Social Environments and Physical Activity Among Active Black Women.

PURPOSE: To explore the social context of physical activity (PA) among active Black women, we examine the patterns of PA engagement and the benefits of social support in PA maintenance. DESIGN: A cross-sectional study design and descriptive phenomenological approach were used to examine social support and lived experiences of active Black women. SETTING: The study setting was an online survey of active Black women, ages 21 to 71 years who were recruited from across the United States. PARTICIPANTS: This secondary data analysis was conducted among a sample of 187 active Black women who maintained PA for ≥6 months. The mean age was 41 ± 12.3 years, 83.4% completed some college, 37.7% were married, and 30.0% had children. MEASURES: Participants self-reported 'with whom' they engaged in PA and provided qualitative responses about their strategies for PA maintenance. Descriptive statistics were used to examine between-group differences among demographic characteristics and PA variables by category of PA engagement using SAS 9.4. Descriptive phenomenology was used to explore social support themes across and within categories of PA engagement. RESULTS: On average, the active Black women in this study reported engaging in 57.0 ± 18.9 minutes of moderate intensity leisure-time PA per session. Most engaged in PA alone (n = 87), with a group (n = 72), or with another individual (n = 28). Social context themes within categories included: alone - self-management, groups - motivation and accountability, family - values health, and friends - shared interests in PA. Subthemes across social context categories included: who? - people, what and how? - types of social support, and where? - place of social support. CONCLUSIONS: Our findings suggest that some Black women may need added social support from others beyond family and friends, while other Black women may prefer additional self-management skills. Nonetheless, this study provides data for developing hypotheses about the mechanisms by which social context may facilitate PA maintenance among Black women. Therefore, intervention studies targeting PA maintenance among Black women should include an in-depth query of social support needs.

Everything counts in sending the right message: science-based messaging implications from the 2020 WHO guidelines on physical activity and sedentary behaviour.

The World Health Organization (WHO) released the 2020 global guidelines on physical activity and sedentary behaviour. The new guidelines contain a significant change from the 2010 guidelines on physical activity for adults and older adults that has important implications for next-generation physical activity messaging: The removal of the need for aerobic activity to occur in bouts of at least 10 min duration. This change in the guidelines provides an opportunity to communicate in new ways that align with behavioural science, permitting physical activity communicators and promoters to better support people's psychological needs, motivation, and ability to fit healthy levels of physical activity into their lives. The frames and messages we use to communicate about the guidelines matter because they influence whether activity is perceived as relevant, meaningful, and feasible - or not. When developing new physical activity communications there are some overarching principles, based on behavioural science, to keep in mind. Using established theory, this commentary aims to support the creation of more strategic frames and messages for increasing the value and integration of physical activity into daily living. Country-specific physical activity campaigns using these ideas will be discussed.

Physical Activity Communication: A Scoping Review of the Literature.

Engaging in regular physical activity can help prevent chronic disease and enhance quality of life. Unfortunately, less than 20% of American adults meet the recommended physical activity guidelines, perhaps indicating ineffective communication efforts around physical activity. In preparation for the release of the second edition of the Physical Activity Guidelines for Americans, and using the physical activity guidelines as a cornerstone of our approach, we conducted a scoping review of physical activity communication research to understand the scholarly efforts related to communicating about physical activity. Using a social-ecological perspective, we identified studies using the keywords physical activity* OR exercise* AND health communication* in three public health and communication databases and retained studies conducted in the United States and published in English from 1995 through 2015. Sixty-seven articles included a mention of physical activity guidelines, a health communication focus, and media channels used in promoting physical activity. Half of the studies were published in health/science communication journals. One third of the studies mentioned physical activity guidelines. Only 19% of the studies featured mental health benefits of physical activity while more than 64% emphasized physical health benefits. Nearly all the studies (96%) mentioned the use of persuasion to encourage engagement in physical activity. More effort is needed to study the influence of communicating physical activity guidelines to the public. Best practices for future physical activity communication are discussed for both researchers and practitioners.

"Keep it Realistic": Reactions to and Recommendations for Physical Activity Promotion Messages From Focus Groups of Women.

PURPOSE: Less than half of US adults meet the recommended guidelines of 150 minutes of exercise each week. Health promotion messages are frequently used to promote physical activity (PA); however, this messaging may be ineffective if it does not resonate with the target audience. The purpose of this exploratory study is to understand how women respond to examples of PA promotion messages. APPROACH/DESIGN: A qualitative study. SETTING: Washington DC Metro Area. PARTICIPANTS: Forty women, stratified by race/ethnicity (white, black, Latina) and level of self-reported PA (active, inactive). METHOD: Eight focus groups were conducted in which participants were shown 3 PA promotion messages representative of typical messaging strategies. Three researchers conducted a thematic analysis to code the data for emergent themes. RESULTS: Current PA promotion messaging strategies do not resonate with women. Women want to see individuals with "realistic" bodies who look similar to them (eg, body shape, age, race/ethnicity), and for PA messaging to include daily activities as a way to be active. CONCLUSIONS: Public health practitioners who promote PA to women should consider developing messages that better resonate with women's dynamic roles and lifestyles. Successful strategies may include depicting busy lifestyles that PA may be physically and logistically difficult to fit into and using models with diverse body shapes.

Positive Outliers Among African American Women and the Factors Associated with Long-Term Physical Activity Maintenance.

Studying positive outliers, individuals who have achieved success with long-term (> 6-month) physical activity (PA) engagement, may be an important approach for understanding strategies for improving leisure-time PA maintenance among African American (AA) women. This cross-sectional, mixed-methods study (1) examined the personal characteristics, PA patterns, and behavioral practices of positive outliers among AA women and (2) compared characteristics of those who maintain PA at recommended levels (HIGH, ≥ 150 min/week > 6 months) with those who maintain low PA volumes (LOW, < 150 min/week > 6 months). A large sample of positive outliers completed this study (n = 290), and most became physically active on their own (76.2%). These AA women were committed to maintaining an active lifestyle, accumulated 249.7 ± 105.8 min of PA/week, and engaged in a variety of activities. Their behavioral practices included scheduling PA during the week (85.9%), goal-setting (82.4%), engaging in PA with others (55.9%), self-monitoring (78.3%), and having a backup plan for missed sessions (54.8%). HIGH maintainers (84.9%) made up most of the sample, and these women were characteristically similar to LOW maintainers with few differences. HIGH maintainers have been active longer, achieved higher commitment scores, and engaged in PA at a higher frequency, duration, and intensity, resulting in higher weekly PA volume compared to LOW maintainers (273.8 ± 96.1 vs. 114.4 ± 24.3 min per week, p ≤ 0.001). Our findings identify factors that may be important for successful PA maintenance among AA women and may help to inform the development of effective behavioral interventions to promote sustained, long-term PA engagement in this population.

Characterizing Employees' Preferences for Incentives for Healthy Behaviors: Examples to Improve Interest in Wellness Programs.

Background. Many employers now incentivize employees to engage in wellness programs, yet few studies have examined differences in preferences for incentivizing participation in healthy behaviors and wellness programs. Method. We surveyed 2,436 employees of a large university about their preferences for incentivizing participation in different types of healthy behaviors and then used multivariable logistic regression to estimate associations between employees' socioeconomic and demographic characteristics and their preferences for incentives for engaging in healthy behaviors. Results. Compared with nonunion members, union members had higher odds of wanting an incentive for eating healthily (adjusted odds ratio [AOR] = 1.60, 95% [CI; 1.21, 2.12]), managing weight (AOR = 1.53, 95% CI [1.14, 2.06]), avoiding drinking too much alcohol (AOR = 1.41, 95% CI [1.11, 1.78]), quitting tobacco (AOR = 1.37, 95% CI [1.06, 1.77]), managing stress (AOR = 1.37, 95% CI [1.08, 1.75]), and managing back pain (AOR = 1.64, 95% CI [1.28, 2.10]). Compared with staff, faculty employees reported higher odds for wanting an incentive for reducing alcohol intake (AOR = 1.34, 95% CI [1.00, 1.78]) and quitting tobacco (AOR = 1.43, 95% CI [1.04, 1.96]). Women had lower odds than men (AOR = 0.80, 95% CI [0.64, 0.99]) of wanting an incentive for managing back pain. Conclusions. Preferences for incentives to engage in different types of healthy behaviors differed by employees' socioeconomic and demographic characteristics. Organizations may consider using survey data on employee preferences for incentives to more effectively engage higher risk populations in wellness programs.

Goals Matter: Exercising for Well-Being But Not Health or Appearance Predicts Future Exercise Among Parents.

BACKGROUND: Many parents are insufficiently active. Further research is needed to understand the goals that drive sustained exercise participation among parents. The purpose of this study was to use self-determination theory derived constructs to examine the relationship between parents' exercise goals and their autonomous motivation, controlled motivation, and exercise behavior across 1 year. METHODS: Mothers (n = 226) and fathers (n = 70) of children less than 16 years completed the Exercise Motivations Inventory-2 and, 1 year later, the Behavioral Regulation in Exercise Questionnaire-2 and Godin Leisure-Time Exercise Questionnaire. Linear mixed effects models were used to examine the longitudinal relationships between exercise goals and autonomous motivation, controlled motivation, and leisure-time exercise. RESULTS: All goals except weight management were significantly associated with autonomous motivation, whereas only weight and appearance goals predicted controlled motivation. Exercising for stress management and revitalization, but not health- or appearance-related goals, was significantly related to exercise behavior over 1 year. CONCLUSIONS: Only goals related to immediate affective outcomes were associated with both autonomous motivation and exercise behavior over time. These findings support recent calls to "rebrand exercise" as a means to improve daily well-being. Such goals may drive parents to prioritize exercise because they value the immediate benefits it provides.

Moving Towards Wellness: Physical activity practices, perspectives, and preferences of users of outpatient mental health service.

OBJECTIVE: This study assessed the beliefs, barriers and preferences for physical activity (PA) among users of outpatient mental health (MH) services. Outpatient discussions with MH providers were also evaluated. METHOD: Between September-December 2014, patient advisors approached adult and family members in an academic MH clinic's waiting room on high volume patient visit days during peak clinic hours; 83% participated in the survey. Analyses were restricted to MH services users (n=295). RESULTS: Fully 84% of respondents reported a link between PA and their mood or anxiety level and 85% wanted to be more active. Less than half currently met US PA guidelines (≥150min/week). Most (52%) reported their mood limited their involvement in PA. Only 37% reported their MH providers regularly discussed PA with them. Beliefs about the benefits of physical activity (p<0.0001), mood limiting their ability to be physically active (p=0.03), and wanting to be more physically active (p=0.02) were significant predictors of PA (min/week) in the multivariate linear regression model. CONCLUSIONS: Most MH outpatients may need and want assistance in increasing PA. Patient-centered research could inform the development of PA programs in MH settings.

Delivery of Health Coaching by Medical Assistants in Primary Care.

BACKGROUND: Health coaching is potentially a practical method to assist patients in achieving and maintaining healthy lifestyles. In health coaching, the coach partners with the patient, helping patients discover their own strengths, challenges, and solutions. METHODS: Two medical assistants were provided with brief training. The 12-week program consisted of telephone coaching with in-person visits at the beginning and end of the program. Coaching targeted improvements in diet, physical activity, and/or sleep habits using a self-care planning form. RESULTS: A total of 82 subjects enrolled in the program, 72% completed 8 weeks and 49% completed 12 weeks. Subjects who completed assessments at 12 weeks had significant weight loss despite the fact that weight loss was not a study goal. There also were improvements in diet and physical activity. Subject who completed the study were highly satisfied with the program and felt that health coaching should be available in all family medicine clinics. The main barrier providers voiced was remembering to refer patients. The medical providers indicated high satisfaction with the study and valued having coaching available for their patients. CONCLUSIONS: Medical assistants can be trained to assist patients with lifestyle changes that are associated with improved health and weight control.

Rethinking physical activity communication: using focus groups to understand women's goals, values, and beliefs to improve public health.

BACKGROUND: Communication about physical activity (PA) frames PA and influences what it means to people, including the role it plays in their lives. To the extent that PA messages can be designed to reflect outcomes that are relevant to what people most value experiencing and achieving in their daily lives, the more compelling and effective they will be. Aligned with self-determination theory, this study investigated proximal goals and values that are salient in everyday life and how they could be leveraged through new messaging to better support PA participation among women. The present study was designed to examine the nature of women's daily goals and priorities and investigate women's PA beliefs, feelings, and experiences, in order to identify how PA may compete with or facilitate women's daily goals and priorities. Preliminary recommendations are proposed for designing new PA messages that align PA with women's daily goals and desired experiences to better motivate participation. METHODS: Eight focus groups were conducted with White, Black, and Hispanic/Latina women aged 22-49, stratified by amount of self-reported PA (29 low active participants, 11 high active participants). Respondents discussed their goals, values, and daily priorities along with beliefs, feelings about and experiences being physically active. Data were collected, coded, and analyzed using a thematic analysis strategy to identify emergent themes. RESULTS: Many of the goals and values that both low and high active participants discussed as desiring and valuing map on to key principles of self-determination theory. However, the discussions among low active participants suggested that their beliefs, feelings, experiences, and definitions of PA were in conflict with their proximal goals, values, and priorities, also undermining their psychological needs for autonomy, competence, and relatedness. CONCLUSIONS: Findings from this study can be used to inform and evaluate new physical activity communication strategies that leverage more proximal goals, values, and experiences of happiness and success to better motivate PA among ethnically diverse low active women. Specifically, this research suggests a need to address how women's daily goals and desired experiences may undermine PA participation, in addition to framing PA as facilitating rather than competing with their daily priorities and desired leisure-time experiences.

Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees.

INTRODUCTION: Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. METHODS: This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. RESULTS: After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-$1,055.39 vs -$577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-$1,037.60 vs -$388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. CONCLUSIONS: Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees.

Words matter: Reframing exercise is medicine for the general population to optimize motivation and create sustainable behaviour change.

Exercise is medicine (EIM) is grounded in strong evidence regarding the benefits of physical activity. Despite the contributions of EIM initiatives worldwide, rates of physical inactivity remain alarmingly high. We propose a reframe of EIM for the general population to improve motivation and foster sustainable behaviour change. We draw on a solid knowledge-base to explain the value of broadening the nomenclature to physical activity and of promoting a message of well-being via enjoyable physical activity.

From a Vital Sign to Vitality: Selling Exercise So Patients Want to Buy It.

Exercise is Medicine (EIM) and physical activity as a vital sign are based on health-focused research and reflect ideal frames and messages for clinicians. However, they are nonoptimal for patients because they do not address what drives patients' decision-making and motivation. With the growing national emphasis on patient-centered and value-based care, it is the perfect time for EIM to evolve and advance a second-level consumer-oriented exercise prescription and communication strategy. Through research on decision-making, motivation, consumer behavior, and meaningful goal pursuit, this article features six evidence-based issues to help clinicians make physical activity more relevant and compelling for patients to sustain in ways that concurrently support patient-centered care. Physical activity prescriptions and counseling can evolve to reflect affective and behavioral science and sell exercise so patients want to buy it.

Opportunity meets planning: an assessment of the physical activity emphasis in state obesity-related plans.

BACKGROUND: In the United States, health promotion efforts often begin with state-level strategic plans. Many states have obesity, nutrition, or other topic-related plans that include physical activity (PA). The purpose of this study was to assess PA content in these state plans and make recommendations for future plan development. METHODS: Publically available plans were collected in 2010. A content analysis tool was developed based on the United States National PA Plan and included contextual information and plan content. All plans were double coded for reliability and analyzed using SPSS. RESULTS: Forty-three states had a statewide plan adopted between 2002 and 2010, none of which focused solely on PA. Over 80% of PA-specific strategies included policy or environmental changes. Most plans also included traditional strategies to increase PA (eg, physical education, worksite). Few plans included a specific focus on land use/community design, parks/recreation, or transportation. Less than one-half of plans included transportation or land use/community design partners in plan development. CONCLUSIONS: Though the majority of states had a PA-oriented plan, comprehensiveness varied by state. Most plans lacked overarching objectives on the built environment, transportation, and land use/community design. Opportunities exist for plan revision and alignment with the National PA Plan sectors and strategies.

Physical activity advertisements that feature daily well-being improve autonomy and body image in overweight women but not men.

The reasons for exercising that are featured in health communications brand exercise and socialize individuals about why they should be physically active. Discovering which reasons for exercising are associated with high-quality motivation and behavioral regulation is essential to promoting physical activity and weight control that can be sustained over time. This study investigates whether framing physical activity in advertisements featuring distinct types of goals differentially influences body image and behavioral regulations based on self-determination theory among overweight and obese individuals. Using a three-arm randomized trial, overweight and obese women and men (aged 40-60 yr, n = 1690) read one of three ads framing physical activity as a way to achieve (1) better health, (2) weight loss, or (3) daily well-being. Framing effects were estimated in an ANOVA model with pairwise comparisons using the Bonferroni correction. This study showed that there are immediate framing effects on physical activity behavioral regulations and body image from reading a one-page advertisement about physical activity and that gender and BMI moderate these effects. Framing physical activity as a way to enhance daily well-being positively influenced participants' perceptions about the experience of being physically active and enhanced body image among overweight women, but not men. The experiment had less impact among the obese study participants compared to those who were overweight. These findings support a growing body of research suggesting that, compared to weight loss, framing physical activity for daily well-being is a better gain-frame message for overweight women in midlife.

Rebranding exercise: closing the gap between values and behavior.

BACKGROUND: Behavior can only be understood by identifying the goals to which it is attached. Superordinate-level goals are linked to individuals' values, and may offer insights into how to connect exercise with their core values and increase participation in sustainable ways. METHODS: A random sample of healthy midlife women (aged 40-60y) was selected to participate in a year-long mixed-method study (n = 226). Superordinate goals were measured inductively and analyzed using grounded theory analysis. Attainment Value and Exercise Participation were quantitatively measured. An ANOVA and pairwise comparisons were conducted to investigate the differences between superordinate exercise goals in attainment value. This study fit a Linear Mixed Model to the data to investigate the fixed effects of superordinate goals on exercise participation, controlling for BMI and social support. RESULTS: Participants mainly exercised to achieve Healthy-Aging, Quality-of-Life, Current-Health, and Appearance/Weight superordinate goals. Despite equally valuing Healthy-Aging, Quality-of-Life, and Current-Health goals, participants with Quality-of-Life goals reported participating in more exercise than those with Current-Health (p < 0.01), and Healthy-Aging (p = 0.06) goals. CONCLUSIONS: Superordinate exercise goals related to health and healthy aging are associated with less exercise than those related to enhancing daily quality of life, despite being equally valued. While important, pursuing distant benefits from exercise such as health promotion, disease prevention, and longevity might not be as compelling to busy individuals compared to their other daily priorities and responsibilities. By shifting our paradigm from medicine to marketing, we can glean insights into how we can better market and "sell" exercise. Because immediate payoffs motivate behavior better than distant goals, a more effective "hook" for promoting sustainable participation might be to rebrand exercise as a primary way individuals can enhance the quality of their daily lives. These findings have important implications for how we as a culture, especially those in fitness-related businesses, health promotion, health care, and public health, prescribe and market exercise on individual and population levels.

Internet-enhanced management of fibromyalgia: a randomized controlled trial.

Both pharmacological and non-pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non-pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet-based exercise and behavioral self-management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web-Enhanced Behavioral Self-Management program (WEB-SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB-SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no-contact, Internet-based, self-management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non-pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.

Type of physical activity goal influences participation in healthy midlife women.

BACKGROUND: Regular physical activity can help to prevent cardiovascular disease in women. Understanding midlife women's exercise goals could offer insight into their motivational facilitators and barriers, and assist in the development of better primary prevention strategies for this population. OBJECTIVES: We sought to investigate the relationship between midlife women's physical activity goals and their physical activity participation over time. METHODS: A random sample of healthy, midlife women (40-60 years of age) was selected to participate in a longitudinal study (n = 156). This study fit a linear mixed model to the data to investigate the fixed effects of physical activity goals on physical activity participation, controlling for Body Mass Index (BMI) and Social Support. Mediational analyses were conducted to investigate whether commitment and planning mediated these results. RESULTS: There were significant differences between participants with distinct types of goals on physical activity participation over time (i.e., baseline, 1 month, and 1 year postbaseline), controlling for the effects of BMI and Social Support. Participants with Weight Loss and Health Benefits goals participated in significantly less physical activity than those with Sense of Well-being and Stress Reduction goals. Commitment and Planning each mediated the relationship between participant goals and their physical activity participation. CONCLUSIONS: These data suggest having physical activity goals that aim to decrease weight or benefit health may not bode well for healthy midlife women who desire to sustain physically active lives. Instead, health care providers and health promotion specialists might better facilitate long-term participation among healthy women if they emphasize physical activity as a means to enhance their quality of life.