Physical activity in young African American women

Feasibility of a progressive protocol of high-intensity interval training for overweight/obese, sedentary African American women: a retrospective analysis

Background

African American (AA) women have a higher prevalence of obesity and related metabolic dysfunction and lower level of physical activity compared to white counterparts. Determining feasible exercise alternatives for AA women is, therefore, paramount. Time-efficient high-intensity interval training (HIIT) might be particularly suited for AA women who cite time constraints as a frequent barrier to exercise adherence. The purpose of this study was to assess the feasibility of a 14-week progressive HIIT protocol for previously-sedentary overweight/obese AA women.

Methods

Twenty-eight healthy, premenopausal (age, 20-40 yr), sedentary, nondiabetic, overweight/obese AA women volunteered to participate in the randomized controlled clinical trial from which these data were retrospectively analysed. After assessment, participants were randomly allocated to a HIIT group (n = 14) or a no-exercise control group. The HIIT intervention consisted of 24-min sessions performed three times per week for 14 weeks during which work-interval intensity (75 to 90% of heart rate reserve; HRR) and duration (30 to 60 s) and work/recovery ratio (1:7 to 1:3) were progressed in four stages. Feasibility was assessed based on adherence (attrition rate), perceptual response (RPE) and success rate, which was calculated based on the degree to which target intensities for work intervals were achieved/maintained.

Results

Five of 14 participants (35%) in the HIIT group dropped out during the intervention. One-way repeated-measures ANOVA revealed a significant difference across stages for success rate (p = 0.018) with post-hoc analysis indicating a significant difference between stage 1 and the other stages and stage 4 and the other stages. There was no significant difference in RPE across stages (p = 0.057).

Conclusion

Albeit based on a limited number of participants, we found an attrition rate that was higher than what has been reported previously for HIIT (~ 17.6%) when previously-sedentary overweight/obese AA women performed a protocol with work-interval intensity progressed from 75 to 90% HRR during a 14-week intervention. With respect to intensity, the precipitous drop for achievement of the target HR during the fourth stage (weeks 8-14) for those who did complete the protocol implies that it might be advisable to restrict work-interval intensity to < 90% HRR.

Trial registration

ClinicalTrials.gov. (NCT04293367). Registered 03 March 2020 - Retrospectively registered.

Behavior-Specific Influences for Physical Activity Among African American Women

The purpose of this study was to describe physical activity (PA) behaviors and physical functioning of prehypertensive and Stage I hypertensive African American Women (AAW) and to examine the relationships between PA behavior, physical functioning, personal factors, and behavior-specific influences. Pender's Health Promotion Model was the conceptual framework for the study. A cross-sectional design and convenience sample were used. The PA domain where the greatest amount of time was spent was in work-related activity, followed by household, leisure time, and transportation activity. Personal factors most strongly correlated to lower PA were greater body mass index and waist circumference. AAW perceived moderate barriers to PA and minimal family and friend social support for PA. Future interventions need to focus on removing barriers to and improving social support for PA among AAW.

High-intensity interval training without weight loss improves exercise but not basal or insulin-induced metabolism in overweight/obese African American women

The purpose of this randomized controlled clinical trial was to determine the effect of a 14-week high-intensity interval training (HIIT) intervention with weight stability on metabolic flexibility, insulin sensitivity, and cardiorespiratory fitness in sedentary, premenopausal, nondiabetic, overweight/obese African American women. Twenty-eight subjects were allocated to one of two groups: HIIT, which performed three sessions per week of four high-intensity cycling intervals, or a control group (CON), which maintained their normal level of physical activity. Diet was controlled for all subjects to ensure weight stability. Pre- and postintervention (pre/post), subjects completed an incremental cycling test to limit of tolerance and, following a 10-day high-fat controlled feeding period, a euglycemic-hyperinsulinemic clamp to determine insulin sensitivity and substrate oxidation. Nine members of HIIT (age, 29 ± 4 yr; body mass, 90.1 ± 13.8 kg) and eleven members of CON (age, 30 ± 7 yr; body mass, 85.5 ± 10.7 kg) completed the study. HIIT experienced an increased limit of tolerance (post, 1,124 ± 202 s; pre, 987 ± 146 s; P < 0.05), gas exchange threshold (post, 1.29 ± 0.34 liters/min; pre, 0.97 ± 0.23 liters/min; P < 0.05), and fat oxidation at the same absolute submaximal work rate compared with CON (P < 0.05 for group-by-time interaction in all cases). However, changes in peak oxygen consumption (V̇o2peak), insulin sensitivity, free fatty acid suppression during insulin stimulation, and metabolic flexibility were not different in HIIT compared with CON. High-intensity interval training with weight stability increased exercise fat oxidation and tolerance in subjects at risk for diabetic progression, but did not improve insulin sensitivity or fat oxidation in the postabsorptive or insulin-stimulated state.

Sociocultural Influences on Weight-Related Behaviors in African American Adolescents

The purpose of this study was to examine the sociocultural factors related to weight behaviors in African American adolescents utilizing a social ecological approach. A descriptive correlational design included a sample of 145 African American adolescents. Perceived familial socialization, ethnic identity, physical activity, and eating behavior patterns were measured. Data were analyzed using descriptive statistics, Pearson product-moment correlations, and multiple regression equations. Perceived maternal socialization was significantly related to adolescent eating behaviors and physical activity whereas perceived paternal socialization was significantly related only to their physical activity. The adolescents' ethnic identity was not significantly related to their eating behaviors or physical activity. Health care providers who work with adolescents and their families can use the initial findings from this study to encourage healthy weight-related behaviors while reducing the obesity epidemic within the African American adolescent population in a developmentally appropriate and culturally sensitive manner.

Developing an intervention to address physical activity barriers for African-American women in the deep south (USA)

AIM

To address high rates of inactivity and related chronic diseases among African-American women.

MATERIALS & METHODS

Eleven focus groups on physical activity barriers for African-American women in the deep south (USA) were conducted (n = 56). Feedback guided an intervention development process. The resulting Home-Based Individually Tailored Physical Activity Print intervention was vetted with the target population in a 1-month, single arm, pre-post test demonstration trial (n = 10).

RESULTS

Retention was high (90%). Intent-to-treat analyses indicated increases in motivational readiness for physical activity (70% of sample) and physical activity (7-day Physical Activity Recall) from baseline (mean: 89.5 min/week, standard deviation: 61.17) to 1 month (mean: 155 min/week, standard deviation: 100.86). Small improvements in fitness (6-Min Walk Test), weight and psychosocial process measures were also found.

CONCLUSION

Preliminary findings show promise and call for future randomized controlled trials with larger samples to determine efficacy. Such low-cost, high-reach approaches to promoting physical activity have great potential for addressing health disparities and benefiting public health.

Religiosity, self-efficacy for exercise, and African American women

Physical inactivity among African American women persists despite health promotion efforts targeting this population. In the African American faith community, thinking patterns related to personal versus divine control over health status could affect self-efficacy beliefs and physical activity behavior. Religiosity, a determinate of self-efficacy for exercise, is influenced by culture. This exploratory pilot study assessed the psychometric properties and relevance of selected study instruments and relationships among the study variables in African American women recruited through a rural church. Findings indicated a trend toward significance among study variables and that the God Locus of Health Control and Physical Exercise Self-Efficacy Scales were reliable for capturing attitudes about ability to engage in physical activity and religiosity in this sample. Six of the twenty-five women recruited failed to complete the Stanford Brief Activity Survey for Work and Leisure Time Activity correctly, suggesting the need to revise instructions prior to future instrument administration.

Attitudes toward physical activity of white midlife women

OBJECTIVE

To explore attitudes toward physical activity of White midlife women in the United States using a feminist perspective.

DESIGN

A cross-sectional qualitative study using a thematic analysis.

SETTING

Internet communities for midlife women.

PARTICIPANTS

Twenty-nine White midlife women in the United States recruited using a convenience sampling method.

METHODS

We used 17 topics on attitudes toward physical activity and ethnic-specific contexts to administer an online forum. We analyzed the data using thematic analysis.

RESULTS

We found three themes: thinking without action, gendered and sedentary culture, and motivating myself. The women knew and understood the necessity of physical activity for their physical and mental health but in most cases had not been able to take action to increase their physical activities. Although the culture that circumscribed the women's physical activity was sedentary in nature, the women tried to motivate themselves to increase their physical activities through several creative strategies.

CONCLUSION

The findings strongly suggest that although women were doing their best, American culture itself needs to be changed to help women increase physical activity in their daily lives.

African American women and weight loss: disregarding environmental challenges

In the United States, almost 80% of African American women are either overweight or obese. In this study, 46 low-income African American women struggling with weight issues participated in structured interviews using a social cognitive theory framework. Participants shared their social cognitive theory related weight loss thoughts and their perceived weight loss obstacles. Results suggest that although participants' primary weight-related obstacles were environment-based, for example, unsafe environments in which to engage in regular exercise, they more often offered individual-based solutions. The study concludes with a discussion of media advocacy as a tool that can be used to promote environmental solutions.

Disconnections of African American public housing residents: connections to physical activity, dietary habits and obesity

African American (AA) and low SES populations report poor health behaviors and outcomes. This study aimed to increase understanding of barriers to participating in healthful behaviors and programs in AA residents of public housing. Twenty two apparently healthy, AA residents (50% female, M = 43.9 years) completed in depth interviews, which were taped, transcribed and analyzed using a constant comparison approach. Residents demonstrated some awareness of health recommendations, but described limited adherence. Physical activity for recreation was reported as primarily for youth, with adults engaging in limited physical activity (primarily incidental to other activities). Barriers reported by residents were both personal and environmental. Few residents were aware of local neighborhood opportunities for physical activity or healthful eating. Future efforts should focus on increasing understanding of health promoting behaviors and awareness and efficacy of residents to connect with the resources of their surrounding communities.

"Physical activity as a luxury": African American women's attitudes toward physical activity

The purpose of this study was to explore African American midlife women's attitudes toward physical activity. Using a feminist perspective, a 6-month online forum was conducted with 21 African American midlife women recruited on the Internet. The data were analyzed using thematic analysis. Four themes emerged: (a) culturally acceptable body, (b) missed opportunity to learn, (c) physical activity as a luxury, and (d) want to do by myself. The women had positive body images regardless of their actual weight. The women considered physical activity "a luxury" in their busy lives and thought that they had already missed opportunities to learn. The women wanted to participate in physical activities alone because of their bad childhood experiences and hesitance to go out in public with sweaty, messy hair. The findings suggested that unique programs that promote physical activity should be developed that consider the women's ethnic-specific attitudes.

Understanding the causal factors of obesity using the International Classification of Functioning, Disability and Health

PURPOSE

Behavioural, personal, psychological, sociodemographic, environmental, biological and childbearing factors have been associated with obesity among women. This study quantitatively explored the effects of these factors on predicting body mass index (BMI) in U.S. women using the International Classification of Functioning, Disability and Health (ICF) and determined the effectiveness of using the ICF with population-level data.

METHODS

We used the ICF Core Sets for Obesity, and data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) in a sample of 8766 U.S. women to quantify the impact of all associated causal factors. Linear regression was used in the analyses.

RESULTS

Body image perceptions (42%) was the most significant contributor, followed by hypertension (12%), general health condition (11%), diabetes/borderline diabetes (10%), arthritis (9%) and performing vigorous activity (9%).

CONCLUSIONS

To decrease obesity prevalence rates in U.S. women, obesity prevention and treatment programmes should parallel the contributory effects of its most significant causal factors of psychological, biological and behavioural. In addition, more research and data are needed to explore the relationship between BMI in women and the multiple influencing factors by going beyond the more frequently available information of age, gender, race, education, income and parity.

Culturally specific dance to reduce obesity in African American women

This article provides evidence of a culturally specific dance intervention to decrease obesity as measured by body fat and body mass index (BMI) in African American women. A community partnership was formed with two African American churches to develop an intervention to address the issue of obesity. The culturally specific dance intervention was delivered two times per week for 8 weeks, choreographed to gospel music selected by the experimental group participants, and taught by an African American woman. Body fat and BMI were assessed at three time points and revealed significant differences between the two groups. Attending a minimum of 7 classes was enough to show an observed dose effect and the intervention was found to be culturally specific by understanding their roles as African American women. This community partnership was an effective way to promote a church-based, culturally specific dance intervention to improve the health of African American women.

Metabolic syndrome and mild to moderate chronic kidney disease among minorities

The incidence and prevalence of metabolic syndrome and chronic kidney disease (CKD) are increasing in the US population as a whole, but much more rapidly among ethnic minorities. Recent studies have shown that metabolic syndrome is an independent risk factor for the development of incident CKD in African Americans and American Indians distinct from its impact on cardiovascular and all-cause mortality. The pathogenesis of metabolic syndrome in ethnic minorities often is multifactorial. We review the myriad facets of the impact of the metabolic syndrome on the pathophysiology of CKD in minorities. In addition to classic biochemical and physiologic factors, increasing attention is being drawn to the major role of novel factors such as adiponectin and socioeconomic and cultural factors in the development of obesity and insulin resistance; an understudied area that may modulate clinically relevant consequences of biochemical and pathophysiologic aberrations. We present an integrated pathophysiologic viewpoint that incorporates insights from basic science, socioeconomic inquiry, and clinical studies into a framework for clinical practice and investigation.

Metabolic syndrome in African Americans: views on making lifestyle changes

This study explores African American adults' understanding of metabolic syndrome (MetS) and their motivations for making lifestyle changes. African Americans have a greater risk for components of MetS, such as hypertension. Three focus groups were conducted with African American adults (n = 11) with MetS. Content analysis revealed five themes: Threat of Poor Health, Building Trust With Providers, Gaining Social Support, Seeking Culturally Acceptable Alternatives, and Getting on Track and Staying on Track. Lifestyle interventions for African Americans with MetS need to focus on building trust, developing self-monitoring skills, social support, and identifying low-cost/convenient opportunities for physical activity.

Relationship of health behavior theories with self-efficacy among insufficiently active hypertensive African-American women

OBJECTIVE

While self-efficacy plays an important role in physical activity, relatively little research has examined this construct in minorities. This study identified theoretical correlates associated with self-efficacy among insufficiently active, hypertensive Black women.

METHODS

Correlates of self-efficacy to: (1) overcoming barriers to physical activity; (2) making time for activity; and (3) "sticking with" physical activity were studied.

RESULTS

Sixty-one women (M=50.48+/-4.2 years) participated. We accounted for 32% of the variance in confidence in overcoming barriers. Women confident in overcoming barriers reported less worry about physical activity. The TTM processes of change were also in the model: consciousness raising, environmental reevaluation, counter conditioning, and self-liberation. We accounted for 16% of the variance in "making time" self-efficacy. An aversiveness barrier (e.g., physical activity is boring, physical activity is hard work) was the dominant variable in the model. Confidence to 'stick with' physical activity was associated with self-reevaluation (i.e., reflection on how personal values correspond to behavior). Social support and competing demands were not associated with self-efficacy.

CONCLUSIONS

Consistent with Social Cognitive Theory, results suggest that self-efficacy is behavior specific and each measure likely provides unique information.

PRACTICE IMPLICATIONS

Interventions should be tailored to address specific self-efficacy types.

Midlife women's attitudes toward physical activity

OBJECTIVE

To explore attitudes toward physical activity among a multiethnic group of midlife women.

DESIGN

A qualitative cross-sectional study using an online forum. RECRUITMENT SETTINGS: Internet communities/groups for midlife women and for ethnic minorities.

PARTICIPANTS

A multiethnic group of 15 midlife women.

INSTRUMENTS

Ten online forum topics on attitudes toward physical activity and seven on ethnic-specific contexts.

DATA ANALYSIS

Thematic analysis, involving line-by-line coding, categorization, and theme extraction.

RESULTS

Six themes across all ethnic groups emerged from the data analysis process, although there were some ethnic differences in details related to each theme. The themes were (a) gendered experience, (b) physical activity as all body movements, (c) no time for physical activity, (d) environment matters, (e) health concerns made me do it, and (f) need a companion.

CONCLUSIONS

Nurses need to consider and further investigate the influence of women's multiple roles, cultural factors, and environmental factors on physical activity in order to promote physical activity of midlife women.

Perspectives on obesity and barriers to control from workers at a community center serving low-income Hispanic children and families

Community center workers serving children and families in a predominantly Hispanic, low-income neighborhood were interviewed qualitatively, to ascertain their perspectives on obesity and barriers to control and prevention, to design a practical and culturally appropriate intervention for obesity control. All 19 respondents recognized obesity as a problem, identified healthy eating and physical activity as requisites for controlling obesity, and mentioned fast food and cultural influences in Hispanic families as contributory factors. Lack of time emerged as a major barrier to all preventive practices related to eating healthy or being physically active. Safety concerns and lack of safe places for walking and running were mentioned as a barrier to being physically active. Further studies have to be conducted with parents of at-risk children, to understand time constraints. Community health workers should be sensitive to issues of time constraints and incorporate time management recommendations into obesity prevention and education.

Lack of time for physical activity: perception or reality for African American and Hispanic women?

Lack of time is a well-known barrier to physical activity. It is not known, however, whether this barrier reflects actual time commitments. This study examined time commitments of women and assessed the relationship between time commitments and perceived lack of time for physical activity. Participants were 249 African American and Hispanic women, aged 45 to 70 years. These women devoted much of their time to their responsibilities as workers, housekeepers, mothers and wives. They also spent 28 hours per week in sedentary leisure-time activity. Actual time commitments did not predict perceived lack of time for physical activity. These findings can be used to address the misperceptions of women about time available to them for physical activity.