Matched and moving: exploring daily social support among women partnered for exercise after a breast cancer diagnosis.

PURPOSE: Exercise and social support are non-pharmacological strategies that improve health and wellbeing in women treated for breast cancer (WTBC). However, strategies to facilitate support and exercise in WTBC are typically resource intensive. The purpose of this study was to examine whether various forms of social support received from a matched peer were associated with increased exercise among WTBC. METHODS: A daily diary study was conducted to examine naturally occurring social support as it relates to daily exercise behavior. Forty-six WTBC were matched (23 pairs) and completed pre-screening survey assessing eligibility and baseline levels of exercise. Participants were given Fitbit devices to track physical activity behavior and completed daily surveys across 3 weeks assessing perceptions of exercise-related social support at fixed times at the end of each day. RESULTS: Mixed models accounting for day of study, baseline support, and baseline exercise levels revealed that higher levels of daily exercise-related tangible social support were associated with more daily steps (b = 506, SE = 143) and more light physical activity (LPA) minutes (b = 7.01, SE = 3.15). Informational social support was associated with higher moderate to vigorous physical activity (MVPA) minutes (b = 3.18, SE = 1.60). CONCLUSIONS: Overall, peer matching programs aimed at increasing exercise-related social support among WTBC might encourage exercise behaviors, especially among women who share exercise-specific information (e.g., benefits, type, activities).

Instructor Social Support in the Group Physical Activity Context: Older Participants' Perspectives.

Instructors in organized physical activity classes can be a source of social support through their relationships with participants, influence on participants' interactions with each other, and design of activities. Grounded in interpretive description, the objective of this study was to examine older adults' experiences of and their perspectives on group physical activity instructors' supportive behaviors. Observations of 16 group physical activity classes (N = 295) and focus groups or interviews with N = 38 class participants aged ≥ 55 (n = 29 women) were conducted at four municipal recreation facilities in a Canadian city. Five themes shed light on how instructors provided social support: (a) supporting autonomous engagement, (b) developing caring connections, (c) fostering trust through expert instruction, (d) managing conflict directly and effectively, and (e) creating a climate where people want to go. Instructor training should consider older adults' social support needs and help instructors embody behaviors that support continued physical activity participation, thereby contributing to healthy aging.

Social Supports and Barriers for Older Adults Not Participating in Group Physical Activity.

Group physical activity can provide physical and social benefits; however, social barriers or a lack of social support may affect participation. This study examined social-support needs and barriers among older adults who were not participating in group physical activities. Using interpretive description, semistructured interviews were conducted with 38 older adults (M = 70.9 years; 81.6% women). Themes were grouped into two categories. Category 1, expectations and initial impressions, consisted of the following: (a) Groups cannot meet everyone's expectations or interests, (b) groups are intimidating to join, and (c) the need for inclusive programming. Category 2, social processes within group physical activity, consisted of (a) modeling physical activity behaviors, (b) sharing information and suggestions about physical activity opportunities, and (c) encouragement and genuine interest. Outreach to this population should aim to address these barriers and utilize these supportive behaviors to reduce feelings of intimidation and promote participation among older adults.

Social Support and Physical Activity in Older Adults: Identifying Predictors Using Data From the Canadian Longitudinal Study on Aging.

This study examined which of nine forms of social support were the strongest predictors of physical activity in older adults, and to what degree these associations were moderated by eight demographic indicators of groups at increased risk of social isolation. Baseline data from 21,491 adults aged 65 and older who were participants of the Canadian Longitudinal Study on Aging were analyzed using multiple regression. Greater social network size, social contact with network members, and participation in community-related activities predicted greater physical activity, whereas being in a domestic partnership and perceiving more tangible support to be available were negatively associated. The strength and direction of these associations varied by sex, living arrangement, and income. Given the findings, various forms of social support should be incorporated in physical activity interventions but tailored to meet the needs of different segments of the aging population.

Social Support and Body Image in Group Physical Activity Programs for Older Women.

Physical declines with aging may negatively impact women's body image. Group physical activity can be a source of social support that may improve body image. We examined how social support experienced in group physical activity programs impacts older women's body image. Guided by interpretive description, we interviewed 14 women age 65 years and older who participated in group physical activity classes. Although women experienced both positive and negative body image, body image was generally positively impacted by physical activity. Four themes described social support processes that affected body image in the physical activity context: fitting in and being inspired through identifying with others; what is discussed and not discussed; providing comfort, understanding, and acceptance; and skilled and empathetic interactions with instructors. Understanding how social support in group physical activity can promote positive body image throughout aging can inform practical guidelines for facilitating and improving support in this context.

Experiences With Social Participation in Group Physical Activity Programs for Older Adults.

Little is known about how social participation can be facilitated among older adults in group physical activity and its psychosocial benefits that contribute to successful aging. This study aimed to understand older adults' experiences with social participation in group physical activity programs. Using interpretive description methodology, 16 observations, eight focus groups, and two interviews with participants unable to attend focus groups were conducted with adults 55 years and older attending programs across four recreation facilities. Group programs were found to influence social participation through (a) a meaningful context for connecting and (b) instructors' expectations of social interaction. Social participation in these programs addressed psychosocial needs by (c) increasing social contact and interaction, (d) fostering social relationships and belonging, and (e) promoting regular engagement. Training for instructors should include balancing the physical aspects of program delivery with the social, while also considering older adults' diverse needs and preferences for social interaction.

The role of social support in physical activity for cancer survivors: A systematic review.

OBJECTIVE: Social support is conceptualized and operationalized in many ways, making it challenging to understand what types of support best predict physical activity (PA) in cancer survivors. This review examined associations between social support and PA among cancer survivors. METHODS: Following PRISMA guidelines, we searched eight databases for studies that reported an association between social support and PA among adult cancer survivors. We conducted an appraisal and a narrative synthesis of the findings from quantitative studies. RESULTS: Fifty studies representing 28 366 participants were included. Studies collectively included concepts addressing the presence of relationships, others' PA behavior, perceptions of being supported, and function/quality. Findings were mixed in suggesting a positive or null association with PA. CONCLUSIONS: While results are not definitive, this review takes a step toward mapping the social support literature in PA for cancer survivors. Limitations include the homogeneity of the participants in extant studies, and the secondary focus on testing the effects of social support on outcomes. Future research systematically testing the effects of social support is important for facilitating PA in this population.

Associations between participation in a Physical Activity-Based Positive Youth Development Program and Academic Outcomes.

INTRODUCTION: Physical activity-based positive youth development (PYD) programs offer asset building experiences to foster the overall well-being of youth. These programs have the potential to enhance success in other important contexts for children, such as school. However, rigorous examination of this potential impact is needed. METHODS: Propensity score matching was used to compare school outcomes among children who participated in a short, summer physical activity-based PYD program in the USA and children who were from similar backgrounds and from the same school district but did not attend the program. The sample included 149 pairs of students aged 7-12 years (M = 10.11, SD = 1.26) and, in each group, 62% were from ethnically diverse backgrounds, 38% were from primarily Caucasian backgrounds, and 80 were female and 69 were male, and birth years were equally distributed. Ordinal and logistic regression models were used to test for differences between standardized math and language arts test scores, excused and unexcused absences, and total suspensions and expulsions between the two groups. RESULTS: PYD program youth had 55% and 46% greater odds being in the highest math (χ2(1, N = 298) = 4.06, p = .04) and total days attended categories (χ2(1, N = 298) = 5.58, p = .02) respectively. No other significant differences were found. When using a more rigorous quasi-experimental and longitudinal design, participation in a PYD program predicted some but not all academic performance and behaviors. PYD programs may need to be designed to specifically nurture academic skills to consistently impact academic outcomes.

Formative Evaluation of a Pilot Afterschool Physical Activity-Based Positive Youth Development Program.

4-H PALS is an afterschool positive youth development program for pre- and early adolescents delivered within the 4-H platform and designed to use physical activity to promote character development. The conceptual framework for this program, informed by the theory of triadic influence, prioritizes the social environment created during physical activities to promote adaptive outcomes. Given the novelty of the 4-H PALS curriculum, it is important to outline program components and identify both strengths and challenges to be addressed. Thus, this study aimed to document, describe, and conduct a formative evaluation of 4-H PALS. Major themes were identified across leader and participant interviews, program observations, lesson planning notes, attendance records, and intervention team feedback using inductive analysis methods. Three key areas of evaluation were identified: curriculum implementation fidelity, participant engagement with the curriculum and context, and the social environment. The program was successful in creating an affirmative, engaging environment fostering positive self-perceptions and social outcomes for participants. Challenges with logistical and conceptual implementation of the curriculum's character development concepts were identified. This evaluation will inform program refinements, with the goal of preparing the program for an efficacy study examining outcomes among participating youth.

Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age = 73.1 ±â€¯6.7 years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI = 1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI = 1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

Changes in social support predict emotional well-being in breast cancer survivors.

BACKGROUND: Breast cancer survivors who have completed surgery and adjuvant treatment have distinct social support needs that may relate to emotional health. There is little research on both levels of social support following treatment and the association between social support and emotional well-being over time following breast cancer diagnosis and treatment. The aims of this study were to assess (1) the direction and magnitude of change in social support quality and quantity and (2) the degree to which change in quality and quantity of social support predicted change in emotional well-being over time following completion of breast cancer treatment. METHODS: A sample of 157 female breast cancer survivors (Mage = 55, SD = 11 years) completed a baseline and a 1-year follow-up questionnaire assessing sociodemographic information, quality and quantity of social support, and emotional well-being including depression symptoms, stress, and positive and negative affect. RESULTS: Social support quantity significantly decreased over 1 year, while social support quality remained stable. Based on change score analyses, a decrease in social support quality was a significant predictor of increases in depression, stress, and negative affect, explaining an extra 4 to 6% of variance in the emotional well-being outcomes compared with social support quantity. CONCLUSIONS: This study highlights the decline in social support among recently treated female breast cancer survivors and the importance of maintaining high-quality social support for emotional well-being. Copyright © 2016 John Wiley & Sons, Ltd.

Direct and Indirect Associations Between the Built Environment and Leisure and Utilitarian Walking in Older Women.

BACKGROUND: The built environment predicts walking in older adults, but the degree to which associations between the objective built environment and walking for different purposes are mediated by environmental perceptions is unknown. PURPOSE: We examined associations between the neighborhood built environment and leisure and utilitarian walking and mediation by the perceived environment among older women. METHODS: Women (N = 2732, M age = 72.8 ± 6.8 years) from Massachusetts, Pennsylvania, and California completed a neighborhood built environment and walking survey. Objective population and intersection density and density of stores and services variables were created within residential buffers. Perceived built environment variables included measures of land use mix, street connectivity, infrastructure for walking, esthetics, traffic safety, and personal safety. Regression and bootstrapping were used to test associations and indirect effects. RESULTS: Objective population, stores/services, and intersection density indirectly predicted leisure and utilitarian walking via perceived land use mix (odds ratios (ORs) = 1.01-1.08, 95 % bias corrected and accelerated confidence intervals do not include 1). Objective density of stores/services directly predicted ≥150 min utilitarian walking (OR = 1.11; 95% CI = 1.02, 1.22). Perceived land use mix (ORs = 1.16-1.44) and esthetics (ORs = 1.24-1.61) significantly predicted leisure and utilitarian walking, CONCLUSIONS: Perceived built environment mediated associations between objective built environment variables and walking for leisure and utilitarian purposes. Interventions for older adults should take into account how objective built environment characteristics may influence environmental perceptions and walking.

A Test of Basic Psychological Needs Theory in a Physical-Activity-Based Program for Underserved Youth.

This study used a randomized controlled design to test the pathways in basic psychological needs theory, where social relationships characterized by autonomy support, involvement, and structure foster psychological need satisfaction and well-being. Participants were recruited from a physical-activity-based youth program. A new staff training was implemented to manipulate the use of each interpersonal characteristic by program staff (N = 24 observed) and perceptions of each interpersonal characteristic, psychological needs, hope, and self-worth in youth (N = 379 surveyed pre- and postprogram). Staff in the intervention condition used greater overall observed autonomy support, involvement, and structure. Condition assignment did not lead to differences in youth perceptions, but observed staff behaviors positively predicted youth perceptions of staff and perceptions of staff positively predicted change in well-being. Findings indicate that the training manipulated how staff engaged youth, and autonomy support, involvement, and structure are useful strategies to foster well-being in youth.

Participant Perceptions of Character Concepts in a Physical Activity-Based Positive Youth Development Program.

Physical activity-based positive youth development (PYD) programs often aim to foster character development. This study examined youth perspectives of character development curricula and the impact these activities have on their lives within and beyond the program. This case study examined youth from low-income families in a physical activity-based summer PYD program that integrated one character concept (respect, caring, responsibility, trust) in each of 4 weeks. Participants (N = 24) included a cross section of age, gender, ethnicity, and past program experience. Semi-structured interviews were analyzed using inductive thematic analysis and constant comparative methods. Thirteen themes were grouped in four categories: building highquality reciprocal relationships; intrapersonal improvement; moral reasoning and understanding; and rejection, resistance, and compliance. The findings provide participant-centered guidance for understanding youth personal and social development through physical activity in ways that are meaningful to participants, which is particularly needed for youth in low-income communities with limited youth programming.

Bi-directional Effects of Peer Relationships and Adolescent Substance Use: A Longitudinal Study.

Understanding the predictors of the onset and maintenance of substance use in adolescence is important because it is a recognized health risk. The present longitudinal study examined whether negative peer influence and peer connectedness predicted changes in adolescent alcohol, cigarette, marijuana, and other illegal drug use, and reciprocally whether substance use predicted changes in peer relationships. Adolescents (N = 1940; 52 % female; 52 % European New Zealanders, 30 % Maori, 12 % Pacific Islander) aged 10-15 years completed measures annually for 3 years. Cross-lagged panel models were used to examine bi-directional effects. Negative peer influence predicted increased use of all substances. In turn, alcohol, cigarette, and marijuana use predicted increased negative peer influence, but this effect was inconsistent over time. Peer connectedness, predicted to diminish the frequency of substance use, was found to be unrelated to it. Breaking the reciprocal cycle between peer coercion and substance use would seem to be useful for reducing substance use.

Youth perceptions of how neighborhood physical environment and peers affect physical activity: a focus group study.

OBJECTIVE: There is need for a youth-informed conceptualization of how environmental and social neighborhood contexts influence physical activity. We assessed youths' perceptions of their neighborhood physical and peer environments as affecting physical activity. METHODS: Thirty-three students (20 girls; ages 12-14 years) participated in focus groups about the physical environment and peers within their neighborhoods, and their understanding of how they affect physical activity. RESULTS: Inductive analysis identified themes of access (e.g., to equipment); aesthetics; physical and social safety; peer proximity and behavior (e.g., bullying); adult support or interference; and adult boundary setting. Participants also identified interconnections among themes, such as traffic shaping parent boundary setting and, in turn, access to physical spaces and peers. CONCLUSIONS: Young adolescents view neighborhoods in ways similar to and different from adults. Examining physical and social environments in tandem, while mindful of how adults shape and youth perceive these environments, may enhance understanding of youth physical activity behavior.

An empirical evaluation of two theoretically-based hypotheses on the directional association between self-worth and hope.

Fostering self-worth and hope are important goals of positive youth development (PYD) efforts, yet intervention design is complicated by contrasting theoretical hypotheses regarding the directional association between these constructs. Therefore, within a longitudinal design we tested: (1) that self-worth predicts changes in hope (self theory; Harter, 1999), and (2) that hope predicts changes in self-worth (hope theory; Snyder, 2002) over time. Youth (N = 321; Mage = 10.33 years) in a physical activity-based PYD program completed surveys 37-45 days prior to and on the second day and third-to-last day of the program. A latent variable panel model that included autoregressive and cross-lagged paths indicated that self-worth was a significant predictor of change in hope, but hope did not predict change in self-worth. Therefore, the directional association between self-worth and hope is better explained by self-theory and PYD programs should aim to enhance perceptions of self-worth to build perceptions of hope.

Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: the role of social support and stress.

OBJECTIVE: Social support is theoretically expected to be positively associated with posttraumatic growth (PTG) and subjective well-being, and stress is expected to be positively associated with PTG and negatively associated with subjective well-being among breast cancer (BC) survivors. However, empirical evidence is mixed, predominantly cross-sectional, and few studies have examined the unique effects of these predictors on positive changes in psychological experiences post cancer diagnosis and systemic treatment. This study examined both general and BC-specific social support and stress as predictors of change in PTG and subjective well-being among BC survivors. METHODS: Women (N = 173, Mage = 55.40, SD = 10.99) who had recently finished treatment completed demographic and treatment measures at baseline (T1); general and cancer-specific social support and stress, PTG and subjective well-being at 3 months (T2); and PTG and subjective well-being again at 6 months (T3). Longitudinal predictors of change in PTG and subjective well-being were examined using hierarchical multiple regression. RESULTS: The BC-specific social support (ß = .12) and stress (cancer worry; ß = .10) predicted increasing levels of PTG. Improvements in subjective well-being were predicted by higher levels of general social support (ß = .21) and lower levels of general stress (ß = -.59). CONCLUSIONS: There are distinct predictors of change in PTG and subjective well-being among BC survivors, supporting the distinction between the trauma-specific process of PTG and well-being.

Factorial validity of an abbreviated neighborhood environment walkability scale for seniors in the Nurses' Health Study.

BACKGROUND: Using validated measures of individuals' perceptions of their neighborhood built environment is important for accurately estimating effects on physical activity. However, no studies to date have examined the factorial validity of a measure of perceived neighborhood environment among older adults in the United States. The purpose of this measurement study was to test the factorial validity of a version of the Abbreviated Neighborhood Environment Walkability Scale (NEWS-A) modified for seniors in the Nurses' Health Study (NHS). FINDINGS: A random sample of 2,920 female nurses (mean age = 73 ± 7 years) in the NHS cohort from California, Massachusetts, and Pennsylvania completed a 36-item modified NEWS-A for seniors. Confirmatory factor analyses were conducted to test measurement models for both the modified NEWS-A for seniors and the original NEWS-A. Internal consistency within factors was examined using Cronbach's alpha. The hypothesized 7-factor measurement model was a poor fit for the modified NEWS-A for seniors. Overall, the best-fitting measurement model was the original 6-factor solution to the NEWS-A. Factors were correlated and internally consistent. CONCLUSIONS: This study provided support for the construct validity of the original NEWS-A for assessing perceptions of neighborhood environments in older women in the United States.

Breast cancer survivors' decisions to join a dragon boating team.

Physical activity is associated with psychosocial and physical health benefits for breast cancer survivors. Little is known, however, about survivors' decision-making processes when considering joining group physical activity programs designed for survivors. Guided by interpretive description methodology (Thorne, 2008), N = 15 breast cancer survivors who were considering or had made the decision to join a dragon boating team were interviewed about their decisions to participate. Four patterns of decision making were identified: searching for a way to care for physical and social needs, taking advantage of opportunities created by breast cancer, dove in with little contemplation, and hesitant to connect with other survivors. Results have implications for understanding decisions to participate in physical activity groups in this population and overcoming challenges to participation.