Longitudinal relationships between self-concept for physical activity and neighborhood social life as predictors of physical activity among older African American adults

How do multi-morbidity and polypharmacy affect general practice attendance and referral rates? A retrospective analysis of consultations

Background

As prevalence of multimorbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare utilisation.

Methods

This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demographics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculated.

Results

Of the 72 practices invited to participate, 68 (94%) accepted, providing complete data on a total of 6603 patients’ records and 89,667 consultations with the GP or practice nurse; 50.1% of patients had been referred to hospital in the previous two years. The attendance rate to general practice was 4.94 per person per year and the referral rate to the hospital was 0.6 per person per year, giving a ratio of over eight attendances for every referral. Increasing age, number of chronic illnesses and number of medications were associated with increased attendance rates to the GP and practice nurse and home visits but did not significantly increase the ratio of attendance to referral rate.

Discussion

As age, morbidity and number of medications rise, so too do all types of consultations in general practice. However, the rate of referral remains relatively stable. General practice must be supported to provide person centred care to an ageing population with rising rates of multi-morbidity and polypharmacy.

Physical Self-Concept Changes in Adults and Older Adults: Influence of Emotional Intelligence, Intrinsic Motivation and Sports Habits

Lifespan is increasing globally as never before, and leading to an aging world population. Thus, the challenge for society and individuals is now how to live these years in the best possible health and wellbeing. Despite the benefits of physical activity for both are well documented, older people are not active enough. Physical self-concept is correlated with high levels of sports practice, although its evolution across one’s life span is not clear. The aim of this research has been to analyze the physical self-concept in older adults and its relationship with emotional intelligence, motivation and sports habits. The sample of 520 adults aged between 41 and 80 was clustered in ranges of age; 70.96% were men (n = 369; 57.34 years (SD: 7.97)) and 29.04% women (n = 151; age = 55.56 years (SD: 9.12)). Questionnaires adapted to Spanish were used to measure physical self-concept (Physical Self-Perception Profile), motivation (Sport Motivation Scale), and emotional intelligence (Trait Meta-Mood Scale). Regarding physical self-concept, the youngest group obtained the highest mean values and the oldest group the lowest. Physical self-concept correlated positively with emotional regulation and intrinsic motivation. Initiation to sports in childhood, the practice of sports activities for more than 150’ per week, and the practice of three or more sports, were associated with a higher score of physical self-concept. The findings reveal that physical self-concept declines in older adults, slightly at first, and sharply between 71 and 80 years, being intrinsic motivation, emotional regulation, and sports habits, factors to consider in favoring a positive physical self-concept and adherence to sporting activities.

Physical Fitness, Exercise Self-Efficacy, and Quality of Life in Adulthood: A Systematic Review

Background: The aim of the present work is the elaboration of a systematic review of existing research on physical fitness, self-efficacy for physical exercise, and quality of life in adulthood. Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, and based on the findings in 493 articles, the final sample was composed of 37 articles, which were reviewed to show whether self-efficacy has previously been studied as a mediator in the relationship between physical fitness and quality of life in adulthood. Results: The results indicate that little research exists in relation to healthy, populations with the majority being people with pathology. Physical fitness should be considered as a fundamental aspect in determining the functional capacity of the person. Aerobic capacity was the most evaluated and the 6-min walk test was the most used. Only one article shows the joint relationship between the three variables. Conclusions: We discuss the need to investigate the mediation of self-efficacy in relation to the value of physical activity on quality of life and well-being in the healthy adult population in adult life.

The Moderating Effects of Social Support and Stress on Physical Activity in African American Women

BACKGROUND

African American women participate in less physical activity (PA), have higher rates of chronic disease, and report higher perceived stress relative to other race and sex demographic groups.

PURPOSE

Based on the stress-buffering hypothesis, this study tested the hypothesis that social support would buffer the negative effects of perceived stress on moderate-to-vigorous PA (MVPA) under high, but not low, perceived stress.

METHODS

Participants were 143 African American women (mean [M] age = 43.94, standard deviation [SD] = 8.62; M body mass index = 37.94, SD = 8.11) enrolled in the Families Improving Together (FIT) for Weight Loss Trial. Average daily minutes of MVPA were obtained via 7 day accelerometer estimates at baseline and 8 and 16 weeks.

RESULTS

A multilevel growth model demonstrated a significant three-way interaction between stress, social support, and time (B = -0.31, standard error [SE] = 0.14, p = .03). Simple slopes analyses revealed that, at baseline, among participants with high social support (+1 SD), stress was positively associated with greater MVPA (B = 0.49, SE = 0.18, p = .008), whereas among participants with low social support (-1 SD), stress was not significantly associated with MVPA (B = -0.04, SE = 0.14, p = .81). However, at 8 and 16 weeks, stress was not significantly associated with MVPA for either high or low support groups.

CONCLUSIONS

Findings highlight the importance of integrating constructs of stress and social support into future physical activity intervention programs for African American women and the need to evaluate changes in stress and social support longitudinally.

Utilizing Social Determinants of Health to Elicit Perceived Control Beliefs About Physical Activity Among African Americans

This qualitative study explored African Americans' perceived behavioral control (PBC) beliefs about how social determinants of health (SDoH) impact their physical activity behavior. Thirty semi-structured interviews were conducted with African Americans aged 30-50 in Oklahoma. Interviews were audio recorded, transcribed, coded, and analyzed for themes by two independent coders. Economic stability themes represented beliefs that financial status facilitates physical activity, yet, employment duties impede physical activity. SES barriers to physical activity did not emerge within this relatively high SES sample. Neighborhood and built environment themes represented beliefs that accessibility facilitates physical activity, while inclement weather impedes physical activity. Although not a part of the question path, motivation emerged as a theme and represented beliefs about how motivation impacts physically active behavior in the absence of other SDoH barriers. This research can inform interventions developed to promote physical activity among African American adults in the central US.

Personal and Social Environmental Correlates of Square Dancing Habits in Chinese Middle-Aged and Older Adults Living in Communities

This study aimed to examine personal and social environmental correlates of the physical activity habit of middle-aged and older adults, using Chinese square dancing as a natural exploratory example. Participants were 385 adults aged ≥45 years (93% female), who habitually danced on squares or parks of three old districts of Guangzhou. Multinomial logistic regression was used to identify personal, social, psychological, and behavioral correlates of multiyear dance. Old age, high education, sufficient leisure time, and stable social environmental factors were associated with persistent dancing, whereby education (relative risk ratio [RRR] = 1.64, 95% confidence interval [1.05, 2.57]) and social engagement (RRR = 1.66, 95% confidence interval [1.05, 2.63]) showed the largest effects. Participants dancing ≤1 year were least satisfied with their social relationships than their counterparts dancing 1-5 years (RRR = 0.68) or over 5 years (RRR = 0.58). Physical activity promotion for older adults should adapt from culturally appropriate group activities and leverage community social resources to encourage voluntary participation, particularly for low-educated older women.

Correlates of Moderate-to-Vigorous Physical Activity and Exercise Motivation in Underserved African American Men

Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today’s Health (PATH) trial. African American men (n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA (B = 1.15, SE = .41, p = .006). Exercise attitudes (B = .16, SE = .07, p = .037), exercise self-concept (B = .28, SE = .06, p < .001), exercise support from friends (B = .12, SE = .06, p = .048), and places for walking and cycling (B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men.

ClinicalTrials.gov # NCT01025726

When Do Intended Performance Standards Predict Goal-Related Affect? A Motivated-Reasoning Perspective

This research used intensive longitudinal methods to examine a motivated cognition perspective on intention–behavior discrepancies. We propose that under conditions of high performance, people are more inclined to evaluate their efforts in light of their intentions; thus, discrepancies between intentions and performance should have stronger impacts on goal-related affect under conditions of high (vs. low) performance. Secondary data analyses were conducted on two daily-diary studies in which participants reported their exercise, goal-related affect, and next-day intentions across 14 days. Under conditions of low performance, people felt negative about their performance irrespective of whether they typically set low versus high intentions. On days with high performance, average intentions significantly related to affect, such that those with low average intentions experienced the greatest satisfaction. Additionally, we observed that average (between-person) affect, but not within-person fluctuations in affect, predicted daily levels of exercise behavior. Implications for self-regulatory theories of affect are discussed.