A review of relationships between active living and determinants of health

Association between engagement in cultural activities and use of general practitioner consultations: 7-year follow-up of adults from the HUNT study, Norway

OBJECTIVE

Assess whether engagement in a range of cultural activities, both 'passive' and 'active' (ie, receptive and creative) participation, is associated with later demand for general practitioner (GP) consultations.

DESIGN

Longitudinal prospective cohort study.

SETTING

Data from the population-based the third Survey of Trøndelag Health Study (2006-2008) in Norway was linked to an administrative register including service information from all GP offices nationwide.

PARTICIPANTS

This study included 17 396 (54.6%) women and 14 451 (45.4%) men aged 30-79 years.

MAIN OUTCOME MEASURES

Multilevel negative binomial regression models assessed the relationship between cultural engagement and GP consultations, and reported as rate ratios.

RESULTS

A mean of 3.57 GP visits per patient was recorded during the 7 years of follow-up. Participation in creative activities and a combination of both receptive and creative activities was associated with lower number of GP consultation. Gender-specific analyses suggest that these effects were attributable to men. The rate ratio of GP consultations among men taking part in creative activities less than once, twice and more than twice (<9 times) per week is 0.90, 0.89 and 0.87 times lower, respectively, compared with non-participants. Whereas weekly frequency of receptive and creative activity engagement showed a 0.92, 0.87 and 0.83 times lower rate ratio among engaged men. The variety of activities shows a similar pattern and participation in creative activities lowers the rate ratio among men. Engagement in a wide range/variety of activities, compared with non-engagement, was associated with lower numbers of GP consultations in men, but not women.

CONCLUSIONS

Engagement in creative or combined receptive and creative cultural activities was associated with lower numbers of GP consultations among men. Thus, facilitating and promoting a culturally engaged lifestyle, particularly in men, may affect primary healthcare use. However, this study design gives no evidence of a causal relationship between cultural engagement and use of GP consultations.

Relative Effects of Demographic, Psychological, Behavioral, and Social Factors on the Initiation and Maintenance of Leisure-time Physical Activity: Results From a Confirmatory Path Analysis in a Longitudinal Study

Background

There is a lack of evidence of the complicated pathways of underlying determinants in the phases of physical activity. The purpose of this study was to evaluate simultaneously a set of potential determinants on the initiation and maintenance phases of leisure-time physical activity (LTPA).

Methods

The longitudinal data of 54,359 Korean adults aged 40–69 years from the Health Examinees study were used. The median follow-up duration was 4.2 years. The self-reported durations per week of LTPA was repeatedly assessed. Based on previous longitudinal studies, the potential determinants were selected, and hypothetical models were constructed that consider the complex associations between the determinants. The standardized coefficients for direct and indirect effects were estimated using path analysis to differentiate contributions of mediation from the total effects.

Results

In the total population, age, education, chronic diseases, smoking, depression symptoms, and self-rated health were significantly associated with both initiation and maintenance phases. Income (B = 0.025) and social supports (B = 0.019) were associated only with the initiation phase. Waist-to-hip ratio (B = −0.042) and stress (B = −0.035) were associated only with the maintenance phase. After stratifying by sex, the significant effects of education, chronic diseases, and smoking were found only in men. The initiation phase-specific effects of income and social supports and the maintenance phase-specific effects of stress were found only in women. It was estimated that indirect effects contributed approximately 15% of the total effect.

Conclusion

The findings suggested that there were initiation- or maintenance-specific determinants of leisure-time physical activity according to sex.

Determinants of Leisure-time Physical Activity and Future Intention to Practice in Spanish College Students

Few studies analyze determinants and patterns of physical activity among college students, so it has not been possible to carry out effective interventions to promote this practice. The aim of this study was to analyze the associations between some personal, social, and environmental determinants, practice of physical activity and future intention to practice in a sample of 639 university students (321 men and 318 women), mean age 21.43 years (± 2.78). Physical fitness self-perception, physical activity history, and coach's support to practice physical activity have a direct effect on the practice of physical activity and an indirect effect on future intention to practice, both in men and women. The practice of physical activity has also a direct effect on future intention to practice. Likewise, the participation in sport competitions predicts practice of physical activity and future intention in men, whereas being a member of a sports club predicts practice and future intention in women.

Prática de atividade física por adolescentes de Fortaleza, CE, Brasil

O objetivo da pesquisa foi conhecer os hábitos cotidianos, relacionados à prática de atividade física, em 307 estudantes entre 12 e 17 anos, de seis escolas privadas, de Fortaleza - Brasil, entre os meses de março e junho de 2007. Foi aplicado um formulário para registrar sedentarismo, IMC, pressão arterial e glicemia. Para análise das proporções foi utilizado o teste do Qui-quadrado. Cerca de 68% dos jovens eram inativos. O sedentarismo foi maior nos pesquisados do sexo feminino (p=0, 000) e naqueles com excesso de peso (p=0,001). Entre os adolescentes ativos o exercício físico mais praticado era o futebol (42%) e a musculação (19%). A educação em saúde nas escolas pode auxiliar no combate desse sedentarismo juvenil.

Predictors of changes in physical activity in a prospective cohort study of the Danish adult population

AIM

To investigate predictors of changes in physical activity, in a prospective population-based study.

METHODS

Data were from the Danish Health Interview Surveys in 1994 and 2000, and included persons between 16 and 64 years of age who answered the questions on physical activity and various covariates in 1994, and who were re-interviewed in 2000. In total 2,957 subjects participated (62% of the original sample). Data were analysed using logistic regression.

RESULTS

Predictors of physical inactivity were, for men and women respectively, heavy smoking (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.24-3.48, and OR 2.23, 95% CI 1.34-3.71), poor self-rated health (OR 2.11, 95% CI 1.25-3.58, and OR 1.75, 95% CI 1.10-2.80), and believing that one's own effort has no effect on health (OR 1.86, 95% CI 1.20-2.88, and OR 1.63, 95% CI 1.00-2.65). For men, further predictors for physical inactivity were obesity as compared to normal weight (OR 2.10, 95% CI 1.11-3.98), and being unmarried as compared to being married (OR 2.22, 95% CI 1.40-3.51). The only predictor for becoming physically active among initially sedentary respondents was meeting often with family (p=0.011).

CONCLUSIONS

Our results show a number of strong predictors for physical inactivity. Variables of an unhealthy lifestyle tend to cluster in some individuals, and physical inactivity interventions may therefore be more successful if they also address smoking, self-belief, and obesity. Interventions tailored to raise inactive people's level of activity should focus on social support from the family.

An exploration of walking behaviour--an interpretative phenomenological approach

The aim of this study was to provide a rich and detailed account of participants' experiences of walking using the qualitative method of interpretative phenomenological analysis. Participants were a snowball sample of 10 members of the UK general public, aged 25-35 years, with equal numbers of males and females. Participants reported walking as not being "proper" exercise, and that it is not a goal in itself. Factors that participants cited as making walking easier included the functionality of walking for transport, contextual factors of social support and psychological benefits. Perceived lack of time was cited as an inhibitory barrier to walking. Participants' perceptions of walking were incongruent with current health promotion campaigns. There is a need to address the misconception that walking is not proper exercise. The traditional focus of walking promotion campaigns concerns beliefs about the benefits of walking on health. People engage in healthy behaviour for reasons other than to be healthy. Interventions to promote walking should consider targeting the psychological meaning and value of walking, in addition to beliefs about health.

Stages of change for moderate-intensity physical activity in deprived neighborhoods

BACKGROUND

This article describes the association of external and psychosocial factors with the stages of change for moderate-intensity physical activity among individuals with generally low socioeconomic positions.

METHODS

A self-administered questionnaire among individuals aged 18-65 years (response rate 60%, n = 2781) in deprived neighborhoods in Eindhoven, The Netherlands, was conducted in September 2000. To identify factors associated with stages of change an ordinal logistic regression model, the "Threshold of Change model (TCM)", was used to analyze the data.

RESULTS

Thirty-six percent of the respondents were in the pre-action stages, 15% was in action and 49% in maintenance. Individuals who were, older, lower educated, had low health locus of control, had less knowledge of physical activity issues, and presented other risky health behaviors, were more likely to be in a lower stage of change category. A positive attitude, high self-efficacy expectations, perceiving the physical activity level of others as high, and much social support were associated with the higher stages of change categories.

CONCLUSION

The distribution across the stages of change supports the need to improve physical activity behavior in these deprived neighborhoods. Interventions need to be tailored to the psychosocial, and the external factors that are likely to play a role in the behavioral change process.

Recreation for children on social assistance, 4–17 years old, pays for itself the same year

A randomized control trial completed in the Hamilton-Wentworth and Halton regions of Ontario, Canada, was created to assess the effects and expense of age-appropriate provider-initiated and subsidized versus self-directed and self-financed methods of recreation. Upon completion, this study proved that the annual per-person expenditure for the subsidized, quality recreation paid for itself by children's lower use of healthcare and social services. The children within the subsidized recreation group had lower use of physician, physiotherapy, probation, children's aid society, social work, psychologist and services in comparison with those in the non-subsidized group. The subsidized group also proved to be beneficial for the parents as well. The use of health and social services, by the parents in the subsidized group, was also decreased in comparison with those of the self-financed group. This group also proved to have improvement of the global socioeconomic status, with a 10% greater exit from the social assistance program within 1 year.

Situations influencing habits in diet and exercise among nurses working night shift

OBJECTIVES

The aim of the investigation was to describe situations with a significant influence on healthy diet and exercise habits among nurses working night shift.

METHODS

A qualitative descriptive design with a Critical Incident Technique approach was used. Situations were collected by means of interviews with 27 registered/enrolled community nurses.

RESULTS

A total of 143 situations were identified comprising two main areas: coping ability at work and coping ability during leisure hours. Coping ability at work included 81 critical incidents grouped into two categories: the nurses' diet and exercise habits were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm. Coping ability during leisure hours included 62 critical incidents grouped into two categories: the diet and exercise habits were influenced when the nurses recovered from the disruption to their circadian rhythm and when they took advantage of the freedom of action offered by night work.

CONCLUSIONS

By identifying the factors that influence diet and exercise habits among nurses working night shift, strategies can be developed in order to strengthen the factors with a positive influence.

‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice

With the geographical literatures and issues outlined in the first paper very much in mind, this paper focuses specifically on the places in the concepts and locales of gerontological nursing practice. Particular attention is paid to the role of nurses in the making of long-term care institutions and to some fundamental priorities of care. Consideration is also given to some broader impacts of neighbourhood and community as an important spatial context to nursing practice based both in institutions and the community. In the final section, the paper makes some observations on how place-sensitive practice and research might contribute to the uptake of evidence for practice. These discussions set the scene for the final paper in this special section focused on the future research agenda for place and older people nursing.

Explaining educational-related inequalities in health: Mediation and moderator models

This paper studies how education and certain lifestyle factors affect people's self-reported health. In addition to the assessment of the effects of education and lifestyle, the study contrasts two models of explaining educational-related health inequalities: the mediation model and the moderator model. The mediation model posits that well-educated people's better health, as compared to the poorly educated, is caused by their more 'healthy' lifestyles. The moderator model suggests, by contrast, that the effects of the lifestyle variables on health are dependent upon educational level. Several analyses are carried out on two large data sets comprising of middle-aged men and women in two Norwegian counties, Rogaland and Nordland. Two main findings are presented: (1) Both education and lifestyle factors have the expected effects on health. (2) The results do not permit a clear-cut conclusion as to which of the two models of educational-related health inequalities should be preferred: whereas the results support the mediation model in the data from Rogaland, the moderator model is partially supported in the Nordland data.

Linking active living and nutrition counselling: dietitians' perceptions

Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.

Promoting participation: evaluation of a health promotion program for low income seniors

This article describes a qualitative evaluation of the Seniors Active Living in Vulnerable Elders (ALIVE) program, a 10-month health promotion program for low income seniors. Program interventions delivered in seniors' apartment buildings included exercise classes, health information sessions (i.e., health corners), and newsletters. The evaluation examined program participation, program impacts, and how the program worked. The most frequent reason for joining the program was recognizing the benefits of exercise, and the most frequent reason for not attending the program was having other priorities. The main participant impact was "feeling better." Specific impacts were also noted in physical, mental, and social domains. Fun, program delivery adaptations, autonomy, social interactions, and staff-participant relationships were discovered to be important program processes. These processes all contributed to participant's "comfort" in the program. How and why the program worked is examined in relation to Pender's (1996) revised health promotion model and implications for nursing are indicated.

Beyond the "fetishism of words": considerations on the use of the interview to gather chronic illness narratives

The author explores the technique of interviewing chronic illness patients to obtain narratives of their illness experiences. It is argued that the perspective that interview responses are accurate reflections of experience (the "fetishism of words") hampers the understanding of patient voice and agency. Discussions of chronic illness and narrative are followed by an examination of the interview based on the work of Charles L. Briggs. The author then uses the concepts of self-presentation and social support to examine what interviewers and interviewees contribute to the coconstructed discourse that is produced by the interview and addresses the question of how these concepts contribute to the beneficial outcomes of constructing narratives. The author offers specific suggestions for future research.

When the bough breaks: provider-initiated comprehensive care is more effective and less expensive for sole-support parents on social assistance

This 5-year study conducted in Ontario, Canada is designed to assess the effects and expense of adding a mix of provider-initiated interventions to the health and social services typically used in a self-directed manner by sole-support parents and their children receiving social assistance in a national system of health and social insurance. Results from a 2-year interim analysis show that providing social assistance families with proactive comprehensive care (health promotion, employment retraining, and recreation activities for children) compared to allowing families to fend for themselves in a self-directed manner, results in 15% more exits from social assistance within 1 year and substantial savings to society in terms of social assistance payouts. It is no more expensive to provide health and social services in a comprehensive fashion, and equivalent reductions in parent mood disorder and child behavior disorders, as well as equivalent increases in parent social adjustment and child competence levels were also observed. This study presents clear evidence that providing comprehensive care to social assistance recipients produces tremendous short- and long-term financial gains and societal benefits.

General social support and physical activity: an analysis of the Ontario Health Survey

In spite of the many benefits of regular physical activity, the majority of Canadians are sedentary. This paper examines the relationship between general social support and physical activity levels. An analysis of data on 29,135 individuals from the 1990 Ontario Health Survey was conducted. Hierarchical multiple regression was used to determine the relationship between measures of general social support, derived from factor analysis, and physical activity levels. Sociodemographic and perceived health status measures were included as control variables. The results showed that general social support, in the form of Social Quantity and Social Frequency (number of friends/family members and frequency of contact), was significantly associated with higher levels of physical activity. Conversely, support in the form of Familial Structure (marital/cohabitation and parental status) was significantly associated with lower levels of physical activity. The findings indicate the types of general social support that facilitate or hinder participation in physical activity.

Religious preference, church activity, and physical exercise

BACKGROUND

Utah has the highest percentage of physically active adults in the United States. It also has a high percentage of religiously active people. About 90% of the adult population has a religious preference and 62% of those individuals attend church weekly. This study evaluates the relationship between religious preference, church attendance, and physical activity.

METHODS

Analysis is based on 6,188 adult respondents ages 18 years and older to a cross-sectional random telephone survey involving 12 health districts in the state of Utah from June 1 to August 31, 1996.

RESULTS

Within religious groups, those attending church weekly were more likely to exercise than individuals attending church less than weekly. About 70% of Utah consists of members of the Church of Jesus Christ of Latter-day Saints (LDS). LDS attending church less than weekly were least physically active in Utah. The percentages of those exercising vigorously at least 20 min three times per week were 52.3% (LDS who attend church weekly), 44.5% (LDS who attend church less than weekly), 57.6% (non-LDS who attend church weekly), 54.3% (non-LDS who attend church less than weekly), and 53.1% (no religious preference) (P = 0.0070). When adjustment was made for age, smoking status, education, marital status, and general health, differences in exercise between church activity levels within religious groups became insignificant. Smoking and general health have the greatest influences on the relationship between religious preference, church attendance, and exercise. LDS were significantly less physically active than non-LDS in the adjusted model.

CONCLUSIONS

Although differential smoking levels and general health status explained differences between church activity levels within religious groups, lower levels of exercise among LDS versus non-LDS could not be explained and require further study.

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

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