Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults.

BACKGROUND: Despite well-known benefits of physical activity for older adults, about two thirds are underactive. Community-based programs are needed to facilitate increased physical activity. We examine the effectiveness of CHAMPS II, an inclusive, choice-based physical activity promotion program to increase lifetime physical activity levels of seniors. CHAMPS guided participants to choose activities that took into account their health, preferences, and abilities. It offered information on ways for them to exercise safely, motivate themselves, overcome barriers, and develop a balanced exercise regimen. METHODS: A 1-year randomized controlled trial was conducted with physically underactive seniors in a multispecialty group practice. Changes in self-reported physical activity by group were evaluated using ANCOVA, controlling for age and sex. RESULTS: Of 173 randomized subjects, 164 (95%) completed the trial. Subjects were aged 65 to 90 years (M = 74, SD = 6); 66% were female. The intervention group increased estimated caloric expenditure by 487 calories/week in moderate (or greater) intensity activities (MET >/= 3.0; p <.001) and by 687 calories/week in physical activities of any intensity (p <.001). Control group changes were negligible. Between-group analyses found that the changes were significantly different in both measures (p values <.05). Overweight persons especially benefited from this program. The program was as effective for women, older adults (75+), and those who did not set aside time to exercise at baseline. CONCLUSIONS: The program led to meaningful physical activity increases. Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community settings.

Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics.

BACKGROUND: Anaerobic colonic flora are necessary for the fermentation of fiber into short-chain fatty acids and constitute the bulk of fecal mass. Lack of dietary fiber in most enteral feedings, compounded by antibiotic therapy, suppresses normal colonic metabolism, resulting in diarrhea. Pectin, a water-soluble fiber, stimulates epithelial growth in the colon and thus reduces diarrhea. METHODS: Forty-four critically ill patients receiving enteral nutrition and antibiotic therapy were randomized to receive fiber-containing or fiber-free tube feedings and pectin or placebo. Data on frequency, consistency, and volume of fecal output; energy (caloric) intake; and administration of specific medications were collected for 9 days. Diarrhea was defined as 2 or more days with scores of 12 or higher on the Hart and Dobb diarrhea scale. RESULTS: Subjects in the 4 groups did not differ significantly in age, sex, severity of illness, or energy intake. Twelve subjects (27.3%) experienced diarrhea. Significantly fewer subjects in the fiber-free/placebo and fiber/pectin groups experienced diarrhea than did subjects in the fiber/placebo group (P = .02). On the basis of repeated-measures analysis of variance of daily mean scores, the severity of diarrhea did not differ significantly among the study groups over time (P = .16). CONCLUSIONS: The reduced rate of diarrhea found in this study may be related to the stringent definition of diarrhea used. The therapeutic dose of pectin for reducing diarrhea needs further exploration. The trend was toward less diarrhea in the fiber/pectin group, but the study needs to be replicated with a larger sample.

Lifetime physical activity is associated with bone mineral density in premenopausal women.

Osteoporosis causes premature disability among millions of elderly people in the United States, particularly women. Exercise helps to maintain bone mass, yet it remains unclear what type of physical activity during what age periods is most beneficial for bone mass and density. This cross-sectional study investigated the relationship between different measures of lifetime physical activity and bone mineral density (BMD) in 25 premenopausal women (mean age 41 years, range 28-50 years). BMD of the total, entire axial, and entire peripheral skeleton were measured by dual energy x-ray absorptiometry (DXA). Lifetime history of physical activity was obtained by a structured interview, and estimates of lifetime weight-bearing exercise, total exercise, total weight-bearing physical activity (including occupational and household activities), and perceived physical activity were computed. Adjustments were made for current body weight and height and lifetime milk consumption. Lifetime weight-bearing exercise was significantly correlated with total and peripheral BMD (total BMD: r = 0.54; peripheral BMD: r = 0.54, all p < 0.05). Total weight-bearing physical activity, including occupational and household activity, was associated with total BMD (r = 0.51, p < 0.05). Physical activity during early age periods was more strongly associated with BMD at all sites than was physical activity in the past 2 years. Our findings suggest that lifetime weight-bearing exercise is more strongly related to BMD of the total and peripheral skeleton than is nonweight-bearing exercise. The inclusion of nonweight-bearing activity resulted in a weakening of the association. Weight-bearing household and occupational activity appeared to be related to BMD. Our results support recommendations to increase physical activity throughout life, particularly during early ages, as a means of osteoporosis prevention.

The 'people assessing their health' (PATH) Project: tools for community health impact assessment.

The People Assessing Their Health (PATH) Project was designed to provide a means for people in selected communities within Eastern Nova Scotia to become more involved in decision making within the province's emerging decentralized health system. Using community health impact assessment (CHIA) as a population health strategy, community members were able to identify factors that determine their health and to develop tools to help them assess the health impact of programs and policies within their communities. The participatory process used throughout the PATH Project enabled a wide range of people to generate information for designing a community health impact assessment tool (CHIAT) unique to their community. It also helped participants to broaden their understanding of the many factors determining health of their community and of the region.

Bone mineral density in mother-daughter pairs: relations to lifetime exercise, lifetime milk consumption, and calcium supplements.

This study investigated associations between lifetime milk consumption, calcium intake from supplements, lifetime weight-bearing exercise, and bone mineral density (BMD) among 25 elderly women (mean age 72 y) and their premenopausal daughters (mean age 41 y). The BMD of the total, axial, and peripheral skeleton was measured by dual-energy X-ray absorptiometry. Lifetime milk consumption, supplemental calcium intake, and weight-bearing exercise were estimated retrospectively by questionnaire and interview. In multiple-linear-regression analyses, mothers' total and peripheral BMD were positively associated with supplemental calcium intake after age 60 y, body weight, current estrogen replacement therapy (ERT), and past oral contraceptive (OC) use, and negatively associated with age and height (all P < 0.05). Mothers' axial BMD was positively correlated with body weight and past OC use. Among daughters, lifetime weight-bearing exercise was a predictor of total and peripheral BMD, whereas total lean mass was a predictor of axial BMD. Mothers' lifetime milk consumption was positively associated with that of their daughters. Mothers' and daughters' peripheral BMD values were positively correlated after adjustment for daughters' exercise, and mothers' age, body weight, and ERT. These results suggest that calcium supplementation and exogenous estrogen positively influence bone mass in postmenopausal years. Our findings lend support to recommendations for physical activity as a means of osteoporosis prevention. In the age groups studied, the effects of behavioral and hormonal factors on BMD appeared to dominate over familial similarity, which suggests that women may successfully enhance their genetically determined bone mass through weight-bearing exercise, post-menopausal ERT, and adequate calcium intake.