Weight status and perception barriers to healthy physical activity and diet behavior

Physical activity self-efficacy online intervention for adults with obesity: protocol for a feasibility study

BACKGROUND

Even without weight loss, adults with obesity can greatly benefit from regular physical activity. The Physical Activity Self-efficacy (PAS) intervention is an online behavioral intervention newly developed to promote physical activity in adults with obesity by providing capability-enhancing learning opportunities. The objective of this manuscript is to describe the protocol for a feasibility study designed to investigate the feasibility and acceptability of implementing the PAS online intervention for adults with obesity recruited from a local weight management center in the United States of America (USA).

METHODS

The study design is a prospective, double-blind, parallel-group individual randomized pilot trial. Thirty participants will be randomly assigned to the PAS group or usual care group to achieve a 1:1 group assignment. Recruitment of participants is scheduled to begin on 1 March 2024 at a local weight management center within a private healthcare system in the USA. There are six eligibility criteria for participation in this study (e.g., a body mass index ≥ 25.00 kg/m2). Eligibility verification and data collection will be conducted online. Three waves of data collection will take up to 14 weeks depending on participants' progress in the study. The primary feasibility outcomes in the study will be: (a) participation rate, (b) engagement behavior, and (c) a preliminary effect size estimate for the effect of the PAS intervention on physical activity. Instruments designed to measure demographic information, anthropometric characteristics, self-efficacy, and acceptability will be included in the survey battery. A research-grade accelerometer will be used to measure free-living physical activity objectively. Data will be analyzed using descriptive statistics and inferential statistical models under an intention-to-treat approach.

DISCUSSION

Results are intended to inform the preparation of a future definitive randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05935111, registered 7 July 2023.

A Systematic Review of eHealth Interventions to Promote Physical Activity in Adults with Obesity or Overweight

Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant’s survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages—most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.

Acute Effects of Whole-Body Electromyostimulation on Energy Expenditure at Resting and during Uphill Walking in Healthy Young Men

The effects of the different electrical frequencies of whole-body electrical stimulation (WB-EMS) on energy expenditure (EE) and the respiratory exchange ratio (RER) remain poorly understood. This study aimed to determine the effects of different WB-EMS electrical frequencies on EE and the RER during supine resting and uphill walking. A total of 10 healthy and recreationally active men (21.6 ± 3.3 years old) participated in the present study. Participants completed two testing sessions in a randomized order. In each session, a variety of impulse frequencies (1 hertz (Hz), 2 Hz, 4 Hz, 6 Hz, 8 Hz, and 10 Hz) were applied in a randomized order, allowing a 10 min passive recovery between them. Oxygen consumption and carbon dioxide production were measured to calculate EE and the RER. All frequencies increased EE at rest (all p ≤ 0.001), with 4 Hz being the frequency producing the highest increase (Δ = 8.89 ± 1.49 kcal/min), as did 6 Hz (Δ = 8.05 ± 1.52 kcal/min) and 8 Hz (Δ = 7.04 ± 2.16 kcal/min). An increment in the RER at rest was observed with 4 Hz, 6 Hz, 8 Hz and 10 Hz (all p ≤ 0.016), but not with 1 Hz and 2 Hz (p ≥ 0.923). During uphill walking, the frequency that elicited the highest increase in EE was 6 Hz (Δ = 4.87 ± 0.84 kcal/min) compared to the unstimulated condition. None of the impulse frequencies altered the RER during uphill walking. WB-EMS increases EE in healthy young men both during resting and uphill walking.

Can Assessing Physical Activity Liking Identify Opportunities to Promote Physical Activity Engagement and Healthy Dietary Behaviors?

Improving our understanding of what physical activities are enjoyed and the factors that are associated with physical activity liking can promote participation in regular physical activity. We aimed to study physical activity (PA) liking in college women by modelling interactions between body size perception and dietary behaviors on PA liking, and by examining discrepancies between PA liking versus engagement on body size perception and dietary behaviors. Women (n = 251; 74% white) utilized an online survey to report their level of liking for PA types (scored into a PA liking index) and frequency of PA participation. They also reported their perceived body size, level of dietary restraint, and frequency of consuming foods (scored into a diet quality index). In multivariate analyses, a greater perceived body size was directly associated with lower PA liking and indirectly through greater dietary restraint but lower diet quality. Healthiest dietary behaviors were reported by women who both liked and engaged in PA. Women who reported high PA liking but low PA participation reported a higher dietary restraint and lower diet quality. These findings support the empowerment of women across all body sizes to identify physical activities that they enjoy. Health promotion efforts should encourage women to couple physical activity liking and engagement with a healthy level of dietary restraint and consumption of a healthy diet.

Sociodemographic characteristics associated with physical activity barrier perception among manual wheelchair users

BACKGROUND

Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers.

OBJECTIVE

We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics.

METHODS

Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers.

RESULTS

Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r²≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r²=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064).

CONCLUSIONS

Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.

Adherence to the Mediterranean Lifestyle and Desired Body Weight Loss in a Mediterranean Adult Population with Overweight: A PREDIMED-Plus Study

Background. Body weight dissatisfaction is a hindrance to following a healthy lifestyle and it has been associated with weight concerns. Objectives. The aim of this study was to assess the association between the adherence to the Mediterranean lifestyle (diet and exercise) and the desired body weight loss in an adult Mediterranean population with overweight. Methods. Cross-sectional analysis in 6355 participants (3268 men; 3087 women) with metabolic syndrome and BMI (Body mass index) between 27.0 and 40.0 kg/m² (55–75 years old) from the PREDIMED-Plus trial. Desired weight loss was the percentage of weight that participants wished to lose. It was categorized into four cut-offs of this percentage (Q1: <10%, n = 1495; Q2: 10–15%, n = 1804; Q3: <15–20%, n = 1470; Q4: ≥20%, n = 1589). Diet was assessed using a validated food frequency questionnaire and a 17-item Mediterranean diet questionnaire. Physical activity was assessed by the validated Minnesota-REGICOR and the validated Spanish version of the Nurses’ Health Study questionnaire. Results. Participants reporting higher percentages of desired weight loss (Q3 and Q4) were younger, had higher real and perceived BMI and were more likely to have abdominal obesity. Desired weight loss correlated inversely to physical activity (Q1: 2106 MET min/week; Q4: 1585 MET min/week. p < 0.001) and adherence to Mediterranean diet (Q1: 8.7; Q4: 8.3. p < 0.001). Conclusions. In older Mediterranean individuals with weight excess, desired weight loss was inversely associated with Mediterranean lifestyle adherence. Deeply rooted aspects of the MedDiet remained similar across groups. Longitudinal research is advised to be able to establish causality.

Sweat and Hair: Online Interventions for Improving Physical Activity in African-American Women

Objective

To evaluate the efficacy of an informational website in improving patient knowledge on hair care and exercise.

Design

Pre- and post-exposure surveys, focusing on exercise and hair care practices, were administered to subjects after 1 h of browsing a dermatologist-designed hair care and exercise website.

Setting

Winston Salem State University, a historically Black university in North Carolina, USA.

Participants

22 African-American women (AAW) aged between 18 and 54 years.

Measurements

The outcome measures of the study include patient demographics, hair care practices, knowledge of hair/care disorders, exercise habits, and website feedback.

Results

There were 22 women enrolled in the study with 95% identifying as African-American. The average age was 28 ± 12 years. A total of 80% (16/20) of subjects reported exercising less than 150 min per week, and 36% of these patients reported modifying their hairstyle to accommodate physical activity. 85% learned new information about hair and scalp disorders from the educational material on the website, and 81% had increased understanding of their hair health. 91% reported that they would return to the website.

Conclusion

An informational website can be an effective tool to educate AAW on hair and scalp disease, as well as appropriate hair care practices and fitness goals.

Dieting for weight-control among older adults: The role of perceived health and perceived overweight status

BACKGROUND

Despite the ever-growing literature on weight-control diets, data about dieting among older adults are scarce.

PURPOSE

To describe the prevalence of weight-control dieting across age groups and weight statuses (from healthy-weight to overweight and obese). To identify cross-sectional associations of perceived health and perceived overweight status with dieting among older adults.

METHODS

Secondary analyses of the second and third waves of the Midlife in the US study (MIDUS). Sample included 2588 participants (40-93 years old, 54.5% females, age = 64.4 ± 11.1 years, BMI = 28.3 ± 5.9 kg/m²). Logistic regressions were used to predict dieting across age groups (independent variables: BMI, perceived health, perceived overweight status; covariates: BMI change, education, age, race).

RESULTS

As many as 15% of participants had reported dieting during the previous year. Older age was associated with less dieting among healthy weight (p = .02) and overweight (p < .001) participants, but not among participants with obesity (p = .36). Among participants younger than 75, overweight perception (vs. healthy-weight perception) was linked with higher likelihood for dieting (40-55 years: OR = 3.94[1.70-9.1]; 55-65 years: OR = 4.11[1.91-8.82]; 65-75 years: OR = 4.50[1.90-10.65]). Nevertheless, among participants older than 75, excellent (vs. good/fair/poor) perceived health was linked with higher likelihood of dieting (good vs. excellent: OR = 0.29[0.09-0.87]; fair/poor vs. excellent: OR = 0.12[0.03-0.54]).

CONCLUSIONS

Older age is associated with less weight-control dieting among people without obesity. Although overweight perception may have a stronger impact on dieting during younger age, health perception may have a stronger impact on dieting during older age, suggesting that the motivation behind weight-control diets may potentially change throughout the adult lifespan.

Relationship between Body Image and Body Weight Control in Overweight ≥55-Year-Old Adults: A Systematic Review

Objective: To assess the scientific evidence on the relationship between body image and body weight control in overweight ≥55-year-old adults. Methods: The literature search was conducted on MEDLINE database via PubMed, using terms related to body image, weight control and body composition. Inclusion criteria were scientific papers, written in English or Spanish, made on older adults. Exclusion criteria were eating and psychological disorders, low sample size, cancer, severe diseases, physiological disorders other than metabolic syndrome, and bariatric surgery. Results: Fifty-seven studies were included. Only thirteen were conducted exclusively among ≥55-year-old adults or performed analysis adjusted by age. Overweight perception was related to spontaneous weight management, which usually concerned dieting and exercising. More men than women showed over-perception of body image. Ethnics showed different satisfaction level with body weight. As age increases, conformism with body shape, as well as expectations concerning body weight decrease. Misperception and dissatisfaction with body weight are risk factors for participating in an unhealthy lifestyle and make it harder to follow a healthier lifestyle. Body image disturbance also made it more likely to underreport calorie intake. Conclusions: Aging is associated with a decrease in weight concerns and lower overweight perception, especially in women. However, when designing a program to improve body image in overweight ≥55-year-old adults, three items ought to be considered: physical activity, dietary and behavioral treatments.

Body Mass Index Perception, Body Image Dissatisfaction and Their Relations with Weight-Related Behaviors among University Students

The prevalence of obesity is increasing globally and is linked with poor body image perception. The aim of the present study was to identify the relationships of body image (BI) and body mass index (BMI) with weight control practices among university students. A cross-sectional study on a sample of 308 university students (150 males and 158 females) aged between 18 and 25 years was carried out. Face-to-face interviews were conducted based on a questionnaire that included socio-demographic, physical activity, the Figure Rating Scale (FRS) and body image dissatisfaction (BID) questions. The majority of the participants (81%: 58.2% females and 41.8% males) were dissatisfied with their BI. Females desired to lose weight and preferred diet to exercise, while males desired to gain weight and preferred exercise to diet (p < 0.001). About 56%, 39.5%, and 4.5% of the participants were normal, overweight/obese, and underweight, respectively. There was a significant, strong correlation (R² = 0.84, p < 0.001) between perceived BMI and actual BMI. Actual BMI showed a significant strong correlation with the BID (r = 0.57, p < 0.001). The results highlighted the need to increase awareness of the importance of healthy eating behaviors and regular physical activities to improve body size, shape perception, and satisfaction among college males and females.

A longitudinal investigation of perceived weight status as a mediator of sexual orientation disparities in maladaptive eating behaviors

Sexual minority adolescents are more likely than heterosexual peers to engage in maladaptive eating behaviors such as restrictive dieting. However, prior studies relied on cross-sectional data and did not test potential mechanisms. This study examined longitudinal associations between adolescent sexual minority status and three maladaptive eating behaviors (restrictive dieting, diet pill use, and drug-related dieting) in young adulthood and tested higher perceived weight status as a mediator of observed disparities. Data were drawn from Waves 2 (11th grade in 2010/2011) to 7 (4 years post high school in 2015/2016) of the NEXT Generation Health Study, a U.S. national longitudinal cohort of adolescents (n = 1925). Logistic regression analyses revealed that, relative to heterosexual females, sexual minority females were more likely to report any restrictive dieting (extreme food intake restriction) in the past year (62.9% vs. 37.0%; Adjusted Odds Ratio = 2.26, 95% CI = 1.07, 4.76). Associations between sexual minority status and diet pills use or drug-related dieting were not found. Results from structural equation modeling indicated that higher perceived weight status was a significant mediator of the association between sexual minority status and restrictive dieting among females. These findings highlight higher perceived weight status as an important cognitive mechanism explaining why sexual minority females are at heightened risk for restrictive dieting in young adulthood. To optimally inform prevention efforts, additional research is needed to test the extent to which minority stressors may shape weight perceptions and their contribution to maladaptive and disordered eating behaviors among sexual minority adolescents.

The role of mindfulness in physical activity: a systematic review

Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness-based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the evidence for the potential of mindfulness-based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross-sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness-physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness-based interventions (n = 20) suggested positive between-subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow-up. Mindfulness-based interventions were more likely to be successful if they were physical activity-specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness-physical activity relationship reliably.

Adolescent Body Weight Perception: Association With Diet and Physical Activity Behaviors

To assess the prevalence of weight misperception in American adolescents and its association with diet and physical activity behaviors, Youth Risk Behavior Survey data were utilized for this study. Based on reported and perceived weight, adolescents in the study were grouped into four categories (true negative [52.4%] = normal body mass index [BMI]/accurate weight perception; false negative [11.3%] = high BMI/weight misperception; false positive [11.6%] = normal BMI/weight misperception; and true positive [24.8%] = high BMI/accurate weight perception). Diet and physical activity of adolescents were compared in these categories. A total of 12,016 participants were included in our analysis (74.9% aged 15–17 years, 54.5% Whites, 52% females). Almost a third (31.8%) were overweight and obese, and more than a fifth (22.9%) misperceived their weight (11.6% overestimated and 11.3% underestimated their weight). In a gender-stratified analysis, the odds of avoiding a healthy diet and physical inactivity were higher among those with body weight misperception.

Perceived weight and barriers to physical activity in parent-adolescent dyads

OBJECTIVE

Family-based physical activity interventions have the potential to reduce obesity, but more information is needed regarding physical activity in the family context. This study used an actor-partner interdependence model to estimate the dyadic association between perceived weight status and barriers to physical activity in dyads of adults and their adolescent children. It was hypothesized that greater perceived weight would be associated with greater barriers perceived by both one's self and one's partner.

METHOD

Data from 1,568 dyads in the Family Life, Activity, Sun, Health, and Eating study were used to examine the dyadic association between perceived weight status (i.e., greater perceived weight category) and barriers to physical activity. Models were stratified by actual weight (an overweight or obese dyad member vs. two normal weight dyad members) and adjusted for parent education, parent and adolescent age, gender, and race.

RESULTS

Among dyads with at least 1 overweight/obese member, greater perceived weight status was positively associated with one's own perceived barriers (significant actor effects, βs = 1.17 and 1.03, ps < 0.01) and one's partner's perceived barriers (significant partner effects, βs = 0.38 and 0.62, ps < 0.01). No statistically significant relationships were found for dyads with only normal weight members.

CONCLUSIONS

Among dyads with at least 1 overweight or obese member, significant partner effects for parents and adolescents demonstrate that the weight perception of 1 dyad member correlates with the barriers of the other member. These dyadic associations highlight the potential importance of family-based interventions for physical activity. (PsycINFO Database Record

Sports participation in sport clubs, gyms or public spaces: How users of different sports settings differ in their motivations, goals, and sports frequency

BACKGROUND

To develop targeted policy strategies to increase sports participation, more insight is needed into the behavioural patterns and preferences of users of different club-organized (i.e., sports clubs) and non-club organized (i.e., gyms, health centres or swimming pools) or informal sports settings such as public spaces. This study investigates 1) how users of different settings differ regarding self-determined motivations and goals, and sociodemographic and sports-related characteristics, and 2) how the association of motivations and goals with sports participation may differ between users of different sports settings.

METHODS

Data were collected through online surveys among Dutch adults aged 18-80 years (N = 910). Ordinal regression analyses were used to investigate the effects of sports settings, the level of self-determined motivations and goals, and interaction effects of motivations and goals with different sports settings, on sports frequency.

RESULTS

Users of different sports settings differed in their personal characteristics, motivations and goals. In general, controlled motivations were negatively associated with sports frequency (B = -0.46). However, among club members, extrinsic goals related to image (B = 0.44), as well as intrinsic goals related to skill development (B = 0.40) and social affiliation (B = 0.47) had significant positive associations with sports frequency. Health-related goals significantly increased sports frequency among users of informal settings, such as public spaces.

CONCLUSION

The association of motivational variables with sports participation differs between settings. This implies that sports frequency is higher when participants engage in settings that better fit their motivations and goals. Because of the growing importance of informal and flexible settings and health goals, professionals in the sports and health domains should take into account the motivations, goals and needs of different target groups who (want to) use unorganized, informal sports settings including public spaces.

Supervised vs. self-selected physical activity for individuals with diabetes and obesity: the Lifestyle Gym program

The effectiveness of different programs of physical activity outside randomized studies is difficult to determine. We carried out an audit in two different units where either a supervised physical activity (PA) program or a self-selected PA program was in use in individuals with type 2 diabetes or obesity. The supervised PA cohort (n = 101) received progressive gym training (120 min, twice a week for 13 weeks) by a dedicated team, with nutritional counseling during resting periods. The self-selected PA cohort (n = 69) was enrolled in a 13-week cognitive-behavioral program (120 min/week, in groups of 12-15 individuals), chaired by an expert team. Body weight and physical fitness (6-min walk test) were measured at baseline and after 6 and 12 months. Outcome measures were attrition, weight loss ≥10 % initial body weight, 10 % increase in 6-min walk test; their association with a PA program was tested by logistic regression analysis. Attrition rate was lower in the supervised PA group (28 vs. 45 % than in the self-selected cohort, P = 0.023). After adjustment for confounders, the supervised PA program was associated with a lower risk of attrition at 1 year (odds ratio 0.45; 95 % confidence interval, 0.21-0.98) at logistic regression analysis. Body weight similarly decreased in both groups (more rapidly in the supervised PA cohort); also physical fitness improved in a similar way, and no differences in achieved targets of body weight (supervised, 31 %; self-selected, 18 %; P = 0.118) or fitness (supervised, 62 %; self-selected, 49 %; P = 0.312) were demonstrated. Different PA programs produce very similar health benefits, but an initially supervised program has lower attrition rates, which might translate into better outcomes in the long term.

Overweight or about right? A norm comparison explanation of perceived weight status

Objectives

Body‐weight norms may explain why personal evaluations of weight status are often inaccurate. Here, we tested a ‘norm comparison’ explanation of weight status perceptions, whereby personal evaluations of weight status are biased by perceived body‐weight norms.

Methods

Study 1 examined whether perceptions of how one's own body weight compares to an average person predict personal evaluations of weight status. Study 2 examined whether manipulating perceptions of how one's own body weight compares to an average person influences whether or not a person identifies their own weight status as being overweight.

Results

In Study 1, if participants rated their body weight as being similar to the body weight of an average person, they were less likely to identify their weight status as being overweight. In Study 2, participants that were led to believe that their body weight was heavier than the average person were more likely to perceive their own weight status as being overweight.

Conclusions

Personal perceptions of weight status are likely to be shaped by a ‘norm comparison’ process. As overweight becomes more normal, underestimation of weight status amongst individuals with overweight and obesity will be more common.

Beliefs, Barriers and Facilitators to Physical Activity in Bariatric Surgery Candidates

BACKGROUND

Bariatric surgery candidates engage in less physical activity (PA) and spend longer periods in sedentary behaviour (SB) when compared to the general adult population. The aim of this study was to explore the beliefs about PA and perceived barriers and facilitators to PA in obese adults scheduled for bariatric surgery.

METHODS

Nineteen obese adults (15 females), with a mean (SD) age of 41.6 (12.1) years, weight of 119.2 (20.5) kg and body mass index of 41.6 (6.7) kg/m(2) participated in a one-on-one in-depth qualitative interview before undergoing bariatric surgery. Data were analysed using inductive thematic analysis.

RESULTS

Most participants believed that engaging in regular PA confers important health benefits, however reported insufficient PA levels to obtain those benefits. The perceived barriers to PA reported by participants were both obesity related (e.g. bodily pain, physical limitation and self-presentational concerns) and non-obesity related (e.g. lack of motivation, environment and restricted resources). All participants stated weight loss to be the main perceived facilitator to PA, together with social factors, better time management and access to financial resources.

CONCLUSIONS

In bariatric surgery candidates, many of the perceived barriers and facilitators to PA are not obesity related and are therefore unlikely to change as a result of bariatric surgery. This may explain why earlier research shows little change in PA or SB following surgery. It is likely that an approach that aims to address the barriers and facilitators identified in this study is needed to change the inactive lifestyle adopted in this population.

The Association of Body Fat and Leisure Time Physical Activity Called into Question for Asian Indians

OBJECTIVE

Thrifty genotypes may predispose to type 2 diabetes and body fat (%BF) excess through a differentiated relationship between physical activity and body fat. We explored this hypothesis in Asian Indians, a population thought to be thrifty.

METHODS

Three hundred and nine Guadeloupian adolescents responded to the modifiable activity questionnaire. Their body fat was assessed by bioimpedancemetry. We first studied the relationship between %BF and leisure time physical activity (LTPA). We then explored the associations of ethnicity with this relationship in a subgroup of 93 Asian Indians matched with 93 controls for age, sex, and LTPA class. The alpha risk retained was .05.

RESULTS

The analyses showed that Asian Indians had higher %BF even when matched with controls for age, sex and LTPA quartile, and the relationship between LTPA and %BF observed in controls was not evidenced in Asian Indians.

CONCLUSIONS

The higher %BF in Asian Indians remained significant even when they were matched with controls for age, sex and LTPA quartile, and their LTPA was not associated ‒ or was at least less robustly associated ‒ with %BF. These findings are consistent with the hypothesis of thriftiness in Asian Indians, with the weaker relationship of high LTPA and low %BF a possible path to thriftiness.

Parental Predictions and Perceptions Regarding Long-Term Childhood Obesity-Related Health Risks

OBJECTIVE

To assess how parents perceive long-term risks for developing obesity-related chronic health conditions.

METHODS

A Web-based nationally representative survey was administered to 502 US parents with a 5- to 12-year-old child. Parents reported whether their child was most likely to be at a healthy weight or overweight, and the probability that their child would develop hypertension, heart disease, depression, or type 2 diabetes in adulthood. Responses of parents of children with overweight and obesity were compared to those of healthy-weight children using multivariate models.

RESULTS

The survey had an overall response rate of 39.2%. The mean (SD) unadjusted parent predicted health risks were 15.4% (17.7%), 11.2% (14.7%), 12.5% (16.2%), and 12.1% (16.1%) for hypertension, heart disease, depression, and diabetes, respectively. Despite underperceiving their child's current body mass index class, parents of children with obesity estimate their children to be at greater risk for obesity-related health conditions than parents of healthy-weight children by 5 to 6 percentage points. Having a family history of a chronic disease, higher quality of care, and older parent age were also significant predictors of estimating higher risk probabilities.

CONCLUSIONS

Despite evidence that parents of children who are overweight may not perceive these children as being overweight, parents unexpectedly estimate greater future risk of weight-related health conditions for these children. Focusing communication about weight on screening for and reducing the risk of weight-related diseases may prove useful in engaging parents and children in weight management.

Barriers to physical activity in obese adults: A rapid evidence assessment

Rising rates of obesity are becoming a major problem in the Western world, with multiple implications for individuals’ health and also health service resources. Physical activity can positively influence weight loss and weight loss maintenance; however, levels are low among obese individuals. The aim of this study was to identify the barriers faced by obese individuals which prevent them from engaging with physical activity. A rapid evidence assessment was undertaken based on the framework provided by Bettany-Saltikov. Studies were identified from an electronic database search using key words, reference list search and manual searching of current journal issues. Identified studies were screened for relevance, appraised for quality and relevant data were extracted in order to identify themes for analysis. Seventeen studies were included in the review, of which twelve were quantitative, five qualitative and one mixed methods. Several barriers were identified relating to three main themes: physical, psychological and external barriers. Due to the variety of barriers faced by obese individuals it is important to treat each person as an individual and identify the barriers perceived by them, in order to provide targeted support to overcome these barriers.

Weight status misperceptions among UK adults: the use of self-reported vs. measured BMI

Background

It has been suggested that a significant proportion of overweight and obese individuals underestimate their weight status and think of themselves as being a healthier weight status than they are. The present study examines the prevalence of weight status misperceptions in a recent sample of UK adults, and tests whether the use of self-reported BMI biases estimation of weight status misperceptions.

Methods

Data came from UK adults who took part in the 2013 Health Survey for England. We examined the proportion of overweight vs. normal weight (categorised using self-reported vs. measured BMI) males and females who perceived their weight as being ‘about right’, as well as how common this perception was among individuals whose waist circumference (WC) placed them at increased risk of ill health.

Results

A large proportion of overweight (according to measured BMI) women (31 %) and men (55 %) perceived their weight as being ‘about right’ and over half of participants with a WC that placed them at increased risk of future ill health believed their weight was ‘about right’. The use of self-reported (vs. measured) BMI resulted in underestimation of the proportion of overweight individuals who identified their weight as ‘about right’ and overestimation of the number of normal weight individuals believing their weight was ‘too heavy’.

Conclusions

A large proportion of UK adults who are overweight misperceive their weight status. The use of self-reported BMI data is likely to produce biased estimates of weight status misperceptions. The use of objectively measured BMI is preferable as it will provide more accurate estimates of weight misperception.

Depressive symptoms predict non-completion of a structured exercise intervention for people with Type 2 diabetes

AIM

To quantify the impact of depressive symptoms on completion of exercise-based rehabilitation for Type 2 diabetes management.

METHODS

Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale in a prospective cohort of consecutive patients with Type 2 diabetes entering a 6-month hybrid (home- and clinic-based) exercise rehabilitation programme. Attendance at exercise sessions was monitored and programme completion/non-completion was ascertained.

RESULTS

Of the programme participants (n=624, mean age 55.6±10.5 years, 47% male), 26.8% endorsed significant depressive symptoms (depression score ≥16) and 68.1% completed the intervention, attending 54.6±30.0% of supervised exercise sessions. Baseline depressive symptoms (depression scale score ≥16) increased the risk of non-completion [hazard ratio 1.49 (95% CI 1.10-2.03); P = 0.010], and predicted fewer sessions attended (β=-2.1, P= 0.002) in adjusted models. A depression score threshold of ≥10 (48.4% of participants) predicted non-completion [hazard ratio 1.60 (95% CI 1.19-2.17); P= 0.002) with optimum accuracy. Non-completions resulting from lack of interest (18.9 vs. 11.0%; P= 0.026) and medical complications (14.6 vs. 6.6%; P= 0.006) were more common among participants with depression scores ≥10. Greater hazard ratios for depression scores ≥10 were observed in subgroups not currently using insulin [hazard ratio 1.70 (95% CI 1.24-2.33); P= 0.001), or an antidepressant [hazard ratio 1.83 (95% CI 1.32-2.54); P<0.001].

CONCLUSIONS

Depressive symptoms were highly prevalent among participants with Type 2 diabetes entering exercise-based rehabilitation, and even mild depressive symptoms posed a significant barrier to completion. Depression screening may help target additional supports to facilitate completion of exercise interventions for people with Type 2 diabetes.

Accelerometer Quantification of Physical Activity and Activity Patterns in Patients with Ankylosing Spondylitis and Population Controls

Objective.

To compare the total amount of physical activity (TPA) and time spent in various activity intensities of patients with ankylosing spondylitis (AS) and population controls, and to explore factors related to physical activity (PA).

Methods.

Subjects were asked to wear a triaxial accelerometer for 7 days and to complete a series of questionnaires. Multivariable regressions were used to assess generic determinants of TPA in patients and controls, and in patients to explore demographic and disease-specific determinants of various PA intensities.

Results.

One hundred and thirty-five patients [51 ± 13 yrs, 60% men, body mass index (BMI) 26.0 ± 4.3 kg/m2] and 99 controls (45 ± 12 yrs, 67% men, BMI 25.1 ± 4.3 kg/m2) were included. Patients did not differ from controls regarding TPA (589 vs 608 vector count/min, p = 0.98), minutes/day spent in sedentary (524 vs 541, p = 0.17), and light PA (290 vs 290 p = 0.95), but spent fewer minutes/day in moderate to vigorous PA (MVPA; 23 vs 30 min/day, p = 0.006). Perceived functional ability (physical component summary of the Medical Outcomes Study Short Form-36) and BMI were associated with TPA independent of having AS (p interaction = 0.21 and 0.94, respectively). Additional analyses in patients showed that time spent in MVPA was negatively influenced by BMI, physical function (Bath AS Functional Index), and disease duration. In patients ≥ 52 years old, a higher Bath AS Disease Activity Index was associated with less time spent in sedentary and more time spent in light activities.

Conclusion.

Compared with controls, patients with AS had similar TPA, but may avoid engagement in higher intensities of PA. Lower levels of functional ability and higher BMI were associated with lower TPA in both patients and controls.

Patterns and correlates of objectively measured free-living physical activity in adults in rural and urban Cameroon

Background

Urbanisation in sub-Saharan Africa is changing lifestyles and raising non-communicable disease burden. Understanding the underlying pattern of physical activity and its correlates may inform preventive interventions. We examined correlates of objectively-measured physical activity in rural and urban Cameroon.

Methods

Participants were 544 adults resident in rural (W-156, M-89) or urban (W-189, M-110) regions. Physical activity was measured using individually-calibrated combined heart rate and movement sensing over seven continuous days. Sociodemographic data were collected by self-report. Independent associations of sociodemographic correlates with physical activity energy expenditure (PAEE) or moderate-to-vigorous physical activity (MVPA) were analysed in multivariate regression models.

Results

Rural dwellers were significantly more active than their urban counterparts (PAEE: 58.0 vs 42.9 kJ/kg/day; MVPA: 107 vs 62 min/day; MVPA of 150 min/week in >10 min bouts: 62 vs 39%) and less sedentary (923 vs 1026 min/day); p<0.001. There was no significant seasonal difference (dry vs rainy) in activity in urban dwellers whereas in rural dwellers activity was higher during dry seasons compared to rainy seasons (p<0.001). Age, obesity and education showed significant inverse associations with activity. Urban dwellers who considered themselves adequately active were only as active as rural dwellers who thought they were not adequately active.

Conclusions

This is the first study providing data on sociodemographic patterning of objectively-measured physical activity in rural and urban sub-Saharan Africa. Age, urban residence, obesity and higher educational level are important correlates of lower levels of physical activity. These suggest targets for public health interventions to improve physical activity in Cameroon.

Correlations of Physical Activity, Body Mass Index, Shift Duty, and Selected Eating Habits among Nurses in Riyadh, Saudi Arabia

Nurses are the largest group of direct health providers and can serve as role models for their patients. In this cross sectional study we assessed the relationship among physical activity and barriers, shift duty, elevated BMI, and selected eating habits among 362 non-Saudi female nurses in Riyadh, Saudi Arabia. Results showed that 46.7% were either overweight or obese. Marital status, shift duty, education level, and BMI were significant predictors of physical activity. Weather was the most frequently reported barrier to physical activity (88.3%), followed by a lack of transportation (82.6%), and a lack of time (81.3%). Nurses who worked shift duty had significantly (p = 0.004) higher BMIs compared with day shift nurses. Nurses who rarely ate breakfast (p = 0.004) and meals (p = 0.001) and often eat fast food (p = 0.001) were more likely to be overweight or obese. Nurses should be encouraged for a better healthy lifestyles.

Overweight Misperception among Adolescents in the United States

The purpose of this study was to examine the discrepancies between perceived and reported overweight status among U.S. adolescents (n>70,000), and to identify factors contributing to such discrepancies. We used the YRBSS data (years 2001-2009) and found statistically significant, gender and race specific discrepancies between perceived and reported overweight status. Factors such as BMI, school performance, and being sexually active are additional predictors of overweight misperception. The findings suggest that evidence based strategies should be employed to help adolescents establish correct weight perception. These strategies should also be tailored based on gender, race, and weight perception of target audience.

Impact of telephone reinforcement and negotiated contracts on behavioral predictors of exercise maintenance in older adults with osteoarthritis

OBJECTIVES

To examine the impact of telephone reinforcement (TR) on predictors of physical activity (PA) maintenance in older adults with osteoarthritis.

METHODS

Mixed effects modeling was conducted of data from a randomized PA trial that used negotiated maintenance contracts, supplemented by TR, to test impact of TR on barriers, decisional balance, and stage of change at multiple points in time.

RESULTS

Participants who were referred to a PA program and received TR improved the most in barriers and decisional balance. Participants who negotiated a tailored maintenance contract but did not receive TR improved the most in stage.

CONCLUSIONS

TR appears to positively affect perceptions around engagement, whereas negotiation positively impacts PA behavior. Further research should examine the effectiveness of specific PA maintenance strategies.

Barriers to Physical Activity in Women

Despite the clear benefits of physical activity for women, few women obtain the recommended levels of physical activity. To address adherence to physical activity in this group, it is important to understand the barriers to physical activity that affect women. These barriers may include lack of time; anticipated lack of enjoyment; self-consciousness about body size, shape, and physical activity ability; and urinary incontinence. By addressing barriers to physical activity, health care providers may experience greater success in their efforts to increase physical activity in their female patients.

Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study. Results from Diabetes MILES--Australia

AIMS

To investigate whether diabetes self-care attitudes, behaviours and perceived burden, particularly related to weight management, diet and physical activity, differ between adults with Type 2 diabetes who are severely obese and matched non-severely obese control subjects.

METHODS

The 1795 respondents to the Diabetes MILES--Australia national survey had Type 2 diabetes and reported height and weight data, enabling BMI calculation: 530 (30%) were severely obese (BMI ≥ 35 kg/m(2); median BMI = 41.6 kg/m(2)) and these were matched with 530 control subjects (BMI < 35 kg/m(2); median BMI = 28.2 kg/m(2)). Diabetes self-care behaviours, attitudes and burden were measured with the Diabetes Self-Care Inventory-Revised. Within-group and between-group trends were examined.

RESULTS

The group with BMI ≥ 35 kg/m(2) was less likely to achieve healthy diet and exercise targets, placed less importance on diet and exercise recommendations, and found the burden of diet and exercise recommendations to be greater than the group with BMI < 35 kg/m(2). The group with BMI ≥ 35 kg/m(2) was more likely to be actively trying to lose weight, but found weight control a greater burden. These issues accentuated with increasing obesity and were greatest in those with BMI > 45 kg/m(2). There were no between-group differences in other aspects of diabetes self-care: self-monitoring of blood glucose, use of medications and smoking. Moderate-to-severe symptoms of depression were independently associated with reduced likelihood of healthy diet and physical activity, and with greater burden associated with diet, physical activity and weight management.

CONCLUSIONS

Severely obese people with diabetes demonstrated self-care attitudes, behaviours and burdens that infer barriers to weight loss. However, other important diabetes self-care behaviours are supported equally by severely obese and non-severely obese individuals.

Associations between self-reported weight management methods with diet quality as measured by the Healthy Eating Index-2005

OBJECTIVE

We examine the relationship between weight management practices and diet quality.

METHOD

Regressions were used to analyze the associations between self-reported weight management methods and diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of 1,933 respondents who tried to lose or not gain weight in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). The regressions controlled for sociodemographics, lifestyle behaviors, and other health-related behaviors and perceptions.

RESULTS

Including both switching to foods with lower calories and exercise in weight management was associated with better diet quality, i.e., a higher total HEI-2005 score and higher scores in eight of the twelve HEI-2005 components than including neither method. The eight components included six components on fruit, vegetables and grains, milk, and calories from solid fat, alcohol beverages, and added sugars. Similar but smaller associations were also found among those who reported including either switching to foods with lower calories or exercise.

CONCLUSIONS

Based on self-reported data, the findings suggest that including switching to lower calorie foods and exercise in weight management, as recommended by the Dietary Guidelines for Americans (DGA), is associated with diet quality that is more consistent with the key diet-related advice of the DGA.

Perceived Barriers to Weight loss Programs for Overweight or Obese Women

BACKGROUND

In order to develop appropriate obesity control and treatment strategies, the key point is to understand the barriers perceived by overweight or obese people in trying to follow weight-loss programs. This study examined perceived barriers to weight-loss programs among overweight or obese women.

METHODS

In this descriptive-analytical study, 204 overweight or obese women aged 31.97± 10.62 yr, were selected randomly from the nutritional counseling centers in 2008 in Tabriz, Iran. The mean BMI was 33.83 ±5.75 kg/ m2. A structured questionnaire including questions on barriers to weight-loss diet and physical activity was filled out for each participant by face-to-face interview. Height and weight measured objectively and demographic details were obtained. Data analysis carried out using multiple regression and factor analysis.

RESULTS

The most important perceived barriers to weight-loss diets were 'situational barriers', stress, depression, and food craving. High educational level was independent determinant of situational barriers (β=0.329, P=0.048). Employee women had a higher mean score on stress and depression than students and housewives. Lack of time and exercising lonely were the most important items of "External barriers" and Lack of motivation was the most important item of "internal barriers" to physical activity. Employment and being student were highly associated with external barriers (β=1.018, P<0.001 and β=0.541, P= 0.002). Moreover, older women who had low educational level, perceived more internal barriers.

CONCLUSION

Weight reducing strategies should take into account the specific perceived barriers to weight-loss diets faced by overweight or obese women, particularly situational barriers, stress and depression and food craving; and lack of time and lack of motivation as barriers to physical activity.

Perceived physical activity barriers related to body weight status and sociodemographic factors among Malaysian men in Klang Valley

Background

Physical inactivity has been acknowledged as a public health issue and has received increasing attention in recent years. This cross-sectional study was conducted to determine the barriers to physical activity among Malaysian men. These barriers were analyzed with regards to sociodemographic factors, physical activity level, BMI and waist circumference.

Methods

Subjects in this study included 308 Malay men and 422 Chinese men aged 20 years and older. Subjects completed the International Physical Activity Questionnaire (IPAQ) and a questionnaire on barriers to physical activity, categorized into personal and psychological, physical and social environment barriers. Weight, height and waist circumference were also measured and BMI was calculated.

Results

Descriptive analyses showed that 79.3% of subjects were married, 52.1% had secondary educational level, 68.8% were still working, and 39.7% had household income between RM1500 to RM3500. The perception that other recreational activities with family and friends were more fun was the most frequently reported barrier, followed by weather, lack of discipline, lack of free time, lack of money, and lack of friends. Marriage status, educational level, household income, BMI, and physical activity status were shown to be associated with perceived barriers.

Conclusions

To increase participation in physical activity, policy makers should consider significant personal, social and environmental barriers when developing appropriate intervention programmes. Health-promoting strategies that increase awareness, knowledge, skills and motivation related to physical activity are required.

Gender and socioeconomic status in relation to weight perception and weight control behavior in Korean adults

AIM

In Korea, obesity is more prevalent among men and lower socioeconomic groups. To explain this obesity disparity, we compared weight perception and weight control behavior across gender and socioeconomic status (SES).

METHODS

We analyzed data from 16,260 participants aged 20 years or older in a nationally representative cross-sectional survey. SES indicators included education and income levels. Weight under-perception was defined when participants considered themselves lighter than their measured BMI status. Either no active or inappropriate weight control (i.e., trying to gain weight in obese individuals) was considered to be unhealthy patterns. Multivariate prevalence ratios were calculated using log-binomial regressions.

RESULTS

Men had a higher prevalence of weight under-perception (24.5 vs. 11.9%) and unhealthy patterns of weight control behavior (57 vs. 40%) than women. Low education level was associated with weight under-perception (ptrend = 0.022 in men, ptrend < 0.001 in women). Both education and income levels were significantly associated with patterns of weight control behavior (for education: ptrend < 0.001 in men and women; for income: ptrend = 0.047 in men, ptrend < 0.001 in women).

CONCLUSION

Weight perception and weight control behavior significantly varied by gender and SES. Public actions should be directed toward improving perception and behavior of high-risk populations.

Is physical activity maintenance from adolescence to young adulthood associated with reduced CVD risk factors, improved mental health and satisfaction with life: the HUNT Study, Norway

BACKGROUND

Little is known about the effect maintaining physical activity throughout adolescence has on cardiovascular risk factors and health status in early adulthood. This ten-year prospective longitudinal study investigated whether differences in physical activity patterns from adolescence to young-adulthood showed different associations with subsequent cardio-metabolic risk factors and mental health in young-adulthood.

METHODS

Based on the second and third Norwegian Nord-Trøndelag Health Surveys (HUNT2 and 3), we included 1869 individuals (838 males) participating in Young-HUNT (1995-97), aged 13-19 years and followed-up at HUNT3 (2006-08), aged 23-31. Self-reported physical activity (PA), mental health and perceived health were recorded, along with measurements of body mass index (BMI), waist circumference (WC), total cholesterol (TC), HDL cholesterol, glucose, triglycerides, resting heart rate (HR) and blood pressure. We used separate linear regressions models to investigate associations between physical activity and each CVD risk factor, and logistic regression analysis to examine PA patterns and subsequent mental health. Physically active maintainers were compared to inactive maintainers. Adopters (inactive as adolescents and physically active as young adults) were compared to inactive maintainers and to those who discontinued activity (relapsers).

RESULTS

Active maintainers had significantly lower HR, compared to all other PA patterns. Active maintaining men had significantly lower WC than relapsers and inactive maintainers. When adjusted for age and gender, WC, BMI, HR, diastolic blood pressure and HDL-C showed significant differences comparing active maintaining to other PA patterns. Comparing inactive maintainers against adopters, only HR was significantly lower. Male adopters did not differ significantly in CVD risk compared to inactive maintainers and relapsers. Among females adopting was associated with lower HR and TC compared to inactive maintainers. Active maintainers showed better mental health than inactive maintainers. Active maintaining males had an increased likelihood of good mental health compared to adopters. Active maintaining females reported greater satisfaction with life compared to adopters.

CONCLUSIONS

Those who maintained their physical activity from adolescence to young adulthood demonstrated a significantly lower CVD risk and better mental health, compared to inactive maintainers. Compared to inactivity maintainers and relapsers, adopting physical activity was not significantly associated with lowered CVD risk. Adopting physical activity between adolescence and young adulthood may not necessarily protect against mental distress.

Underassessment of weight and weight management in patients with diabetes: one more reason in support of weight management advice

AIMS

The purpose of this study was to determine whether underassessment of weight affects weight management behaviors of overweight and obese individuals with diabetes and to determine whether weight management advice from health care professionals modifies the effect of underassessment of weight.

METHODS

Data (n=979) from the 2006 and 2008 National Health and Nutrition Examination Survey were analyzed. Multivariate logistic regression was used to identify factors associated with underassessment of weight, weight management behaviors, and receipt of weight management advice from health care professionals.

RESULTS

Underassessment of weight was common (26%). Men, overweight persons, Blacks and Hispanics were more likely to underassess their weight. Those who underassessed their weight were 53% less likely to report weight management behaviors, odds ratio 0.47 (95% CI=0.31-0.73). Weight management advice increased weight management behaviors among individuals who underassessed their weight, 3.49 (95% CI=1.70-7.18).

CONCLUSIONS

Underassessment of weight can negatively affect weight management behaviors of overweight and obese individuals with diabetes. Weight management advice from health care professionals is important, and can modify the effect of underassessment of weight on weight management behaviors in this high risk group.

Physical activity counseling intervention to promote weight loss in overweight rural women

PURPOSE

To identify key behavioral factors that contribute to physical activity and weight management in overweight, rural women and determine the degree to which social support, stage of behavior change, and self-efficacy for physical activity and depressive symptoms are linked to physical activity, body weight, and body mass index (BMI).

DATA SOURCES

Twenty-five overweight or obese rural women completed self-report scales and height and weight measurements; BMI was calculated. Self-report scales included the International Physical Activity Questionnaire (physical activity level), Social Support for Exercise and Social Support Questionnaire (social support), Stage of Exercise Adoption (stage of behavior change), Self-efficacy for Exercise (self-efficacy), and the Patient Health Questionnaire (depressive symptoms).

CONCLUSIONS

Higher levels of physical activity were associated with greater self-efficacy and the self-esteem domain of social support. Rural women reported more depressive symptoms over the year. Women did not significantly increase physical activity and gained weight during the 1-year study.

IMPLICATIONS FOR PRACTICE

Rural women have limited resources available to increase physical activity to facilitate weight loss. Routine screening and treatment for depression in rural women may need to be initiated concurrently with interventions to promote health behavior changes.

Choose to Move for Positive Living: physical activity program for obese women

The Choose to Move for + (Positive) Living program was implemented to increase physical activity among obese women. A holistic approach was used to promote stage of health behavior change, social support, and quality of life and reduce depression. Within 6 months, physical fitness improved and depressive symptoms decreased.