TRACking health behaviors in people with Multiple Sclerosis (TRAC-MS): Study protocol and description of the study sample.

Introduction: People with multiple sclerosis (PwMS) experience a range of physical, cognitive, and affective symptoms. Behavioral interventions targeting increased physical activity show promising support as low-cost methods to improve working memory, episodic memory, and processing speed in PwMS. In this randomized controlled trial, we will examine the efficacy of a pedometer-tracking intervention, designed to increase low-to-moderate levels of physical activity, for improving working memory in PwMS. Methods and Analysis: Eighty-seven PwMS, between the ages of 30-59, have been recruited for the study. Seventy-five of the eligible and interested individuals were randomized to six-month health behavior monitoring groups: a Step-track group or a Water-track group (serving as the active control). Neuropsychological measures, assessing the primary outcome of the study, were administered at pre, midpoint, and post-intervention. Exploratory factor analysis of neuropsychological measures resulted in three factors: a working memory/processing speed factor, a visual episodic memory factor, and a verbal episodic memory factor. Changes in this latent measure of working memory/processing speed is the primary outcome of the current study. Functional MRI data will be analyzed to examine changes in the functional connectivity of the neural network supporting working memory. Ethics and dissemination: The institutional review board granted approval for the study and all participants provided written informed consent. The results of this study will provide support showing that step-tracking increases overall levels of physical activity, improves working memory and processing speed, and strengthens the neural circuitry that supports better cognition. Evidence from this study will thus offer promising support for the routine use of step-tracking devices to improve cognitive functioning in PwMS. Study results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

Efficacy of "Mentoring to Be Active" on Weight Loss, Body Mass Index, and Body Fat among Obese and Extremely Obese Youth in Rural Appalachia.

PURPOSE: This study compares the efficacy of a behavioral skills mentoring program (Mentored Planning to Be Active [MBA]) to a teacher-led program (Planning to Be Active [PBA]) for increasing physical activity in Appalachian teens on health outcomes (weight loss, body mass index (BMI), and body fat). METHODS: Secondary analysis of a larger group-randomized controlled trial was conducted in 20 rural Appalachian schools. Descriptive Pearson correlations and multivariate analyses with between-subject effects were conducted. Effect sizes (ES) using Cohen's d and odds ratios (OR) with 95% confidence intervals were calculated. FINDINGS: The obese MBA group lost 77.5% more weight by T3 compared to the PBA group; T2 was (F = 8.51, P = .000) and T3 was (F = 7.62, P = .000). ES was 0.34. OR = 1.45 (95% CI: 0.558-3.792) at T2 and OR = 3.32 (95% CI: 1.103-9.978) at T3. Extremely obese in the MBA group lost 80.0% more weight compared to the PBA group; T2 was (F = 5.23, P = .025) and at T3 (F = 6.33, P = .015) ES was 0.58. OR = 4.36 (95% CI: 0.981-19.34). Extremely obese females lost more weight compared to males (F = 4.75, P = .034). BMI and body fat had similar results; youth in the MBA group had the most improvement. CONCLUSIONS: Rural Appalachian youth are disproportionately extremely obese. BMI does not capture adiposity or cardiovascular risk. BMI, BMI percentile, raw weight, fat mass, and percent body fat are more complete analyses of adiposity and cardiovascular risk.

A Review of Systematic Reviews Targeting the Prevention and Treatment of Overweight and Obesity in Adolescent Populations.

PURPOSE: Adolescent obesity is a powerful predictor of morbidity and mortality, yet amenable to modifiable behaviors. To accurately summarize the effects of behavioral interventions on changes in adolescent body mass index and/or weight status, we assessed existing systematic reviews for reporting transparency and methodological quality. METHODS: Five databases were searched through September 2017 to identify relevant systematic reviews. Reviews were evaluated for reporting transparency and methodological quality using PRISMA Reporting Checklist and Assessment of Multiple Systematic Reviews Instrument. Evidence was synthesized across high-quality reviews. RESULTS: Four of twelve systematic reviews were of high methodological quality. All four focused on the treatment of overweight/obesity in adolescent populations, representing 97 international studies. Findings indicate intervention compared with no intervention/wait list showed larger effects for improving BMI/BMI z-scores. Small improvements (averaging a 3.7-kg decrease) in weight/weight percentile were observed following a supervised exercise plus dietary and/or behavior support intervention. Health-related quality of life may improve following interventions, but overall attention to associated psychological variables (depression, self-esteem/perception) is limited. CONCLUSIONS: Adherence to objective checklists and protocols for rigorous conduct and reporting of systematic reviews is warranted. Consensus evidence is urgently needed to define and report behavior change interventions related to obesity prevention and treatment.

Rates of Obesity and Obesogenic Behaviors of Rural Appalachian Adolescents: How Do They Compare to Other Adolescents or Recommendations?

BACKGROUND: To better understand the unique challenges of Appalachians, community-based studies are needed to establish benchmark rates. This study compares obesity rates and obesogenic behaviors among Appalachian adolescents to other adolescent populations or clinical recommendations. METHODS: This study was conducted in 11 Appalachian schools. Body mass index, body mass index percentile, and body fat percentage were measured using a Tanita DC-430U analyzer. Physical activity was measured using Actigraph wGT3X-BT accelerometers. Sugar-sweetened beverage consumption was self-reported. Pearson's correlations, independent t tests, and multivariate analyses with tests of between-subject effects were conducted. RESULTS: Mean (n = 345) age was 15.23 (SD = 1.02) years. Appalachian adolescents were extremely obese (13.1%) by more than double that of national adolescent rates. Nearly 29% of males and over 55% of females were at increased cardiovascular risk. Only 15% were moderately active for at least 60 minutes a day, but only for 1 day per week. Mean afterschool sedentary time was 4.75 hours. Only 2.1% recorded vigorous activity for a minimum of 10 minutes at 1 day per week. Nearly all regularly consumed sugar-sweetened beverages. CONCLUSION: Obesogenic health disparities were evident in Appalachia. Rates of obesogenic factors among Appalachian adolescents exceed national rates. Appalachian adolescents were far less active, and extreme obesity is a major health concern.

Peer mentor versus teacher delivery of a physical activity program on the effects of BMI and daily activity: protocol of a school-based group randomized controlled trial in Appalachia.

BACKGROUND: Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Appalachians are the most sedentary U.S. population and teens are particularly sedentary. Obesity prevention through improving physical activity is a top priority in Rural Healthy People 2020. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Organized sports has not been effective at improving daily physical activity or health outcomes for Appalachian teens. The purpose of this study is to test the efficacy of a 10-week school-based intervention in promoting self-regulation of physical activity among adolescents not participating in organized sports. By using accelerometers, our study will measure both sedentary time and planned exercise during waking hours. METHODS: The design for this four-year study is a group-randomized controlled trial (G-RCT). We will recruit high schools in 3 waves, with 4 in Wave 1, 8 in Wave 2, and 8 in Wave 3, for a total of 20 schools. For each wave of schools, we will randomly assign half of the schools to each condition--intervention (peer-to-peer mentoring [MBA]) and comparison (teacher-led [PBA])--for a total of 10 schools in each of the two conditions by study's end. We will collect data at baseline (T1), 3 months post intervention (T2), and 6 months post intervention (T3). Linear Mixed Models (LMMs) and Generalized Linear Mixed Models (GLMMs) will be used to test the main hypotheses. Power for this study was based the primary analysis comparing BMI outcomes at T2 between the groups, adjusting for baseline BMI values. DISCUSSION: This study provides age-appropriate lifestyle education and skill building. Peer-to-peer mentoring by local high school students and school-based tailored support strengthens sustainable behavioral change. Focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia such as overcoming environmental, social, and psychological barriers may improve adherence to physical activity. Serving as role models, peer mentors may improve their own lifestyle behaviors, providing a dual intervention. TRIAL REGISTRATION: NCT02329262 .

A Structured Peer-Mentoring Method for Physical Activity Behavior Change Among Adolescents.

Despite national guidelines for regular physical activity, most adolescents are not physically active. Schools serve an estimated 60 million youth and provide an educational environment to meet the current physical activity guidelines. The obesity epidemic and chronic disease comorbidities associated with physical inactivity are not likely to be reversed without a strong contribution from local schools. This article describes how a structured peer-mentoring method provides a feasible, flexible, and tailored means to meet the current guidelines for best practice in a school setting. Structured peer mentoring using trained high school mentors to support behavior change in younger peers is an innovative method to meeting the School Health Guidelines to Promote Healthy Eating and Physical Activity Through structured peer mentoring, adolescents are provided consistent social support in a caring and personalized manner. This support builds skills and competencies enhancing self-efficacy to sustain a lifetime of physical activity behavior.

Effect of a behavioral intervention on dimensions of self-regulation and physical activity among overweight and obese adults with type 2 diabetes: a pilot study.

The purpose of this pilot study was to determine the preliminary effect of a behavioral intervention on the use of self-regulation strategies and moderate-to-vigorous physical activity (MVPA) in overweight and obese adults with type 2 diabetes. 23 individuals recruited from ResearchMatc.org and campus advertisements were randomized into an intervention (n = 12) and control (n = 11) group. The intervention group received a behavioral intervention that used goal setting, time management, and self-monitoring to target dimensions of self-regulation and MVPA. The control received information regarding their PA habits. MVPA was measured via BodyMedia Armbands at pre- and post-test. The use of self-regulatory strategies for MVPA was assessed at pretest and posttest using the Self-Regulation for Exercise Scale. Cohen's d effect sizes were calculated to determine the practical impact of the intervention. The intervention had a large effect on all dimensions of self-regulation across time: including total self-regulation (3.15), self-monitoring (4.63), goal setting (3.17), social support (1.29), self-reward (1.98), time management (4.41), and overcoming barriers (2.25). The intervention had no impact on dimensions of MVPA across time. This pilot study demonstrated the ability of a behavioral intervention to improve the use of self-regulation strategies for MVPA in a sample of adults with type 2 diabetes. These findings can further inform the development of health promotion programs to promote self-regulation. Future research should focus on determining ability of improvements in self-regulation to stimulate behavior change.

Impact evaluation of a pilot web-based intervention to increase physical activity.

PURPOSE: The purpose of this pilot study was to conduct an impact evaluation of a 10-week Web-based physical activity intervention. DESIGN: Quasi-experimental, three-group pretest, posttest design. SETTING: Large Midwestern university. SUBJECTS: Participants (N = 233) included college students registered for three courses. The study employed a convenience sample consisting of a Web-based group (n = 108), a physical activity group (n = 64), and a general health group (n = 61). INTERVENTION: The Web-based group received a Social Cognitive Theory behavioral skill-building intervention and exercised 3 days per week in their leisure time. The physical activity group received exercise instruction and was required to attend three physical activity labs per week. The comparison group received health instruction. MEASURES: Outcome variables included moderate and vigorous physical activity, self-regulation, social support, self-efficacy, and outcome expectations and expectancies. ANALYSIS: Differences between groups were assessed at pretest and posttest using multiple analyses of variance. RESULTS: Vigorous physical activity, self-regulation, and outcome expectancy value changed significantly in the Web-based and physical activity course groups (p < .01). CONCLUSIONS: Even with consideration of limitations such as small sample size and lack of randomization, the Web-based and traditional physical activity lecture and activity lab interventions were superior in eliciting changes in vigorous physical activity, self-regulation, and outcome expectancy value than a traditional health course.

Neighborhoods on the move: a community-based participatory research approach to promoting physical activity.

BACKGROUND: There is a scientific and practical need for high-quality effectiveness studies of physical activity interventions in "real-world" settings. OBJECTIVE: To use a community-based participatory research (CBPR) approach to develop, implement, operate, and evaluate an intervention for promoting physical activity called Neighborhoods on the Move. METHODS: Two communities with similar physical and social characteristics participated in this study. One community was involved in Neighborhoods on the Move; the other (comparison community) participated only in the assessments. Academic personnel and residents/organizations in the Neighborhoods on the Move community worked together to create a community environment that was more conducive for physical activity. Pre- and posttest data on new initiatives promoting physical activity, existing physical activity initiatives, and business policies supporting physical activity were collected simultaneously in both communities. RESULTS: The success of the CBPR approach was evidenced by several developments, including substantial resident involvement and the formation of a leadership committee, marketing campaign, and numerous community partnerships. The number of businesses with policies promoting physical activity and breadth of existing physical activity initiatives (participants, activities, hours) increased substantially more in the Neighborhoods on the Move community than in the comparison community. A total of sixty new initiatives promoting physical activity were implemented in the Neighborhoods on the Move community during the intervention. CONCLUSION: The CBPR approach is an effective strategy for inducing environmental changes that promote physical activity. Additional research is needed to assess the portability and sustainability of Neighborhoods on the Move.

Impact of the "Planning to be Active" leisure time physical exercise program on rural high school students.

PURPOSE: The purpose of the study was to evaluate the effects of a Social Cognitive Theory-based intervention designed to increase the frequency of leisure time planned moderate and vigorous physical exercise among rural high school students attending physical education class. METHODS: Students in treatment and comparison groups were exposed to an activity-based physical education curricula. The treatment group received eight behavioral skill-building lessons integrated into the existing curriculum. RESULTS: The Social Cognitive Theory-based educational treatment increased levels of moderate physical exercise occurring outside the classroom. CONCLUSIONS: This study demonstrated an impact on adolescent leisure time moderate physical exercise using classroom instruction. The intervention was most effective with students who were previously sedentary. The curricular approaches used to promote regular moderate exercise may be useful for sedentary adolescents.

A method for observing physical activity on residential sidewalks and streets.

Assessment of physical activity needs to improve in order to gain a more comprehensive understanding of the relationship between characteristics of the environment and physical activity. Our study evaluated a method [Block Walk Method (BWM)] for observing physical activity along residential sidewalks and streets. The BWM was utilized in 12 U.S. Census block groups over a three-month period. Examination transportation routes (ETRs), 1,524 m in length, were constructed and examined in each block group. On 6 days, ETRs were traversed by a trained observer for 50 min. Physical activities, street names, and geographical locations (e.g., addresses) were recorded. We found encouraging results for the BWM. The level of agreement between independent observers was >98% for activity type. The number of individuals seen walking, running, or biking did not differ significantly between the days of the week or observation times. The number of individuals observed was correlated with block group characteristics (e.g., percent walking/biking to work) and weather (e.g., temperature). The BWM is an easy to use, economically viable observational approach to obtaining reliable information concerning physical activities performed on residential streets and sidewalks. Its use could help advance our understanding about the environment-physical activity relationship.

Web-assisted instruction for changing social cognitive variables related to physical activity.

The authors examined the efficacy of Web-assisted instruction for promoting the use of social cognitive theory (SCT) strategies related to physical activity. They recruited college students attending health courses. The authors created 3 groups (Web-assisted, comparison, and control) based on the course structure. The Web-assisted group received information on exercise and fitness and a Web-based program (treatment, n = 127); 7 sections received the same exercise and fitness information as the treatment condition, but no Web-based program (comparison, n = 118); and 6 sections received information in unrelated areas (control, n = 178). The Web-based program consisted of 9 Web assignments (1 per week) that targeted key SCT variables. Satisfaction with the Web-based program was high. Use of self-regulation strategies was significantly higher at posttest in the treatment group than it was in the other groups. Knowledge concerning the skills taught by the Web assignments was significantly greater in the treatment group than it was in the comparison group. The results of this study demonstrate that a Web-based instructional program has a positive impact on knowledge and skills related to SCT strategies for changing physical activity behavior.

Features of the neighborhood environment and walking by U.S. adults.

BACKGROUND: Manipulating the physical environment may be an efficacious way to promote physical activity. This study examined the relationships between features of the neighborhood environment and walking in the neighborhood by U.S. adults. METHODS: A random sample of women (n =266) and men (n =208) aged >18 years participated. Door-to-door interviews were conducted in 2003 to collect information about demographics, walking behavior, and features of the neighborhood environment. RESULTS: The analyses conducted in 2004 revealed that women were more likely to walk for exercise (odds ratio [OR]=4.6, 95% confidence interval [CI]=1.01-20.72) or walk a dog (OR=3.3, 95% CI=1.01-11.08) in the neighborhood if neighborhood safety was average as opposed to below average (p <0.05). Women with an average number of neighborhood destinations were more likely to walk for transportation in the neighborhood (OR=5.7, 95% CI=1.63-19.73) than women with a below average number of neighborhood destinations (p <0.01). In men, none of the neighborhood features were significantly associated with walking for exercise or walking a dog. Men were less likely to walk for transportation in the neighborhood if the functional (OR=0.22, 95% CI=0.06-0.89) or aesthetic (OR=0.17, 95% CI=0.03-0.89) features of the neighborhood were average versus below average. CONCLUSIONS: Prospective studies are needed to determine if changes in neighborhood safety and awareness of neighborhood destinations promote increases in walking by women. Evaluations of the relationships between other environmental features and walking behavior in men are warranted.

A meta-analysis of adolescent psychosocial smoking prevention programs published between 1978 and 1997 in the United States.

Psychosocial smoking prevention studies have shown inconsistent results and theory-driven programs have been related to program success. This meta-analysis was used as a judgment tool for resolving these issues by estimating average program effects and investigating the relative efficacy of program types. The present study examined 65 adolescent psychosocial smoking prevention programs (1978 to 1997) among students in Grades 6 to 12 in the United States. Three program modalities (social influence, cognitive behavior, life skill) and two program settings (exclusively school based, school-community-incorporated) were identified as major a priori classifications. Knowledge had the highest effect sizes (.53) at short-term (< or = 1 year) but rapidly decreased (.19) at long-term (> 1 year). Behavioral effect was the most meaningful, being persistent over a 3-year period (.19 at < or = 1 year; .18 at 1 to 3 years). Adolescent smoking reduction rates were increased by using either cognitive behavior or life skills program modalities, and/or a school-community-incorporated program setting.

The long-term impact of a four-session work-site intervention on selected social cognitive theory variables linked to adult exercise adherence.

Many work-site physical activity interventions use theoretical variables in the design of their programs. Yet, these interventions do not document the degree of change in theoretical variables produced by the intervention. This study examined the construct validity of an intervention designed to affect social cognitive theory variables linked to exercise behavior. Construct validation methods were used to evaluate an instructional intervention composed of four 60-minute sessions delivered across 2 weeks. Increases were found in self-regulation skills, outcome-expectancy values, and self-efficacy for the treatment group. No significant increases were detected for the comparison group on any study variables. Sixty-seven percent of the treatment group was able to maintain exercise behavior across 12 months, whereas the comparison group declined in exercise participation from 68% to 25% across 12 months. The study revealed the intervention effective in producing the intended changes in social cognitive theory constructs. The analysis shows self-regulation-mediated exercise behavior.

Using social cognitive theory to explain discretionary, "leisure-time" physical exercise among high school students.

PURPOSE: To examine whether knowledge of high school students' actions of self-regulation, and perceptions of self-efficacy to overcome exercise barriers, social situation, and outcome expectation will predict non-school related moderate and vigorous physical exercise. METHODS: High school students enrolled in introductory Physical Education courses completed questionnaires that targeted selected Social Cognitive Theory variables. They also self-reported their typical "leisure-time" exercise participation using a standardized questionnaire. Bivariate correlation statistic and hierarchical regression were conducted on reports of moderate and vigorous exercise frequency. RESULTS: Each predictor variable was significantly associated with measures of moderate and vigorous exercise frequency. All predictor variables were significant in the final regression model used to explain vigorous exercise. After controlling for the effects of gender, the psychosocial variables explained 29% of variance in vigorous exercise frequency. Three of four predictor variables were significant in the final regression equation used to explain moderate exercise. The final regression equation accounted for 11% of variance in moderate exercise frequency. CONCLUSIONS: Professionals who attempt to increase the prevalence of physical exercise through educational methods should focus on the psychosocial variables utilized in this study.

Physical activity among ethnically diverse college students.

The authors compared physical activity patterns among 874 Asian, 332 African, 1,101 White, and 529 Hispanic American college students aged 18 to 25 years. According to self-report responses, 46.7% of the sample did not engage in vigorous physical activity and 16.7% were physically inactive. Among women, ethnic-specific rates of physical inactivity were Asian, 28.1%; African, 23.5%; White, 17.4%; and Hispanic, 20.3%. For men, rates of inactivity were Asian 11.7%; African, 7.7%; White, 12.0%; and Hispanic, 13.8. Weight-training activity, youthful physical activity, and TV viewing accounted for a significant portion of the variance in physical activity levels (13.1% for women and 14.8% for men). The results of this study support the need for physical activity interventions for college students, particularly minorities.

Stages of change among ethnically diverse college students.

The authors applied the stage-of-change construct in the transtheoretical model to examine the distribution of Asian (n = 869), African American (n = 373), White (n = 1322), and Hispanic (n = 535) American undergraduate students across the 5 stages of change for exercise. Stage of change varied as a function of ethnicity. Higher percentages of minorities were in the precontemplation and contemplation stages. The likelihood of being in these stages was from 43% to 82% greater for minorities than for White students. Also examined were the congruency between stage of change and self-reported levels of physical activity. Half of the sedentary students and 15.6% of the active students were misclassified by the stage-of-change procedure. Misclassification rates were higher for minority women (27.8%) than for White women (17.8%) and for Asian students (24.6%) compared with all others (20.6%). The results of this study have implications for the design of physical activity interventions based on stage of change.