Positive Affect and Physical Activity Associations in Women and Their Spouses.

BACKGROUND: Only 21% of U.S. women meet the recommended physical activity guidelines, placing them at increased risk for long-term conditions such as heart disease and diabetes. Physical activity is influenced by individual and interpersonal factors (e.g., romantic partners). Individual factors, such as positive affect, are associated with lower mortality risk and improved health behaviors. OBJECTIVES: This secondary data analysis, guided by Fredrickson's Broaden and Build Theory, aims to examine the relationship between positive affect of married women (n = 115 couples) and their physical activity behavior on the same- and next- day, while also considering their spouses' positive affect. METHODS: Two population average models assessed the relationship of calm and happy (positive affect) to physical activity. Physical activity was assessed as the sum of the minutes of moderate-to-vigorous physical activity (MVPA) over the prior 24 hours. Covariates of age, baseline activity frequency, education, marital quality, and race/ethnicity were also included. RESULTS: Women's happiness (ß = 0.15, p < .005), not calmness (ß = -0.03, p = .60), was found to have a significant association with same-day MVPA. Spouses' happiness (ß = 0.11, p = .045) was significantly associated with women's next-day MVPA while their calmness (ß = -0.04, p = .44) was not. CONCLUSIONS: The results of this study support that incorporating positive affect could be valuable for improving physical activity behaviors. Spouse reports provide additional context to consider in physical activity promotion research.

Changes to gait speed when romantic partners walk together: Effect of age and obstructed pathway.

BACKGROUND: Walking at a brisk pace is widely recommended to promote health. When partners walk together, walking activity is increased and maintained due to enhanced social support and accountability, but at least one person must adjust their gait speed. Decreased gait speed could compromise health benefits, which may be especially relevant for the aging population. RESEARCH QUESTION: Do adults change gait speed when walking with their romantic partner, relative to walking alone, and is the change in speed affected by age or pathway conditions? METHODS: Participants were 141 individuals from 72 romantic couples; age range 25-79 years. The three couple conditions were walking alone, walking with their partner, and walking while holding hands with their partner. The two pathway conditions were clear pathway and pathway with obstacles. Gait speed was modeled as a function of the couple conditions, pathway conditions, and covariates (gender, age, relationship duration, and physical activity) using mixed-effects (3-level) regression. RESULTS: In both pathway conditions, both partners reduced speed when walking together (p < 0.001), and reduced speed further while holding hands (p < 0.001), when compared to walking alone. These effects were unchanged when covariates were included in the model. Further, speed was slower on the obstructed pathway for all participants, but the magnitude of slowing was greater with increasing age (p < 0.001) and in females (p=0.03). SIGNIFICANCE: Across the adult lifespan, when walking together, both partners decreased gait speed by a clinically meaningful amount (≥0.05 m/s). While walking with a partner may increase walking activity due to social support, reduced speed when walking together may unintentionally reduce health benefits and gait quality in both partners. Future research should identify how health is impacted by the trade-off between increased walking activity and reduced gait speed when romantic partners walk together.

Short- and Long-term Effects of Support Visibility on Support Providers' Negative Affect.

OBJECTIVES: Seminal research with spouses of chronic pain patients indicates that providing patients with instrumental support can be either costly or beneficial for spouses' well-being. Drawing from the invisible support literature, this study evaluated the extent to which patients' recognition of spouses' support moderated daily and long-term associations between spouses' support provision and negative affect. METHOD: Data came from a sample of spouses (N = 145) of knee osteoarthritis (OA) patients, and the patients themselves. Participants completed a baseline interview, 22 days of daily diaries, and two follow-up interviews 6 and 18 months after baseline. Multilevel models were estimated to test study hypotheses. RESULTS: As expected, support visibility moderated daily and long-term associations between spouses' instrumental support provision and negative affect. Spouses reported elevated levels of negative affect in response to providing patients with extra care and attention, but only when their support was not recognized (i.e., reported) by patients. DISCUSSION: Findings from the current study pinpoint support visibility as a protective factor that may mitigate negative short- and long-term effects of spousal instrumental support provision on spouses' negative affect. Promoting patients' awareness of their spouses' support may offset negative emotional consequences of caregiving in the context of chronic health stressors.

Military Spouses' Self- and Partner-Directed Minimization in the Context of Deployment.

In light of technological advances enabling military couples to communicate throughout deployment, spouses of deployed service members often make decisions about what to share with service members, and how to respond to service members' concerns. In doing so, they manage an emotional boundary between service members and their families. This study focused on two behaviors military spouses may use when managing this boundary, namely their minimization of (1) their own concerns (i.e., self-directed minimization) and (2) service members' concerns (i.e., partner-directed minimization). The purpose of the current study was to identify correlates and consequences of these behaviors. Findings from a longitudinal structural equation model utilizing three waves of data from a sample of 154 married military couples in which the husband was a male National Guard soldier indicated that spouses were more likely to minimize both their own-and service members'-concerns when they themselves reported higher levels of depressive symptomology prior to deployment. Spouses' minimization of service members' concerns during deployment, in turn, predicted higher levels of service members' depressive symptomology at reintegration, even after accounting for their initial depressive symptomology and combat exposure. Implications for intervention efforts aimed at promoting individual and couple adjustment to deployment are discussed.

Daily Marital Tension and Symptom Severity in Older Adults With Diabetes or Osteoarthritis.

Background: Greater marital quality is associated with better psychological and physical health. The quality of daily marital interactions is likely to be especially important for individuals with chronic illness, but this question has received little attention. Purpose: Using data from two diary studies, the current study examined whether individuals with chronic illness would experience more severe symptoms on days with more marital tension due in part to greater negative affect on those days. Methods: The samples included individuals with knee osteoarthritis (OA, N = 145) or type 2 diabetes mellitus (T2DM, N = 129) and their spouses. Participants reported on daily marital interaction quality, affect, and symptom severity (patients only) for 22 days (knee OA) or 24 days (T2DM). Separate multilevel models were run for patients and spouses, controlling for the partner's marital tension and negative affect as well as both partners' daily marital enjoyment and positive affect. We examined same-day and across-day associations. Results: For individuals with T2DM or knee OA, more severe symptoms on days with more marital tension were due in part to their greater negative affect on those days. Individuals with knee OA who experienced more pain had more negative affect and marital tension the next day. Conclusions: Negative marital interactions may exacerbate physical symptoms. Effects of daily marital tension likely accumulate over time and have long-term implications for health.

Communication and connection during deployment: A daily-diary study from the perspective of at-home partners.

In this study, 87 partners of deployed National Guard service members completed daily diaries in which they recorded for up to 7 consecutive days the channels (e.g., phone) by which they communicated with their service member, the communication activities (e.g., support provision) they and their service member engaged in, and how connected they felt to their service member. Multilevel modeling was used to explore two types of associations between couples' communication activities and partners' feelings of connection for partners who communicated with their service member via phone and/or video during the week. Findings indicated that, across the week, partners who reported that their service member provided them with higher levels of support and who made decisions together more often as a couple felt more connected to their service member (between-person associations). Additionally, on days when partners reported they provided support during phone calls more than they did on average, or their service member provided them support during video calls more than their service member did on average, they reported greater feelings of connection (within-person associations). Future research should explore how daily fluctuations in deployment communication may reinforce or challenge existing relationship processes, thus impacting how couples maintain their relationships after, as well as during, deployment. (PsycINFO Database Record

Too much of a good thing? Overexertion of self-control and dietary adherence in individuals with Type 2 diabetes.

OBJECTIVES: The resource model of self-control posits that self-control is a finite resource that can be depleted. Individuals with diabetes must continually restrict their diet, requiring self-control. As a result, dietary adherence is difficult, and lapses are common. People with diabetes who overexert self-control following a lapse may be especially likely to experience a subsequent relapse, as suggested by the resource model. This investigation used the resource model of self-control to test whether overexertion of dietary self-control following a lapse would be predictive of a subsequent relapse in dietary control. DESIGN: We tested this prediction in a daily diary study of 128 individuals with diabetes (Mage  = 66.12). METHODS: Participants' reports of their daily dietary adherence were used to define lapses in adherence, post-lapse adherence, and relapses. RESULTS: Individuals who overexerted self-control after a lapse were more likely to experience a subsequent relapse (OR = 3.276, p = .016) and to do so sooner (HR = 2.12, p = .023). CONCLUSIONS: People with diabetes may seek to compensate for a lapse in adherence by overexerting self-control, but doing so may deplete their self-control and increase the risk of a future relapse. Statement of contribution What is already known on this subject? The resource model of self-control posits that self-control is a limited resource that can be temporarily depleted. Numerous experimental studies have demonstrated support for this model showing that when participants are instructed to engage in a self-control task, they produce less self-control on a subsequent task. The majority of the existing studies are not conducted in naturalistic settings and do not use patient populations. What does this study add? This study is an ecologically valid test of the resource model of self-control. This study applies the resource model of self-control to a patient population.

Emotional reactivity to daily stress, spousal emotional support, and fasting blood glucose among patients with type 2 diabetes.

Stress is associated with higher blood glucose in patients with diabetes, but the strength of this association varies considerably across patients. The current daily diary study of 129 patients with type 2 diabetes examined whether individual differences in emotional stress reactivity were associated with fasting blood glucose and whether emotional support provided by spouses moderated this association. Greater stress reactivity was related to greater variability in patients' fasting glucose readings and, among patients with less support, to higher fasting glucose levels. Investigating individual differences in emotional stress reactivity may help to clarify the role of stress in blood glucose control.

The role of social networks in adult health: introduction to the special issue.

The goal of this special issue is to highlight recent research examining the role of social networks in adults' physical health.

Spouses' involvement in their partners' diabetes management: associations with spouse stress and perceived marital quality.

Spouses frequently attempt to influence (control) or support their chronically ill partners' adherence behaviors. Studies have documented effects of spousal control and support on chronically ill individuals, but little is known about how these two forms of involvement in a partner's disease management may be associated with spouses' stress or the quality of their interactions with their ill partners. The current study sought to address this gap by examining spouses' day-to-day involvement in their marital partner's management of type 2 diabetes (n = 129). Multilevel analyses of daily diary data revealed that on days when spouses exerted control, they reported more stress and more tense marital interactions, although these associations were more pronounced when patients exhibited poor adherence, had been ill for a longer period of time, and had more comorbid health conditions. On days when spouses provided support, in contrast, they reported less stress and more enjoyable marital interactions. The findings from the current study suggest that spouses' day-to-day stress and quality of interactions with their partners are associated with spouses' involvement in their partners' disease management, with health-related social control and support exhibiting distinctive associations.

Spousal undermining of older diabetic patients' disease management.

Marriage can enhance health for individuals with a chronic disease, yet spouses may also undermine disease management. The current study investigated spousal undermining of dietary regimen in 129 patients with type 2 diabetes mellitus. A total of 40 patients reported that their spouses tempted them with forbidden foods, and 15 reported that their spouses conveyed disregard for their diabetic diet. Spousal tempting was associated with worse dietary adherence, and spousal disregard with worse nondietary adherence. Spousal undermining is relatively rare but is associated with patients' disease management and warrants further investigation to better understand how spouses influence partners' day-to-day management of chronic diseases.

Influences of spousal support and control on diabetes management through physical activity.

OBJECTIVES: Spouses may be involved in their partner's diabetes management by providing social support to affirm healthy behaviors and social control to modify health behaviors. Yet, investigations of the influence of spousal involvement on daily patient health behaviors are limited. In daily diaries, we investigated how spousal support and control independently and jointly influence patient physical activity and efficacy to engage in physical exercise on a daily basis. METHODS: Older adults (age 55 and older) with Type 2 diabetes and their spouses (N = 70 couples) completed electronic diaries for seven consecutive days that assessed spouse-reported involvement and patient-reported minutes of physical exercise and efficacy to engage in future physical exercise. A subset of patients (N = 53) also wore an activity monitoring device on the wrist that provided a measure of energy expenditure. RESULTS: Multilevel analyses indicated that on a daily basis, spousal support was positively associated with physical activity, whereas spousal control was either unrelated or linked to less physical activity. On days in which spouses provided high levels of both support and control, however, patients felt more efficacious that day about exercising tomorrow and exhibited an increase in energy expenditure on the next day. CONCLUSIONS: Findings suggest that spousal exercise support on its own or in conjunction with spousal exercise control may facilitate daily diabetes management through physical activity.

Spouses' attempts to regulate day-to-day dietary adherence among patients with type 2 diabetes.

OBJECTIVE: To investigate daily dietary adherence and diabetes-specific distress among older adults with type 2 diabetes mellitus (T2DM) as a function of spouses' diet-related support and diet-related control (persuasion and pressure) and whether these daily processes differ among couples who do and do not appraise responsibility for managing T2DM as shared. METHODS: End-of-day diaries were completed by 126 couples in which one partner had T2DM (patient) and the other did not (spouse). Using electronic diary methods, each partner independently recorded data for 24 consecutive days (patients recorded their day's dietary adherence and diabetes-specific distress; spouses recorded their day's involvement in patients' dietary management). To assess dietary adherence, patients reported the extent to which they followed dietary recommendations that day with items from the Summary of Diabetes Self-Care Activities Measure. To assess diabetes-specific distress, patients reported the extent to which they worried about diabetes that day using items from the Problem Areas in Diabetes (PAID) scale. RESULTS: Multilevel modeling revealed that, relative to the prior day, spouses' diet-related support was associated with increases in patients' adherence whereas diet-related persuasion and pressure were associated with decreases in adherence; spouses' pressure was associated with increases in patients' diabetes-specific distress. When partners appraised responsibility for managing T2DM as shared, support was associated with decreases in diabetes-specific distress; pressure was associated with decreases in adherence. CONCLUSIONS: Our findings offer insight into partners' day-to-day disease-related interactions and identify those that are likely to be beneficial versus detrimental for patients' physical and psychological health.

Older adults' beliefs about the timeline of type 2 diabetes and adherence to dietary regimens.

The common-sense model posits that behavioural coping with illness is shaped by a complex combination of individuals' abstract and concrete beliefs about their illness. We investigated this theoretical assumption in a study of 116 older adults diagnosed with type 2 diabetes who completed in-person interviews at baseline and six and 12 months later. Specifically, we examined (1) the interaction of patients' abstract and concrete beliefs about the timeline of their diabetes as a predictor of change in adherence to a healthy diet and (2) whether these interactive effects differ among male and female patients. Abstract timeline beliefs were conceptualised as those pertaining to disease duration; concrete timeline beliefs were conceptualised as those pertaining to variability of disease symptoms (i.e. symptoms are stable versus fluctuating). As predicted, duration beliefs were positively associated with improvement in adherence among patients who viewed disease symptoms as stable, but not among those who viewed symptoms as variable. When gender was considered, these interactive effects were observed among male (but not female) patients. Findings revealed that the behavioural effects of men's abstract knowledge about their diabetes were conditioned by their concrete representations of the disease, suggesting a bottom-up process of influence with implications for intervention.

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement.

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet-related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet-related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.

Table for two: diabetes distress and diet-related interactions of married patients with diabetes and their spouses.

In adjusting to chronic illness, patients often negotiate new or altered daily routines within a dynamic family context. Yet, the responses of family members to the disease and its management are understudied. The authors investigated patients with Type 2 diabetes and their spouses (N = 55 couples) and examined the association of diet-related interactions (i.e., diet-related support, diet-related pressure, and frequency of sharing meals together) with each partner's adjustment to the illness context (i.e., diabetes distress). All spouses (100%) reported providing some type of diet-related support to their partners with diabetes in the past month, and many reported exerting pressure to improve their partners' diet choices (60%). In addition, many couples (64%) indicated that they frequently shared meals together in the past month. For spouses, their provision of diet-related pressure was associated (positively) with their diabetes distress. Frequently sharing meals was associated with less diabetes distress among patients, even after controlling for their glycemic control and diet adherence. Findings reveal that spouses of patients with diabetes are actively involved in illness management with their partners, and these activities are associated with their own diabetes distress and with that of their ill partners.

Setbacks in diet adherence and emotional distress: a study of older patients with type 2 diabetes and their spouses.

OBJECTIVES: We investigated patients' difficulties in managing their diet (i.e. diet setbacks) and associations with change in disease-specific and general emotional distress (diabetes distress and depressive symptoms) among patients with type 2 diabetes and their spouses. METHOD: Data for this study were collected in couples' homes (N=115 couples) using structured interviews and self-administered questionnaires at three time points: baseline (T1), six months after baseline (T2) and 12 months after baseline (T3). RESULTS: Patients' diet setbacks were associated with an increase in their diabetes distress in the shorter-term (over six months). Patients' diet setbacks were not associated with longer-term change in diabetes distress or with change in depressive symptoms at either time point (six months or one year). In contrast, spouses' perceptions of patients' diet setbacks were associated with increases in their own diabetes distress at both time points (over six months and one year), and also with an increase in their depressive symptoms in the longer-term (over one year). CONCLUSION: Findings reveal detrimental consequences of patients' diet nonadherence for emotional well-being that extend to the well-being of their spouses.

I will if you will: similarity in married partners' readiness to change health risk behaviors.

Married men and women (N = 1,899 couples) reported readiness to eat a healthier diet, lose weight, and get more exercise (stage of change) and indicated whether they were confident to make these changes (self-efficacy). Husbands' and wives' reports of readiness to change each health behavior were positively associated. Furthermore, women who indicated readiness to eat a healthier diet and get more exercise (contemplation or preparation stages) were less likely to endorse confidence to change when their husbands were in a lower stage than they were relative to those whose husbands shared the same stage of change. Similarly, men who indicated readiness to lose weight were less likely to endorse being confident in their ability to lose weight when their wives were in a lower stage than they were relative to those who shared the same stage. Consideration of interpersonal factors in the behavior change process may enhance behavioral interventions that include married partners together rather than either individual alone.

Are spouses of chronically ill partners burdened by exerting health-related social control?

Spouses often seek to influence the health behaviors of chronically ill partners, but little research has examined whether spouses find such involvement to be burdensome. The current study examined this question in a sample of 191 nondiabetic spouses whose partners had type 2 diabetes. Results revealed that spouses who attempted to exert more control over their partners' dietary behavior experienced greater burden, particularly when their partners exhibited poor dietary adherence and reacted negatively to spouses' involvement. The findings contribute to a sparse body of knowledge on how spouses are affected by efforts to influence their chronically ill partners' disease management.

Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study.

OBJECTIVES: To compare the characteristics and outcomes of caregivers of adults with dementia with those of caregivers of adults with cognitive impairment, not dementia (CIND). DESIGN: Cross-sectional. SETTING: In-home assessment for cognitive impairment and self-administered caregiving questionnaire. PARTICIPANTS: One hundred sixty-nine primary family caregivers of participants in the Aging, Demographics, and Memory Study (ADAMS). ADAMS participants were aged 71 and older drawn from the nationally representative Health and Retirement Study. MEASUREMENTS: Neuropsychological testing, neurological examination, clinical assessment, and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics. RESULTS: Dementia caregivers spent approximately 9 hours per day providing care, compared with 4 hours per day for CIND caregivers (P=.001). Forty-four percent of dementia caregivers exhibited depressive symptoms, compared with 26.5% of CIND caregivers (P=.03). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Behavioral problems (P=.01) and difficulty with instrumental activities of daily living (P=.01) in persons with CIND partially explained emotional strain experienced by CIND caregivers. For those with dementia, behavioral problems predicted caregiver emotional strain (P<.001) and depressive symptoms (P=.01). CONCLUSION: Although support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the U.S. population may therefore be greatly underestimated if people who have reached the diagnostic threshold for dementia are focused on exclusively.