Physical activity interventions in African American women: A systematic review

A focus group study among insufficiently physically active African American adults regarding technology-delivered team-based gamification for physical activity promotion

Background

Gamification represents a promising approach for facilitating positive social interactions among groups of individuals and is increasingly being leveraged in physical activity (PA) interventions to promote enhanced intervention engagement and PA outcomes. Although African American (AA) adults experience disparities associated with health conditions that can be ameliorated with increased PA, little is known about how best to culturally target PA gamification strategies for this population. The purpose of this study was to gather perspectives from AA adults residing in the Southeast United States and subsequently identify themes to help inform the cultural adaptation of an existing electronic and mobile health (e/mHealth) gamification- and theory-based PA intervention for teams of insufficiently active AA adults.

Methods

An AA moderator facilitated six online focus groups among AA adults (n=42; 93% female; 45.09±9.77 years; 34.40±57.38 minutes/week of reported moderate-intensity equivalent PA), using a semi-structured focus group guide. Drawing from a content analysis approach, transcripts were coded and salient themes were identified.

Results

The focus groups revealed the following seven themes: (I) motivation (team-based gamification motivating); (II) accountability (team-based gamification promotes accountability); (III) competition (competitive elements attractive); (IV) weekly challenges (prefer to choose weekly PA challenges); (V) leaderboard feedback (preference for viewing steps and active minutes via a leaderboard); (VI) cultural relevancy (prefer elements reflective of their race and culture that promote team unity); (VII) teammate characteristics (mixed preferences regarding ideal sociodemographic characteristics and starting PA level of teammates).

Conclusions

Integrating team-based gamification in an e/mHealth-based PA intervention may be acceptable among AA adults. The identification of specific design preferences and perceptions of the value of the social environment points to the need to consider surface-level and deep structure cultural targeting when developing and further exploring best practices regarding gamified PA interventions for insufficiently active AAs.

Active Moms: a feasibility study of a community-based and home-based physical activity intervention for low-income, ethnic-minority mothers

BACKGROUND

Despite the health benefits of physical activity, increasing regular physical activity levels among low-income, ethnic-minority mothers has remained a significant challenge. Yet, few studies have examined the feasibility of implementing interventions to address physical activity barriers often experienced by this population.

METHODS

The current mixed-methods pilot study assessed the feasibility, impact, and acceptability of a 3-month community-based (CBI) and a home-based intervention (HBI) designed to improve physical activity and fitness levels, as well as psychosocial outcomes (self-efficacy and social support), among low-income, ethnic minority mothers. Mothers were randomized to either a 3-month CBI or HBI and completed pre- and post-intervention assessments of physical activity, fitness, self-efficacy, and social support. Intervention feasibility was assessed by tracking recruitment, retention, and adverse event rates, whereas intervention acceptability was assessed through post-intervention focus groups.

RESULTS

Although participant recruitment was lower than expected (30 vs. target of 52 mothers), retention and adverse event feasibility goals were met (> 60% retention rate, 0% adverse events). Mothers in both groups (CBI and HBI) showed significant improvements in their physical activity and fitness levels and short-term improvements in receiving social support for physical activity. However, only mothers in the CBI group showed improvements in their self-efficacy for physical activity. Mothers also reported both types of interventions (CBI and HBI) to be acceptable with minor modifications highlighted, including the potential for graduates of these programs to serve as group facilitators.

CONCLUSIONS

Overall, the study protocol was feasible, impactful, and acceptable to low-income, ethnic minority mothers with modifications required before large-scale evaluation. (TRN: NCT05540509; 9/12/22; retrospectively registered; ClinicalTrials.org).

Exploring experiences engaging in exercise from the perspectives of women living with HIV: A qualitative study

OBJECTIVES

To explore experiences engaging in exercise from the perspectives of women living with HIV, specifically, i) nature and extent of exercise, ii) components that characterize exercise experiences, iii) facilitators and barriers, and iv) strategies for uptake and sustainability of exercise.

DESIGN

Qualitative descriptive study involving online semi-structured interviews.

RECRUITMENT

We recruited women living with HIV from a specialty hospital, community-based organization, and medical clinic in Toronto, Canada.

PARTICIPANTS

Ten women living with HIV who may or may not have engaged in exercise.

DATA COLLECTION

Using a semi-structured interview guide, we asked participants to describe their experiences with, facilitators and barriers to, and strategies to facilitate uptake of exercise. We electronically administered a demographic questionnaire to describe personal, HIV and physical activity characteristics of participants. We conducted a descriptive thematic analysis with the interview data, and descriptive analysis (medians, frequencies, percentages) of questionnaire responses.

RESULTS

Women characterized their experiences with exercise with six intersecting components: (1) culture, (2) gender, (3) HIV-related stigma, (4) episodic nature of HIV, (5) sense of belonging, and (6) perceptions of exercise. Facilitators to exercise included: aspirations to achieve a healthy lifestyle, using exercise as a mental diversion, having an exercise companion, and receiving financial support from community-based organizations to facilitate engagement. Barriers to exercise included: limited resources (lack of mental-health support and fitness resources in the community), financial limitations, time and gym restrictions, and cold winter weather conditions. Strategies to facilitate uptake of exercise included: creating social interactions, provision of online exercise classes, raising awareness and education about exercise, and offering practical support.

CONCLUSIONS

Experiences with exercise among women living with HIV were characterized by intersecting personal and environmental contextual components. Results may help inform tailored implementation of exercise rehabilitation programs to enhance uptake of exercise and health outcomes among women living with HIV.

An overview of the Together Everyone Achieves More Physical Activity (TEAM-PA) trial to increase physical activity among African American women

BACKGROUND

The Together Everyone Achieves More Physical Activity (TEAM-PA) trial is a randomized controlled trial testing the efficacy of a group-based intervention for increasing physical activity (PA) among insufficiently active African American women.

DESIGN

The TEAM-PA trial uses a group cohort design, is implemented at community sites, and will involve 360 African American women. The trial compares a 10-week group-based intervention vs. a standard group-delivered PA comparison program. Measures include minutes of total PA/day using 7-day accelerometer estimates (primary outcome), and body mass index, blood pressure, waist circumference, walking speed, sedentary behavior, light physical activity, and the percentage achieving ≥150 min of moderate to vigorous PA/week (secondary outcomes) at baseline, post-intervention, and 6-months post-intervention.

INTERVENTION

The intervention integrates elements from Social Cognitive Theory, Self-Determination Theory, Group Dynamics Theory, and a focus on collectivism to evaluate different components of social affiliation (relatedness, reciprocal support, group cohesion, and collective efficacy). The intervention integrates shared goal-setting via Fitbits, group-based problem-solving, peer-to-peer positive communication, friendly competition, and cultural topics related to collectivism. Compared to the standard group-delivered PA program, participants in the intervention are expected to show greater improvements from baseline to post- and 6-month follow-up on minutes of total PA/day and secondary outcomes. Social affiliation variables (vs. individual-level factors) will be evaluated as mediators of the treatment effect.

IMPLICATIONS

The results of the TEAM-PA trial will determine the efficacy of the intervention and identify which aspects of social affiliation are most strongly related to increased PA among African American women.

TRIAL REGISTRATION

This study was registered on Clinicaltrials.gov (# NCT05519696) in August 2022 prior to initial participant enrollment.

Depression and HIV risks: Engaging older African American women in HIV prevention education through the church

This report describes the recruitment of a sample of older African American women to test the effectiveness of an educational HIV prevention intervention that sought to reduce depressive symptoms and thereby HIV risks in this population. The outreach venue is the Black church. A framework for maximizing response is suggested. Of 62 women who participated in two arms of the intervention, 29 were assigned randomly to a four-session discussion group (experimental condition) and 33 were assigned to a one-session informational group (control condition) focused on HIV prevention education. Between-within subjects analyses of variance showed that participation in the study was associated with a significant improvement in the women's psychological status, i.e., decreased depressive symptoms. This change in depressive symptoms was due in part to the experimental condition assignment. Implications for future HIV prevention interventions, research, and methods used to maximize the probability of response among older African American women are discussed.

Smart Walk: A Culturally Tailored Smartphone-Delivered Physical Activity Intervention for Cardiometabolic Risk Reduction among African American Women

This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24−49 years; BMI range = 30−58 kg/m2) were randomized to the Smart Walk intervention (n = 30) or a wellness comparison intervention (n = 30). Results supported the acceptability and feasibility of the intervention, as demonstrated by participant retention (85% at 4 months and 78% at 8 months), Smart Walk app use, and intervention satisfaction (i.e., 100% of PA participants completing the intervention [n = 24] reported they would recommend it to friend). Smart Walk participants also reported greater increases in moderate-to-vigorous PA (4-month between-arm difference in change [b] = 43.3 min/week; p = 0.018; Cohen’s d = 0.69; 8-month b = 56.6 min/week; p = 0.046; d = 0.63) and demonstrated clinically relevant, although not statistically significant (p-values > 0.05), baseline to 4 months improvements in cardiorespiratory fitness (b = 1.67 mL/kg/min; d = 0.40), systolic blood pressure (b = −3.33 mmHg; d = 0.22), diastolic blood pressure (b = −4.28 mmHg; d = 0.37), and pulse wave velocity (b = −0.46 m/s; d = 0.33). Eight-month cardiometabolic outcomes followed similar trends, but had high rates of missing data (45−53%) due to COVID-19 restrictions. Collectively, findings demonstrated favorable outcomes for acceptability and feasibility, while also highlighting key areas for refinement in future research.

Effects of a Walking Exercise-Focused Health Promotion Program for Middle-Aged Women in the Korean Community

We assessed the effectiveness of a walking exercise-focused health promotion program based on an information-motivation-behavioral skills model. This intervention study employed a non-equivalent control group pre-test/post-test design. We recruited 44 middle-aged women (22 per group) who visited two health check-up centers in G city of South Korea. The intervention included information (health education), personal motivation (pedometer monitoring, setting goals, and keeping an exercise log), social motivation (group discussion and support, telephone counseling), and behavioral skills (walking exercise) components. Ten sessions of this program involved three face-to-face and seven online interactions via mobile instant messaging. As primary outcomes (health behavior), physical activity level and health-promoting lifestyle were measured by standardized scales. As secondary outcomes (health status), physiological indicators by body measurements and perceived stress by a scale were produced. We used the chi-squared test, independent t-test, and Mann-Whitney U test for the analysis. After the intervention, in the experimental group, the level of physical activity (Z = -2.065, p = 0.039) and health-promoting lifestyle improved (t = 3.344, p = 0.002), and both waist circumference (t = -4.328, p < 0.001) and perceived stress (t =-3.578, p < 0.001) decreased. In conclusion, our theory-based intervention has advantages in terms of high standardization potential, high availability, and improvement of health behavior and health status. In future, this approach will be useful for devising interventions that meet the health needs of people who are concerned about quality of life in the second half of life.

Results from "Developing Real Incentives and Volition for Exercise" (DRIVE): A pilot randomized controlled trial for promoting physical activity in African American women

OBJECTIVE

Motivation is a barrier to physical activity (PA) among African American (AA) women, but past studies have implemented a "one-size-fits-all" approach and have not addressed differences in autonomous motivation. This pilot randomized controlled trial assessed the preliminary efficacy of "Developing Real Incentives and Volition for Exercise," a community- and theory-based intervention, which evaluated whether a motivationally matched (vs. a nonmatched) intervention increases daily total PA.

METHOD

In total, 68 AA women (50.72 ± 13.66 years; 86.8% with obesity) were randomized to an 8-week challenge-focused program (targeted toward high autonomous motivation) or rewards-focused program (targeted toward low autonomous motivation). Randomization was stratified by baseline autonomous motivation. FitBits were used during the intervention to promote self-monitoring (both programs) and social connectedness (challenge program only).

RESULTS

Both programs retained ≥ 80% of participants. Process evaluation revealed high attendance, dose, and fidelity (both programs). However, contrary to expectations, across all motivational levels (low and high autonomous), the challenge-focused intervention resulted in a greater increase in total daily PA (primary outcome), with an average increase of 17.9 min in the challenge-focused intervention versus an average decrease of 8.55 min in the rewards-focused intervention. An exploratory follow-up analysis revealed that engagement with the FitBit mobile app predicted greater PA at postintervention in the challenge-focused program.

CONCLUSIONS

A team-based approach targeting social connectedness, enjoyment of PA, and positive intragroup competition is a promising approach for promoting PA among AA women. These findings are used to guide a discussion on best practices for engaging AA women in future behavioral interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Role of Social Support in Cardiovascular Clinical Trial Participation among Black Men: Black Impact

BACKGROUND

Attainment of the American Heart Association's Life's Simple 7 (LS7) metrics reduces cardiovascular disease (CVD) risk; yet, Black Americans have the lowest LS7 attainment among all communities, the highest rate of CVD mortality, and low clinical trial participation. Social support is positively correlated with chronic disease self-management. Here, we describe the role of social support in a single-arm pilot clinical trial of a community-based lifestyle intervention among Black American men.

METHODS

The 24-week intervention featured weekly team-based physical activity and LS7-themed education. Seventy-four Black men participated in the intervention; twenty agreed to participate in exit surveys via one of three semi-structured focus groups. Data were transcribed verbatim and analyzed using content analysis framed by House's social support framework.

RESULTS

Participants reported support from both peers and health coaches. The sub-themes of social support among peers were: (1) acknowledgement, understanding, and validation, (2) inspiration, (3) sense of community, (4) fear of disappointing fellow participants, and (5) group synergy. The sub-themes of social support from the health coaches and study team staff included: (1) contemplation of current health status, (2) racial concordance of health coaches and study team staff, (3) investment of the research team, (4) incentives, (5) access to healthcare providers, and (6) the COVID-19 pandemic. Emotional support was the most frequently discussed theme.

CONCLUSIONS

Social support, especially emotional support, from peers and health coaches was a driver of clinical trial participation among participants. The intervention created a positive social environment and decreased medical mistrust. This intervention may provide a framework by which to facilitate clinical trial participation among Black men.

The Influence of Memorable Message Receipt on Dietary and Exercise Behavior among Self-Identified Black Women

Guided by Control Theory and the memorable messages framework, the current investigation examined the relationship between receipt of a health-related memorable message and self-reported diet and exercise behavior. A cross-sectional survey methodology was utilized to evaluate the relationship between receipt of a memorable message and dietary and exercise behaviors in a sample of Black women. Over 80% of the research sample (N = 121) reported receiving a memorable health message regarding diet and/or exercise. Women receiving a memorable message reported a significantly higher number of days engaging in healthy eating and exercise behaviors each week. Messages from medical professionals had the greatest impact on healthy dietary practices, while media-based messages were most influential on the enactment of exercise behavior. Additional research is warranted to determine how the utilization and reinforcement of memorable messages impacts health outcomes among Black women.

A Lifestyle Intervention Program to Improve Knowledge and Health Behaviors in Women

OBJECTIVE

To improve health knowledge, facilitate healthy behaviors, and provide social support for a high-risk population of women by implementing a culturally tailored, gender-specific lifestyle intervention program.

DESIGN

Evidence-based practice project.

SETTING/LOCAL PROBLEM

A Chicago neighborhood in Cook County, Illinois, where there are increased rates of diabetes, heart disease, cancer, stroke, hypertension, obesity, preterm birth, and violent crime.

PARTICIPANTS

Female residents of the community, ages 19 to 45 years; 12 participants registered for the program, and 11 participants completed the entire 2-month program.

INTERVENTIONS/MEASUREMENTS

The BE WISE Lifestyle Intervention, a culturally tailored, gender-specific behavior change curriculum, was used for this project. An interprofessional team was used to enhance participant experience, and neighborhood collaborations were established to create sustainability of efforts. Pre- and postintervention measures of diet, physical activity, social support, and knowledge acquisition were used to evaluate outcomes.

RESULTS

Improvement was noted for knowledge in most of the content areas, as well as for dietary and physical activity behaviors. All participants rated the program highly and responded positively to the social support experienced in the group.

CONCLUSION

Culturally tailored lifestyle interventions can be effective in improving knowledge and encouraging behavior change, especially when delivered in group settings to enhance social support. Community-level collaborations enhance interventions by providing local support and resources for participants. Because behavior change takes time, follow-up at the 6-month and 1-year intervals is recommended to determine longer-term outcomes.

Disparity and Multimorbidity in Heart Failure Patients Over the Age of 80

Background: Healthcare is currently struggling to provide access and coverage for an increasingly diverse aging population who frequently have multiple co-morbid conditions complicating their care and medical management. Methods: This retrospective study analyzed the prevalence and distribution of common co-morbid conditions (hypertension, dyslipidemia, dementia, and diabetes mellitus) in 316 elderly heart failure patients (age range 80–103; mean 87 ±4.9). Results: Chart review analysis showed a racial distribution of 65 African American versus 251 Caucasian patients (21 vs. 79%). Hypertension was comparable in both groups (98.5% African American vs. 92.4% Caucasian). Dyslipidemia, diabetes and dementia diagnoses were all approximately 20% higher in African American versus Caucasian patients. The concurrent presence of all four conditions was approximately three times more prevalent in African Americans (18.5%) versus Caucasians (7.2%). Conclusion: Our study is unique for studying disparity in octogenarian and nonagenarians residing in a rural setting. Our results also highlight the importance of making a special effort to engage older African American patients in seeking healthcare. In addition, strategies must be designed to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.

Time trends of physical inactivity in Brazilian adults from 2009 to 2017

OBJECTIVE

The aim was to evaluate the changes in the prevalence of physical inactivity in the Brazilian adults from 2009-2017.

METHODS

This study used a time-series research design based on the cross-sectional data of 462,498 Brazilian adults from 2009-2017. Participants were classified as physically inactive if they indicated not participating in physical activity in the last three months. The Prais-Winsten regression analyzed physical inactivity trends over time.

RESULTS

The overall prevalence of physical inactivity was stable (p>0.05). Physical inactivity increased for women in four state capitals (annual growth rate: Goiânia 1.62%, Campo Grande 3.28%, Porto Velho 0.93%, and Vitória 2.09%) and decreased in one (annual growth rate: Rio Branco 4.50%). Physical inactivity decreased for men in four state capitals (annual growth rate: Campo Grande 4.72%, Natal 2.73%, São Luís 4.94%, and Rio Branco 2.95%).

CONCLUSION

The physical inactivity among the Brazilian adults was stable between 2009 and 2017. Physical inactivity increased in women from Goiânia, Campo Grande, Porto Velho, and Vitória and decreased in women from Rio Branco and in men from Campo Grande, Natal, São Luís, and Rio Branco.

Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review

BACKGROUND

African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical.

METHODS

A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of 'barbershops,' 'hair salons,' and 'African Americans' identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020.

RESULTS

Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes.

CONCLUSIONS

Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery.

TRIAL REGISTRATION

PROSPERO CRD42020159050 .

A Cluster Randomized Trial of a Community-Based Intervention Among African-American Adults: Effects on Dietary and Physical Activity Outcomes

Evidence of the effectiveness of community-based lifestyle behavior change interventions among African-American adults is mixed. We implemented a behavioral lifestyle change intervention, Heart Matters, in two rural counties in North Carolina with African-American adults. Our aim was to evaluate the effect of Heart Matters on dietary and physical activity behaviors, self-efficacy, and social support. We used a cluster randomized controlled trial to compare Heart Matters to a delayed intervention control group after 6 months. A total of 143 African-American participants were recruited and 108 completed 6-month follow-up assessments (75.5%). We used mixed regression models to evaluate changes in outcomes from baseline to 6-month follow-up. The intervention had a significant positive effect on self-reported scores of encouragement of healthy eating, resulting in an increase in social support from family of 6.11 units (95% CI [1.99, 10.22]) (p < .01). However, intervention participants also had an increase in discouragement of healthy eating compared to controls of 5.59 units (95% CI [1.46, 9.73]) among family (p < .01). There were no significant differences in changes in dietary behaviors. Intervention participants had increased odds (OR = 2.86, 95% CI [1.18, 6.93]) of increased frequency of vigorous activity for at least 20 min per week compared to control participants (p < .05). Individual and group lifestyle behavior counseling can have a role in promoting physical activity levels among rural African-American adults, but more research is needed to identify the best strategies to bolster effectiveness and influence dietary change. Trial Registration: Clinical Trials, NCT02707432. Registered 13 March 2016.

Practical implications for providing physical activity counseling for the older adult: An integrative review

BACKGROUND

Physical inactivity in the older adult is associated with functional decline, increased fall risk, and threatens the ability of the older adult to live independently. Nurse practitioners, with their expertise in health promotion and chronic disease management, are well positioned to provide physical activity (PA) counseling. However, there is a gap in the literature describing a practical formula for providing PA counseling and PA prescriptions for clinical practice.

OBJECTIVE

The objective of this integrative review was to synthesize the literature related to counseling interventions designed to increase PA among older adults and provide practical recommendations for incorporating recommendations into practice.

DATA SOURCES

Five different databases were searched along with ancestry searching of relevant articles. Eligible studies tested methods of recommending PA for adults age ≥65 years, including in-person counseling, phone calls, written information, and exercise prescriptions.

CONCLUSIONS

Health care providers are able to motivate older adults to increase PA in the short term. Diverse health care disciplines are efficacious at motivating older adults to increase PA. Various counseling interventions can be used with varying amounts of time investment.

IMPLICATIONS FOR PRACTICE

Physical activity counseling is an underused but effective intervention for increasing PA in older adults. Older adults respond well to advice to increase their PA especially with the addition of a written exercise prescription. Basing PA counseling interventions on a theoretical construct such as social cognitive theory or transtheoretical stages of change theory improves the efficacy of the interventions.

Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity

INTRODUCTION

Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women.

METHODS AND ANALYSIS

An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named 'tailored-to-place') to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals' PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised.

ETHICS AND DISSEMINATION

This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter.

TRIAL REGISTRATION NUMBER

NCT03288207.

Better Together? A Pilot Study of Romantic Partner Influence on Exercise Adherence and Cardiometabolic Risk in African-American Couples

Background

African-Americans (AAs) have higher rates of inactivity, obesity, and cardiometabolic risk compared to other races/ethnicities. Romantic partners can positively influence health habits, yet whether or not couples have to exercise together in order to adopt regular exercise remains unclear. This study examined whether exercising together influences exercise adherence and cardiometabolic risk in AA couples.

Methods

Nine AA romantic couples (age 62.8 ± 7.7 years; body mass index 31.0 ± 4.4 kg/m²; 6105 ± 1689 average steps/day) completed a 12-week walking (≥ 30 min, 3 days/week) plus resistance training (RT; 2 days/week) pilot intervention. Couples were randomized to either exercise together (ET) or separately (ES). Waist and hip circumferences, iDXA-measured body composition, blood pressure, and blood biomarkers (glucose, hemoglobin A1c (HbA1c), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, and fibrinogen) were assessed pre- and post-intervention. Independent-sample t tests and generalized linear mixed models, controlling for gender, were used to analyze data. Significance was accepted at P < 0.05.

Results

There were no significant group × time interactions for any outcome. However, ET trended toward more walking (86.5 ± 57.7 min/week) than ES (66.1 ± 31.7 min/week). There were also significant overall time effects for waist circumference (P < 0.001), body fat (P = 0.020), fat mass (P = 0.007), gynoid fat (P = 0.041), HbA1c (P = 0.020), and HDL (P = 0.047), where all variables decreased.

Conclusions

Trends showed exercising together may promote walking prescription adherence, although more research is needed in a larger sample. This intervention may also improve cardiometabolic risk factors in this population. These pilot data will inform the current investigators’ future exercise intervention research in AA adult dyads.

Protocol for a systematic review of health promotion interventions for African Americans delivered in US barbershops and hair salons

INTRODUCTION

African American adults are disproportionately burdened by chronic diseases, particularly at younger ages. Developing culturally appropriate interventions is paramount to closing the gap in these health inequities. The purpose of this systematic review is to critically evaluate health promotion interventions for African Americans delivered in two environments that are frequented by this population: barbershops and hair salons. Characteristics of effective interventions will be identified and evidence for the effectiveness of these interventions will be provided. Results of this review will inform future health promotion efforts for African Americans particularly focused on the leading health inequities in obesity-related chronic diseases: cardiovascular disease, cancer and type 2 diabetes.

METHODS AND ANALYSIS

Subject headings and keywords will be used to search for synonyms of 'barbershops,' 'hair salons' and 'African Americans' to identify all relevant articles (from inception onwards) in the following databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index) and ProQuest Dissertations. Experimental and quasi-experimental studies for adult (>18 years) African Americans delivered in barbershops and hair salons will be included. Eligible interventions will include risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer and type 2 diabetes. Two reviewers will independently screen, select and extract data and a third will mediate disagreements. The methodological quality (or risk of bias) of individual studies will be appraised using the Effective Public Health Practice Project Quality Assessment Tool. Quality and content of the evidence will be narratively synthesised.

ETHICS AND DISSEMINATION

Since this is a protocol for a systematic review, ethical approval is not required. Findings from the review will be widely disseminated through conference presentations, peer-reviewed publications and traditional and social media outlets.

HIV Prevention Programming for Older African American Women: The Impact of a Faith-Based and Behavioral Science Partnership on Depressive Symptoms

Objective

The current study sought to test the effect of an HIV prevention intervention on depressive symptoms in a sample of older African American women.

Design Setting and Participants

A pretest-posttest randomized control group design was conducted in a mega-church in Los Angeles with a sample of 62 older African American women, aged ≥50 years, 29 of whom were randomly assigned to the experimental condition and 33 to the comparison/control condition.

Measures

A measure of psychological wellbeing (CES-D) was utilized to test the effect of the four-session group intervention vs the one-session informational group intervention on change in depressive symptoms from pretest to posttest. Demographic characteristics included: measures of age in years; relationship and employment statuses (coded 1 for yes, 0 for no); and educational attainment.

Results

Participation in the study was associated with a significant improvement in the women's psychological wellbeing from baseline to time 2; ie, decreased depressive symptoms. This change was greater for women in the four-session experimental group than for those in the one-session comparison group, due in part to a marginally significant interaction between time and experimental conditions.

Conclusions

This study demonstrates the utility of faith-based/behavioral-scientist partnerships in HIV programming. Findings contribute to the evidence on interventions that might reduce depressive symptoms and HIV risk among older African American women.

Partnerships to Evaluate the Social Impact of Dance for Health: A Qualitative Inquiry

Objectives: The purpose of this study is to determine the social impact and meaning of "Dance for Health" for participants who attended this community driven, intergenerational, physical activity dance program. Methods:This study employed a descriptive, qualitative design and utilized a participatory action research approach to obtain pilot data on fourteen participants between the ages 18 to 75. One focus group discussion with 13 participants and an individual interview with a female participant was conducted. Data collection took place in the community where intervention sessions were held. Audiotapes from one focus group discussion and one in depth individual interview were transcribed by a professional transcription service. The NVIVO computer program was used to organize the data. Directed content analysis of the data took place utilizing primary and secondary coding, category and theme development. Results: Three broad themes emerged representing the social impact of Dance for Health and included: (1) Enhancing the Well-being of the Individual, (2) Fostering Interpersonal Relationships and Connections, (3) Fostering Connections with the Community. Conclusion: A participatory action research approach facilitates successful collaborations between community organizations and academic institutions and can be used to evaluate the impact of physical activity programs on urban community residents. Participants experienced interpersonal and social benefits from regular attendance at the "Dance for Health" program, subsequently contributing to program sustainability. Focused attention to social determinants of physical activity participation can improve physical activity maintenance in residents who reside in under-resourced communities.

A Faith-Integrated Physical Activity Intervention and Cardiometabolic Risk in African American Women

PURPOSE

To determine the effects of a 10-month secular (SEC) versus faith-integrated (FI) community-based physical activity (PA) intervention on cardiometabolic risk factors in low active, African-American women.

METHODS

Participants (age: 55.4±11.6 years; body mass index (BMI): 36.0±7.9 kg/m²; average baseline steps/day: 3,807±1,250) from a larger study (n=418) participated in a sub-study to measure cardiometabolic disease indicators (primary outcomes) and PA (secondary outcomes) pre- and post-intervention (SEC: n=42; FI: n=43). Height, weight, waist and hip circumferences, resting blood pressure, hemoglobin A1c, average steps/day, sedentary behavior, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) were acquired at baseline and 10 months. Multivariate generalized linear mixed models that included churches as a random effect were used to compare mean changes in outcomes at 10 months between the two study groups (α=0.05).

RESULTS

The FI group showed significant time effects for weight (93.4±2.4 to 92.2±2.3 kg), BMI (35.7±1.0 to 35.3±1.0 kg/m²), and waist circumference (106.9±2.2 to 103.8±2.5 cm), while the SEC group had a significant time effect for hip circumference (121.6±1.9 to 119.9±1.7 cm). There were no time effects in either group for blood pressure, hemoglobin A1c, steps/day, sedentary time, or MVPA. FI significantly decreased LPA in both 1-minute activity bouts (641±13 to 588±16 minutes/day) and 10-minute bouts (536±11 to 479±15 minutes/day). There were no significant differences between SEC and FI for any variable.

CONCLUSIONS

The improvements in body weight, BMI, and waist circumference shown after the FI intervention could have long-term implications on cardiometabolic health, particularly if exercise is continued. Further research is needed to examine the effects of culturally-relevant interventions on chronic disease indicators in African-American women, particularly those established as high risk for cardiometabolic disease.

Positive Outliers Among African American Women and the Factors Associated with Long-Term Physical Activity Maintenance

Studying positive outliers, individuals who have achieved success with long-term (> 6-month) physical activity (PA) engagement, may be an important approach for understanding strategies for improving leisure-time PA maintenance among African American (AA) women. This cross-sectional, mixed-methods study (1) examined the personal characteristics, PA patterns, and behavioral practices of positive outliers among AA women and (2) compared characteristics of those who maintain PA at recommended levels (HIGH, ≥ 150 min/week > 6 months) with those who maintain low PA volumes (LOW, < 150 min/week > 6 months). A large sample of positive outliers completed this study (n = 290), and most became physically active on their own (76.2%). These AA women were committed to maintaining an active lifestyle, accumulated 249.7 ± 105.8 min of PA/week, and engaged in a variety of activities. Their behavioral practices included scheduling PA during the week (85.9%), goal-setting (82.4%), engaging in PA with others (55.9%), self-monitoring (78.3%), and having a backup plan for missed sessions (54.8%). HIGH maintainers (84.9%) made up most of the sample, and these women were characteristically similar to LOW maintainers with few differences. HIGH maintainers have been active longer, achieved higher commitment scores, and engaged in PA at a higher frequency, duration, and intensity, resulting in higher weekly PA volume compared to LOW maintainers (273.8 ± 96.1 vs. 114.4 ± 24.3 min per week, p ≤ 0.001). Our findings identify factors that may be important for successful PA maintenance among AA women and may help to inform the development of effective behavioral interventions to promote sustained, long-term PA engagement in this population.

Physical Activity Maintenance Following Home-Based, Individually Tailored Print Interventions for African American Women

African American women report low participation in physical activity and are disproportionately burdened by related conditions (obesity, breast, and colon cancer). Physical activity interventions have shown promising results among African American women, but most studies in this area have focused on short-term increases. More enduring changes in health behavior will be needed to eliminate existing health disparities. Thus, the current study examined 12-month physical activity and psychosocial outcomes from a pilot randomized controlled trial (N = 84) of a Home-based Individually tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. Retention was 77.4% at 12 months. HIPP participants increased self-reported moderate-to-vigorous physical activity from 35.1 minutes/week (standard deviation [SD] = 47.8) at baseline to 124 minutes/week (SD = 95.5) at 12 months, compared with the wellness contact control participants who reported increases from 48.2 minutes/week (SD = 51.3) to 102.5 minutes/week (SD = 94.5) over 12 months (between-group p > .05). Results indicate that modest improvements in moderate-to-vigorous physical activity and related psychosocial variables occurred during the active intervention phase (months 0-6) and were sustained during the tapered maintenance period (months 6-12). Low-cost, high-reach, home-based strategies have great potential for supporting sustained participation in physical activity and achieving long-term health benefits among African American women in the Deep South.

Increasing Physical Activity in Black Women: Results from a Randomized Trial Conducted in Faith-Based Settings

Objective

The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-integrated (FI) and a secular (SEC) intervention for increasing physical activity with a self-guided (SG) control group among African American women.

Design/Setting/Participants

L.A.D.I.E.S. was a cluster randomized, controlled trial. Churches (n=31) were randomized and women within each church (n=12 - 15) received the same intervention.

Interventions

FI and SEC participants received 24 group-based sessions, delivered over 10 months. SG participants received printed materials to review independently for 10 months. Participants were followed for 12-months post-intervention to assess long-term intervention impact.

Main Outcome Measures

Data on participant characteristics, physical activity, and intervention-related constructs were collected at baseline, 10 months, and 22 months.

Results

Intervention session attendance was greater for FI compared with SEC participants (15.7 + 5.7 vs 12.4 + 7.3 sessions, respectively, P<.01). After 10 months, FI and SEC participants significantly increased daily walking (+1,451 and +1,107 steps/day, respectively) compared with SG participants (-128 steps/day). Increases were maintained after 22 months in the FI group compared with the SG group (+1092 vs. +336 daily steps, P<.01). Between-group changes in accelerometer-assessed physical activity were not statistically significant at any time point.

Conclusions

The FI intervention is a feasible strategy for short- and long-term increases in physical activity among African American women. Additional dissemination and evaluation of the strategy could be useful for reducing chronic disease in this high-risk population.

Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life: A Church-Based Physical Activity Intervention - Baseline Participant Characteristics

OBJECTIVE

Physical activity (PA) is beneficial for health, yet most African American women do not achieve recommended levels. Successful, sustainable strategies could help to address disparities in health outcomes associated with low levels of PA. The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-based and a secular intervention for increasing PA with a self-guided control group.

DESIGN SETTING AND PARTICIPANTS

This cluster randomized, controlled trial was conducted from 2010 - 2011 in African American churches (n=31) in suburban North Carolina. Participants were 469 self-identified low active African American women.

MEASURES

Baseline data were collected on participant demographics, objective and self-reported PA, and constructs related to social ecological theory and social cognitive theory.

RESULTS

Complete baseline data were available for 417 participants who were aged 51.4 ± 12.9 years, with average BMI (kg/m²) 35.8 ± 9.9; 73% of participants were obese (BMI >30). Participants averaged 3,990 ± 1,828 pedometer-assessed daily steps and 23.9 ± 37.7 accelerometer-assessed minutes of daily moderate-to-vigorous PA, and self-reported 25.4 ± 45.4 minutes of weekly walking and moderate- and vigorous-intensity PA. Baseline self-reported religiosity and social support were high.

CONCLUSIONS

L.A.D.I.E.S. is one of the largest PA trials focused on individual behavior change in African American women. Baseline characteristics suggest participants are representative of the general population. Findings from the study will contribute toward understanding appropriate strategies for increasing PA in high-risk populations.