Evaluation of a physical activity intervention for new parents: protocol paper for a randomized trial.

BACKGROUND: Identifying critical life transitions in people's physical activity behaviors may illuminate the most opportune intervention apertures for chronic disease prevention. A substantive evidence base now indicates that parenthood is one of these critical transition points for physical activity decline. This study will examine whether a brief theory-based intervention can prevent a decline in physical activity among new parents over 6 months following intervention. This study protocol represents the first dyad-based physical activity initiative in the parenthood literature involving both mothers and fathers; prior research has focused on only mothers or only fathers (albeit limited), and has shown only short-term changes in physical activity. This study will be investigating whether a theory-based physical activity intervention can maintain or improve moderate to vigorous intensity physical activity measured via accelerometry of new parents over a 6 month period following intervention compared to a control group. METHODS: This study is a 6-month longitudinal randomized controlled trial. Parents are measured at baseline (2 months postpartum) with two assessment points at 6 weeks (3.5 months postpartum) and 3 months (5 months postpartum) and a final follow-up assessment at 6 months (8 months postpartum). The content of the theory-based intervention was derived from the results of our prior longitudinal trial of new parents using an adapted theory of planned behavior framework to predict changes in physical activity. RESULTS: A total of 152 couples have been recruited to date. Sixteen couples dropped out after baseline and a total of 88 couples have completed their 6-month measures. DISCUSSION: If the intervention proves successful, couple-based physical activity promotion efforts among parents could be a promising avenue to pursue to help mitigate the declines of physical activity levels during parenthood. These findings could inform public health materials and practitioners. TRIAL REGISTRATION: This trial has been registered with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health on April 19, 2014. The registration ID is NCT02290808 .

Ecologically optimizing exercise maintenance in men and women post-cardiac rehabilitation: Protocol for a randomized controlled trial of efficacy with economics (ECO-PCR).

BACKGROUND: Exercise-based cardiac rehabilitation (CR) participation results in increased cardio-metabolic fitness, which is associated with reduced mortality. However, many graduates fail to maintain exercise post-program. ECO-PCR investigates the efficacy and cost-effectiveness of a social ecologically-based intervention to increase long-term exercise maintenance following the completion of CR. METHODS/DESIGN: A three-site, 2-group, parallel randomized controlled trial is underway. 412 male and 192 female (N=604) supervised CR participants are being recruited just before CR graduation. Participants are randomized (1:1 concealed allocation) to intervention or usual care. A 50-week exercise facilitator intervention has been designed to assist CR graduates in the transition from structured, supervised exercise to self-managed home- or community-based (e.g., Heart Wise Exercise programs) exercise. The intervention consists of 8 telephone contacts over the 50week period: 3 individual and 5 group. Assessments occur at CR graduation, and 26, 52 and 78weeks post-randomization. The primary outcome is change in minutes of accelerometer-measured moderate to vigorous-intensity physical activity (MVPA) from CR graduation to 52weeks post-randomization. Secondary measures include exercise capacity, quality of life, and cardiovascular risk factors. Analyses will be undertaken based on intention-to-treat. For the primary outcome, an analysis of variance will be computed to test the change in minutes of MVPA in each group between CR graduation and 52week follow-up (2 [arm]×2 [time]). Secondary objectives will be assessed using mixed-model repeated measures analyses to compare differences between groups over time. Mean costs and quality-adjusted life years for each arm will be estimated.

Family planning to promote physical activity: a randomized controlled trial protocol.

BACKGROUND: Physical activity is associated with the reduction of several chronic conditions in adults. Additionally, physical activity is extremely important for children for their development and cognitive functioning and also to create a physically active lifestyle that continues into adulthood. Despite the known benefits of physical activity, only one in five adults are achieving the public health recommendations of 150 minutes of moderate-to-vigorous physical activity per week and only 13 % of boys and 6 % of girls between the ages of 5 and 17 years are meeting the guidelines of 60 minutes per day. This study aims to evaluate whether a planning condition improves adherence to regular physical activity compared to an education-only control condition among families. Families are eligible if there is at least one child between the ages of 6 and 12 years who is not meeting the Canadian Physical Activity Guidelines. METHODS/DESIGN: A six-month longitudinal randomized controlled trial will be used to compare the two conditions. Materials will be delivered at baseline with 'booster' sessions at six weeks and three months. Participants will be assessed at baseline and at six months with a fitness test, as well as questionnaires and accelerometery at baseline, six weeks, three months and six months. A total of 137 families have been recruited thus far from Greater Victoria. This study is ongoing and recruitment will continue until December 2015 with the target goal of reaching 160 families. DISCUSSION: This protocol describes the implementation of a randomized controlled trial that utilizes planning strategies to try and increase physical activity among families. Research findings could be useful in public health in providing effective strategies to families to help decrease sedentary lifestyles. Additionally, findings may help to inform future interventions aimed at increasing physical activity among families. TRIAL REGISTRATION: This trial was registered on June 5, 2012 with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health. The registration ID is NCT01882192.

Prevalence and correlates of strength exercise among breast, prostate, and colorectal cancer survivors.

PURPOSE/OBJECTIVES: To identify and compare the prevalence and correlates of strength exercise among breast, prostate, and colorectal cancer survivors.
 DESIGN: Cross-sectional, descriptive survey.
 SETTING: Nova Scotia, Canada.
 SAMPLE: 741 breast, prostate, and colorectal cancer survivors.
. METHODS: A stratified sample of 2,063 breast, prostate, and colorectal cancer survivors diagnosed from 2003-2011 were identified and mailed a questionnaire. Descriptive, chi-square, and logistic regression analyses were used to determine any correlations among the main research variables. 
 MAIN RESEARCH VARIABLES: Strength exercise behavior; medical, demographic, and motivational correlates using the Theory of Planned Behavior.
 FINDINGS: Of 741 respondents, 23% were meeting the strength exercise guidelines of two or more days per week. Cancer survivors were more likely to meet guidelines if they were younger, more educated, had a higher income, better perceived general health, fewer than two comorbidities, and a healthy body weight. In addition, those meeting guidelines had significantly more favorable affective attitude, instrumental attitude, injunctive norm, perceived behavioral control, planning, and intention. The correlates of strength exercise did not differ by cancer site.
 CONCLUSIONS: The prevalence of strength exercise is low among breast, prostate, and colorectal cancer survivors in Nova Scotia and the correlates are consistent across those survivor groups. 
. IMPLICATIONS FOR NURSING: Nurses should take an active role in promoting strength exercise among cancer survivors using the Theory of Planned Behavior, particularly among those survivors at higher risk of not performing strength exercise. 


Spatial classification of youth physical activity patterns.

BACKGROUND: Physical activity is an essential element in reducing the prevalence of obesity, but much is unknown about the intensity and location of physical activity among youth-this is important because adolescent health behaviors are predictive of behaviors in adults. PURPOSE: This study aims to identify the locations where youth moderate-to-vigorous physical activity (MVPA) occurs, and to examine how MVPA varies according to urbanicity (urban, suburban, rural). METHODS: Participants included adolescent students (N=380, aged 12-16 years) from Halifax, Nova Scotia. Locations of MVPA were measured using accelerometers and GPS data loggers for up to 7 days. Specialized software was developed to integrate and process the data. Frequencies of MVPA by location were determined, and differences in MVPA were assessed for association with urbanicity. RESULTS: Active commuting accounted for the largest proportion of time in MVPA among urban and suburban students. Rural students achieved most MVPA at school. Other residential locations, shopping centers, and green spaces accounted for a majority of the remaining MVPA. Minutes in MVPA varied significantly overall (196.6 ± 163.8, 84.9 ± 103.2, 81.7 ± 98.2); at school (45.7 ± 45.2, 18.6 ± 28.0, 29.8 ± 39.7); while commuting (110.3 ± 107.1, 31.5 ± 55.2, 19.5 ± 39.7); and at other activity locations (19.7 ± 27.1, 14.8 ± 26.8, 12.0 ± 22.1) and by urbanicity. CONCLUSIONS: Findings reveal that the journeys between locations are as important as home and school settings in contributing to greater MVPA in adolescent youth. The relative importance of context as a contributor to MVPA varies with urbanicity. Combining actimetry and GPS data provides a precise link between physical activity measurements and contexts of the built environment.

Understanding nonsmoking in African American and Caucasian college students: an application of the theory of planned behavior.

Few studies have considered whether psychological determinants of nonsmoking among college students vary by ethnicity. The authors tested the theory of planned behavior (TPB) to explain differences in nonsmoking intentions of 238 African American and 197 Caucasian college students who completed an in-class TPB questionnaire and a smoking assessment 1 week later. After removing 35 students who reported smoking at the baseline assessment, regressions were used to examine ethnic effects on TPB constructs when predicting nonsmoking intentions. Caucasians had statistically significant higher nonsmoking intentions than African Americans. Further, subjective norms for Caucasians and attitudes for African Americans had small but significant relations to intention, but perceived behavioral control (PBC) was a strongly significant predictor for both ethnic groups. However, the prediction of nonsmoking intentions was not statistically moderated by ethnicity for any of the TPB constructs. This study suggests that the TPB may aid in understanding collegiate nonsmoking intentions and help begin to explain differences in smoking on the basis of ethnicity. Last, because of strong associations shown in this study, PBC should be considered when developing ethnic-specific smoking interventions in college students.

Identifying belief-based targets for the promotion of leisure-time walking.

Walking is the most common type of physical activity (PA) and the likely target of efforts to increase PA. No studies, however, have identified the belief-level correlates for walking using the theory of planned behavior. This study elicits salient beliefs about walking and evaluates beliefs that may be most important for walking-promotion campaigns. A random sample of 55 Canadian adults participated in the elicitation study, and the validation study includes 358 participants who completed measures of demographics, beliefs from the elicitation study, and self-reported walking behavior. Belief-behavior relationships show that almost all behavioral expectancies are correlates of intention and behavior, but normative and control expectancies are more select correlates. But when belief-behavior relations are evaluated by participants meeting PA recommendations, only beliefs about feeling good, appearance, stress relief, and time are significant. Public health efforts to promote walking should focus on making time for regular walking and the affective advantages that walking can provide.

Do ethnicity and gender matter when using the theory of planned behavior to understand fruit and vegetable consumption?

A majority of Americans do not meet the recommendation to eat five servings of fruits and vegetables per day (5-A-Day). The purpose of the present study was to examine the utility of the theory of planned behavior (TPB) for understanding 5-A-Day intentions and behavior and to determine whether any of the TPB relationships were moderated by ethnicity or gender. A total of 413 participants completed a baseline TPB questionnaire and a fruit and vegetable consumption measure 2 weeks later. Path analyses showed that affective attitude and perceived behavioral control significantly predicted intention for blacks, whites, males and females (R(2) ranged from .32 to .40), whereas subjective norm was a significant predictor for blacks, males, and females only. Intention significantly predicted 5-A-Day (R(2) ranged from .17 to .22) for all groups. Follow-up invariance analyses showed that the subjective norm/intention relationship was significantly stronger for black compared to white students. Finally, several key beliefs were identified for all four demographic groups. Therefore, the current results suggest that the TPB may be a useful framework to utilize when developing 5-A-Day interventions.

Ethnicity as a moderator of the theory of planned behavior and physical activity in college students.

Most college students do not meet physical activity (PA) guidelines, and ethnic disparities exist. The present study examined the utility of the theory of planned behavior (TPB) in explaining PA intentions and behavior in black and white college students and whether any TPB relationships were moderated by ethnicity. Black (n=170) and white (n=180) students completed a baseline TPB questionnaire and PA assessment 2 weeks later Hierarchical latent variable regression analyses showed that affective attitude, subjective norm, and perceived behavioral control (PBC) were significant predictors of intention for both ethnic groups, whereas the PBC-intention relationship was significantly stronger for white students. Intention significantly predicted PA for both ethnic groups. Furthermore, common and ethnic-specific beliefs were identified.

Comparing short form and RAND physical and mental health summary scores: results from total hip arthroplasty and high-risk primary-care patients.

OBJECTIVES: Summary physical health scores for the Short Form (SF) measures are computing using positive weights for physical items and negative weights for mental health items. Mental health summary scores use positive weights for mental items and negative weights for physical. The RAND Health Status Inventory (HSI) measures do not use negative weights. Do these different approaches to scoring matter? The objective was to compare summary scores using both the SF and RAND-HSI. METHODS: SF-36 and the Health Utilities Index Mark 3 (HUI3) were administered to a cohort of patients waiting for elective total hip arthroplasty (THA). SF-12 and HUI3 were administered to a cohort of high-risk primary-care patients. Summary scores were generated and compared. Single-attribute utility scores for emotion in HUI3 were also computed. Canadian and US norms for SF, RAND-HSI, and HUI3 were used to interpret results. RESULTS: For THA patients, mean physical health scores were 28 and 36 for SF and RAND-HSI. Mean mental health scores were 55 and 42. For the primary-care patients, the scores were 34 and 36 for physical and 46 and 40 for mental health. CONCLUSIONS: SF and RAND-HSI provided somewhat similar summary scores in the THA study. However, SF and RAND-HSI mental health scores differed in the primary-care patient cohort and results from HUI3 corroborate the mental health deficits identified by the RAND-HSI. It may be wise for investigators to use both SF and RAND-HSI scoring systems.

Ethnicity and the theory of planned behavior in the exercise domain.

OBJECTIVE: To examine the moderating influence of ethnicity on the theory of planned behavior (TPB) in the exercise domain and to generate common and ethnic-specific underlying accessible beliefs. METHODS: 90 Caucasian and 94 African American undergraduate students completed a TPB questionnaire. RESULTS: Multilevel modeling analyses indicated that ethnicity and gender interacted by moderating the relationships between exercise intention and effective (beta = -0.44) and instrumental (betaeta = 0.39) attitudes. Furthermore, common and ethnic-specific underlying accessible beliefs were identified. CONCLUSION: When exercise interventions are developed, ethnicity and gender may need to be considered when dealing with affective and instrumental attitudes.