Affective determinants of physical activity in cancer survivors.

Objective: Research with non-cancer survivor populations finds affective variables to be important determinants of physical activity. This study assessed the ability of explicit and implicit affective variables to predict the physical activity of cancer survivors, above that accounted for by cognitive variables. The study also tested whether the affective variables were connected to physical activity directly or indirectly through their association with behavioural intentions. Design: In a cross-sectional design, cancer survivors (n = 122) completed questionnaires and an implicit affect task. Main outcome measures: Self-report measures assessed three affective variables (e.g. positive affective associations), five cognitive variables (e.g. cognitive beliefs), physical activity estimates, behavioural intentions and participants also completed an implicit affect task regarding physical activity. Results: Two of the three explicit affect variables and the implicit affect variable accounted for significant variability in physical activity estimates beyond that accounted for by the cognitive variables. Positive affective associations were the strongest predictor in multivariate analyses. Behavioural intentions did not mediate the link between the affect variables and physical activity estimates. Conclusions: Explicit and implicit affective variables are direct and unique predictors of physical activity in cancer survivors. Physical activity interventions for cancer survivors should target both explicit affect and implicit affect.

Assessing the Relationship Between Implicit and Explicit Evaluations of Fruit and Vegetable Consumption by Cancer Survivors.

BACKGROUND: Currently, little is known about the implicit evaluations that cancer survivors have for health behaviors, such as eating fruits and vegetables. Understanding both the implicit and explicit evaluations of fruit and vegetable consumption among cancer survivors may aid future interventions for changing motivations and intentions in this higher risk population. METHODS: A cross-sectional study at a university cancer center assessed explicit and implicit evaluations of fruit and vegetable consumption among 122 cancer survivors. The explicit evaluations regarding fruit and vegetable consumption were self-report data. To obtain implicit evaluations, participants completed an implicit evaluation task, the Affect Misattribution Paradigm. Moderating variables of time since first cancer treatment and if participants had a prior cancer occurrence were also self-reported. RESULTS: Simple correlations found no significant association between the implicit and explicit evaluations of fruit and vegetable consumption. Moderation regression analyses showed that the implicit and explicit evaluations became negatively associated as time since first treatment increased and when participants had a prior cancer occurrence. CONCLUSION: The results support the view that implicit and explicit measures of fruit and vegetable consumption diverge for cancer survivors, consistent to implicit and explicit evaluations in other domains and samples. Further, the association between these evaluations differed depending on time since first treatment and if they have been treated for a prior cancer occurrence. By knowing more about implicit and explicit positive evaluations, and their moderators, it may be possible for interventionists to alter cancer survivors' motivation and intention to eat fruits and vegetables.

Affective associations as predictors of health behavior in urban minority youth.

OBJECTIVE: Affective associations are key predictors of health-relevant action that can mediate the relationships between cognitive variables and health behavior. Little data, however, has examined affective associations in high-risk groups, the individuals with the greatest need for intervention. Further, few studies have examined the unique predictive ability of positive and negative affective associations. METHODS: The present study assessed positive affective associations, negative affective associations, cognitive beliefs, subjective norms, and reports of 4 obesity-related behaviors (physical activity, fruit consumption, vegetable consumption, and soft drink consumption) across a cross-sectional (n = 1,499) and a longitudinal sample (n = 104) of predominantly African American adolescents of low socioeconomic status from the inner city of urban Detroit. RESULTS: In both samples, positive (not negative) affective associations were the strongest and most consistent predictor of health behavior. Analyses also suggested that positive affective associations mediate the relationships between cognitive beliefs, subjective norms, and health behavior. Interaction tests revealed no evidence that the link between positive affective associations and health behavior is moderated by negative affective associations, cognitive beliefs, subjective norms, sex, or age. CONCLUSIONS: The results are consistent with affective association research and support the development of health interventions for urban minority youth aimed at changing positive (rather than negative) affective associations. The consistency across behaviors and the lack of reliable interactive effects suggests that changing positive affective associations may benefit urban youth regardless of behavior domain, age, sex, negative affective associations, subjective norm, and cognitive beliefs. (PsycINFO Database Record

Advocacy and Public Policy Perceptions and Involvement of Master Certified Health Education Specialists.

Master Certified Health Education Specialists (MCHES; n = 186) participated in a mail survey on advocacy and public policy. Over half of participants reported that they had contacted a public official or provided policy-related information to consumers or other professionals. Participants identified barriers and benefits to influencing public policy. The greatest benefit was identified as improving the health or welfare of the public while the greatest barrier was that they were busy with other priorities. Participants also described their level of involvement, knowledge, training in advocacy, and their self-efficacy in performing various advocacy activities. Most MCHES reported voting and other basic advocacy functions while far fewer had participated in more advanced advocacy activities. Although nearly 73% had formal training on advocacy and policy, only 26% received it through college coursework. Factors predictive of advocacy and policy involvement were determined through a stepwise regression analysis. Five independent variables predicted the total number of advocacy activities and when combined accounted for nearly 61% of the variance. Government-level health educators' misconception that they cannot participate in advocacy and public policy issues should be dispelled. Health education specialists with the MCHES credential need coursework and additional training on how to effectively influence public health policy.

Public Policy Involvement by Certified Health Education Specialists: Results of a National Study.

BACKGROUND: Advocating for health-related activities is an essential part of being a health educator and knowing how to advocate is an important part of the Certified Health Education Specialist (CHES) exam. However, based on previous research, there may be a gap between knowing how to and actually participating in public policy activities. The purpose of this study was to determine public policy involvement of CHES. METHOD: Surveys were mailed to a random sample of 500 CHES (41% response rate). RESULTS: The highest selected public policy activities by CHES were the following: voting at an election (88.9%), contacting a public office (49%), and providing policy-related information (42.9%). The number of locations CHES individuals selected in having training on advocacy was a predictive factor in their confidence to perform advocacy. Positive correlations between perceived knowledge and effectiveness of the public policy process and self-reported involvement in public policy were found. CONCLUSION: Although there is moderate self-reported involvement in public policy activities, more emphasis needs to be placed on raising the confidence of CHES to perform advocacy-related activities in the field.

The delivery of a health promotion intervention by a public health promotion specialist improves patient satisfaction in the emergency department.

OBJECTIVES: The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction. METHODS: Patients in the intervention group were offered and received a 5- to 10-minute presentation about exercise, heart health, healthy eating on a budget, or weight control by a trained PHPS. Patients in the control group received usual ED care. Both groups completed the patient satisfaction instrument. Ordinal logistic regression models were used to compare the two groups on patient satisfaction questions and to identify predictors of the likelihood of patients referring others to the ED. RESULTS: Subjects in the intervention group were more likely to rate the services as great in areas of patient satisfaction such as provider listening, staff being friendly and helpful, comfort and safety, and privacy. Those in the intervention group were three times more likely than those in the control group to state that they would refer others to the ED. CONCLUSIONS: Health promotion and disease prevention interventions carried out by PHPS in the ED can improve patient satisfaction.

Effects of resistance training on functional ability in elderly individuals.

PURPOSE: Determine the effects of 16 weeks of strength training on measures of functional ability in elderly who are functionally limited. DESIGN: Quasi-experimental trial in which elderly volunteers were assigned to either an exercise group or a control group. PARTICIPANTS: Eighty-seven participants (65-93 years) living independently but with some functional limitations. INTERVENTION: Thirteen different strength training exercises using Thera-Band resistive bands (Hygenic Corporation, Akron, Ohio). The program was 16 weeks in duration, and the frequency was three times per week. Participants exercised in a group setting one time per week and were given a home exercise book to follow for two additional sessions per week. MEASURES: Functional ability was operationalized to include a variety of measures related to functional ability that impact activities of daily living, morbidity, and mortality in the elderly, including upper- and lower-body strength and gait. ANALYSIS: Intervention effects were analyzed using a 2 (groups: exercise group vs. control group) × 3 (time: baseline vs. mid vs. post) analysis of variance. RESULTS: The exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl (F[2,140] = 39.870; p < .05) and lower-body strength as measured by chair sit-to-stand (F[2,124] = 25.887; p < .05). Gait velocity (F[2,140] = 37.317; p < .05) and step length (F[2,140] = 4.182; p < .05) both increased for the exercise group at week 9, but this increase disappeared by week 17. Compared with minimal changes in the control group, the exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl and lower-body strength as measured by chair sit-to-stand. CONCLUSION: Some measures of function ability were improved after a 16-week structured exercise program for functionally limited elderly. Because functional ability has been inversely correlated with short-term morbidity and the need for assisted living among older adults, providing opportunities to exercise is crucial to future functioning and independence of the elderly population.

Obesity on the rise.

The prevalence of obesity has increased markedly during recent years with the burden of obesity higher in minority groups in the United States. Rates of obesity vary according to age and employment, although the effect by socioeconomic strata is diminishing. Body mass index (BMI) and waist circumference (WC) are the primary anthropometric measures of obesity, but waist-to-height is increasingly being used as a measure that identifies both overweight and metabolic risk. BMI should be interpreted with caution in the elderly, children, and some Asian populations.

Public policy involvement by health commissioners.

The purpose of this national study was to determine advocacy activities and level of involvement of health commissioners regarding public policy. Benefits, barriers, and perceived outcomes of advocacy efforts were also explored. A previously validated (Holtrop et al., Am J Health Behav 24(2):132-142, 2000) four-page survey was mailed to 700 health commissioners, who were randomly selected from the National Association of County and City Health Officials (NACCHO) database. A three-wave mailing was performed which yielded a 50% response rate. Of these respondents, the majority (70%) were female and (88%) Caucasian. Overall, 31% of health commissioners reported being involved in influencing public policy in the last 4 years. The most common reported activities engaged in by health commissioners included voting (84%), and providing policy information to consumers or other professionals (77%). Perceived barriers to influencing policy were time, (64%), and other priorities (46%). Perceived benefits to influencing policy included improving the health of the public (94%) and making a difference in others' lives (87%). Only 15% perceived their knowledge regarding the process of changing public policy was excellent. Although health commissioners are often spokespersons for health agencies and communities, their public policy involvement is marginal. Professional preparation programs and continuing education opportunities should focus on advocacy, public policy development, and removing barriers to action.

Structured Exercise in Older Adults With Limited Functional Ability: Assessing the Benefits of an Aerobic Plus Resistance Training Program

The authors of this study examined the effects of a 16-week exercise program designed to increase aerobic capacity, muscular strength, and muscular endurance in older adults who reported and exhibited limited functional ability. Participants were randomly assigned to either an exercise (n=39) or a control (n=34) group. Dependent variables tested included measures of fitness (aerobic exercise capacity and isokinetic strength testing of the legs and arms) and measures of functional capacity (time to and off the floor, stair test, chair stand, and bicep curl). At the end of the program, there were significant differences between the exercise and control groups in arm strength, chair stand, and biceps curl. The results of this study indicate functionally limited older adults who maintain a structured exercise program for 16 weeks exhibit increased functional ability.

Combination training and resistance training as effective interventions to improve functioning in elders.

The purpose of the study was to determine whether resistance training (RT) or a combination of resistance and aerobic training (CT) resulted in the most improvement in measures of functional ability in functionally limited elders. Elderly adults who exhibited some limits in functional ability were randomly assigned to either a CT, RT, or control (C) group. Both RT and CT exercised three times per week for 16 weeks. At Weeks 0 and 17, participants completed six measures of strength and six functional tests. A 3 (group) x 3 (time) ANOVA with repeated measures on the time factor was used to analyze the results. CT and RT scored significantly better than C at Week 17 for biceps curl, elbow extension, chair stand, and time up the stairs. These findings demonstrate that RT and CT are both effective at increasing measures of strength and functional ability in elderly adults who begin exercise with functional limitations.

Obesity evaluation and intervention during family medicine well visits.

PURPOSE: The purpose of this study was to determine the extent that primary care providers assess overweight and obesity and offer treatment strategies during well visits in a family medicine setting. METHODS: This was a cross-sectional study of 553 consecutive patients who presented for family medicine well visits. Patient charts were reviewed for documentation of body mass index (BMI) and patient education regarding weight, exercise, and diet. RESULTS: BMI was calculated for 63.5% of adults at the well visit. For patients who were overweight or obese (BMI greater than 25), 48.9% received education on weight, 50.2% on diet, and 41% on exercise. Adults who had BMI calculated were also more likely to receive weight-related education (P < .001). Although height and weight were measured for most of the children and adolescents, their BMI-for-age was not calculated and they were unlikely to receive weight-related education. CONCLUSIONS: Training staff to measure and record BMI is a useful prompt for the physician to discuss overweight. To address weight during critical periods of development, children and adolescents need to have growth monitored with standardized tools.

The impact of exercise training on blood lipids in older adults.

Increasing physical activity is often prescribed to improve blood lipids; however, the efficacy of exercise in improving blood lipids in older adults is not clear. The objective of this study was to examine the effects of different exercise modes on blood lipid levels in previously sedentary older adults engaging in a 16-week exercise intervention. One hundred thirty-one subjects (mean age 74.6+/-6 years) were randomly assigned to a resistance training group, aerobic walking group, combined exercise group, or nonexercising control group. Blood lipids were measured at baseline, 8 weeks, and postintervention. Exercise mode did not impact blood lipids. All groups had lower lipid levels over time. Total cholesterol, low- and high-density lipoprotein, and triglycerides were significantly lower. The decrease in all groups, including the controls, may be due to a seasonal effect in older adults that has been documented in younger individuals.

Collegiate athletic trainers' knowledge and perceptions of disordered eating behaviors in athletes.

To assess athletic trainers' perceptions and knowledge regarding disordered eating behaviors and to estimate their confidence in response to a test of knowledge, a cross-sectional mail survey was distributed to a national random sample of 500 athletic trainers from the National Collegiate Athletic Association and National Association of Intercollegiate Athletics. 408 collegiate certified athletic trainers responded (rate of 81.6%). A 30-item questionnaire assessed perceptions of disordered eating behaviors within 5 domains. Opinions regarding the prevalence of disordered eating, athletic injury and nutritional status, and their role in recognizing disordered eating were assessed. Most respondents reported perceiving disordered eating to be a significant problem. Also, athletic trainers needed knowledge in all domains of disordered eating.

Parents' perceptions of curricular issues affecting children's weight in elementary schools.

The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.

Exercise and functional tasks among adults who are functionally limited.

This study compared the efficacy of 16 weeks of either resistance training, aerobic walking, or combined resistance training and aerobic walking on the performance of functional tasks among adults age 65 years and older with limited functional ability. One hundred thirty-one older adult individuals were randomized into four groups: resistance training, aerobic walking, combined resistance and aerobic walking groups, or a nonexercise control group. Each of the exercise groups documented 70% compliance with their respective exercise intervention, which included three weekly exercise sessions. At baseline, and 8 and 16 weeks following baseline, all participants completed six assessments of their functional ability. Analysis of covariance indicated that all three exercise intervention groups significantly improved measures of functional ability, with the resistance group demonstrating the most consistent gains over the six measures. These findings indicate that older adults who are functionally limited can improve their functional ability through a variety of types of exercise.

Healthy aging: health promotion and disease prevention.

Successful aging includes the ability to perform functional tasks. This ability to perform functional tasks, or functional ability, is influenced by musculoskeletal and cardiovascular functioning and the presence and severity of symptoms of chronic disease. Empirical evidence indicates that musculoskleletal and cardiovascular functioning and symptoms of chronic disease in later life are strongly related to lifestyle choices involving physical activity and nutritional intake. Previous researchers have demonstrated that increases in physical activity and appropriate changes in nutritional intake can be effective interventions to prevent and treat symptoms of chronic disease and improve musculoskeletal and cardiovascular functioning. As a result of this evidence, several organizations have developed physical activity and nutritional intake recommendations aimed at maintaining or increasing the functional ability of older adults. These physical activity recommendations include engaging in cardiorespiratory, flexibility, strength, and balance training 3 to 5 days per week. Broad nutritional recommendations for older adults include a low-fat, plant-based diet including fruits, vegetables, whole grains, 8 glasses of water per day, and a vitamin and mineral supplement.

Hydration status of community-dwelling seniors.

BACKGROUND AND AIMS: Dehydration is the most common fluid or electrolyte disorder among older persons. This study was designed to examine the hydration status of community-dwelling seniors. METHODS: Blood and urine samples were collected from 67 independently living volunteers (65-93 yrs) who had functional limitations but no condition that contraindicated 10 min of moderate exercise. Forty-six subjects who were not diabetic, had fasted for 12 hours, and had blood glucose levels < or = 115 mg/dL were thus included. Urine and serum samples were analyzed for osmolality (mosm/kg), Na+ (mmol/L) and K+ (mmol/L). Whole blood was analyzed for hemoglobin (Hb, g/dL) and hematocrit (Hct, %) and urine for specific gravity (USG). Means and standard deviations for the current data were compared with normal values. RESULTS: All values were within normal ranges except urine osmolality. CONCLUSIONS: While changes associated with aging may predispose an individual to dehydration, functionally limited, independently living older individuals demonstrate normal hydration status following a 12-hr fast. This suggests that dehydration is not solely a function of the aging process, but may be more related to concomitant medical conditions or dependent living.

Rehabilitation of a functionally limited, chronically ill older adult: a case study.

This case study presents MV, a 78-year-old woman who was being treated pharmacologically for several common chronic health problems and who presented with self-reported and observed limitations in her functional ability. After being screened for contraindications to exercise, MV participated in a 16-week rehabilitation program of regular exercise that included aerobic and resistance training. She maintained a high level of compliance with this rehabilitation training and showed improvements in her aerobic capacity, strength, ability to complete functional tasks, blood components, and lipid profile. She also reported decreased levels of pain and improved perceptions of functional ability. This case study indicates that older adults with chronic illness can benefit from participating in a program of regular exercise.

Effects of endurance training and resistance training on plasma lipoprotein profiles in elderly women.

It has been shown that high levels of high-density lipoprotein (HDL) cholesterol and low levels of low-density lipoprotein (LDL) cholesterol are associated with health maintenance in older women, but the few studies that have examined the relationship between exercise and plasma lipoprotein levels in this elderly population have been equivocal. In addition, there are no studies that examine the plasma lipoprotein response of two different types of exercise in a group of active but nonexercising women. Thus, the effects of exercise training on plasma lipoprotein levels in elderly women remain unclear. The purpose of this research was to examine the effects of endurance and resistance exercise on plasma lipoprotein levels in elderly women who were active but nonexercising prior to the study. A total of 45 healthy, active women, aged 70-87 years, were randomly assigned to either an aerobic training (AT, 76 +/- 5 years, n = 15), resistance training (RT, 73 +/- 3 years, n = 15), or control (C, 74 +/- 5 years, n = 15) group. The AT group walked 3 days a week at 70% heart rate reserve. The duration on day 1 was 20 minutes, and it was increased by 5 minutes each day until subjects were walking for 50 minutes (week 3). The exercise training session for the RT group consisted of one to three sets of eight repetitions of eight different exercises at an eight repetition maximum; the C group maintained normal activity. Weight and diet were unchanged across groups. The exercise interventions lasted 10 weeks. Blood samples were obtained from all subjects at week 0 and week 11. Training resulted in a significant decrease in 1-mile walk times and heart rate at completion of the walk for the AT group and a significant increase in eight repetition maximum of all RT exercises. Both AT and RT groups experienced increased HDL cholesterol and decreased triglycerides at week 11 compared with week 0. There were no positive changes in control lipoproteins. Both triglycerides and the total cholesterol to HDL ratio increased significantly while total cholesterol, HDL cholesterol, and LDL cholesterol remained unchanged. The RT group also had significantly lower LDL cholesterol and total cholesterol compared with controls at week 11. Both RT and endurance training resulted in favorable changes to plasma lipoprotein levels for elderly women in only 10 weeks. The fact that this occurred without concurrent changes in weight or diet is an indication that high-intensity exercise alone can be used to modify lipoproteins in populations of healthy elderly women.