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Gonzalo-Encabo P, Sami N, Wilson RL, Kang DW, Ficarra S, Dieli-Conwright CM. Exercise as Medicine in Cardio-Oncology: Reducing Health Disparities in Hispanic and Latina Breast Cancer Survivors. Curr Oncol Rep 2023; 25:1237-1245. [PMID: 37715884 PMCID: PMC10640421 DOI: 10.1007/s11912-023-01446-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW This review aims to access the current state of the evidence in exercise as medicine for cardio-oncology in Hispanic and Latina breast cancer survivors and to provide our preliminary data on the effects of supervised aerobic and resistance training on cardiovascular disease (CVD) risk in this population. RECENT FINDINGS Breast cancer survivors have a higher risk of CVD; particularly Hispanic and Latina breast cancer survivors have a higher burden than their White counterparts. Exercise has been shown to reduce CVD risk in breast cancer survivors; however, evidence in Hispanic and Latina breast cancer survivors is scarce. Our review highlights a clear need for exercise oncology clinical trials in Hispanic and Latina breast cancer survivors targeting CVD risk factors. Moreover, our exploratory results highlight that 16 weeks of aerobic and resistance training may reduce the 10-year risk of developing CVD by 15% in Hispanic and Latina breast cancer survivors.
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Affiliation(s)
- Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Madrid, Spain
| | - Nathalie Sami
- Department of Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Salvatore Ficarra
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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Jones MK, Davis SM, Gaskin-Cole G. An Integrative Review of Sistah Circles in Empirical Research. PSYCHOLOGY OF WOMEN QUARTERLY 2023. [DOI: 10.1177/03616843231154564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Sistah circles are spaces shared by Black women who share similar goals, exchange resources (e.g., support), and invest in developing strong relational bonds over time. Considering the significance of sistah circles for Black women's wellness and survival, in this study we examined how this phenomenon has been researched in the social sciences literature and, in turn, offered a more refined conceptual definition and framework that will direct future research on this topic. Specifically, we completed an integrative review of empirical studies on sistah circles using social science databases and search engines to identify relevant literature. Articles included for review met the following criteria: (a) published between 2000 and 2020, (b) analyzed empirical data, (c) were composed of Black women participants, and (d) mentioned Black women groups or friendships. Qualifying sources ( N = 45) were organized into a taxonomy of three types of sistah circles: health-focused, social, and professional. We also analyzed sample characteristics, research methods, and publication trends across all of the articles included in the review. Based upon our taxonomy and results of our review, we highlight the strengths and limitations of the current scholarship focused on Black women's sistah circles and offer suggestions regarding future research and practice. Additional online materials for this article are available on PWQ's website at http://journals.sagepub.com/doi/suppl/10.1177/03616843231154564
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Affiliation(s)
| | - Shardé M. Davis
- Department of Communication, University of Connecticut, Storrs, CT, USA
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Arigo D, Romano KA, Pasko K, Travers L, Ainsworth MC, Jackson DA, Brown MM. A scoping review of behavior change techniques used to promote physical activity among women in midlife. Front Psychol 2022; 13:855749. [PMID: 36211932 PMCID: PMC9534296 DOI: 10.3389/fpsyg.2022.855749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Women in midlife experience health risks that could be mitigated by regular physical activity and reduced sedentary time, but this population rarely achieves physical activity levels that would protect their health. As a result, many behavioral interventions are designed to promote physical activity in this population, which are purportedly guided by theoretical models of health behavior (change) and activate an associated set of behavior change techniques (BCTs). The efficacy and effectiveness of these interventions appear to be limited, however, raising questions about their design and adaptation for women in midlife. Several aspects of these interventions are currently unclear. Specifically, which women they target (i.e., how “midlife” and “sedentary” or “inactive” are defined), which theoretical models or behavior BCTs are used, and how BCTs are activated in such interventions. A synthesis of this information would be useful as an initial step toward improving physical activity interventions for this at-risk group, and thus, represented the goal of the present scoping review. Eligibility required publication in a peer-reviewed journal in English between 2000 and 2021, inclusion of only women in midlife who did not have any medical or other restrictions on their physical activity (e.g., cancer diagnosis), and free-living physical activity or sedentary behavior as the target outcome (with associated assessment). Of the 4,410 initial results, 51 articles met inclusion criteria, and these described 36 unique interventions. More than half of the articles (59%) named an underlying theoretical model and interventions included an average of 3.76 identifiable BCTs (range 1–11). However, descriptions of many interventions were limited and did not provide enough detail to determine whether or how specific BCTs were activated. Interventions also used a wide range of inclusion criteria for age range and starting activity level, which has implications for targeting/tailoring and effectiveness, and many interventions focused on marginalized populations (e.g., women from racial/ethnic minority backgrounds, those un- or under-insured). The present review identifies some strengths and highlights important limitations of existing literature, as well as key opportunities for advancing the design and potential utility of physical activity interventions for women in midlife.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, NJ, United States
- Department of Family Medicine, Rowan School of Osteopathic Medicine, Stratford, NJ, United States
- *Correspondence: Danielle Arigo
| | - Kelly A. Romano
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Kristen Pasko
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Laura Travers
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - M. Cole Ainsworth
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Daija A. Jackson
- Clinical Psychology Program, Chicago School of Professional Psychology, Washington, DC, United States
| | - Megan M. Brown
- Department of Psychology, Rowan University, Glassboro, NJ, United States
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Eizagirre-Sagastibeltza O, Fernandez-Lasa U, Yanci J, Romaratezabala E, Cayero R, Iturrioz I, Usabiaga O. Design and Validation of a Questionnaire to Assess the Leisure Time Physical Activity of Adult Women in Gipuzkoa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095736. [PMID: 35565129 PMCID: PMC9103327 DOI: 10.3390/ijerph19095736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/10/2022]
Abstract
Inactivity is higher among women than among men, and there are few specific questionnaires used to assess physical activity (PA) in women that are truly meaningful to them. This article tackles the design and validation process of an ad hoc multidimensional questionnaire to assess leisure time physical activity (LTPA) among adult women of Gipuzkoa. The questionnaire was completed by 3595 adult women (43.5 ± 12.1 years), 32% of which were inactive and 68% of which were active. Content validation, ecological validation, and internal consistency analysis results were satisfactory. The Gipuzkoa Women’s Physical Activity Questionnaire (GWPAQ) consists of four dimensions and 21 items. Barriers to PA were found related to intrapersonal, environmental, and socio-cultural aspects. The importance of family and spousal support in increasing PA levels was also observed. It is concluded that the GWPAQ is valid for obtaining evidence that can be used by public institutions to optimise women-specific PA promotion policies.
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Affiliation(s)
| | - Uxue Fernandez-Lasa
- Society, Sport and Physical Activity (GIKAFIT) Research Group, Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Lasarteko Bidea 71, 01007 Vitoria-Gasteiz, Spain; (J.Y.); (E.R.); (O.U.)
- Correspondence: ; Tel.: +34-945013530
| | - Javier Yanci
- Society, Sport and Physical Activity (GIKAFIT) Research Group, Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Lasarteko Bidea 71, 01007 Vitoria-Gasteiz, Spain; (J.Y.); (E.R.); (O.U.)
| | - Estibaliz Romaratezabala
- Society, Sport and Physical Activity (GIKAFIT) Research Group, Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Lasarteko Bidea 71, 01007 Vitoria-Gasteiz, Spain; (J.Y.); (E.R.); (O.U.)
| | - Ruth Cayero
- Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain;
| | - Iñaki Iturrioz
- Diputación Foral de Gipuzkoa, Gipuzkoa Provincial Council, 20004 Donostia-San Sebastian, Spain;
| | - Oidui Usabiaga
- Society, Sport and Physical Activity (GIKAFIT) Research Group, Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Lasarteko Bidea 71, 01007 Vitoria-Gasteiz, Spain; (J.Y.); (E.R.); (O.U.)
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Self-Efficacy, Outcome Expectations, Group Social Support, and Adherence to Physical Activity in African American Women. Nurs Res 2021; 70:239-247. [PMID: 33870956 DOI: 10.1097/nnr.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African American women have lower levels of leisure time physical activity compared to White American women. Interventions to improve physical activity have mixed benefits for African American women, even when guided by theory. Understanding how theoretical constructs used in physical activity interventions relate to changing behavior may provide direction for more successful interventions. OBJECTIVE The study aimed to examine the relationships among social cognitive constructs (self-efficacy, social support from group behavioral meetings, outcome expectations/realizations), and change in physical activity from baseline to 48 weeks in African American women participating in a lifestyle physical activity program. METHODS A secondary data analysis of longitudinal data using a correlational design was conducted using data from a 48-week physical activity randomized controlled trial (RCT). The RCT included a group behavioral meeting component with one of three telephone intervention conditions (no calls, personal motivation calls, or automated motivational calls) randomly assigned across six community healthcare sites. The participants were 260 sedentary, midlife African American women with no major signs or symptoms of cardiovascular disease who completed baseline and 48-week assessments of the RCT. Measures included self-efficacy for change in overcoming barriers to physical activity at 24 weeks, physical and psychological outcome realizations at 24 weeks, social support from group behavioral meetings at 24 weeks, and physical activity (self-report and device-measured) change from baseline to 48 weeks. RESULTS In a hierarchical regression model predicting change in self-reported time spent in weekly moderate-vigorous physical activity at 48 weeks, psychological outcome realizations at 24 weeks were significant positive predictors. In a hierarchical regression model for change in device-measured daily steps at 48 weeks, a self-efficacy change at 24 weeks was a significant positive predictor. DISCUSSION Attention should be given to increasing self-efficacy to overcome physical activity barriers and achieve self-identified physical and psychological outcomes in physical activity programs.
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Nyenhuis SM, Shah N, Kim H, Marquez DX, Wilbur J, Sharp LK. The Feasibility of a Lifestyle Physical Activity Intervention for Black Women with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4312-4321.e2. [PMID: 34333191 DOI: 10.1016/j.jaip.2021.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are disproportionately affected by both physical inactivity and asthma. Lifestyle physical activity (PA) interventions targeted for Black women with asthma are lacking. OBJECTIVE To assess the feasibility and acceptability as well as preliminary effects of a lifestyle PA intervention culturally tailored for Black women with asthma. METHODS Black women (age 18-70 years) with uncontrolled asthma (Asthma Control Test <20) were recruited. Outcome assessments at baseline and 24 weeks included measures of: feasibility and acceptability, asthma control, quality of life, health care use, and PA levels. Participants were randomized to the intervention (asthma education, Fitbit, monthly group sessions, text messages, individual step goals, and study manual) or enhanced usual care (EUC) (asthma education plus Fitbit) group. RESULTS Of the 53 women randomized (EUC = 28; intervention = 25), 92% remained in the intervention (23 of 25) and 76% completing the 24-week outcome assessment. Overall intervention satisfaction (mean score, 6.88 of 7) and individual components were high at 24 weeks. Mean change in asthma control questionnaire between groups was not significant at 24 weeks (intervention = -0.41 vs EUC = 0.03 [P = .08]; effect size = -0.38) but approached clinical significance (0.5). At 24 weeks, more women receiving the intervention had controlled asthma compared with EUC (36.84% vs 9.52%; P = .04). Clinically significant improvements (0.5) in quality of life were found in the intervention group (mean change: intervention = 0.58 vs EUC = 0.10; P = .10) at 24 weeks. CONCLUSIONS A culturally tailored lifestyle PA intervention is feasible and demonstrates improvements in asthma control and quality of life among Black women with asthma. These preliminary findings support the need for PA lifestyle interventions in urban Black women with asthma.
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Affiliation(s)
| | - Nida Shah
- Department of Medicine, University of Illinois at Chicago, Chicago, Ill
| | - Hajwa Kim
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Ill
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Ill
| | - JoEllen Wilbur
- Department of Women, Children and Family Nursing, Rush University, Chicago, Ill
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, Ill
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Bandera EV, Alfano CM, Qin B, Kang DW, Friel CP, Dieli-Conwright CM. Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities. Am Soc Clin Oncol Educ Book 2021; 41:1-17. [PMID: 33989021 DOI: 10.1200/edbk_321315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.
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Affiliation(s)
- Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Catherine M Alfano
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY.,Northwell Health Cancer Institute, New York, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ciarán P Friel
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY
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Hall CM, Ram Y. Weather and climate in the assessment of tourism-related walkability. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:729-739. [PMID: 31691853 DOI: 10.1007/s00484-019-01801-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/12/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
Walking is an important outdoor recreational and tourism activity, both in natural surroundings and in urban settings. Walkability is the extent to which the built environment promotes walking, and addresses issues such as comfort, connectivity, safety and aesthetic values. The paper explores a relatively overlooked domain of recreation- and tourism-related walkability: the extent to which weather and climatic conditions are incorporated into assessments of walkability and their influence on walking behaviour. Following a discussion of the assessment of walkability, the results of a scoping review of weather- and climate-related variables in walkability articles published up to June 2018 are presented. The review indicates there is little research on walkability from a tourist perspective, although there is substantial interest in walking for leisure and recreation. Four major themes were identified. The descriptive theme focuses on the general importance of weather and climate to walkability; the passive analyses the weather and climate conditions as barriers to, or as promoters of, walking; proactive studies refer to adapting to and managing weather, such as provision of shade or snow-clearing. The proactive perspective gains less attention than the passive analysis. Finally, statistical controlling was only employed by a minority of studies that adjusted their results to the impacts of weather conditions. The work concludes that the sub-field has been poorly served with respect to concept and variable definition and consistency of use mean that present knowledge is of limited scientific value. Strategies for future research are suggested.
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Affiliation(s)
- C Michael Hall
- Department of Management, Marketing and Entrepreneurship, University of Canterbury, Christchurch, New Zealand.
- Department of Geography, University of Oulu, Oulu, Finland.
- School of Business and Economics, Linneaus University, Kalmar, Sweden.
| | - Yael Ram
- Department of Tourism Studies, Ashkelon Academic College, Ben Zvi 12, 78211, Ashkelon, Israel
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Group Dance and Motivational Coaching for Walking: A Physical Activity Program for South Asian Indian Immigrant Women Residing in the United States. J Phys Act Health 2021; 18:262-271. [PMID: 33540381 DOI: 10.1123/jpah.2019-0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/05/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND South Asian Indian immigrants residing in the United States are at high risk of cardiovascular disease (prevalence ≥35%), diabetes (prevalence 45.4%), and stroke (prevalence 26.5%). This study examined the effect of culturally relevant physical activity interventions on the improvement of physiological measures and average daily steps in at-risk midlife South Asian Indian immigrant women. METHODS In this 2-arm interventional research design, the dance (n = 25) and the motivational phone calls group (n = 25), attended social cognitive theory-based motivational workshops every 2 weeks for the first 12 weeks. Data for weight, waist circumference, blood pressure, blood sugar, cholesterol level, and 12-lead electrocardiogram were collected at the baseline, 12 weeks, and 24 weeks. RESULTS Significant differences were seen in body weight (F2,94 = 4.826, P = .024; ηp2=.093), waist circumference (F2,92 = 7.496, P = .001; ηp2=.140), systolic blood pressure (F2,94 = 19.865, P = .000; ηp2=.2970), triglyceride (F2,94 = 11.111, P = .000; ηp2=.191), cholesterol (F2,94 = 8.925, P = .001; ηp2=.160), blood sugar level (F2,94 = 8.851, P = .000; ηp2=.158), and average daily steps across both intervention groups over time (F2,96 = 30.94, P = .000; ηp2=.392). CONCLUSION Culturally relevant motivational workshops with Indian dance and walking are an innovative approach to increasing lifestyle physical activity among South Asian Indian immigrant women.
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Hu YL, Junge K, Nguyen A, Hiegel K, Somerville E, Keglovits M, Stark S. Evidence to Improve Physical Activity among Medically Underserved Older adults: A Scoping Review. THE GERONTOLOGIST 2020; 59:e279-e293. [PMID: 29668895 DOI: 10.1093/geront/gny030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Participation in leisure physical activity (PA) and engagement in PA interventions among older adults is influenced by socioeconomic status (SES), race/ethnicity, and environment. However, studies of PA for medically underserved older adults have not yet been systematically evaluated. The objective of this study is to map the nature and extent of research conducted on PA participation, interventions, and components of effective leisure PA programs for medically underserved older adults. RESEARCH DESIGN AND METHODS The five-stage approach was used to conduct this scoping review. We searched PubMed, CINAHL, and Cochrane Library for peer-reviewed studies published between 2006 and 2016. Data extracted from selected studies included study population, study type, purpose of intent, evidence level, barriers to PA participation, and components of PA intervention. RESULTS Three hundred and ninety-two articles were identified, and 60 studies were included in the final data charting. Existing literature showed that most studies remained descriptive in nature, and few intervention studies have achieved a high level of evidence. Among 21 intervention studies, only 4 were explicitly conducted for older adults. Culturally adapted materials, race/ethnicity-specific barriers and facilitators, and form of intervention were important components for intervention programs. DISCUSSION AND IMPLICATIONS Findings indicate that more studies are needed to reduce health disparities related to PA participation for medically underserved older adults. Intervention components such as race/ethnicity-relevant barriers and facilitators and culturally sensitive materials are also needed for PA interventions targeting underserved older adults in order to provide evidence for best practices.
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Affiliation(s)
- Yi-Ling Hu
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Kristin Junge
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - An Nguyen
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Kelsey Hiegel
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Emily Somerville
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Marian Keglovits
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Susan Stark
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
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Buchholz SW, Wilbur J, Halloway S, Schoeny M, Johnson T, Vispute S, Kitsiou S. Study protocol for a sequential multiple assignment randomized trial (SMART) to improve physical activity in employed women. Contemp Clin Trials 2020; 89:105921. [PMID: 31899371 PMCID: PMC7242143 DOI: 10.1016/j.cct.2019.105921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Physical activity monitors, motivational text messages, personal calls, and group meetings, have proven to be efficacious physical activity interventions. However, individual participant response to these interventions varies drastically. A SMART design (sequential multiple assignment randomized trial) provides an effective way to test interventions that start with an initial treatment and then transition to an augmented treatment for non-responders. We describe a SMART to determine the most effective adaptive intervention to increase physical activity (steps, moderate-to-vigorous physical activity) and improve cardiovascular health among employed women who are not regularly physically active. The SMART uses combinations of four treatments: 1) enhanced physical activity monitor (Fitbit wearable activity monitor and mobile app with goal setting and physical activity prescription), 2) text messages, 3) personal calls, and 4) group meetings. METHODS Participants (N = 312) include women ages 18-70 employed at a large academic medical center. Women will be randomized to an initial intervention, either an enhanced physical activity monitor or enhanced physical activity monitor + text messaging. Non-responders to the initial intervention at 2 months will be randomized to either personal calls or groups meetings for the next 6 months. At 8 months, all participants will return to only an enhanced physical activity monitor until their final 12-month assessment. DISCUSSION Results of this study will add to the literature on improving physical activity in employed women. This study will identify effective interventions for women who respond to less intensive treatments, while maximizing benefits for those who need a more intensive approach.
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Affiliation(s)
- Susan W Buchholz
- Rush University, College of Nursing, Chicago, IL, United States of America.
| | - JoEllen Wilbur
- Rush University, College of Nursing, Chicago, IL, United States of America
| | - Shannon Halloway
- Rush University, College of Nursing, Chicago, IL, United States of America
| | - Michael Schoeny
- Rush University, College of Nursing, Chicago, IL, United States of America
| | - Tricia Johnson
- Rush University, College of Health Sciences, Chicago, IL, United States of America
| | - Sachin Vispute
- Rush University, College of Nursing, Chicago, IL, United States of America
| | - Spyros Kitsiou
- University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, United States of America
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12
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Sweeney AM, Wilson DK, Brown A. A qualitative study to examine how differences in motivation can inform the development of targeted physical activity interventions for African American women. EVALUATION AND PROGRAM PLANNING 2019; 77:101718. [PMID: 31539644 PMCID: PMC6900870 DOI: 10.1016/j.evalprogplan.2019.101718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Self-Determination Theory proposes that some people are motivated to initiate physical activity by externally-controlled reasons (e.g., physical appearance, approval from others), whereas others feel compelled by more autonomous sources of motivation (e.g., enjoyment, personal importance). This study used qualitative methods to examine whether individual differences in autonomous motivation offers a useful framework for developing targeted intervention programs for African American women. Focus groups (k = 6) were conducted to examine how different levels of autonomous motivation for physical activity related to differences in physical activity barriers and facilitators among African American women (N = 31). Sessions were audiotaped, transcribed, and coded by independent raters (r = 0.70). QSR NVivo 11 was used to analyze data, and themes were identified separately for women with low, medium, or high autonomous motivation. Those with high autonomous motivation focused on themes of wanting novelty, excitement, and competition, whereas those with low autonomous motivation focused on themes of wanting instrumental support and financial incentives for increasing engagement in physical activity. Implications for developing physical activity intervention programs for African American women that are targeted toward differences in autonomous motivation are discussed.
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Affiliation(s)
- Allison M Sweeney
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, United States.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, United States.
| | - Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, United States.
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Subjective Versus Objective Estimated Cardiovascular Disease Risk and Adherence to Physical Activity in African American Women. J Cardiovasc Nurs 2019; 33:111-117. [PMID: 28723836 DOI: 10.1097/jcn.0000000000000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death for African American (AA) women in the United States. Despite high prevalence of CVD risk factors, AA women perceive their CVD risk as low. OBJECTIVE Our objectives were to (1) identify relationships between subjective (self-reported perceived) CVD risk and objective CVD risk estimated by the American College of Cardiology/American Heart Association atherosclerotic CVD (ASCVD) risk estimator, (2) identify demographic and psychosocial factors associated with subjective perceived risk and discrepancy with objective estimated CVD risk, and (3) determine whether subjective perceived CVD risk was associated with physical activity (PA) adherence. METHODS This was a secondary data analysis of data collected from a 12-month lifestyle PA intervention conducted with 281 AA women. Subjective perceived CVD risk was measured by 1 question; objective estimated CVD risk was calculated using the ASCVD score. Women were categorized by congruence or discrepancy between subjective perceived and objective estimated CVD risk. RESULTS Subjective perceived CVD risk and objective ASCVD risk scores were both low. Approximately 20% subjectively perceived their risk as lower than objective ASCVD scores. Atherosclerotic CVD risk discrepancy groups differed by depressed mood symptoms. Participants reported many perceived barriers to PA. Perceived CVD risk was not related to PA adherence. CONCLUSIONS The significance of associated CVD risk factors may be underestimated by AA women, leading to discrepancy between subjective and objective risk estimates. Research is needed to clarify relationships among perceived risk, estimated risk using risk calculators such as ASCVD, and health behavior.
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Ozemek C, Phillips SA, Fernhall B, Williams MA, Stamos TD, Bond S, Claeys H, Laddu DR, Arena R. Enhancing Participation in Cardiac Rehabilitation: A Question of Proximity and Integration of Outpatient Services. Curr Probl Cardiol 2018; 43:424-435. [DOI: 10.1016/j.cpcardiol.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Physical inactivity significantly impacts mortality worldwide. Physical inactivity is a modifiable risk factor for obesity, diabetes, cardiovascular disease, and other chronic conditions. African American women in the United States have the highest rates of physical inactivity when compared with other gender/ethnic groups. A paucity of research promoting physical activity (PA) in African American women has been previously identified. The purpose of this review was to identify intervention strategies and outcomes in studies designed to promote PA in African American women. METHODS Interventions that promoted PA in African American women published between 2000 and May 2015 were included. A comprehensive search of the literature was performed in Health Source: Nursing/Academic Edition, PsycINFO, CINAHL Complete, and MEDLINE Complete databases. Data were abstracted and synthesized to examine interventions, study designs, theoretical frameworks, and measures of PA. RESULTS Mixed findings (both significant and nonsignificant) were identified. Interventions included faith-based, group-based, and individually focused programs. All studies (n = 32) included measures of PA; among the studies, self-report was the predominant method for obtaining information. Half of the 32 studies focused on PA, and the remaining studies focused on PA and nutrition. Most studies reported an increase in PA or adherence to PA. This review reveals promising strategies for promoting PA. CONCLUSIONS Future studies should include long-term follow-up, larger sample sizes, and objective measures of PA. Additional research promoting PA in African American women is warranted, particularly in studies that focus on increasing PA in older African American women.
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Wilbur J, Miller AM, Fogg L, McDevitt J, Castro CM, Schoeny ME, Buchholz SW, Braun LT, Ingram DM, Volgman AS, Dancy BL. Randomized Clinical Trial of the Women's Lifestyle Physical Activity Program for African-American Women: 24- and 48-Week Outcomes. Am J Health Promot 2018; 30:335-45. [PMID: 27404642 DOI: 10.1177/0890117116646342] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the effects of a physical activity (PA) intervention of group meetings versus group meetings supplemented by personal calls or automated calls on the adoption and maintenance of PA and on weight stability among African-American women. DESIGN Randomized clinical trial with three conditions randomly assigned across six sites. SETTING Health settings in predominately African-American communities. SUBJECTS There were 288 women, aged 40 to 65, without major signs/symptoms of pulmonary/cardiovascular disease. INTERVENTION Six group meetings delivered over 48 weeks with either 11 personal motivational calls, 11 automated motivational messages, or no calls between meetings. MEASURES Measures included PA (questionnaires, accelerometer, aerobic fitness), weight, and body composition at baseline, 24 weeks, and 48 weeks. ANALYSIS Analysis of variance and mixed models. RESULTS Retention was 90% at 48 weeks. Adherence to PA increased significantly (p < .001) for questionnaire (d = .56, 128 min/wk), accelerometer (d = .37, 830 steps/d), and aerobic fitness (d = .41, 7 steps/2 min) at 24 weeks and was maintained at 48 weeks (p < .001), with no differences across conditions. Weight and body composition showed no significant changes over the course of the study. CONCLUSION Group meetings are a powerful intervention for increasing PA and preventing weight gain and may not need to be supplemented with telephone calls, which add costs and complexity.
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Affiliation(s)
- JoEllen Wilbur
- Women, Children, and Family Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Arlene Michaels Miller
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Louis Fogg
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Judith McDevitt
- Women, Children, and Family Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Cynthia M Castro
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael E Schoeny
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Susan W Buchholz
- Adult Health/Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Lynne T Braun
- Adult Health/Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Diana M Ingram
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | | | - Barbara L Dancy
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Burton WM, White AN, Knowlden AP. A Systematic Review of Culturally Tailored Obesity Interventions among African American Adults. AMERICAN JOURNAL OF HEALTH EDUCATION 2017. [DOI: 10.1080/19325037.2017.1292876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee H, Chae D, Cho S, Kim J, Yoo R. Influence of a community-based stretching intervention on the health outcomes among Korean-Chinese female migrant workers in South Korea: A randomized prospective trial. Jpn J Nurs Sci 2016; 14:277-287. [PMID: 27981744 DOI: 10.1111/jjns.12156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/21/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Abstract
AIM To investigate the long-term effectiveness of stretching exercises on the health outcomes of Korean-Chinese female migrant workers. METHODS This study was a randomized prospective trial. The study's participants (n = 80) were middle-aged, Korean-Chinese women who had worked full-time during the previous 6 months. They were assigned randomly to an enhanced stretching intervention group or a standard stretching intervention group. Both groups were instructed to carry out a structured 6 min stretching exercise program for at least three times per day and 5 days per week. The enhanced intervention group received additional interventions to increase exercise adherence through individual phone counseling and short message service during the 12 weeks, followed by three sets of acculturation workshops during the period of weeks 13-24. Musculoskeletal fitness, symptoms, and acculturative stress were assessed at baseline, week 12, and week 24. Linear mixed-models were used to test the interventions' effects. RESULTS The amount of stretching that was carried out, as a percentage of the recommended amount, was not significantly different between groups. There were significant improvements in flexibility of the back and work-related musculoskeletal disorder symptoms after completing the 24 week intervention but no significant difference existed between the groups. Acculturative stress decreased at week 12 but there was no significant change at week 24. CONCLUSIONS The 24 week, community-based stretching program for the Korean-Chinese female migrant workers was effective in increasing their flexibility and decreasing work-related musculoskeletal disorder symptoms. Culturally adaptive augmented interventions to increase social support are suggested in order to reduce acculturative stress.
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Affiliation(s)
- Hyeonkyeong Lee
- Department of Nursing Environments and Systems, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Duckhee Chae
- Chonnam National University College of Nursing, Gwangju, South Korea
| | - Sunghye Cho
- Department of Nursing Environments and Systems, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Junghee Kim
- Department of Nursing Environments and Systems, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Ri Yoo
- Department of Nursing Environments and Systems, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
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Buscail C, Menai M, Salanave B, Daval P, Painsecq M, Lombrail P, Hercberg S, Julia C. Promoting physical activity in a low-income neighborhood of the Paris suburb of Saint-Denis: effects of a community-based intervention to increase physical activity. BMC Public Health 2016; 16:667. [PMID: 27473296 PMCID: PMC4966720 DOI: 10.1186/s12889-016-3360-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Physical activity (PA) is a key factor for facing the increasing prevalence of obesity and overweight, and should be part of every public health programs. In this context, a community-based public health program promoting PA was developed in a low-income neighborhood of the city of Saint-Denis (France). Methods This work aimed at assessing the effectiveness of a 2-year PA promotion program. A quasi-experimental study was carried out using a pre/post design, with an assessment before (2013) and after (2015) the program. The interviewees were selected using a stratified random cluster sampling. The primary outcome was the proportion of participants practicing sufficient PA (WHO guidelines), and was measured using the RPAQ questionnaire. External interventions (on both neighborhood environment and inhabitants) were listed. Results We collected 199 questionnaires at baseline and 217 in 2015. There was a majority of women in both samples: 64.3 % in 2013 and 58.2 % in 2015. The average age of participants was 38.1 years (+/−1.1) and 40.6 (+/−1.1) respectively. The proportion of people practicing sufficient PA was modified from 48.1 % in 2013 to 63.5 % in 2015 (p = 0.001). This was mainly driven by women whose level of PA, increased from 40.3 % to 60.3 % (p = 0.002), reaching the average national French estimation of PA level among adults (63.5 %). Conclusions This work showed a significant increase of the proportion of people practicing PA in a disadvantaged neighborhood where a community-based program promoting PA was developed. Simultaneous external interventions contributed to the results, showing the necessity of synergic interventions to reach efficiency.
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Affiliation(s)
- Camille Buscail
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017, Bobigny, France. .,Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidemiologie et Biostatistiques Sorbonne Paris Cité (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne-Paris-Cité, F-93017, Bobigny, France.
| | - Mehdi Menai
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidemiologie et Biostatistiques Sorbonne Paris Cité (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne-Paris-Cité, F-93017, Bobigny, France
| | - Benoît Salanave
- Unité de surveillance et d'épidémiologie nutritionnelle (USEN), Institut de veille sanitaire (INVS), Université Paris 13, Centre de recherche en épidémiologie et statistiques, COMUE Sorbonne-Paris-Cité, F-93017, Bobigny, France
| | - Paul Daval
- Maison de la Santé, 6 rue des Boucheries, F-93200, Saint-Denis, France
| | - Marjorie Painsecq
- Maison de la Santé, 6 rue des Boucheries, F-93200, Saint-Denis, France
| | - Pierre Lombrail
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017, Bobigny, France
| | - Serge Hercberg
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017, Bobigny, France.,Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidemiologie et Biostatistiques Sorbonne Paris Cité (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne-Paris-Cité, F-93017, Bobigny, France
| | - Chantal Julia
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017, Bobigny, France.,Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidemiologie et Biostatistiques Sorbonne Paris Cité (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne-Paris-Cité, F-93017, Bobigny, France
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Mama SK, Leach HJ, Soltero EG, Lee RE. Improved Physical Activity Screening Enhances Intervention Effectiveness in Ethnic Minority Women. Health Promot Pract 2016; 18:54-61. [DOI: 10.1177/1524839916657325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identified inconsistencies in physical activity (PA) reported at screening and baseline of a 6-month health promotion intervention and explored how these inconsistencies influenced intervention effectiveness in African American and Hispanic women. Participants completed a telephone screener to determine eligibility for a PA intervention. Inactive participants (≤90 minutes of PA/week) were invited to a baseline assessment, where they completed the International Physical Activity Questionnaire, measuring work, transportation, gardening/housework, and leisure-time PA. Women returned after 6 months to complete an identical post-intervention assessment. Despite being screened as inactive, baseline Questionnaire data indicated that 85.0% of participants (N = 274, M age = 44.6 years, M body mass index = 34.8 kg/m2) were active (>90 minutes of PA/week). Women who reported any work-related PA were 20.9 times more likely to be active at baseline than those who did not (p < .001). Participants who were inactive at both screening and baseline reported greater increases in domestic and gardening PA and total PA from baseline to postintervention (ps < .05). Overweight/obese ethnic minority women may misreport being physically inactive during screening if specific questions about type of PA are not included. Post hoc analyses controlling for screening inaccuracies may improve effectiveness of PA interventions and help intervention programs reach women who may benefit the most.
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Cardiovascular Risk in Midlife African American Women Participating in a Lifestyle Physical Activity Program. J Cardiovasc Nurs 2016; 31:304-12. [PMID: 27074650 DOI: 10.1097/jcn.0000000000000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the largest contributor to disparate morbidity and mortality in African American women. OBJECTIVE The aims of this article are to describe in a cohort of sedentary, urban community-based midlife African American women eligible for a physical activity program their (1) CVD risk factors and (2) awareness, treatment, and control of hypertension and hypercholesterolemia. METHODS Cross-sectional baseline findings on 297 women were examined at baseline of a controlled physical activity clinical trial. Cardiovascular disease risks included hypertension, hypercholesterolemia, smoking, diabetes, and obesity. Among women with hypertension and hypercholesterolemia, rates of awareness, treatment, and control were calculated. RESULTS Our sample had significantly more hypertension and obesity than reported in other national samples of African American women. The women mirrored national samples of African American women: fewer than 60% had adequate control of hypertension. Versus national samples of African Americans (men/women combined), our study groups both showed significantly lower low-density-lipoprotein cholesterol level: treatment, 33% versus 63.8%, and control, 24.8% versus 45.3%. CONCLUSIONS Because national samples are more heterogeneous, our sample provides important information about CVD risks in inactive, urban community-dwelling, midlife African American women. Given the opportunity, many such women at elevated risk for CVD are willing to participate in a physical activity intervention. They must be identified and offered pharmacological and lifestyle interventions.
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Johnson TJ, E Schoeny M, Fogg L, Wilbur J. The Cost of Increasing Physical Activity and Maintaining Weight for Midlife Sedentary African American Women. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:20-7. [PMID: 26797232 PMCID: PMC4724643 DOI: 10.1016/j.jval.2015.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/10/2015] [Accepted: 10/19/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the marginal costs of increasing physical activity and maintaining weight for a lifestyle physical activity program targeting sedentary African American women. METHODS Outcomes included change in minutes of total moderate to vigorous physical activity, leisure-time moderate to vigorous physical activity and walking per week, and weight stability between baseline and maintenance at 48 weeks. Marginal cost-effectiveness ratios (MCERs) were calculated for each outcome, and 95% confidence intervals (CIs) were computed using a bootstrap method. The analysis was carried out from the societal perspective and calculated in 2013 US dollars. RESULTS For the 260 participants in the analysis, program costs were $165 ± $19, and participant costs were $164 ± $35, for a total cost of $329 ± $49. The MCER for change in walking was $1.50/min/wk (95% CI 1.28-1.87), for change in moderate to vigorous physical activity was $1.73/min/wk (95% CI 1.41-2.18), and for leisure-time moderate to vigorous physical activity was $1.94/min/wk (95% CI 1.58-2.40). The MCER for steps based on the accelerometer was $0.46 per step (95% CI 0.30-0.85) and weight stability was $412 (95% CI 399-456). CONCLUSIONS The Women's Lifestyle Physical Activity Program is a relatively low-cost strategy for increasing physical activity. The marginal cost of increasing physical activity is lower than for weight stability. The participant costs related to time in the program were nearly half the total costs, suggesting that practitioners and policymakers should consider the participant cost when disseminating a lifestyle physical activity program into practice.
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Buchholz SW, Wilbur J, Schoeny ME, Fogg L, Ingram DM, Miller A, Braun L. Retention of African American Women in a Lifestyle Physical Activity Program. West J Nurs Res 2015; 38:369-85. [PMID: 26475680 DOI: 10.1177/0193945915609902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the article is to examine how well individual characteristics, neighborhood characteristics, and intervention participation predict study retention and staff level of effort needed for retention, using a cohort of African American women enrolled in a physical activity program. Secondary data analysis was conducted from a randomized clinical trial. Participants were aged 40 to 65 years without major signs/symptoms of cardiovascular disease. Assessments were conducted at community sites in/bordering African American communities. Study retention was 90%. Of those retained, 24% required moderate/high level of staff effort for retention. Retention was predicted by being older, having lower perceived neighborhood walkability, living in neighborhoods with greater disadvantage and crime, and having greater program participation. More staff effort was predicted by participants being younger, having more economic hardships, poorer health, or lower intervention participation. We may be able to identify people at baseline likely to require more staff effort to retain.
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Affiliation(s)
| | | | | | - Louis Fogg
- Rush University, College of Nursing, Chicago, IL, USA
| | | | - Arlene Miller
- Rush University, College of Nursing, Chicago, IL, USA
| | - Lynne Braun
- Rush University, College of Nursing, Chicago, IL, USA
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Tennant GA. Relationships Between Body Areas Satisfaction, Exercise, and Mood in Obese African American Women. JOURNAL OF BLACK PSYCHOLOGY 2015. [DOI: 10.1177/0095798414560438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite a rate of morbid obesity that is 2.5 times that of European American women, African American women have higher body areas satisfaction than any other ethnicities. Previous research suggested differences in African American women’s attitudes toward body image may contribute to a lack of motivation to engage in weight management behaviors, such as physical activity. In addition, factors such as self-efficacy, self-regulation, and mood have been shown to affect healthy behavior participation but have not been studied among obese African American women. This study investigated if changes from baseline to posttreatment in self-efficacy and self-regulation for exercise and mood mediatedthe association between changes in body areas satisfaction and physical activity. The study used archival data consisting of 109 obese African American women who participated in a 6-month weight management intervention. The relationship between changes in body areas satisfaction and physical activity was mediated by changes in self-regulation for exercise and mood but not by change in self-efficacy for exercise. These findings may help in devising treatments targeted at this population. Implications are discussed.
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Conn VS, Chan K, Banks J, Ruppar TM, Scharff J. Cultural relevance of physical activity intervention research with underrepresented populations. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2015; 34:391-414. [PMID: 25228486 DOI: 10.2190/iq.34.4.g] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article describes cultural relevance in physical activity intervention research with underrepresented populations. Seventy-one extant studies which tested interventions to increase physical activity among underrepresented adults were included. Verbatim descriptions of efforts to enhance cultural relevance of study designs and interventions were extracted and then content analyzed. We found strategies to enhance cultural relevance of interventions as soliciting input from population members, linking intervention content with values, addressing language and literacy challenges, incorporating population media figures, using culturally relevant forms of physical activity, and addressing specific population linked barriers to activity. Methodological approaches included specialized recruitment and study locations, culturally relevant measures, underrepresented personnel, and cost-awareness study procedures to prevent fiscal barriers to participation. Most reported activities were surface matching. Existing research neither compared the effectiveness of cultural relevance approaches to standardized interventions nor addressed economic, education, geographic, or cultural heterogeneity among groups.
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Bambra CL, Hillier FC, Cairns JM, Kasim A, Moore HJ, Summerbell CD. How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BackgroundTackling obesity is one of the major contemporary public health policy challenges and is vital in terms of addressing health inequalities.ObjectivesTo systematically review the effectiveness of interventions (individual, community and societal) in reducing socioeconomic inequalities in obesity among (1) children aged 0–18 years (including prenatal) and (2) adults aged ≥18 years, in any setting, in any country, and (3) to establish how such interventions are organised, implemented and delivered.Data sourcesNine electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and NHS Economic Evaluation Database were searched from database start date to 10 October 2011 (child review) and to 11 October 2012 (adult review). We did not exclude papers on the basis of language, country or publication date. We supplemented these searches with website and grey literature searches.Review methodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Experimental studies and observational studies with a duration of at least 12 weeks were included. The reviews considered strategies that might reduce existing inequalities in the prevalence of obesity [i.e. effective targeted interventions or universal interventions that work more effectively in low socioeconomic status (SES) groups] as well as those interventions that might prevent the development of inequalities in obesity (i.e. universal interventions that work equally along the SES gradient). Interventions that involved drugs or surgery and laboratory-based studies were excluded from the reviews. The initial screening of titles and abstracts was conducted by one reviewer with a random 10% of the sample checked by a second reviewer. Data extraction was conducted by one reviewer and independently checked by a second reviewer. The methodological quality of the included studies was appraised independently by two reviewers. Meta-analysis and narrative synthesis were conducted focusing on the ‘best-available’ evidence for each intervention type (defined in terms of study design and quality).ResultsOf 56,967 papers of inequalities in obesity in children, 76 studies (85 papers) were included, and of 70,730 papers of inequalities in obesity in adults, 103 studies (103 papers) were included. These studies suggested that interventions that aim to prevent, reduce or manage obesity do not increase inequalities. For children, there was most evidence of effectiveness for targeted school-delivered, environmental and empowerment interventions. For adults, there was most evidence of effectiveness for primary care-delivered tailored weight loss and community-based weight loss interventions, at least in the short term among low-income women. There were few studies of appropriate design that could be included on societal-level interventions, a clear limitation of the evidence base found.LimitationsThe reviews located few evaluations of societal-level interventions and this was probably because they included only experimental study designs. The quality assessment tool, although described as a tool for public health interventions, seemed to favour those that followed a more clinical model. The implementation tool was practical but enabled only a brief summary of implementation factors to be made. Most of the studies synthesised in the reviews were from outside the UK and related to women.ConclusionsThe reviews have found some evidence of interventions with the potential to reduce SES inequalities in obesity and that obesity management interventions do not increase health inequalities. More experimental studies of the effectiveness and cost-effectiveness of interventions (particularly at the societal level) to reduce inequalities in obesity, particularly among adolescents and adult men in the UK, are needed.Study registrationThe studies are registered as PROSPERO CRD42011001740 and CRD42013003612.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Clare L Bambra
- Department of Geography, Durham University, Durham, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Frances C Hillier
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Joanne-Marie Cairns
- Department of Geography, Durham University, Durham, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Helen J Moore
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Carolyn D Summerbell
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
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Carroll JK, Yancey AK, Spring B, Figueroa-Moseley C, Mohr DC, Mustian KM, Sprod LK, Purnell JQ, Fiscella K. What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings. Transl Behav Med 2014; 1:234-51. [PMID: 24073048 DOI: 10.1007/s13142-011-0034-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purposes of this review are to (1) describe recruitment and retention strategies for physical activity interventions focusing on underserved populations and (2) identify successful strategies which show the most promise for "best practices" recommendations to guide future research. The method used was systematic review. Data on recruitment and retention strategies were abstracted and analyzed according to participant characteristics, types of strategies used, and effectiveness using an ecological framework. Thirty-eight studies were identified. Populations included African American (n = 25), Hispanic (n = 8), or Asian (n = 3) groups. Successful recruitment strategies consisted of partnering with respected community stakeholders and organizations, well-trained study staff ethnically, linguistically, and culturally matched to the population of interest, and use of multiple advertising channels. Successful retention strategies included efficient administrative tracking of participants, persistence, skillful teamwork, and demonstrating a positive, caring attitude towards participants. Promising recruitment and retention strategies correspond to all levels of ecological influence: individual, interpersonal, organizational, and societal.
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Affiliation(s)
- Jennifer K Carroll
- University of Rochester School of Medicine, Family Medicine Research Programs, 1381 South Avenue, Rochester, NY 14620 USA
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JoEllen W, Braun LT, Buchholz SW, Ingram DM, Fogg L, Miller AM, Johnson TJ, Volgman AS, McDevitt J. Effectiveness, efficiency, duration, and costs of recruiting for an African American women's lifestyle physical activity program. Res Nurs Health 2013; 36:487-99. [PMID: 23775371 PMCID: PMC3788077 DOI: 10.1002/nur.21550] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2013] [Indexed: 12/31/2022]
Abstract
In a 48-week lifestyle physical activity controlled trial in African American women, we analyzed recruitment effectiveness, efficiency, duration, and costs. Social networking was the most effective approach for inviting women to the trial. Of the 609 who responded to invitations, 514 completed telephone screening; of these, 409 (80%) were found eligible. The health assessment screening was completed by 337 women; of these, 297 (88%) were found eligible. The mean number of days from completion of the telephone and health assessment screenings to beginning the intervention was 23.01, and the mean cost was $74.57 per person. Results suggest that provision of health assessment screening by study staff as part of recruitment is effective for minimizing attrition and also might be cost-effective.
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Affiliation(s)
- Wilbur JoEllen
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Lynne T. Braun
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Susan W. Buchholz
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Diana M. Ingram
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Louis Fogg
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Arlene M. Miller
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Tricia J. Johnson
- College of Health Sciences, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Annabelle S. Volgman
- College of Medicine, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
| | - Judith McDevitt
- College of Nursing, Rush University, 600 S Paulina St., 1062A, Chicago, IL 60612, USA
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Lemacks J, Wells BA, Ilich JZ, Ralston PA. Interventions for improving nutrition and physical activity behaviors in adult African American populations: a systematic review, January 2000 through December 2011. Prev Chronic Dis 2013; 10:E99. [PMID: 23786910 PMCID: PMC3690829 DOI: 10.5888/pcd10.120256] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of preventable chronic diseases is disproportionally high among African Americans and could be reduced through diet and physical activity interventions. Our objective was to systematically review the literature on clinical outcomes of diet and physical activity interventions conducted among adult African American populations in the United States. Methods We used the Preferred Reporting Items for Systematic Review and Meta Analysis construct in our review. We searched Medline (PubMed and Ovid), Cochrane, and DARE databases and restricted our search to articles published in English from January 2000 through December 2011. We included studies of educational interventions with clinically relevant outcomes and excluded studies that dealt with nonadult populations or populations with pre-existing catabolic or other complicated disorders, that did not focus on African Americans, that provided no quantitative baseline or follow-up data, or that included no diet or physical activity education or intervention. We report retention and attendance rates, study setting, program sustainability, behavior theory, and education components. Results Nineteen studies were eligible for closer analysis. These studies described interventions for improving diet or physical activity as indicators of health promotion and disease prevention and that reported significant improvement in clinical outcomes. Conclusion Our review suggests that nutrition and physical activity educational interventions can be successful in improving clinically relevant outcomes among African Americans in the United States. Further research is needed to study the cost and sustainability of lifestyle interventions. Further studies should also include serum biochemical parameters to substantiate more specifically the effect of interventions on preventing chronic disease and reducing its incidence and prevalence.
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Butler J, Quinn SC, Fryer CS, Garza MA, Kim KH, Thomas SB. Characterizing researchers by strategies used for retaining minority participants: results of a national survey. Contemp Clin Trials 2013; 36:61-7. [PMID: 23764697 DOI: 10.1016/j.cct.2013.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/15/2022]
Abstract
Limited attention has been given to the optimal strategies for retaining racial and ethnic minorities within studies and during the follow-up period. High attrition limits the interpretation of results and reduces the ability to translate findings into successful interventions. This study examined the retention strategies used by researchers when retaining minorities in research studies. From May to August 2010, we conducted an online survey with researchers (principal investigators, research staff, and IRB members) and examined their use of seven commonly used retention strategies. The number and type of retention strategies used, how these strategies differ by researcher type, and other characteristics (e.g., funding) were explored. We identified three clusters of researchers: comprehensive retention strategy researchers - utilized the greatest number of retention strategies; moderate retention strategy researchers - utilized an average number of retention strategies; and limited retention strategy researchers - utilized the least number of retention strategies. The comprehensive and moderate retention strategy researchers were more likely than the limited retention strategy researchers to conduct health outcomes research, work with a community advisory board, hire minority staff, use steps at a higher rate to overcome retention barriers, develop new partnerships with the minority community, modify study materials for the minority population, and allow staff to work flexible schedules. This study is a novel effort to characterize researchers, without implying a value judgment, according to their use of specific retention strategies. It provides critical information for conducting future research to determine the effectiveness of using a combination of retention strategies.
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Affiliation(s)
- James Butler
- University of Maryland, School of Public Health, Maryland Center for Health Equity and Department of Behavioral and Community Health, College Park, MD 20742, USA.
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Bock C, Jarczok MN, Litaker D. Community-based efforts to promote physical activity: a systematic review of interventions considering mode of delivery, study quality and population subgroups. J Sci Med Sport 2013; 17:276-82. [PMID: 23693030 DOI: 10.1016/j.jsams.2013.04.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/12/2012] [Accepted: 04/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Despite the known benefits of physical activity, the majority of adults in developed countries lead sedentary lifestyles. The community setting is a promising venue for physical activity-promoting interventions. Our objectives were to investigate the effectiveness of community-based physical activity interventions by mode of delivery, study quality and to analyse intervention effectiveness in different subgroups in the population. DESIGN We conducted a systematic literature review in Medline and other databases to identify controlled, community-based physical activity interventions published between 2001 and 2012. METHODS We performed several post hoc subgroup comparisons for mode of delivery, study quality and selected population characteristics, using net per cent change in physical activity outcomes between baseline and follow-up as an effect measure. RESULTS We identified 55 studies on exercise/walking sessions, face-to-face counselling, public campaigns and interventions by mail, the Internet and telephone presenting data on 20,532 participants. Overall, half of the studies reported positive physical activity outcomes (total net per cent change: 16.4%; p=0.159; net per cent change for high-quality studies, i.e. studies meeting more than 5 out of 7 quality criteria: 16.2%; p=0.010). Interventions using face-to-face counselling or group sessions were most effective (net per cent change: 35.0%; p=0.014). Net per cent change was also higher in studies exclusively tailored to women (27.7%; p=0.005) or specific ethnic groups (38.9%; p=0.034). CONCLUSIONS This systematic review supports the effectiveness of community-based physical activity interventions in high-quality studies. Our results suggest that interventions using personal contact as well as tailored interventions are most promising.
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Affiliation(s)
- Christina Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany.
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - David Litaker
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Medicine, Case Comprehensive Cancer Centre, Case Western Reserve University, Cleveland, OH, USA; Department of Epidemiology and Biostatistics, Case Comprehensive Cancer Centre, Case Western Reserve University, Cleveland, OH, USA
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Lee H, Chae D, Wilbur J, Miller A, Lee K, Jin H. Effects of a 12 week self-managed stretching program among Korean-Chinese female migrant workers in Korea: a randomized trial. Jpn J Nurs Sci 2013; 11:121-34. [PMID: 24698648 DOI: 10.1111/jjns.12010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 12/08/2012] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study was to assess the efficacy of a 12 week, self-managed, community-based stretching program on musculoskeletal fitness, musculoskeletal symptoms, and acculturative stress, in Korean-Chinese female migrant workers in Korea. METHODS This was a randomized controlled trial with random assignment of eligible full-time Korean-Chinese female migrant workers to a stretching exercise intervention (n=40) or an enhanced stretching exercise intervention (n=40) condition. Both conditions received a 6 min stretching exercise program that included an orientation and three work-related musculoskeletal disorder (WMSD) educational classes. Between educational classes, the enhanced stretching exercise condition also received mobile phone text messaging and telephone counseling to increase self-efficacy (confidence in overcoming barriers) and provide social support. Flexibility, muscle strength, musculoskeletal symptoms, and acculturative stress were assessed at baseline and 12 weeks. RESULTS Significant increase in flexibility was noted for both conditions, but acculturative stress was significantly reduced only in the standard intervention condition. Muscle strength and WMSD symptoms had no significant changes at the 12 week follow up in both conditions. CONCLUSION The 12 week, self-managed, community-based, stretching exercise program was effective to increase flexibility. The standard stretching intervention without any enhancements may be a more cost-effective way to increase flexibility. Longitudinal studies, however, are needed to see if the long-term effects are greater in the enhanced intervention for the migrant worker population.
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Affiliation(s)
- Hyeonkyeong Lee
- Department of Nursing Environments and Systems, Yonsei University, Seoul, South Korea
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Freene N, Waddington G, Chesworth W, Davey R, Cochrane T. Physiotherapist-led home-based physical activity program versus community group exercise for middle-aged adults: Quasi-experimental comparison. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpm.2013.32031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Conn VS, Phillips LJ, Ruppar TM, Chase JAD. Physical activity interventions with healthy minority adults: meta-analysis of behavior and health outcomes. J Health Care Poor Underserved 2012; 23:59-80. [PMID: 22643462 DOI: 10.1353/hpu.2012.0032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This meta-analysis is a systematic compilation of research focusing on various exercise interventions and their impact on the health and behavior outcomes of healthy African American, Hispanic, Native American, and Native Hawaiian adults. Comprehensive searching located published and unpublished studies. Random-effects analyses synthesized data to calculate effect sizes (ES) as a standardized mean difference (d) and variability measures. Data were synthesized across 21,151 subjects in 100 eligible samples. Supervised exercise significantly improved fitness (ES=.571-.584). Interventions designed to motivate minority adults to increase physical activity changed subsequent physical activity behavior (ES=.172-.312) and anthropometric outcomes (ES=.070-.124). Some ES should be interpreted in the context of limited statistical power and heterogeneity. Attempts to match intervention content and delivery with minority populations were inconsistently reported. Healthy minority adults experienced health improvements following supervised exercise. Interventions designed to motivate subjects to increase physical activity have limited magnitude heterogeneous effects.
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Affiliation(s)
- Vicki S Conn
- University of Missouri, S317 School of Nursing, Columbia, MO 65211, USA.
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Improving participation rates for women of color in health research: the role of group cohesion. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2012; 13:27-35. [PMID: 21826476 DOI: 10.1007/s11121-011-0241-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adherence to physical activity and dietary interventions is a common challenge. Interventions that use group cohesion strategies show promise for increasing adherence, but have not been tested among women of color. The purpose of this study was to determine whether dimensions of group cohesion mediate the association between intervention condition and attendance within a community physical activity program for women of color. African American and Hispanic or Latina women (N = 310) completed measurements at baseline and post-intervention and participated in a social cohesion intervention to improve physical activity and dietary habits. Women were assigned to a physical activity or fruit and vegetable intervention group. Social and task cohesion was measured using the Physical Activity Group Environment Questionnaire (PAGE-Q). Attendance was recorded at each of six intervention sessions. Women were generally middle-age (M age = 46.4 years, SD = 9.1) and obese (M BMI = 34.4 kg/m2, SD = 7.7). The estimate of the mediated effect was significant for all group cohesion constructs, indicating both task constructs-attraction to the group's task (SE = 0.096, CI: -0.599 to -0.221) and group integration around the task (SE = 0.060, CI: -0.092 to -0.328)-and social constructs-attraction to the group's social aspects (SE = 0.046, CI: -0.546 to -0.366) and group integration around social aspects (SE = 0.046, CI: -0.546 to -0.366)-significantly mediated the association between group assignment and attendance. Both task and social constructs are important to improve attendance in health promotion interventions for women of color.
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Ingram D, Wilbur J, McDevitt J, Buchholz S. Women's walking program for African American women: expectations and recommendations from participants as experts. Women Health 2012; 51:566-82. [PMID: 21973111 DOI: 10.1080/03630242.2011.606357] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Effective interventions that increase adherence to physical activity are important for African American women because generally they are less active and more obese compared to white American women. The purpose of the authors in this study was to elicit from women who began a 12-month physical activity program between 2002 and 2005: (1) their recollections of outcome expectations and barriers, (2) feedback on program components, and (3) suggestions for program change. In 2007, the authors conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three African American women aged 44-69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked<50% of expected walks) versus high (walked≥50% of expected walks) adherence and low (0-2) versus high (3-4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed, coded independently, and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components include a lifestyle physical activity prescription, pedometers for self-monitoring, ongoing group support, and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.
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Affiliation(s)
- Diana Ingram
- College of Nursing, Rush University, Chicago, Illinois 60612, USA.
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Foster CE, Brennan G, Matthews A, McAdam C, Fitzsimons C, Mutrie N. Recruiting participants to walking intervention studies: a systematic review. Int J Behav Nutr Phys Act 2011; 8:137. [PMID: 22171531 PMCID: PMC3261095 DOI: 10.1186/1479-5868-8-137] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 12/15/2011] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Most researchers who are conducting physical activity trials face difficulties in recruiting participants who are representative of the population or from specific population groups. Participants who are often the hardest to recruit are often those who stand to benefit most (the least active, from ethnic and other minority groups, from neighbourhoods with high levels of deprivation, or have poor health). The aim of our study was to conduct a systematic review of published literature of walking interventions, in order to identify the impact, characteristics, and differential effects of recruitment strategies among particular population groups. METHODS We conducted standard searches for studies from four sources, (i) electronic literature databases and websites, (ii) grey literature from internet sources, (iii) contact with experts to identify additional "grey" and other literature, and (iv) snowballing from reference lists of retrieved articles. Included studies were randomised controlled trials, controlled before-and-after experimental or observational qualitative studies, examining the effects of an intervention to encourage people to walk independently or in a group setting, and detailing methods of recruitment. RESULTS Forty seven studies met the inclusion criteria. The overall quality of the descriptions of recruitment in the studies was poor with little detail reported on who undertook recruitment, or how long was spent planning/preparing and implementing the recruitment phase. Recruitment was conducted at locations that either matched where the intervention was delivered, or where the potential participants were asked to attend for the screening and signing up process. We identified a lack of conceptual clarity about the recruitment process and no standard metric to evaluate the effectiveness of recruitment. CONCLUSION Recruitment concepts, methods, and reporting in walking intervention trials are poorly developed, adding to other limitations in the literature, such as limited generalisability. The lack of understanding of optimal and equitable recruitment strategies evident from this review limits the impact of interventions to promote walking to particular social groups. To improve the delivery of walking interventions to groups which can benefit most, specific attention to developing and evaluating targeted recruitment approaches is recommended.
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Affiliation(s)
| | - Graham Brennan
- Scottish Physical Activity Research Collaboration (SPARColl) & School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Anne Matthews
- Department of Public Health, University of Oxford, UK
| | - Chloe McAdam
- Scottish Physical Activity Research Collaboration (SPARColl) & School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Claire Fitzsimons
- Scottish Physical Activity Research Collaboration (SPARColl) & School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Nanette Mutrie
- Scottish Physical Activity Research Collaboration (SPARColl) & School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Lee RE, Medina AV, Mama SK, Reese-Smith JY, O'Connor DP, Brosnan M, Cubbin C, McMillan T, Estabrooks PA. Health is Power: an ecological, theory-based health intervention for women of color. Contemp Clin Trials 2011; 32:916-23. [PMID: 21782975 DOI: 10.1016/j.cct.2011.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. This manuscript describes the rationale, design and methodology of Health Is Power (HIP), a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity and improve dietary habits in African American and Hispanic or Latina women in Houston and Austin, Texas. METHODS The intervention development was guided by group dynamics principles anchored within an ecologic model. RESULTS Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods - integrated into strategies to promote group cohesion - framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests. CONCLUSIONS Neighborhood contextual and environmental measures are described to test ecologic factors that may contribute to behavioral maintenance. Theoretically guided interventions that account for multiple levels of influence in behavior initiation and maintenance stand to improve health outcomes in vulnerable populations.
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Affiliation(s)
- Rebecca E Lee
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison Gym Rm 104, Houston, TX 77204-6015, USA.
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Abstract
Tailored health communication research represents a very promising line of inquiry that has the potential to produce major impacts on lifestyle behaviors. This study defines tailoring and discusses how tailored interventions operate, including comparing/ contrasting different tailoring channels. Next, the authors review the literature on tailored interventions to change lifestyle behaviors, with a focus on smoking cessation, dietary change, and physical activity, as well as interventions that address multiple lifestyle behaviors. Finally, future directions for tailoring research are discussed. To date, a large literature has amassed showing the promise of tailored programs delivered via print, Internet, local computer/kiosk, telephone, and interpersonal channels. Numerous studies demonstrate that these programs are capable of significant impacts on smoking cessation, dietary change, physical activity, and multiple behavior change. It is concluded that the potential of tailoring will be more fully realized as (a) the field builds a more cumulative science of tailoring and (b) greater dissemination of efficacious tailored programs takes place.
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Artinian NT, Franklin B. Counseling African Americans in Cardiac Rehabilitation: Implications for Comprehensive Lifestyle Modification. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610363251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
African Americans are more likely to die of a myocardial infarction than any other racial group and have higher rates of sudden cardiac death, and in comparison to whites, these deaths are likely to occur at a younger age. Because secondary prevention interventions have been reported to reduce overall mortality, it is important that health care providers understand and respond with sensitivity to the needs and preferences that African Americans bring to cardiac rehabilitation. Providing culturally appropriate cardiac rehabilitation services to African Americans has the potential to improve access to care, quality of care, and health outcomes. This article reviews the historical legacy and general values and beliefs that African Americans bring to their participation in cardiac rehabilitation and examines values and beliefs about diet, weight, body image, exercise, rest, and preferences for depression treatment that should be considered when counseling African Americans. Social-ecological factors that influence the ability to commit to and maintain cardiovascular risk—reducing behaviors are also discussed. Strategies for responding to the health-related beliefs and cultural values of African Americans are examined.
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Wilbur J, Zenk S, Wang E, Oh A, McDevitt J, Block D, McNeil S, Ju S. Neighborhood characteristics, adherence to walking, and depressive symptoms in midlife African American women. J Womens Health (Larchmt) 2009; 18:1201-10. [PMID: 19630546 PMCID: PMC2825683 DOI: 10.1089/jwh.2008.1168] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women. METHODS Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included. RESULTS Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks. CONCLUSIONS Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.
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Affiliation(s)
- JoEllen Wilbur
- College of Nursing, Rush University, Chicago, IL 60612, USA.
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Zenk SN, Wilbur J, Wang E, McDevitt J, Oh A, Block R, McNeil S, Savar N. Neighborhood environment and adherence to a walking intervention in African American women. HEALTH EDUCATION & BEHAVIOR 2008; 36:167-81. [PMID: 18669878 DOI: 10.1177/1090198108321249] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban, midlife African American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women's neighborhoods included walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. The presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African American women who want to be more active.
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Affiliation(s)
- Shannon N Zenk
- University of Illinois at Chicago, Chicago, IL 60612, USA.
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