first to investigate how meeting the UK Physical Activity Guidelines (PAG) impacted quality of life, stress, coping and menopausal symptoms in UK midlife women, aged 45-55 years, during the unfolding Covid pandemic (Phase 1 quantitative, n=164). The study also explored their motivation to undertake regular physical activity during Covid lockdown (Phase 2 qualitative, n=4). An explanatory sequential mixed-methods design was used to collate quantitative (survey) and qualitative (focus group) data. Participants who met PAG experienced fewer depressive symptoms and less perceived stress, and had better physical and mental health and quality of life than women who did not. This was supported by focus group discussions reporting lack of facilities, time constraints, reduced social support and existing health complaints as barriers to physical activity. Factors motivating women to exercise during Covid lockdown were benefits for physical and mental health, and support from friends (Qualitative). Women are postmenopausal for one-third of their lives, and health interventions need to promote positive healthy ageing around menopause. Menopausal changes could be used by clinicians as cues to action to promote female health and well-being. Clinicians should be promoting the health benefits of exercise and making women aware of the importance of aiming to meet the PAG for optimal health benefits. Women should be encouraged to increase their levels of physical activity by making plans and setting goals and gaining support by exercising with friends or family, as a way to better control menopausal symptoms.

Residents' Physical Activities in Home Isolation and Its Relationship with Health Values and Well-Being: A Cross-Sectional Survey during the COVID-19 Social Quarantine

The objective of the present study was to examine the associations between residents' physical activity, health values, and well-being during isolation. On the basis of the physical activity rating scale, health values scale, subjective well-being scale, and the satisfaction with life scale, we collected 505 valid questionnaires online from 31 provinces, municipalities, and autonomous regions in China. A series of multiple linear regression models were established to study the relationship between variables, and the bootstrap confidence interval was selected to test the mediating effect. The results showed that during the period of isolation, physical activity directly (b = 0.463, p < 0.001) or indirectly (b = 0.358, p < 0.001) had a positive impact on residents' well-being through the mediating effect of health values. There was a positive correlation between physical activity and health values (b = 0.710, p < 0.001), while health values had a direct positive association on well-being (b = 0.504, p < 0.001). In addition, a moderate amount of physical activity was found to be more associated with the well-being of residents during home isolation compared to small and large amounts of physical activity. This study shows the importance of residents' physical activities in home isolation. Moderate exercise at home and regular physical activity are beneficial to our physical and mental health, especially in terms of improving overall well-being.

A multi-study approach to refining ecological momentary assessment measures for use among midlife women with elevated risk for cardiovascular disease

BACKGROUND

Ample evidence indicates that everyday perceptions of the social environment can affect health behaviors; these include social comparisons (i.e., self-evaluations compared to others) and positive versus negative social interactions. However, relations between social perceptions and healthy behaviors have received little attention among specific medical populations for whom an improved understanding of behavioral determinants could inform updates to tailored interventions. Research methods that capture and differentiate between stable, person-level differences and dynamic, within-person variability in these relations would be particularly useful, both for identifying their nature in daily life and informing improvements to tailored interventions.

METHODS

We conducted a series of three formative research studies to adapt and test the measures and instructions for an ecological momentary assessment (EMA) protocol with midlife women who had elevated risk for cardiovascular disease (CVD; e.g., current diagnosis of hypertension, type 2 diabetes). Study 1 involved a pilot test of initial EMA items, sent to participants' smartphones 5 times per day for 7 days (N=13; M_Age =47, M_BMI =33.7 kg/m²), as well as brief exit interviews to identify points of confusion and suggestions for improvement. Study 2 used 1-hour, individual qualitative interviews with a new sample to elicit women's perceptions of revised items and identify additional opportunities for refinement (N=10, M_Age =52, M_BMI =29.8 kg/m²). In Study 3, a new sample of participants completed 7 days of EMA with revised items and instructions (5 times per day; N=13, M_Age =50, M_BMI =33.4 kg/m²).

RESULTS

Item performance in Study 3, including the frequencies of reporting social comparisons and interactions, was compared to that in Study 1 using multilevel modeling; these tests showed meaningful improvement in reporting patterns between Studies 1 and 3 (e.g., changes of d=0.33-0.75 where appropriate).

CONCLUSIONS

Together, findings from this series of studies demonstrate the utility of a multi-study approach to refining EMA methods for use with midlife women who have elevated CVD risk, which may generalize to other populations of interest.

Perception of health, health behaviours and the use of prophylactic examinations in postmenopausal women

BACKGROUND

Pro-health behaviours aim at disease prevention, recovery from an illness and maintenance of good health in a physical, mental and social sphere. The study had two main objectives: (a) to analyse health behaviours of postmenopausal women and their understanding of the notion of health, and (b) to analyse the relationship between individual categories of health behaviours and prophylactic activities undertaken by postmenopausal women.

METHODS

A cross-sectional study was conducted among a convenience sample of 510 postmenopausal women. Three study instruments were used: an original questionnaire and two instruments designed by Juczyński: the List of Health Criteria and the Health Behaviour Inventory.

RESULTS

In the view of the respondents health was primarily synonymous with a feature, because the following three associations were given the highest priority when defining health: to be healthy means 'have all body parts functioning well' (M = 1.82), 'do not experience any physical problems' (M = 1.43) and 'not be sick, only occasionally suffer from flu, cold or indigestion'. The score for health behaviours was average (M = 86.18). The highest score was achieved in the area of prophylactic behaviours. General indicator of health-related behaviours was higher in women who rated their health as very good (p < 0.05). Women whose general indicator of health-related behaviours was higher regularly performed prophylactic gynaecological examinations (p < 0.05).

CONCLUSIONS

Results showed that women after menopause treat health mainly as a feature of their body and condition specific for this period of life. The analysis of postmenopausal women's health behaviours and their perception of health helped to identify areas that require the focus of medical personnel in regard to health promotion and prophylaxis. The average general indicator of health-related behaviours is positive for this group of women as it shows that they care about their health, especially in terms of prophylaxis.