The effects of three different types of macronutrient feedings on golf performance and levels of fatigue and alertness.

Background: No study has evaluated the effect of macronutrient feedings on golf performance. Aim: Determine the effect of feedings during simulated golf game using a randomized cross-over study design. Methods: Male participants (n = 6, USGA handicap index 8.5 ± 6.72) played three standardized nine-hole rounds, consuming 30 g of carbohydrate, 15 g + 15 g protein and carbohydrate, or a zero-calorie control. Measurements of driving, chipping, and putting distance and accuracy were taken, as well as perceived levels of fatigue and alertness. Results: No relevant differences (P > 0.05) were seen in golf performance or alertness, but self-reported fatigue differed between conditions (P = 0.02), with scores of 2.5 (0.8 to 3.6) for the combination of carbohydrate and protein, 3.0 (1.5 to 4.3) for carbohydrate, and 4.0 (2.9 to 6.5) for the control, with higher levels indicating more fatigue. Conclusion: Macronutrient feedings led to a significantly lower level of self-reported fatigue without affecting golf performance and alertness compared to a control.

Dietary Patterns with Healthy and Unhealthy Traits Among Overweight/Obese Hispanic Women with or at High Risk for Type 2 Diabetes.

Hispanic women are at high risk for type 2 diabetes (T2D), with obesity and unhealthy eating being important contributing factors. A cross-sectional design was used in this study to identify dietary patterns and their associations with diabetes risk factors. Participants completed a culturally adapted Food Frequency Questionnaire capturing intake over the prior 3 months. Overweight/obese Hispanic women (n = 191) with or at risk for T2D were recruited from a community clinic into a weight loss intervention. Only baseline data was used for this analysis. Dietary patterns and their association with diabetes risk factors (age, body mass index, abdominal obesity, elevated fasting blood glucose [FBG], and hemoglobin A1c). An exploratory factor analysis of dietary data adjusted for energy intake was used to identify eating patterns, and Pearson correlation coefficient (r) to assess the association of the eating patterns with the diabetes risk factors. Six meaningful patterns with healthful and unhealthful traits emerged: (1) sugar and fat-laden, (2) plant foods and fish, (3) soups and starchy dishes, (4) meats and snacks, (5) beans and grains, and (6) eggs and dairy. Scores for the "sugar and fat-laden" and "meats and snacks" patterns were negatively associated with age (r = - 0.230, p = 0.001 and r = - 0.298, p < 0.001, respectively). Scores for "plant foods and fish" were positively associated with FBG (r = 0.152, p = 0.037). Being younger may be an important risk factor for a diet rich in sugar and fat; this highlights the need to assess dietary patterns among younger Hispanic women to identify traits potentially detrimental for their health.

The Use of Virtual Reality Through Head-Mounted Display on Balance and Gait in Older Adults: A Scoping Review.

Introduction: Falls are the most prominent cause of injury and injury-related deaths among older adults (OAs). Virtual reality has been utilized as a method of improving balance and gait in OAs. However, the use of virtual reality through a head-mounted display (VR-HMD) in this area is limited. Objective: The objective of this scoping review was to identify research that used VR-HMD in relation to balance and gait in OAs and to evaluate how VR-HMD is being used with this population. Materials and Methods: A systematic search of the literature was carried out from June 2019 to July 2019 through the following databases: Scopus, Web of Science, PUBMED, and PsycInfo. Eligible studies involved the use of VR-HMD to assess or intervene in balance or gait outcomes of OAs (≥65 years). Articles were not limited to any specific study design or by the year of publication. Results: Our search identified 306 possible articles, of which eight citations met the eligibility criteria. Four studies utilized VR-HMD as an assessment tool or to perturb the balance, while the other four used VR-HMD in their interventions. Conclusions: Currently, it is not clear whether VR-HMD alone is an effective tool for improving balance and gait. However, this review suggests that it is feasible to use VR-HMD with OAs to affect balance and gait. More research is needed in this area, although there appears to be great potential in utilizing VR-HMD with OAs to improve balance outcomes.

African-American Views of Food Choices and Use of Traditional Foods.

Objectives: In this study, we describe dietary intakes and examine variation among African-American adults in the Southwest, and identify barriers to engaging in healthy dietary behaviors, and use of traditional African-American foods, including pulses. Methods: Using mixed-methods parallel analysis, 97 African Americans aged 25-60 years completed surveys on lifestyle and dietary habits prior to focus group discussions in 3 geographic regions of Arizona. We identified themes in the qualitative transcripts using an inductive approach informed by Grounded Theory. Survey data were compared by sex, and age cohort via chi-square and ANOVA. Results: Qualitative knowledge of healthy choices was high for most participants, but survey dietary in-takes were below recommendations for fruit, vegetables, fiber, and pulses. Greens, fried chicken and fish, barbequed meats, okra-corn-tomato mix, grits, and sweet potatoes were eaten at least twice a month by 30%-50%. Statistically significant food consumption differences were observed by sex, age, and income. Healthy eating barriers included cost, access, convenience or time to prepare, accessibility, and cultural preferences and traditions. Interest in food preparation education was a common theme. Conclusions: Arizona African Americans retain elements of traditional foods in their diet. Health education should offer practical solutions for the cited barriers, be culturally relevant, and build on existing knowledge.

¡Ojo! What to expect in recruiting and retaining older Latinos in physical activity programs.

Older Latinos are the fastest growing cohort among older adults in the USA, and their lives are often fraught with comorbidities, such as diabetes and obesity. Strong evidence has demonstrated health benefits of regular physical activity for older adults. In spite of this, older Latinos participate in low levels of physical activity. Interventions designed to increase the physical activity of older Latinos are lacking, yet more are emerging as the number of older Latinos grows. Unfortunately, older Latinos face many impediments to participating in physical activity interventions that researchers are unaware of. The purpose of the current article was to identify barriers that researchers are likely to face in conducting physical activity interventions for older Latinos, highlighting recently identified barriers, and providing barriers we encountered specifically with older Latino adults; and strategies to overcome these barriers to implementation.

Perceptions of Heart-Healthy Behaviors among African American Adults: A Mixed Methods Study.

African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.

Impacts of Encouraging Dog Walking on Returns of Newly Adopted Dogs to a Shelter.

This study involved examining the ability of a postadoption intervention to reduce returns of newly adopted dogs to shelters by encouraging physical activity between adopters and their dogs. Guardians in the intervention group received emails with dog behavior and human activity advice as well as invitations to join weekly dog walks. Both the intervention and control groups completed surveys regarding outdoor activity with their dogs, their dog-walking habits, and perceptions of their dogs' behaviors. Adopter-dog pairs in the intervention group were not significantly more active than those in the control group, nor did they show a reduced incidence of returning their dogs. Guardians in both groups who reported higher obligation and self-efficacy in their dog walking were more active regardless of experimental condition; however, obligation, dog-walking self-efficacy, and perceptions about their dogs' on-leash behaviors did not predict rates of return to the shelter. These findings add to the understanding of shelter dog re-relinquishment and the effective utilization of resources postadoption, and they indicate further research is needed to address the complexities of this newly forming human-dog relationship.

Efficacy of a Student-Led, Community-Based, Multifactorial Fall Prevention Program: Stay in Balance.

BACKGROUND: Falls are a major public health concern in older adults. Recent fall prevention guidelines recommend the use of multifactorial fall prevention programs (FPPs) that include exercise for community-dwelling older adults; however, the availability of sustainable, community-based FPPs is limited. METHODS: We conducted a 24-week quasi-experimental study to evaluate the efficacy of a community-based, multifactorial FPP [Stay in Balance (SIB)] on dynamic and functional balance and muscular strength. The SIB program was delivered by allied health students and included a health education program focused on fall risk factors and a progressive exercise program emphasizing lower-extremity strength and balance. All participants initially received the 12-week SIB program, and participants were non-randomly assigned at baseline to either continue the SIB exercise program at home or as a center-based program for an additional 12 weeks. Adults aged 60 and older (n = 69) who were at-risk of falling (fall history or 2+ fall risk factors) were recruited to participate. Mixed effects repeated measures using Statistical Application Software Proc Mixed were used to examine group, time, and group-by-time effects on dynamic balance (8-Foot Up and Go), functional balance (Berg Balance Scale), and muscular strength (30 s chair stands and 30 s arm curls). Non-normally distributed outcome variables were log-transformed. RESULTS: After adjusting for age, gender, and body mass index, 8-Foot Up and Go scores, improved significantly over time [F(2,173) = 8.92, p = 0.0; T0 - T2 diff = 1.2 (1.0)]. Berg Balance Scores [F(2,173) = 29.0, p < 0.0001; T0 - T2 diff = 4.96 (0.72)], chair stands [F(2,171) = 10.17, p < 0.0001; T0 - T2 diff = 3.1 (0.7)], and arm curls [F(2,171) = 12.7, p < 0.02; T0 - T2 diff = 2.7 (0.6)] also all improved significantly over time. There were no significant group-by-time effects observed for any of the outcomes. CONCLUSION: The SIB program improved dynamic and functional balance and muscular strength in older adults at-risk for falling. Our findings indicate continuing home-based strength and balance exercises at home after completion of a center-based FPP program may be an effective and feasible way to maintain improvements in balance and strength parameters.

Translation of Fit & Strong! for Use by Hispanics With Arthritis: A Feasibility Trial of ¡En Forma y Fuerte!

This study evaluated the feasibility and effectiveness of translating the evidence-based program, Fit & Strong!, into a Spanish program, ¡En Forma y Fuerte!. A single-group, quasi-experimental design (n = 34, mean age = 58.8 [8.1], 87.2% female, 87.2% reported speaking mostly Spanish) was used to assess implementation feasibility and the impact of ¡En Forma y Fuerte! on arthritis-related outcomes in Hispanics with arthritis. Significant improvements in lower-extremity strength, perceived physical function, and pain were observed from baseline to 8 weeks (p < .05); these improvements were maintained at 6 months. Significant improvements in aerobic endurance and stiffness were observed from baseline to 6 months (p < .05). No major program adaptations (other than language) were observed or reported. However, the instructors provided several suggestions for program improvements, including adjusting the literacy level and length of the program. Findings suggest ¡En Forma y Fuerte! is feasible and effective, potentially providing a much-needed program for older Hispanics with arthritis.

Correlates of Physical Activity among Blacks and Whites with Arthritis.

OBJECTIVE: To evaluate the correlates of physical activity (PA) participation among white and black individuals with diagnosed arthritis. METHODS: This study used a cross-sectional design, grounded in the Social Ecological Model. Participants (N = 205) completed a survey regarding PA participation and potential correlates of PA. Bivariate and multivariate analyses were used to examine the correlates of PA. RESULTS: Nearly 30% of the population met the current guidelines for aerobic PA. A greater proportion of Whites (35.3%) than Blacks (20.9%) met current guidelines (χ(2) = 4.98, p = .03). In bivariate analyses, ethnicity, income, body mass index, self-efficacy for exercise, exercise outcome expectations, physical function, physician advice to exercise, and perceived safety from neighborhood crime and traffic were associated with meeting PA guidelines (p < .05). In regression analyses adjusted for socio-demographic characteristics, exercise self-efficacy and physician's advice to exercise were the only significant predictors of PA (p < .05). This finding was confirmed with stepwise forward regression. CONCLUSIONS: PA interventions for people with arthritis should focus on enhancing self-efficacy for exercise and include strategies to optimize communication about PA by healthcare providers.

Effects of Home-Based Walking on Quality of Life and Fatigue Outcomes in Early Stage Breast Cancer Survivors: A 12-Week Pilot Study.

BACKGROUND: Adjuvant treatment for breast cancer may result in long-lasting, adverse emotional and physical side effects, and reduce quality of life (QOL). This pilot study examined the effects of a home-based walking program on QOL and fatigue in early stage breast cancer survivors and whether changes in walking behavior were associated with changes in outcomes. METHODS: Participants (n = 32) were randomized to a 12-week home-based walking intervention plus brief telephone counseling (n = 20) or a wait-list control group (n = 12). Self-reported fatigue, QOL, and walking were assessed at baseline and 12-weeks. Results are presented as effect sizes. RESULTS: Participants in the intervention had improvements in a majority of fatigue and QOL outcomes, whereas the control group had no change or worsened in many; effect sizes were generally in the small to medium range. Changes in fatigue/QOL outcomes were associated with changes in walking behavior, with effects generally in the small to medium range. CONCLUSION: Home-based physical activity (walking) programs may be an appropriate avenue for alleviating the adverse side effects that often accompany adjuvant treatment for breast cancer. These programs have potential for widespread dissemination, which may have considerable impact on the quality of life of women recently completing breast cancer treatment.

Sociodemographic correlates of meeting US Department of Health and Human Services muscle strengthening recommendations in middle-aged and older adults.

INTRODUCTION: A growing body of evidence demonstrates the health benefits of muscular strength training. Physical activity recommendations encourage all adults to participate regularly in muscle strengthening activities. The purpose of this study was to examine the prevalence of meeting the US Department of Health and Human Services (DHHS) muscular strengthening recommendations by middle-aged and older adults and the sociodemographic characteristics associated with meeting these recommendations, using data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS). METHODS: Data from the 2011 BRFSS were used to examine the prevalence of meeting the DHHS muscle strengthening recommendations by adults older than 45. Simple and multiple regression analyses were used to examine the sociodemographic characteristics associated with meeting the recommendations. RESULTS: Of respondents to the muscle strengthening question (N = 333,507), 79,029 (23.7%) reported meeting the muscle strengthening recommendations. Respondents who were female (odds ratio [OR] = 0.80; 95% confidence interval [CI] 0.78-0.83), widowed (OR = 0.69; 95% CI, 0.66-0.72), 85 or older (OR = 0.63; 95% CI, 0.58-0.68), Hispanic (OR = 0.73; 95% CI, 0.67-0.78), with a body mass index of 30.0 kg/m(2) or higher (OR = 0.47; 95% CI, 0.45-0.49), and with less than a high school education (OR = 0.32, 95% CI, 0.30-0.35) were less likely to meet the recommendations than their counterparts. CONCLUSION: Sociodemographic characteristics such as sex, age, education, and race/ethnicity are significantly associated with meeting the muscle strengthening recommendations, suggesting a need to create tailored interventions and messages to promote participation in strength training.

An examination of the differences between two methods of estimating energy expenditure in resistance training activities.

To date, few studies have looked at the energy expenditure (EE) of individual resistance training (RT) exercises. The purpose of this study was to evaluate the EE of 4 modes of RT (push-ups, curl-ups, pull-ups, and lunges) using 2 different calculation methods for estimating EE. Twelve healthy men with a minimum of 1 year of RT experience were randomly assigned to an RT circuit. Each circuit contained the 4 RT exercises in a specified order. The participants completed 3 trials of their assigned circuit during one visit to the laboratory. Oxygen consumption was measured continuously throughout the trial using indirect calorimetry. Two different calculation methods were applied to estimate EE. Using the traditional method (TEC), we estimated EE by calculating the average oxygen consumption recorded during each activity. Using the second, nontraditional method (NEC), we estimated EE by calculating the average oxygen consumption recorded during the recovery period. Independent T-tests were used to evaluate mean EE differences between the 2 methods. Estimates of EE obtained from the NEC were significantly higher for all the 4 activities (p < 0.001). Using the NEC, 3 of the 4 activities were classified as vigorous intensity (push-ups: 6.91 metabolic equivalents (METs); lunges: 7.52 METs; and pull-ups: 8.03 METs), whereas none were classified as vigorous using the TEC. Findings suggest that the methods we use to calculate the EE of anaerobic activities significantly affect EE estimates. Using the TEC may underestimate actual EE of anaerobic activities.

Differences in active commuting among younger and older adults.

The demonstrated health benefits of active commuting (AC) and low participation rates among older adults indicate a need to examine the socioecological correlates of AC by age category. An online survey of employed U.S. adults examined AC participation and individual, employment-related, community, and environmental variables. Participants were dichotomized by age (younger: 18-49 yr; n = 638, 64% and older: ≥ 50 yr; n = 359, 36%). Logistic-regression analyses examined differences in AC correlates by age. Older adults were less likely to be active commuters (13.4%) than younger adults (27.9%; p < .001) For older adults, analyses yielded a Nagelkerke R2 = .76, with perceived behavioral control, behavioral beliefs, household cars, and walking distance as predictors. Analyses for younger adults resulted in a Nagelkerke R2 = .79, with perceived behavioral control, coworker normative beliefs, parking problems at work, greater employer and community support for AC, and bad weather as predictors. Findings suggest age should be considered when examining and targeting AC behaviors.

Effects of a 6-Month Walking Study on Blood Pressure and Cardiorespiratory Fitness in U.S. and Swedish Adults: ASUKI Step Study.

PURPOSE: The aim of this study was to assess the effects of a six-month pedometer-based workplace intervention on changes in resting blood pressure (BP) and cardiorespiratory fitness (CRF). METHODS: A subsample of ASUKI Step participants (n= 355) were randomly selected to have changes in their BP and CRF monitored during the intervention. Pedometers were used to monitor steps taken with a goal of walking more than 10,000 steps/day. Systolic and diastolic BP were taken using an Omron automated BP cuff. Estimated VO2 max was obtained using the Åstrand-Rhyming cycle ergometer test. A multi-level growth modeling approach, and a mixed model ANOVA were used to predict changes in systolic and diastolic BP, and estimated VO2 max over time by steps, age, gender, and university site. RESULTS: Steps/day averaged 12,256 (SD = 3,180) during month 1 and steadily decreased to month 6. There were significant linear and quadratic trends in systolic and diastolic BP over time. Age was positively related to initial starting values for systolic and diastolic BP, and approached significance for systolic BP changes over time. Steps/day approached significance for linear changes in systolic BP. There was a significant difference between ASU and KI participants' estimated VO2 max. There was a significant change over time in the estimated VO2 max. The number of steps taken was significantly related to changes in estimated VO2 max over time. CONCLUSIONS: The results of the present study indicate that healthy individuals who took part in a pedometer intervention improved several cardiovascular disease risk factors.

"ASUKI Step" pedometer intervention in university staff: rationale and design.

BACKGROUND: We describe the study design and methods used in a 9-month pedometer-based worksite intervention called "ASUKI Step" conducted at the Karolinska Institutet (KI) in Stockholm, Sweden and Arizona State University (ASU) in the greater Phoenix area, Arizona. METHODS/DESIGN: "ASUKI Step" was based on the theory of social support and a quasi-experimental design was used for evaluation. Participants included 2,118 faculty, staff, and graduate students from ASU (n = 712) and KI (n = 1,406) who participated in teams of 3-4 persons. The intervention required participants to accumulate 10,000 steps each day for six months, with a 3-month follow-up period. Steps were recorded onto a study-specific website. Participants completed a website-delivered questionnaire four times to identify socio-demographic, health, psychosocial and environmental correlates of study participation. One person from each team at each university location was randomly selected to complete physical fitness testing to determine their anthropometric and cardiovascular health and to wear an accelerometer for one week. Study aims were: 1) to have a minimum of 400 employee participants from each university site reach a level of 10,000 steps per day on at least 100 days (3.5 months) during the trial period; 2) to have 70% of the employee participants from each university site maintain two or fewer inactive days per week, defined as a level of less than 3,000 steps per day; 3) to describe the socio-demographic, psychosocial, environmental and health-related determinants of success in the intervention; and 4) to evaluate the effects of a pedometer-based walking intervention in a university setting on changes in self-perceived health and stress level, sleep patterns, anthropometric measures and fitness.Incentives were given for compliance to the study protocol that included weekly raffles for participation prizes and a grand finale trip to Arizona or Sweden for teams with most days over 10,000 steps. DISCUSSION: "ASUKI Step" is designed to increase the number of days employees walk 10,000 steps and to reduce the number of days employees spend being inactive. The study also evaluates the intra- and interpersonal determinants for success in the intervention and in a sub-sample of the study, changes in physical fitness and body composition during the study. TRIAL REGISTRATION: Current Controlled Trials NCT01537939.

Nurse practitioner and physician assistant physical activity counseling knowledge, confidence and practices.

OBJECTIVE: This exploratory cross-sectional study examined nurse practitioners' (NPs) and physician assistants' (PAs) perceptions about their physical activity counseling practices. METHOD: Participants were currently practicing NPs (n=240) and PAs (n=78) primarily in Arizona, USA during 2010. Participants completed a modified version of the Promotion of Physical Activity by Nurse Practitioners Questionnaire either online or in person during a practitioner specific conference. Mann-Whitney U tests and Chi-Square analyses examined differences between NPs and PAs. RESULTS: NP respondents were older (48 vs. 40 yrs, p<0.001) and more likely to be female (94% vs. 76%; p<0.001) compared to PAs. The majority of respondents (NPs:75%; PAs:64%; p<0.07) reported routinely counseling patients about physical activity. There were no differences in perceived knowledge (p=0.10) or confidence (p=0.75) to provide physical activity counseling between NPs and PAs. Approximately half of all respondents reported receiving training to provide physical activity counseling as part of their educational preparation to become a health practitioner (p=0.18). CONCLUSION: Study results indicate that NPs and PAs are knowledgeable, confident and currently providing some level of physical activity counseling to patients. However, the majority of respondents are interested in receiving additional training to aid in providing physical activity counseling.

Factors associated with exercise participation in adults with arthritis.

Most people with arthritis are not regularly active. Understanding what factors influence exercise is essential for designing programs to increase participation. The objective of this study was to examine the correlates of exercise in people with arthritis. Using a cross-sectional design, sociodemographic, health-related, and psychosocial variables were collected from community-dwelling individuals with arthritis (N = 141). Associations with exercise level were examined with bivariate statistics (ANOVAs, chi-squares) and logistic-regression analyses. Exercisers were less likely than nonexercisers and insufficiently active people to report that arthritis negatively affected their physical and social functioning, and they reported more positive affect and greater self-efficacy (p < .05). Exercisers also reported less pain than nonexercisers (p < .05). In multiple logistic-regression analyses, self-efficacy and physical limitations remained independent predictors of exercise. The results suggest the need to target exercise self-efficacy when designing exercise interventions. Results also suggest the need to tailor exercise programs to individuals' physical limitations.

Evaluation of a 12-week home-based walking intervention for breast cancer survivors.

GOALS OF WORK: To evaluate a 12-week home-based walking intervention among breast cancer survivors and to quantify changes in physical activity (PA) behaviors, body weight, and body composition in response to the intervention. PATIENTS AND METHODS: Breast cancer survivors that were in the posttreatment period were randomized to intervention (n=23) or wait-list usual care (n=13). PA was assessed by self-report, and in a study subsample (n=23), by an accelerometer. Intention to treat principles were employed to estimate the intervention effect on PA behaviors, body weight, and body composition. Intervention adherence was calculated as the proportion of exercise sessions completed relative to the number of exercise sessions recommended, as reported each week on walking logs. MAIN RESULTS: Thirty-four of 36 women randomized (94%) completed the study. Average intervention adherence over 12 weeks was 94%. Intervention participants reported a significantly greater increase in walking for exercise [+11.9 metabolic equivalent (MET)-h/week] over time than did usual care participants (+1.7 MET-h/week, p=0.01). Objective measures of activity also indicated that intervention participants increased their activity levels over time as compared to usual care participants [i.e., counts/min/day and steps/day (p< or =0.04)]. No significant changes in body weight or composition were observed. CONCLUSION: We found that a 12-week home-based walking intervention was safe and effective for increasing short-term PA levels in breast cancer survivors. Future studies are needed to assess the ability of brief interventions to facilitate the maintenance of increased activity levels and to produce favorable quality of life and risk factor outcomes.

The exercise experience in adults with arthritis: a qualitative approach.

OBJECTIVE: To examine perceptions of exercise prior to arthritis, the ways in which arthritis affects exercise behavior, and current exercise behaviors in people with arthritis. METHODS: Qualitative analyses were used to identify themes in 12 focus groups segmented by exercise status, education, and race. RESULTS: Non exercisers identified arthritis as a factor in exercise cessation. Exercisers described making changes in type, duration, intensity, and approach to exercise after diagnosis. Exercisers also described participating in a wide range of activities, whereas nonexercisers primarily cited walking. CONCLUSIONS: Intervention and marketing strategies should focus on different capabilities of exercisers and nonexercisers to modify exercise routines to accommodate arthritis.