Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups

Incorporating Physical Activity Assessments and Behavior Change Techniques Into Geriatrics

Ninety-one percent of adults 65 years and older do not perform the recommended levels of physical activity (PA), resulting in increased risk of disability, morbidity, and mortality. Despite knowing the benefits of PA and acknowledging the importance of assessing and addressing inadequate PA levels, 50%-75% of health care providers do not incorporate behavior change techniques into clinical practice. This clinical gap can be explained by a lack of knowledge or confidence in (1) assessing PA levels; (2) addressing inadequate PA levels; and (3) justifying the time needed to use these techniques in clinical practice. In this special communication, we address this gap by providing a 3-step theoretical-based clinical decision pathway that guides health care providers on how to identify older adults with inadequate PA levels, determine readiness to increase PA, and empower patents to develop an action plan that will increase their PA levels. We also provide a conceptual model that supports the use of techniques that assess and address inadequate PA by tying PA to the Age-Friendly Health System's 4Ms (ie, What Matters to the older adult, Mentation, Mobility, and Medications).

Fourth-Grade Cooking and Physical Activity Intervention Reveals Associations With Cooking Experience and Sex

OBJECTIVE

Examine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index.

DESIGN

Randomized controlled trial.

SETTING

Eight elementary schools in 2 Northern Colorado districts.

PARTICIPANTS

Fourth-grade students; 7-month interventions: school (S.FFF)-theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities.

MAIN OUTCOME MEASURE(S)

Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight.

ANALYSIS

Individual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05.

RESULTS

The sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable.

CONCLUSIONS AND IMPLICATIONS

Cooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions.

The Longitudinal Association Between Physical Activity and Physical Function in Older Women

Purpose

The age-related decline in physical function is ameliorated by physical activity; however, less is known about changes in physical function in active vs. inactive older women. The purpose of this study was to determine the longitudinal associations between physical activity and physical function in community-dwelling older women.

Methods

238 participants (age 79.0 ± 5.1) were dichotomized into two activity groups [inactive (IG); n = 144 or active (AG); n = 94] based on self-reported exercise at baseline. Repeated measures ANCOVA, controlling for age, measured differences in physical function between activity groups at baseline and 48-months using the Timed Up and Go, 30-s chair stand, and 30-second arm curl. Differences in Timed Up and Go classification [normal (≤ 8.23 s); preclinical limitations/limited physical function (&gt;8.23 s)] were analyzed using chi-square tests for activity group and for activity-age group (AG, &lt;80 years; AG, ≥ 80 years; IG, &lt;80 years; IG, ≥ 80 years).

Results

The repeated measures ANCOVA yielded a significant main effect for activity group for the Timed Up and Go (p = 0.006), 30-s chair stand (p = 0.002) and 30 s arm curl (p = 0.007) and a significant time main effect for the Timed Up and Go (p = 0.016). There were no significant group by time interactions. A larger proportion of the IG than the AG (58.2 vs. 86.5%, respectively) had Timed Up and Go scores &gt;8.23 s (p &lt; 0.001). At 48-months, individuals in the AG were more likely to have normal Timed Up and Go scores compared to those in the IG in both age groups [χ(3, N=236)2 = 42.56, p &lt; 0.001].

Conclusion

Older women who engaged in regular exercise at baseline had higher levels of objectively measured physical function and were less likely to have abnormal Timed Up and Go scores. These findings help illustrate the long-term benefit of exercise on physical function in older women.

Perceived Motivational Climate and Stages of Exercise Behavior Change: Mediating Roles of Motivation Within and Beyond Physical Education Class

This study examined the relationship between the perceived motivational climate in physical education (PE) classes and the stage of exercise behavior change among 322 high school students in northeastern China. Furthermore, the chain-mediating effects of autonomous motivation in PE and the five types of motivation (interest, competence, social relatedness, appearance, and health) in leisure-time physical activity (PA) were examined. Results showed that autonomous motivation in PE and the five types of motivation in leisure-time PA had chain-mediating effects on the relationships between the perceived mastery- and performance-oriented motivational climate and the stage of exercise behavior change in the whole sample (controlling for gender). Specifically, a perceived mastery-oriented motivational climate promoted autonomous motivation in PE, which, in turn, increased the five types of motivation in leisure-time PA and led to a higher stage of exercise behavior change. Conversely, a perceived performance-oriented motivational climate reduced autonomous motivation in PE which, in turn, decreased the five types of motivation in leisure-time PA and led to earlier stages of exercise behavior change. The patterns of the chain-mediating effects of autonomous motivation in PE and the five types of motivation in leisure-time PA were somewhat similar in girls and boys. The results suggested that PE teachers should create mastery-oriented climates and avoid performance-oriented motivational climates, which may promote intrinsic or identified motivations of students for PA within and beyond PE classes, thereby affecting the leisure-time PA of students.

Predictors of physical activity behavior change based on the current stage of change-an analysis of young people from Hawai'i

This study investigated the corresponding change between psycho-social predictors and physical activity (PA) behavior and if these relationships were dependent on the stages of change from the Transtheoretical Model in Minority American adolescents. We conducted a longitudinal field study with N = 357 students aged 13-18 years (M = 14.24 years, SD = 0.88); predominantly Filipino (61.2%) using a test-retest design assessing psycho-social PA predictors (enjoyment, self-efficacy, family support, friends' support, knowledge, stage of change) and moderate-to-vigorous physical activity (MVPA) at two time points over six months. Hierarchical regression results indicated that a positive change of enjoyment, knowledge about PA and family support predicted a change of MVPA, independently of stage. The time-varying covariation showed the importance of the current stage of change for enjoyment, self-efficacy and support of friends for a change of MVPA. Overall, our findings suggest that an individual's current stage of change should be considered to determine individually appropriate starting points and goals for designing interventions to promote PA among Minority American adolescents.

Patient perspectives on tablet-based technology to collect risk factor information in primary care

BACKGROUND

Primary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This study explores the integration of the tablet-based RFIT in primary care clinics to support exploration of patient risk factor information.

METHODS

Qualitative study to explore patients' perspectives of RFIT. RFIT was implemented in two primary care clinics in Manitoba, Canada. There were 207 patients who completed RFIT, offered to them by eight family physicians. We conducted one-on-one patient interviews with 86 patients to capture the patient's perspective. Responses were coded and categorized into five common themes.

RESULTS

RFIT had a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Patients reported that the tablet-based RFIT provided a user-friendly interface that enabled self-reflection while in the waiting room. Patients discussed the impact of RFIT on the patient-provider interaction, utility for the clinician, their concerns and suggested improvements for RFIT. Among the patients who used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 min of PA a week, and 8.2% lived in poverty.

CONCLUSION

RFIT is a user-friendly tool for the collection of patient risk behaviour information. RFIT is particularly useful for patients lacking continuity in the care they receive. Information technology can promote self-reflection while providing useful information to the primary care clinician. When combined with practical tools and resources RFIT can assist in the reduction of risk behaviours.

Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation

BACKGROUND

Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review.

OBJECTIVE

This study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics.

METHODS

This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation.

RESULTS

Clinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups.

CONCLUSIONS

Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients' context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care.

Smartphone-Based Health Program for Improving Physical Activity and Tackling Obesity for Young Adults: A Systematic Review and Meta-Analysis

The need for physical activity for health promotion is recognized, yet young adults still perform insufficient physical activity. Smartphone health programs can be applied easily without time and space constraints, and various mobile health programs based on smartphone applications have recently been developed and applied. This study aimed to measure the effects of mobile smartphone-based health programs on physical activity and obesity outcomes in young adults through a systematic review and meta-analysis. We searched publications in English through electronic databases up to May 2019. Studies were included that provided interventions to improve physical activity using smartphone applications for young adults. After assessing study quality, data were extracted and synthesized concerning whether smartphone interventions affect health outcomes including physical activity and weight using Meta-Analysis software. Four randomized controlled studies and a quasi-experimental study were analyzed. They provided information related to health management, diet, physical activity, and personalized feedback using smartphone applications. The meta-analysis showed that smartphone-based health interventions significantly affect weight loss and increase physical activity. This study provides modest evidence for using smartphone health programs to improve young adults’ physical activity, weight control, and body mass index (BMI). Future research is needed to understand long-term effects and the reliability of increasing physical activity through smartphone health programs.

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model

OBJECTIVE

Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity.

METHODS

A random sample provided baseline data (n=689; 63% female; M _age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals.

RESULTS

Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035).

CONCLUSIONS

Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

Changing multiple health behaviors in cancer survivors: smoking and exercise

Research regarding cross-behavioral relationships between the cognitive mechanisms motivating health behavior change is lacking for cancer survivors. This study investigated these relationships to inform the development of multiple health behavior change (MHBC) interventions for this at-risk population. Eligible participants included cancer survivors attending an intake appointment for smoking cessation services. This cross-sectional survey study assessed participants' self-efficacy and motivation (stage of change) for smoking cessation and exercise, as well as self-reported health behaviors. Analyses evaluated cross-behavioral associations between cognitive mechanisms and their relationships with smoking and exercise behaviors. Seventy-six participants completed the survey questionnaire. The correlation between self-efficacy scores for smoking cessation and exercise was statistically significant (r = .45, 95% CI [.09, .67]), as were correlations between self-efficacy and reported levels of exercise ((r = .44, 95% CI [.20, .65]) strenuous); ((r = .36, 95% CI [.12, .59]) moderate), exercise self-efficacy and smoking behavior (r = -.27, 95% CI [-.46, -.05]), and smoking self-efficacy and smoking behavior (r = -0.41, 95% CI [-.61, -.18]). For cancer survivors, associations between exercise self-efficacy and smoking cessation self-efficacy may offer an opportunity to leverage MHBC; specifically, this positive association may facilitate exercise intervention in survivors seeking smoking cessation services..

Matched or nonmatched interventions based on the transtheoretical model to promote physical activity. A meta-analysis of randomized controlled trials

PURPOSE

The aim of this study was to examine whether the efficacy of transtheoretical model (TTM)-based interventions on physical activity (PA) varied according to the following criteria: (1) interventions targeted the actual stages of change (SOCs) or did not; (2) participants were selected according to their SOC or were not; and (3) its theoretical constructs (decisional balance, temptation, self-efficacy, processes of change).

METHODS

Thirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified.

RESULTS

The between-group heterogeneity statistic (Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not (Qb = 1.48, p = 0.22) or in interventions selecting participants according to their SOC compared with those that did not (Qb = 0.01, p = 0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC (Cohen's d = 0.36; 95% confidence interval (CI): 0.22-0.49) or not (d = 0.23; 95%CI: 0.09-0.38) and whether they selected their participants according to their SOC (d = 0.33; 95%CI: 0.13-0.53) or not (d = 0.32; 95%CI: 0.19-0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention (Qb = 8.82, p = 0.003), the use of self-efficacy (Qb = 6.09, p = 0.01), and the processes of change (Qb = 3.51, p = 0.06).

CONCLUSION

TTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs.

Self-Efficacy for Adoption and Maintenance of Exercise Among Fibromyalgia Patients: A Pilot Study

Objective. While multimodal treatment approaches for fibromyalgia (FM), incorporating exercise, have been found most effective, information about factors associated with exercise adoption and maintenance is lacking. Design, Setting, and Methods. Women veterans with FM (N = 19) completed an anonymous Internet survey measuring FM impact (FI), adoption of exercise behavior, and self-efficacy for exercise. Using classifications of behavior specified by the transtheoretical model, the self-efficacy of participants classified in the action or maintenance (AM) stages was compared with those in earlier stages (precontemplation through preparation) of exercise readiness. Multivariate analysis of variance analyses examined differences in FI domains by stage of change. Analysis of covariance examined whether exercise self-efficacy differed by stage of change while controlling for FI. Results. Higher levels of self-efficacy were detected among participants in the AM stages. Participants in the AM stages also reported higher levels of FI symptoms. After controlling for FI, self-efficacy did not differ significantly between the 2 groups; however the effect size was large (η² = .11). Conclusions. Findings of this pilot study suggest a role for self-efficacy in exercise adoption and maintenance, even in the setting of higher FM symptoms. Replication of this study with a larger sample size is warranted.

Trajectories of Maintenance and Resilience in Healthful Eating and Exercise Behaviors in Older Adults

OBJECTIVE

Our objective was to describe behavioral change trajectories for healthful eating and exercise in a group of community-dwelling older adults. A secondary aim was to determine predictors of maintenance and resilience.

METHOD

Subjects were participants in the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) I study who had achieved postaction stage of change for at least one behavior by its end. They were recruited for SENIOR II, a 48-month study with annual assessments on demographic, anthropometric, cognitive, psychosocial, and behavioral variables.

RESULTS

Maintainers generally had higher levels of healthy behaviors and better cognitive function. Resilient older adults were similar to maintainers but were older and had greater functional limitations.

DISCUSSION

Findings suggest that both physical health and psychological capital provide important resources upon which to draw as older adults grow even older. The trajectory model can provide useful information for developing resilience interventions for older adults.

Differences in Psychosocial and Behavioral Variables by Dietary Screening Tool Risk Category in Older Adults

BACKGROUND

The Dietary Screening Tool (DST) has been validated as a dietary screening instrument for older adults defining three categories of potential nutritional risk based on DST score cutoffs. Previous research has found that older adults classified as being "at risk" differed from those categorized as being "not at risk" for a limited number of health-related variables. The relationship between risk categories and a wide variety of variables has not yet been explored. This research will contribute to an increased understanding of clustering of multiple health concerns in this population.

OBJECTIVE

The aim of this study was to determine whether DST risk categories differed by demographic, anthropometric, cognitive, functional, psychosocial, or behavioral variables in older adults.

DESIGN

This study utilized a cross-sectional design with data collected from September 15, 2009 to July 31, 2012. Participants completed an interviewer-administered survey including the DST and other measures.

PARTICIPANTS/SETTING

Community-dwelling older adults (n=255) participating in the Study of Exercise and Nutrition in Older Rhode Islanders Project were included if they met study inclusion criteria (complete DST data with depression and cognitive status scores above cutoffs).

MAIN OUTCOME MEASURES

DST scores were used to classify participants' dietary risk (at risk, possible risk, and not at risk).

STATISTICAL ANALYSES PERFORMED

Multiple analysis of variance and χ² analyses examined whether DST risk categories differed by variables. Significant predictors were entered into a logistic regression equation predicting at-risk compared to other risk categories combined.

RESULTS

Participants' mean age was 82.5±4.9 years. Nearly half (49%, n=125) were classified as being at possible risk, with the remainder 26% (n=66) not at risk and at risk 25% (n=64). At-risk participants were less likely to be in the Action/Maintenance Stages of Change (P<0.01). There was a multivariate effect of risk category (P<0.01). At-risk participants had a lower intake of fruits and vegetables, fruit and vegetable self-efficacy, satisfaction with life, and resilience, as well as higher Geriatric Depression Scale scores, indicating greater negative affect than individuals not at risk (P<0.05). In a logistic regression predicting at risk, fruit and vegetable self-efficacy, Satisfaction with Life Scale score, and fruit and vegetable intake were independent predictors of risk (P<0.05).

CONCLUSIONS

Older adults classified as at risk indicated a greater degree of negative affect and reduced self-efficacy to consume fruits and vegetables. This study supports the use of the DST in assessment of older adults and suggests a clustering of health concerns among those classified as at risk.

A Bit of Fit: Minimalist Intervention in Adolescents Based on a Physical Activity Tracker

Background

Only 5% of Canadian youth meet the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day, with leisure time being increasingly allocated to technology usage. Direct-to-consumer mHealth devices that promote physical activity, such as wrist-worn physical activity trackers, have features with potential appeal to youth.

Objective

The primary purpose of this study was to determine whether a minimalist physical activity tracker-based intervention would lead to an increase in physical activity in young adolescents. A secondary aim of this study was to assess change in physical activity across a 7-week intervention, as measured by the tracker.

Methods

Using a quasi-experimental crossover design, two groups of 23 young adolescents (aged 13-14 years) were randomly assigned to immediate intervention or delayed intervention. The intervention consisted of wearing a Fitbit-Charge-HR physical activity tracker over a 7-week period. Actical accelerometers were used to measure participants’ levels of MVPA before and at the end of intervention periods for each group. Covariates such as age, sex, stage of change for physical activity behavior, and goal commitment were also measured.

Results

There was an increase in physical activity over the course of the study period, though it was not related to overall physical activity tracker use. An intervention response did, however, occur in a subset of participants. Specifically, exposure to the physical activity tracker was associated with an average daily increase in MVPA by more than 15 minutes (P=.01) among participants who reported being in the action and maintenance stages of behavior change in relation to participation in physical activity. Participants in the precontemplation, contemplation, and preparation stages of behavior change had no change in their level of MVPA (P=.81).

Conclusions

These results suggest that physical activity trackers may elicit improved physical activity related behavior in young adolescents demonstrating a readiness to be active. Future studies should seek to investigate if integrating physical activity trackers as part of more intensive interventions leads to greater increases in physical activity across different levels of stages of behavior change and if these changes can be sustained over longer periods of time.

Validating Stages of Change for Obesogenic Behaviors Across Filipino and Other Asian-American and Pacific Islander Adolescents

Filipino adolescents are underrepresented in obesity research, although Filipinos are the second largest Asian-American and Pacific Islander (AAPI) subpopulation in the USA. An understanding of how well the theories of behavior change apply to Filipino and other AAPI adolescents is critical to addressing obesogenic behaviors in these groups. This study aimed to validate the transtheoretical model of behavior change (TTM) for physical activity (PA) and fruit and vegetable intake (FV) among a majority Filipino adolescent population. Adolescents in grades 9-11 (N = 159, 82.4% female) completed measures of PA and FV behaviors and PA and FV stages of change. One-way ANOVAs and Tukey's HSD post hoc tests were computed to assess the validity of the PA and FV stages of change with the respective behaviors. There was a significant effect for fruit (action > contemplation, preparation) and vegetable (maintenance, action > contemplation) intakes across the FV stages of change. There was a significant effect of strenuous PA (precontemplation/contemplation, preparation < action < maintenance) and moderate PA (precontemplation/contemplation < action, maintenance) across the PA stages of change. Some variability in associations emerged when the sample was stratified by gender. This study provides validity evidence for the TTM stages of change for FV and PA among Filipino and other AAPI adolescents. This validation, in turn, extends the generalizability of the stages of change construct to include this ethnic group and replicates other adolescent studies.

Predictors of Physical Activity Stage of Change among Adults with Physical Disabilities

Purpose.

To use the Transtheoretical Model (TTM) constructs to examine the most important physical activity stage of change predictors for mostly inactive adults with physical disabilities.

Methods.

A cross-sectional survey completed on the Internet. One hundred fifty-one individuals with physical disabilities (50% response rate) completed the survey questionnaires. Self-report standardized measures were used.

Results.

A direct discriminant function analysis revealed that the most important stage of change predictors were the behavioral (r2 = .88) and cognitive (r2 = .50) processes of change, followed by self-efficacy (r2 = .33) and decisional balance (r2 = .13). The most accurate stages in prediction were the contemplation (76.3%), preparation (58.3%), and precontemplation (40%) stages, whereas the least accurate stages were the action (0.0%) and maintenance (8.3%) stages.

Conclusion.

Health promoters and educators may use strategies from the TTM to develop theory-driven physical activity motivational programs for the posited populace. Considering the cross-sectional design, study replication is warranted.

Intervening on Exercise and Nutrition in Older Adults

Presented are the basic design, methods, and baseline data analyses for the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR Project) an experimental study to investigate the relative effectiveness of a 12-month, stage of readiness to change-based multiple-behavior intervention (exercise and nutrition) compared to single-behavior interventions in a community-dwelling population of 1,277 older adults. Relationships between stage of readiness to change in the two target behaviors, as well as the relationship between stage of readiness and self-reported exercise levels and fruit and vegetable consumption, were examined using a combination of Pearson chi-squares, analyses of variance (ANOVA), and Spearman’s rank order correlations. Stage of change (SOC) for fruit and vegetable consumption was significantly associated with the dietary measure, and SOC for exercise was associated with both the three physical activity measures and servings of fruits and vegetables per day. Overall, individual older adult's readiness to change seems largely to be behavior-specific.

Fuel for Fun: a cluster-randomized controlled study of cooking skills, eating behaviors, and physical activity of 4th graders and their families

Background

Childhood obesity remains a serious concern in the United States and in many other countries. Direct experience preparing and tasting healthful foods and increasing activity during the school day are promising prevention approaches. Engaging parents and families remains an important challenge. Fuel for Fun: Cooking with Kids Plus Parents and Play is a multi-component school- and family-based intervention for 4th graders and their families intended to promote positive food and activity environments, policies and behaviors at the individual, family and school levels. This paper describes the design and evaluation plan.

Methods/Design

Four cohorts of 4th-graders and their parents from 8 schools in 2 districts in the same Northern Colorado region are participating in a 4-arm cluster randomized controlled trial. Theory-based Fuel for Fun consists of 5 components delivered over 1 school year: 1) Cooking with Kids - Colorado; an experiential classroom-based cooking and tasting curriculum, 2) Cafeteria Connections; cafeteria-based reinforcements of classroom food experiences using behavioral economic strategies, 3) SPARK active recess; a playground intervention to engage children in moderate to vigorous activity, 4) Fuel for Fun Family; multi-element supports targeting parents to reinforce the 3 school-based components at home, and 5) About Eating; an online interactive program for parents addressing constructs of eating competence and food resource management. Outcomes include child and parent measures of fruit and vegetable preferences and intake, cooking, physical activity, sedentary behaviors and attitudes. School level data assess lunch plate waste and physical activity at recess. In-depth diet and accelerometry assessments are collected with a subsample of parent-child dyads. Data are collected at baseline, immediately post-intervention at 7 months, and at 12 month follow-up. We anticipate recruiting 1320–1584 children and their parents over the length of the project.

Discussion

The Fuel for Fun study design allows for impact assessment of school-, family- and online parent-based intervention components separately and in combination. Study strengths include use of theory- and evidence-based programs, valid child and parent self-report instruments, and objective measures of food, cooking, and physical activity behaviors at the individual, family and school levels. Parent involvement and engagement is examined through multiple strategies.

Trial registration

Clinicaltrials.gov registration number NCT02491294. Registered 7 July, 2015.

Study design, intervention, and baseline characteristics of a group randomized trial involving a faith-based healthy eating and physical activity intervention (Walk by Faith) to reduce weight and cancer risk among overweight and obese Appalachian adults

BACKGROUND

Increased prevalence of overweight and obesity among Appalachian residents may contribute to increased cancer rates in this region. This manuscript describes the design, components, and participant baseline characteristics of a faith-based study to decrease overweight and obesity among Appalachian residents.

METHODS

A group randomized study design was used to assign 13 churches to an intervention to reduce overweight and obesity (Walk by Faith) and 15 churches to a cancer screening intervention (Ribbons of Faith). Church members with a body mass index (BMI) ?25 were recruited from these churches in Appalachian counties in five states to participate in the study. A standard protocol was used to measure participant characteristics at baseline. The same protocol will be followed to obtain measurements after completion of the active intervention phase (12months) and the sustainability phase (24months). Primary outcome is change in BMI from baseline to 12months. Secondary outcomes include changes in blood pressure, waist-to-hip ratio, and fruit and vegetable consumption, as well as intervention sustainability.

RESULTS

Church members (n=664) from 28 churches enrolled in the study. At baseline 64.3% of the participants were obese (BMI?30), less than half (41.6%) reported regular exercise, and 85.5% reported consuming less than 5 servings of fruits and vegetables per day.

CONCLUSIONS

Church members recruited to participate in a faith-based study across the Appalachian region reported high rates of unhealthy behaviors. We have demonstrated the feasibility of developing and recruiting participants to a faith-based intervention aimed at improving diet and increasing exercise among underserved populations.

Evidence for the construct validity of self-motivation as a correlate of exercise adherence in French older adults

OBJECTIVES

Exercise adherence involves a number of sociocognitive factors that influence the adoption and maintenance of regular physical activity. Among trait-like factors, self-motivation is believed to be a unique predictor of persistence during behavior change. The aim of this study was to validate the factor structure of a French version of the Self-Motivation Inventory (SMI) and to provide initial convergent and discriminant evidence for its construct validity as a correlate of exercise adherence.

METHOD

Four hundred seventy-one elderly were recruited and administered the SMI-10. Structural equation modeling tested the relation of SMI-10 scores with exercise adherence in a correlated network that included decisional balance and perceived quality of life.

RESULTS

Acceptable evidence was found to support the factor validity and measurement equivalence of the French version of the SMI-10. Moreover, self-motivation was related to exercise adherence independently of decisional balance and perceived quality of life, providing initial evidence for construct validity.

Persuading students to exercise: what is the best way to frame messages for normal-weight versus overweight/obese university students?

OBJECTIVE

The authors investigated the effect of gain-framed (GF) compared with loss-framed (LF) messages on exercise behaviors in normal weight and among overweight/class I obese. The authors also examined which groups would have significantly improved exercise behaviors over time.

PARTICIPANTS

Sixty-four undergraduates were randomized to the 4 groups by message type and weight category from September 2008 to December 2011.

METHODS

After screening, students received messages and attended an exercise instruction session.

RESULTS

There were no significant differences between GF or LF message groups among normal weight or overweight/obese on the primary outcomes at posttest. After receiving the GF messages, the overweight/obese group was the only group to have a significant increase on all 3 primary outcomes: fitness center attendance (p = .038), combined moderate- and vigorous-intensity activity (p = .005), and strength training (p = .037).

CONCLUSIONS

The exercise behaviors of undergraduate students who are overweight or obese can benefit from GF messages.

Validation of the measures of the transtheoretical model for exercise in an adult African-American sample

PURPOSE

African-Americans have high rates of physical inactivity-related morbidity and mortality, thus effective interventions to increase exercise are necessary. Tailored interventions show promise, but measures need validation in this population. This study validated transtheoretical model measures for exercise in an African-American sample.

DESIGN

Cross-sectional measure development.

SETTING

Telephone survey of individuals in North Carolina.

SUBJECTS

521 African-American adults.

MEASURES

Stages of change, decisional balance (pros and cons), self-efficacy and processes of change (POC) for regular exercise.

ANALYSIS

Confirmatory factor analyses tested measurement models. Multivariate analyses examined relationships between each construct and stages of change.

RESULTS

For decisional balance, the two-factor uncorrelated model was the most parsimonious good-fitting model (χ(235) = 158.76; comparative fit index [CFI], .92; average absolute standardized residual [AASR], .04), and alphas were good (pros α = .85 and cons α = .74). The one-factor model for self-efficacy (α = .80) revealed an excellent fit (χ(29) = 45.51; CFI, .96; AASR, .03). For the POC subscales with good alphas (α = .62-.91), a 10-factor fully correlated model fit best (χ(2)[360] = 786.75; CFI, .91; AASR, .04). Multivariate analyses by stage of change replicated expected patterns for the pros, self-efficacy, and POC measures with medium-sized effects (η(2)  =  .05-.13). Results by stage of change did not replicate for the cons scale.

CONCLUSIONS

The structures of these measures replicated with good internal and external validity, except for the cons scale, which requires additional development. Results support the use of these measures in tailored interventions to increase exercise among African-Americans.

Physical Activity and Stages of Change among College Students

BACKGROUND

To investigate of physical activity distribution bases on stages of change among Isfahan University of Medical Sciences central part of Iran.

METHODS

Exercise behavior stages of change construct questionnaire were collected from 504 participants by using a convenience sample in May 2010.

RESULTS

73.8% of subjects were in earlier stages of exercise behavior (Precontemplation, contemplation, and preparation stages) and tended to be inactive. The exercise behavior was not influenced by age, education levels, and marital status.

CONCLUSION

The majority of the university students are suffering physical inactivity that need to design more effective physical activity promotion programs in the community and univer-sities level.

Comparison of two health-promotion programs for older workers

OBJECTIVES

We examined the effects of 2 worksite health-promotion interventions (compared with a health-education control) on older workers' healthy behaviors and health outcomes.

METHODS

We conducted a prospective, randomized controlled trial with 423 participants aged 40 years and older. Participants were categorized into 3 study arms: the COACH intervention combined Web-based risk assessments with personal coaching support, the RealAge intervention used a Web-based risk assessment and behavior-specific modules, and a control group received printed health-promotion materials. Participants were assessed at baseline, 6 months, and 12 months. Random-effects modeling controlled for baseline stage of change for all behaviors of interest in all groups.

RESULTS

At 6 and 12 months, COACH participants showed significantly increased fruit and vegetable consumption (P = .026; P < .001) and participation in physical activity (P = .05; P = .013), and at 12 months they showed decreased percentage of energy from fat (P = .027). RealAge participants showed significantly decreased waist circumference at 6 and 12 months (P = .05; P = .018).

CONCLUSIONS

COACH participants were twice as likely to use the COACH intervention as RealAge participants were to use the RealAge intervention. COACH participants experienced twice the number of positive outcomes that control participants experienced.

Maintaining exercise and healthful eating in older adults: the SENIOR project II: study design and methodology

The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) Project II is an intervention study to promote the maintenance of both exercise and healthful eating in older adults. It is the second phase of an earlier study, SENIOR Project I, that originally recruited 1277 community-dwelling older adults to participate in behavior-specific interventions designed to increase exercise and/or fruit and vegetable consumption. The general theoretical framework for this research is the Transtheoretical Model (TTM) of Health Behavior Change. The current intervention occurs over a 48-month period, using a manual, newsletters, and phone coaching calls. Annual assessments collect standardized data on behavioral outcomes (exercise and diet), TTM variables (stage of change and self-efficacy), psychosocial variables (social support, depression, resilience, and life satisfaction), physical activity and functioning (SF-36, Up and Go, Senior Fitness Test, and disability assessment), cognitive functioning (Trail Making Test and Forward and Backward Digit Span), physical measures (height, weight, and waist circumference), and demographics. The SENIOR Project II is designed to answer the following question as its primary objective: (1) Does an individualized active-maintenance intervention with older adults maintain greater levels of healthful exercise and dietary behaviors for 4years, compared to a control condition? In addition, there are two secondary objectives: (2) What are the psychosocial factors associated with the maintenance of health-promoting behaviors in the very old? (3) What are the effects of the maintenance of health-promoting behaviors on reported health outcomes, psychosocial measures, anthropometrics, and cognitive status?

Make Better Choices (MBC): study design of a randomized controlled trial testing optimal technology-supported change in multiple diet and physical activity risk behaviors

Background

Suboptimal diet and physical inactivity are prevalent, co-occurring chronic disease risk factors, yet little is known about how to maximize multiple risk behavior change. Make Better Choices, a randomized controlled trial, tests competing hypotheses about the optimal way to promote healthy change in four bundled risk behaviors: high saturated fat intake, low fruit and vegetable intake, low physical activity, and high sedentary leisure screen time. The study aim is to determine which combination of two behavior change goals - one dietary, one activity - yields greatest overall healthy lifestyle change.

Methods/Design

Adults (n = 200) with poor quality diet and sedentary lifestyle will be recruited and screened for study eligibility. Participants will be trained to record their diet and activities onto a personal data assistant, and use it to complete two weeks of baseline. Those who continue to show all four risk behaviors after baseline recording will be randomized to one of four behavior change prescriptions: 1) increase fruits and vegetables and increase physical activity, 2) decrease saturated fat and increase physical activity, 3) increase fruits and vegetable and decrease saturated fat, or 4) decrease saturated fat and decrease sedentary activity. They will use decision support feedback on the personal digital assistant and receive counseling from a coach to alter their diet and activity during a 3-week prescription period when payment is contingent upon meeting behavior change goals. They will continue recording on an intermittent schedule during a 4.5-month maintenance period when payment is not contingent upon goal attainment. The primary outcome is overall healthy lifestyle change, aggregated across all four risk behaviors.

Discussion

The Make Better Choices trial tests a disseminable lifestyle intervention supported by handheld technology. Findings will fill a gap in knowledge about optimal goal prescription to facilitate simultaneous diet and activity change. Results will shed light on which goal prescription maximizes healthful lifestyle change.

Trial Registration

Clinical Trials Gov. Identifier NCT00113672

Physical activity behaviors of students of a rural historically black college

Physical activity can have a positive impact on health disparities among African Americans.

OBJECTIVE

In this study, we assessed physical activity behaviors and correlates of students of a Historically Black College.

METHODS

In September 2004, an online survey and pedometers were used to measure physical activity behavior and correlates.

PARTICIPANTS

A convenience sample of 106 students completed the survey and received pedometers. Pedometer data were submitted online for 5 weeks.

RESULTS

One hundred and six students completed the survey. Twenty-eight percent and 41% of respondents met recommendations for moderate physical activity and vigorous physical activity, respectively. Week 1 daily pedometer step count average was 8,707. Most students reported positive outcome expectations for physical activity. Students submitting pedometer data were less likely to meet MPA recommendations than students only completing the survey.

CONCLUSIONS

African American students feel positive about physical activity yet most do not meet recommended levels.

US acculturation, food intake, and obesity among Asian-Pacific hotel workers

BACKGROUND

Both obesity and immigration continue to increase in the United States. Studies suggest that a transition in lifestyle patterns, such as food intake, may mediate the relationship between immigration and obesity.

OBJECTIVE

We examine obesity among hotel workers in relation to age, sex, race/ethnicity, and indicators of food intake, immigration, and acculturation.

SUBJECTS/SETTING

Four thousand five hundred thirty hotel workers in 30 hotels were studied from the first year of the Work, Weight and Wellness program, before intervention (during 2005-2006).

MAIN OUTCOME MEASURES

Weight and height were measured, whereas race/ethnicity, language, education, immigration, acculturation, and food intake variables were assessed by questionnaire.

RESULTS

The study included 43% male and 57% female hotel workers (mean age 44.4+/-11.3 years; 42% Filipino, 32% other Asian, 13% Pacific Islander, 9% white, 1% black/African American, and 3% other race/ethnicity). On average (mean value), 55% of participants were born outside the United States; 57% were overweight or obese (body mass index [BMI] >25). The BMI of those born in the United States was 1.3 higher than that of those born in another country, adjusting for sex and race/ethnicity. Intake of sweet drinks and meat was positively associated with BMI while intake of fruit was negatively associated with BMI. Age at arrival in United States ("generation") was negatively associated with BMI, whereas greater acculturation was positively associated with BMI.

CONCLUSIONS

Food intake behaviors are probably related to place of birth, generation of migration to the United States, and acculturation. Direct measures of food intake added explanatory power to models, suggesting the importance of food intake to obesity. Further study of the influence of immigration, acculturation, and food intake on obesity using longitudinal study designs is warranted.

Construct validation of the stages of change with strenuous, moderate, and mild physical activity and sedentary behaviour among children

The stages of change construct of the Transtheoretical Model have been successfully applied to examine physical activity adoption among adults. Thus far, little research on the stages of physical activity change has been focused on children. Therefore, the purpose of this study is to validate the stages of change with vigorous, moderate, and light physical activity, and sedentary behaviour among children. Two different samples (sample 1: n=513, 52% male; sample 2: n=258, 45% male) completed Godin's Leisure-Time Exercise Questionnaire and the physical activity stage questions. One-way ANOVAs revealed significant differences in both the samples between the stages of change for vigorous (sample 1: F=15.9, df=4508, p<.0125, eta(2)=.17; sample 2: F=12.8, df=4252, p<.0125, eta(2)=.11) and moderate (sample 1: F=8.54, df=4508, p<.0125, eta(2)=.07; sample 2: F=4.72, df=4252, p<.0125, eta(2)=.06) physical activity. There are no or weak correlations found between the stages of change and light physical activity (sample 1: F=3.12, df=4508, ns, eta(2)=.05; sample 2: F=3.38, df=4250, p<.0125, eta(2)=.02), or sedentary behaviour (sample 1: F=.54, df=4508, ns, eta(2)=.05; sample 2: F=3.13, df=4252, ns, eta(2)=.00). These results extend the validation of the stages of physical activity to children's moderate and vigorous intensity activities.

Long-term effects of a stage-based intervention for changing exercise intentions and behavior in older adults

PURPOSE

We examined the efficacy of an intervention tailored to the individual's stage of change for exercise adoption on exercise stage of change, physical activity, and physical function in community-dwelling older adults.

DESIGN AND METHODS

We randomized participants to a print and telephone intervention or a contact comparison group. Through the use of longitudinal analyses we examined the intervention's effectiveness in promoting stage progression, altering decisional balance and the processes of change, increasing self-efficacy and physical activity, and improving physical function among older adults who completed the 24-month study (N = 966). We conducted similar analyses that excluded individuals who were in maintenance at baseline and 24 months.

RESULTS

At the end of the study, there were no differences in stage progression, self-efficacy, decisional balance, the processes of change, physical activity, or physical function by intervention assignment. When the analyses excluded those participants (n = 358) who were in the maintenance stage for exercise throughout the intervention, we found that, compared with the comparison group, a greater proportion of individuals who received the exercise intervention progressed in stage by 24 months. Conversely, more individuals in the comparison group remained stable or regressed in stage compared with the intervention group.

IMPLICATIONS

Results indicate that a tailored intervention is effective in increasing motivational readiness for exercise in individuals who were in stages of change other than maintenance.

Correlates of the stages of change for physical activity in a population survey

OBJECTIVES

We sought to identify variables associated with being in a particular stage of change for physical activity-a measure of behavioral intention to engage in regular physical activity. Understanding behavioral intentions can be useful in explaining why individuals are physically inactive or active.

METHODS

Data from the Rhode Island 2000 Behavioral Risk Factor Surveillance System were used to evaluate predictors of stage of change for physical activity. There were 3454 observations in the data set, representing a weighted population of 742636 people. Estimates were obtained from polytomous multiple logistic models.

RESULTS

Being a woman, Hispanic, non-Hispanic Black, and older than 55 years of age were associated with being in precontemplation and contemplation stages of change rather than maintenance. Self-perceived health status and rarely feeling healthy or full of energy were strongly predictive of stage of change. Having a health limitation was a dichotomous predictor, predicting being in action and precontemplation stages.

CONCLUSIONS

Several sociodemographic and health variables were associated with varying patterns of stages of change for physical activity. The complexity of individual intentions for physical activity provides evidence for the potential existence of mediating, effect-modifying, and confounding variables that differ depending on individual characteristics.

Meta-analytic examination of the strong and weak principles across 48 health behaviors

OBJECTIVE

The strong and weak principles of change state that progress from the precontemplation to the action stage of change is associated with a one standard deviation increase in the pros and a one-half standard deviation decrease in the cons of change. In this study these relationships, originally developed by Prochaska [Prochaska, J.O., 1994. Strong and weak principles for progressing from precontemplation to action on the basis of 12 problem behaviors. Health Psychology, 13, 47-51] based on an examination of 12 studies of 12 different behaviors, were re-examined using many more datasets and much more rigorous statistical methods.

METHODS

The current study analyzes 120 datasets from studies conducted between 1984 and 2003 across and within 48 health behaviors, including nearly 50,000 participants from 10 countries. The datasets were primarily analyzed utilizing meta-analytic techniques.

RESULTS

Despite the range of behaviors and populations, the results were remarkably consistent with the original results (pros=1.00 standard deviation, cons=0.56 standard deviation). Few potential moderators showed any impact on effect size distributions.

CONCLUSIONS

This updated and enhanced examination of two important principles of behavior change is a significant contribution to the field of multiple health risk behaviors, as it clearly demonstrates the consistency of the theoretical principles across multiple behaviors, which has implications for developing multiple health risk behavior interventions.

Recruiting and retaining older adults for health promotion research: the experience of the SENIOR Project

This paper examines recruitment and retention efforts utilized by a community-based health promotion intervention with older adults (N = 1,277). Recruitment strategies were classified as either involving or not involving personal interaction with project staff. There was no difference by recruitment method in demographic characteristics, but a greater proportion of participants recruited using strategies without personal interaction were in the earlier stage of change (SOC) for fruit and vegetable consumption compared with those recruited using strategies involving personal contact. Conversely, a greater proportion recruited without interaction with project staff was in action/maintenance SOC for exercise. Attrition was greater among individuals in the earlier SOC for exercise and among those who perceived their health to be fair/poor. As most participants were recruited using strategies involving interaction with project staffs, it may be best to emphasize techniques involving personal contact when recruiting older adults to participate in research studies.

Stages of change for physical activity in adults from Southern Brazil: a population-based survey

Background

There is evidence that physical activity (PA) interventions tailored to individual's stages of change (SoC) are more effective in promote behavior change than "one-size-fits-all" interventions. However, only a few researches have investigated these stages towards PA behavior in representative samples of the population. Thus, the purpose of this study was to determine the prevalence and factors associated with the SoC for PA in a probabilistic sample of adults aged 20 years or over.

Methods

A population-based survey was undertaken in Pelotas, Southern Brazil, in 2005. An algorithm was applied to evaluate the SoC for PA, and PA was defined as being engaged in moderate-to-vigorous PA for at least 20 minutes on three times per week. The covariates collected in the questionnaire were: sex, age, skin color, marital status, education level, economic status, family income, smoking, body mass index (BMI) and self-reported health status. Data analyses were performed through Poisson and multinomial regression, taking the sampling design into account.

Results

Face-to-face interviews were applied to 3136 individuals, corresponding to a response rate of 93.5%. The prevalence across the stages was as follows: 38.3% in precontemplation, 13.0% in contemplation, 19.5% in preparation, 5.2% in action and 24.0% in maintenance. The elderly, married, smokers, and those with lower socioeconomic status were less likely to adopt, initiate and maintain regular PA.

Conclusion

Despite the all benefits of PA, a high proportion of adults from Southern Brazil are physically inactive and do not present intention to engage in regular PA. The profile of those who are inactive but intend to do PA resembles those who are physically active. The findings of the present study can contribute to improve health behaviors and to plan health promotion strategies aimed at increasing the level of PA in the community.

Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature

Three questions guided a literature review of the transtheoretical model (TTM) as applied to exercise to address the evidence for stage-matched interventions, the description of priority populations, and the identification of valid TTM measurement tools. One-hundredand-fifty studies were reviewed. Results indicate preliminary support for the use of stage-matched exercise interventions. Most studies have focused on White, middle-class, female populations, limiting the generalizability of their findings. Valid and reliable measures exist for stage of change, decisional balance, processes of change, self-efficacy, and temptations to not exercise; however, more research is needed to refine these measures. Evidence for the construct validity of the TTM as applied to exercise is mixed. When designing and implementing TTM-based exercise interventions, practitioners and policy makers are encouraged to clearly define the term exercise, choose a valid and reliable staging tool, and employ all TTM constructs and not just stage membership.

Comparison of the traits of physically active and inactive women

PURPOSE

To explore the determinants of physical activity for working women and to compare traits of active with inactive women.

DATA SOURCES

Original research articles, books, government reports, and self-report survey data from 373 university employees who attended an employer-sponsored health screening.

CONCLUSIONS

Active women had lower body mass indexes and more beneficial high-density lipoprotein cholesterol when compared to inactive women. They were more likely to have a past history of sustained physical activity. Significant psychosocial determinants to physical activity included time constraints, confidence in finding an activity that can be enjoyed in bad weather, and not being too tired at the end of the day to engage in physical activity.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are in key positions to help women increase their levels of physical activity. Knowing the traits of active women can help busy clinicians focus interventions that address those traits, leading to greater efficiency and effectiveness.

Construct validity of physical activity and sedentary behaviors staging measures for adolescents

PURPOSE

To evaluate the construct validity of physical activity (PA) and sedentary behaviors (SB) staging measures for adolescents that incorporate the current national recommendations.

METHOD

The Progressive Aerobic Cardiovascular Endurance Run, Actigraph accelerometer, and self-reported hours of TV viewing served as criterion measures. Participants were 878 adolescents (M age = 12.74, 53.6% girls, 39.9% non-White).

RESULTS

The PA staging measure had mixed evidence of convergent validity and strong evidence of divergent validity. The SB staging measure had strong and generalized evidence of convergent validity but weak evidence of divergent validity, which could be related to inaccurate assumptions about the relation of SB to PA and fitness. Results were generally in the expected direction and provide preliminary evidence for the construct validity and generalizability of both staging measures. However, more research is warranted to validate the staging measures with Actigraph-measured PA and sedentary time. Effect sizes (eta(2) values) ranged from small to large (.02-.63).

CONCLUSION

PA and SB stage-of-change measures that are congruent with current national recommendations and appropriate for use among adolescents were partially supported for their construct validity.

Stages of change in adolescents: an examination of self-efficacy, decisional balance, and reasons for relapse

PURPOSE

The purpose of this study was to test selected constructs of the transtheoretical model (TTM) of behavior change in relation to exercise behavior with an adolescent sample. A further purpose was to examine reasons why adolescents stop physical activity and to relate these to stages of exercise change.

METHODS

Participants were 15 to 17 year old students at a private high school (N = 327). Participants completed a questionnaire consisting of an exercise measure, measures of the TTM variables, and an open-ended question that asked if they used to exercise in the past but currently did not, why they had stopped. The TTM data were analyzed using ANOVA F-tests with post-hoc Scheffe tests. To evaluate the ability of the TTM variables to discriminate between stages of exercise behavior, standard discriminant function analyses were performed. Open-ended answers to the relapse question were themed according to a model which categorizes barriers preventing youth's participation in recreational activities as infrastructural, superstructural, and procedural. The relationship of perceived barriers to stage of behavior change was assessed using cross-tabulation and chi-square analyses.

RESULTS

Moderate support for the TTM constructs were found, with the strongest discriminator between stages being strenuous exercise, and self-efficacy being the most supported construct. Infrastructural, superstructural, and procedural barriers were all evident.

CONCLUSION

Over 30% of previously active adolescents in this study reported barriers precluding extracurricular physical activity. Interventions should target the most often cited reasons for relapse: time and limits relating to the nature of the adolescent self.

Physical activity staging distribution: Establishing a heuristic using multiple studies

The purpose of this study was to identify the population prevalence across the stages of change (SoC) for regular physical activity and to establish the prevalence of people at risk. With support from the National Institutes of Health, the American Heart Association, and the Robert Wood Johnson Foundation, nine Behavior Change Consortium studies with a common physical activity SoC measure agreed to collaborate and share data. The distribution pattern identified in these predominantly reactively recruited studies was Precontemplation (PC) = 5% (+/- 10), Contemplation (C) = 10% (+/- 10), Preparation (P) = 40% (+/- 10), Action = 10% (+/- 10), and Maintenance = 35% (+/- 10). With reactively recruited studies, it can be anticipated that there will be a higher percentage of the sample that is ready to change and a greater percentage of currently active people compared to random representative samples. The at-risk stage distribution (i.e., those not at criteria or PC, C, and P) was approximately 10% PC, 20% C, and 70% P in specific samples and approximately 20% PC, 10% C, and 70% P in the clinical samples. Knowing SoC heuristics can inform public health practitioners and policymakers about the population's motivation for physical activity, help track changes over time, and assist in the allocation of resources.

Ratings of perceived exertion are not influenced by exercise stage of change in physically active college students

Comparisons of ratings of perceived exertion based on fitness have been equivocal but have not accounted for recent exercise history. The purpose of this study was to test mean differences in ratings of perceived exertion among individuals of differing exercise histories as measured by exercise stage of change. Participants completed questionnaires to measure exercise stage of change and physical activity [preparation stage (n=32), action stage (n=31), and maintenance stage (n=41)]. Ratings of perceived exertion were measured during a graded maximal exercise test. Individual regression equations were computed to estimate the ratings for 50%, 60%, 70%, and 80% of VO2 max. There were no significant differences in the ratings across the preparation, action, and maintenance stages. Therefore, the hypothesis that recent exercise history would influence ratings of perceived exertion during an aerobic fitness test was rejected.