Primary Care and Physical Literacy: A Non-Randomized Controlled Pilot Study to Combat the High Prevalence of Physically Inactive Adults in Austria

The multidimensional concept of physical literacy is fundamental for lifelong physical activity engagement. However, physical literacy-based interventions are in their infancy, especially among adults. Therefore, the purpose of this pilot study was to assess the association of a physical literacy-based intervention with changes in self-reported physical literacy among inactive adults. A non-randomized controlled study (2 × 2 design) was conducted, comparing pre- vs. postintervention. Twenty-eight inactive healthy participants in the intervention group (89% female, 53 ± 10 years) entered a physical literacy-based intervention once weekly for 14 weeks. The non-treated control group consisted of 22 inactive adults (96% female, 50 ± 11 years). Physical literacy was evaluated with a questionnaire encompassing five domains: physical activity behavior, attitude/understanding, motivation, knowledge, and self-efficacy/confidence. ANOVA models were applied to evaluate changes by time and condition. Following the intervention, significant improvements were seen for overall physical literacy and in four out of five physical literacy domains, including physical activity behavior, attitude/understanding, knowledge, and self-efficacy/confidence (all p < 0.01, Cohen's d = 0.38-0.83). No changes by time x condition were found for motivation. The physical literacy-based intervention applied in this study may be a promising approach to help inactive adults to adopt an active lifestyle.

Holistic physical exercise training improves physical literacy among physically inactive adults: a pilot intervention study

BACKGROUND

Physical literacy (PL), given as a multidimensional construct, is considered a person's capacity and commitment to a physically active lifestyle. We investigated the effect of a holistic physical exercise training on PL among physically inactive adults.

METHODS

A non-randomised controlled study was conducted. Thirty-one physically inactive adults in the intervention group (IG; 81% females, 44 ± 16 years) participated in a holistic physical exercise training intervention once weekly for 15 weeks. A matched, non-exercising control group (CG) consisted of 30 physically inactive adults (80% female, 45 ± 11 years). PL, compliance and sociodemographic parameters were measured. PL was evaluated by a questionnaire, covering five domains: physical activity behaviour, attitude towards a physically active lifestyle, exercise motivation, knowledge and self-confidence/self-efficacy. Data were analysed using ANCOVA models, adjusted for age, gender and BMI at baseline.

RESULTS

At post-training intervention, the IG showed significant improvements in PL (p = 0.001) and in the domains physical activity behaviour (p = 0.02) and exercise self-confidence/self-efficacy (p = 0.001), with no changes overserved for the CG regarding PL and those domains. No intervention effect were found for the other three domains, i.e. attitude, knowledge and motivation. Additionally, for the IG baseline BMI was identified to be positively correlated with physical exercise-induced improvements in PL (β = 0.51, p = 0.01).

CONCLUSIONS

The results from this study are very useful for further public health activities, which aim at helping physically inactive adults to adopt a physically active lifestyle as well as for the development of further PL intervention strategies. This pilot-study was a first attempt to measure PL in inactive adults. Yet, a validated measurement tool is still not available. Further research is necessary to determine the psychometric properties for this PL questionnaire.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS), DRKS00013991 , date of registration: 09.02.2018, retrospectively registered.

Complexity of Exercise Behavior Among Older African American Women

Despite the exercise benefits, disparities among diverse older adults continue to exist, where African American women have the lowest percentage of any population group in meeting national recommended activity guidelines. Drawing on the philosophical tradition of phronesis (practical reasoning) introduced by Aristotle, we studied perceptions of the exercise value among 14 older African American women. Three themes included: (1) exercise goals (e.g., effort exerted), (2) exercise reasons (e.g., health benefits, enjoyment and convenience, and activity recommendation), and (3) inactivity reasons (e.g., health issues, lack of motivation, and family responsibilities/priorities). Although most women reported being active, only three participants met the Healthy People 2020 guidelines for aerobic and muscle-strengthening activities, while two individuals were inactive. Exercise promoters should consider the values that motivate older African American women to exercise, such as the provision of accessible, nondiscriminatory exercise facilities, and not to exercise, such as concerns about neighborhood safety, in designing programs.

Life stage influences on U.S. South Asian women's physical activity

PURPOSE

South Asian (SA) women in the United States report extremely low rates of leisure time physical activity (PA) compared with women in other ethnic minority groups. This study explored SA women's perspectives on PA during different life stages.

DESIGN

This is a community-based participatory research study that used focus groups.

SETTING

The study setting was a community-based organization that provides social services to SA immigrants in Chicago, Illinois.

PARTICIPANTS

The study team conducted six focus groups (in English and Hindi) with 42 SA women, ages 18 to 71 years.

METHOD

A semistructured interview guide was used to foster discussion about perceptions of, barriers to/facilitators of, and suggestions for PA programs. Discussions were transcribed and independently coded by two reviewers using thematic content analysis and guided by a coding scheme that was developed a priori.

RESULTS

Participants said that different life stages strongly influenced their PA. PA decreased after marriage and having children. Chronic diseases constrained older women from more vigorous PA. Barriers to PA among younger women were family disapproval and perceptions that PA is unnecessary if you are "skinny." Women agreed that PA is not a priority within the culture, and that interventions must take into account cultural, religious, and family context.

CONCLUSION

Sociocultural norms, family constraints, and lack of awareness about the benefits of PA strongly influenced PA among SA women. Culturally salient intervention strategies might include programs in trusted community settings where women can exercise in women-only classes with their children, and targeted education campaigns to increase awareness about the benefits of PA across life stages.

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was to provide a comprehensive review of the literature to identify lifestyle and behavioral modification obesity intervention studies for Black women. We included articles published between February 1992 and January 2013. This search identified 28 articles from the PsycInfo, MEDLINE, CINAHL, and SPORTDiscus databases. Results of these studies were summarized primarily into six categories. The importance of modest improvements in health outcomes that result from adapting healthier behaviors was highlighted. Future research is required for identifying the most salient intervention component or combination of components that lead to the best outcomes for ensuring intervention success and minimizing weight regain postintervention.

Counseling African Americans in Cardiac Rehabilitation: Implications for Comprehensive Lifestyle Modification

African Americans are more likely to die of a myocardial infarction than any other racial group and have higher rates of sudden cardiac death, and in comparison to whites, these deaths are likely to occur at a younger age. Because secondary prevention interventions have been reported to reduce overall mortality, it is important that health care providers understand and respond with sensitivity to the needs and preferences that African Americans bring to cardiac rehabilitation. Providing culturally appropriate cardiac rehabilitation services to African Americans has the potential to improve access to care, quality of care, and health outcomes. This article reviews the historical legacy and general values and beliefs that African Americans bring to their participation in cardiac rehabilitation and examines values and beliefs about diet, weight, body image, exercise, rest, and preferences for depression treatment that should be considered when counseling African Americans. Social-ecological factors that influence the ability to commit to and maintain cardiovascular risk—reducing behaviors are also discussed. Strategies for responding to the health-related beliefs and cultural values of African Americans are examined.

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.

Reliability and validity of the self-efficacy for exercise and outcome expectations for exercise scales with minority older adults

Older African Americans and Latinos tend to exercise less than older Whites and are more likely to have chronic diseases that could benefit from exercise. Measurement of self-efficacy of exercise and exercise outcome expectations in this older population is required if exercise is to be monitored carefully and enhanced in this population. The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise Scale (SEE) and Outcome Expectations for Exercise Scale (OEE) in a sample of African American and Latino older adults. A total of 166 individuals, 32 males (19%) and 134 females (81%) with an average age of 72.8 +/- 8.4 years participated in the study. The SEE and OEE scales were completed using face-to-face interviews. There was evidence of internal consistency for both scales with alphas of .89 and .90 for the SEE scale and .72 and .88 for the OEE scale. There was some evidence of validity for both scales based on confirmatory factor analysis and hypothesis testing, because factor loadings were greater than .50 in all but two items in the OEE, and there were significant relationships between self-efficacy and outcome expectations and exercise behavior at all testing time-points. The measurement models showed a fair fit of the data to the models. The study provided some evidence for the reliability and validity of the SEE and OEE when used with minority older adults, and it provides some guidelines for future scale revisions and use.

Motivating elders to initiate and maintain exercise

This article addresses the motivation of elders to initiate exercise. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on the health benefits of exercise, describes a theoretical model for assessing and improving an individual's motivation to pursue exercise, details the particular challenges elders face in initiating and adhering to an exercise program, and outlines professional interventions to address these obstacles.

OVERALL ARTICLE OBJECTIVE

To explore the particular challenges elders face in motivation to exercise and to develop a systematic approach for counseling elders toward greater activity.

Measuring perceptions of diabetes-related concepts: a preliminary study

PURPOSE

This pilot study explored health professionals' and patients' perceptions of diabetes through the development of the Diabetes Semantic Differential Scales (DSDS). These scales evaluate the meaning of diabetes-related concepts.

METHODS

Health professionals (n = 39) attending a CME course completed the health professional version of the DSDS. Patients (n = 70) completed the patient version of the DSDS.

RESULTS

The reliability of the DSDS was supported. The scale scores of health professionals, African American patients, and Caucasian patients, examined initially by one-way analyses of variance, showed significant differences among the groups for 4 of the 18 diabetes concepts. Effect sizes were also examined among these groups. For 7 concepts, there was a significant practical difference between the perceptions of the health professionals and the African American patients. For the Caucasian patients, differences were noted for 6 concepts.

CONCLUSIONS

There are 3 primary inferences from this pilot study. First, health professionals and patients are likely to hold different perceptions of key diabetes concepts. Second, the concepts on which professionals and patients differ are not always what one would expect. Third, health professionals should clarify patients' understanding of diabetes to minimize the potential for miscommunication.

Reliability and validity of the self-efficacy and outcome expectations for osteoporosis medication adherence scales

PURPOSE

The purpose of this study was to test the reliability and validity of the self-efficacy and outcome expectations for osteoporosis medication adherence measures (SEOMA and OEOMA).

DESIGN

This was a descriptive study involving a single face-to-face interview.

SAMPLE

The study included 152 older adults with a mean age of 85.7 (+) 5.5 years, the majority of whom were Caucasian (99%), female (74%), and unmarried (75%).

METHODS

In addition to the SEOMA and OEOMA measures, demographic information (age, gender, and marital status) and other health behaviors (exercise and osteoporosis medication use) were explored.

RESULTS

There was evidence of reliability of the SEOMA and OEOMA based on internal consistency and R values. Evidence of the validity of the SEOMA and OEOMA measures was based on confirmatory factor analysis and hypothesis testing.

CONCLUSION

This study is an important first step to developing reliable and valid measures of self-efficacy and outcome expectations for adherence to osteoporosis medications.

IMPLICATIONS FOR NURSING PRACTICE

The SEOMA and OEOMA can be used to evaluate self-efficacy and outcome expectancy beliefs related to osteoporosis medication use in older adults and interventions developed to strengthen those beliefs and improve medication adherence.

Testing the effect of the WALC intervention on exercise adherence in older adults

The purpose of this study was to test the feasibility of the WALC intervention (Walk; Address pain, fear, fatigue during exercise; Learn about exercise; Cue by self-modeling), and determine its effects on self-efficacy and outcome expectations, exercise activity and free living activity, physical and mental health status, and falls and fall-related injuries. A total of 17 sedentary older women with a mean age of 88 +/- 3.7 years were randomly assigned to receive either the WALC intervention or routine care. Ninety percent of those in the treatment group initiated and engaged in a regular exercise program during the 6 months of the study. There was a statistically significant difference in self-efficacy expectations, exercise behavior, and overall activity between the two groups. Those in the treatment group had stronger self-efficacy expectations related to exercise; engaged in more exercise and more free living activity; and although not statistically significant, had stronger outcome expectations following exposure to the WALC intervention when compared with those who received routine care. To help older adults initiate and adhere to an exercise program, nurses can easily implement the WALC intervention in a variety of settings.

The effect of social support on exercise behavior in older adults

The purpose of this study was to test the relationship among social supports related to exercise (family, friends, and expert support), self-efficacy expectations, outcome expectations, and exercise behavior in a sample of older adults living in a continuing care retirement community. The sample included 74 older adults with a mean age of 85.6 +/- 5.5. Path analysis using Amos 4.0 was done. The model fit the data (chi-square = 4.6, df = 3, p = .21, normed fit index of .99, relative fit index of .98, and root mean square error of approximation of .08) and explained 53% of the variance in exercise behavior. Five of the seven hypothesized paths in the model were statistically significant. Friend support indirectly influenced exercise through self-efficacy and outcome expectations. This suggests interventions to improve exercise behavior in older adults should incorporate social supports to strengthen self-efficacy and outcome expectations related to exercise.

Managing arthritis with exercise

Almost half of all older adults have arthritis, either degenerative or inflammatory. Regular exercise is an important therapeutic intervention for all types of arthritis. Specifically, regular exercise can prevent deconditioning of the muscles, keep the joints stable, improve joint function and flexibility, decrease pain, enhance aerobic fitness, improve balance, and decrease falls. A comprehensive exercise program should include stretching exercises followed by a range-of-motion program for joints, muscle strengthening, and aerobic exercise, if possible. Unfortunately, despite these known benefits, most older adults with arthritis do not engage in regular exercise. The Seven Step Approach was developed to provide a practical framework to help overcome barriers and improve exercise activity in older adults with arthritis.

Outcome expectations for exercise scale: utility and psychometrics

OBJECTIVES

The purpose of this study was to develop a measure of outcome expectations for exercise specifically for the older adult (The Outcome Expectations for Exercise [OEE] Scale), and to test the reliability and validity of this measure in a sample of older individuals. This scale was developed based on Bandura's theory of self-efficacy and the work of prior researchers in the development of measures of outcome expectations.

METHODS

The OEE scale, which was completed during a face-to-face interview, was tested in a sample of 175 residents in a continuing care retirement community.

RESULTS

There was support for the internal consistency of the OEE scale (alpha coefficient of .89), and some support for reliability based on a structural equation modeling approach that used R2 estimates, although less than half of these were greater than 0.5. There was evidence of validity of the measure based on: (a) a confirmatory factor analysis in which the model fit the data (normed fit index [NFI] = .99, root mean square error of approximation [RMSEA] - .07, chi2/df = 2.8); (b) support for the hypothesis that those who exercised regularly had higher OEE scores than those who did not (F = 31.3, p < .05, eta squared = .15); and (c) a statistically significant relationship between outcome expectations and self-efficacy expectations (r = .66).

DISCUSSION

This study provides some initial support for the reliability and validity of the OEE scale. Outcome expectations for exercise were related to exercise behavior in the older adult, and the OEE scale can help identify older adults with low outcome expectations for exercise. Interventions can then be implemented to help these individuals strengthen their outcome expectations, which may subsequently improve exercise behavior.

Functional performance and exercise of older adults in long-term care settings

Performing functional activities and exercising are important for older adults living in long-term care settings. Participation in these activities not only improves and maintains function in older adults but also can improve physical and emotional health and quality of life. The purpose of this study was to explore the variables that influence functional performance and exercise activity in a group of nursing home residents. Participants included 59 residents in a long-term care facility. The mean age of participants was 88 +/- 6.9, and the majority were women (76%), White (97%), and unmarried (76%). Residents participated in a single face-to-face interview. Chart reviews for demographic and health information also were performed. Based on stepwise multiple regression analyses, upper and lower extremity contractures and cognitive status were the only variables that significantly influenced functional performance and accounted for 49% of the variance in function. Self-efficacy and outcome expectations were the only variables to significantly influence exercise behavior and accounted for 57% of the variance in this behavior. These findings can be used to help develop and implement effective restorative nursing care programs in long-term care settings.

Understanding what motivates older adults to exercise

The purposes of this study were to explore the factors that influenced adherence to an exercise program for older adults, and compare differences in motivation, efficacy expectations, health status, age, functional performance, and falls between adherers and nonadherers. A combined qualitative and quantitative design was used. Participants included 23 of the 24 members of an existing walking group, with an average age of 81 +/- 7.2 years. Fourteen (60%) participants did not adhere to walking, while 9 (40%) adhered. Those that adhered had fewer functional limitations due to their health, (F = 7.7, p < .05), better functional performance (F = 4.0, p < .05), stronger self-efficacy expectations related to exercise (F = 4.3, p < .05), and fewer falls (F = 4.4, p < .05). Six major themes were identified that impacted adherence: a) beliefs about exercise; b) benefits of exercise; c) past experiences with exercise; d) goals; e) personality; and f) unpleasant sensations associated with exercise. Interventions that focus on teaching older adults about the benefits of exercise, establishing appropriate goals, and decreasing unpleasant and increasing pleasant sensations associated with exercise may be useful to improve adherence to a regular exercise program.

A seven step approach to starting an exercise program for older adults

There is strong experimental evidence to indicate that regular aerobic exercise can prevent disease, decrease the risk of failing, reduce physical disability, improve sleep, and enhance mood and general well being. Despite these benefits, approximately 50% of sedentary adults who start an exercise program stop them within the first 6 months of involvement. To help older adults initiate and adhere to a regular exercise program, a seven step approach was developed and implemented in a continuing care retirement community (CCRC). The seven steps include: (1) education; (2) exercise pre-screening; (3) setting goals; (4) exposure to exercise; (5) role models; (6) verbal encouragement; and (7) verbal reinforcement/rewards. Following implementation of the seven step approach, 40 (19%) of the 212 residents living in the CCRC exercise regularly.

Screening Efficiency of the Revised Physical Activity Readiness Questionnaire in Older Adults

The Physical Activity Readiness Questionnaire (PARQ) offers a safe preexercise screening of participants prior to physical activity involvement. However, the measure seems to screen out a relatively high proportion of apparently healthy older adults. In an attempt to improve this situation, an expert panel convened by Fitness Canada worked to revise the measure (rPARQ). The present study compares the number of exclusions resulting from the original and revised PARQ instruments in older adults (84 men, 85 women;Mage 76.5 yrs). The number of participants screened out by the rPARQ decreased significantly (p< .001), from 139 to 105. Agreement between measures was achieved in 78.7% of the participants (Cohen's kappa = .50). In an effort to promote physical activity involvement, researchers and practitioners are encouraged to consider the use of the recently developed rPARQ over the PARQ as a preexercise screening alternative.