Capacity Development and Evaluation of a Parent Advisory Team Engaged in Childhood Obesity Research.

Guided by community-based participatory research principles, this mixed-methods process evaluation explored the experience and capacity of a newly formed Parental Advisory Team (PAT) engaged in childhood obesity research in a medically underserved region. Following the successful completion of a 3-month evidence-based childhood obesity treatment program (iChoose), 13 parents/caregivers who completed iChoose consented to participate in the PAT. Between June 2015 and March 2016, the PAT had nine monthly meetings and completed mixed-methods capacity assessments. They engaged in activities related to understanding iChoose outcomes, defining their role and purpose as a partnership, initiating content development, and pilot testing maintenance intervention components for future iChoose efforts. Assessments included a quantitative survey administered at baseline and 9 months, and a qualitative interview completed at 9 months. Results indicated that PAT members' perceptions of the identified capacity dimensions were positive at baseline (3.8-4.3 on a 5-point scale) and remained positive at follow-up (3.9-4.4 on a 5-point scale); changes were not statistically significant. Qualitative data revealed that PAT members were satisfied with group participation and desired to enhance their role in subsequent iChoose research. Understanding and promoting parental engagement in the research process fills an important gap in childhood obesity literature.

Effects of high-intensity interval training on cardiometabolic risk in overweight and obese African-American women: a pilot study.

OBJECTIVE: Little is known about high-intensity interval training (HIIT) in African-American (AA) women. The purpose of this pilot study was to evaluate the effects of HIIT and steady-state (SS) exercise on cardiometabolic risk factors in young AA women. DESIGN: A 16-week exercise intervention was conducted 3x/week. Twenty-seven AA women were randomized to SS (n = 11; 32 continuous minutes of treadmill walking at 60-70% of maximum heart rate (HRmax)), or HIIT (n = 16; 32 min of treadmill HIIT alternating 3 min at 60-70% of HRmax with 1 min at 80-90% of HRmax). Two-way repeated measures ANOVA with intention-to-treat analysis was used to identify changes between groups. Significance was accepted at P ≤ 0.05. RESULTS: Of the 27 women who entered the study (age: 30.5 ± 6.8 years; BMI: 35.1 ± 5.1 kg/m2; 5274 ± 1646 baseline steps/day), 14 completed the intervention. HIIT significantly decreased waist circumference (107.0 ± 11.3 to 105.1 ± 11.9 cm) compared to SS, which showed no change. There was a significant time effect for steps where HIIT increased steps/day (5334 ± 1586 to 7604 ± 1817 steps/day), and SS had no change. There were no significant changes in either group for any other measurements. CONCLUSION: HIIT was more effective at reducing waist circumference and increasing daily steps/day than SS treadmill exercise over 16 weeks. Further research in a larger sample is indicated to evaluate the effects of each protocol on cardiometabolic risk factors.

Pastoral perceptions of the learning and developing individual exercise skills (L.A.D.I.E.S.) intervention: a qualitative study.

African-American women experience higher rates of obesity compared to other racial/ethnic groups. High levels of reported church attendance among African-Americans have led to the proliferation of faith-based health programs. Pastors can influence success for faith-based programs. The purpose of this study was to assess pastors' perceptions of the L.A.D.I.E.S. intervention, designed to increase physical activity levels in sedentary African-American women. For the L.A.D.I.E.S. intervention, 31 churches (n = 418 women) were randomized at the church level to a faith-based, non-faith-based or self-guided program. All 31 pastors were invited by telephone to participate in the current study. Using a qualitative design, semi-structured interviews were conducted with 11 pastors from participating churches. Thematic analysis and the ecological model were used to examine the findings. According to the pastors, women showed heightened awareness of the importance of health and physical activity, and increased levels of fellowship. L.A.D.I.E.S. also encouraged healthy church climates and new health ministries. Lessons learned included the need for an expanded participant base and curriculum. Pastors expressed appreciation for the culturally fitting approach of L.A.D.I.E.S. Findings have implications for faith-based and public agency partnerships.

Changes in social support over time in a faith-based physical activity intervention.

African-American women report higher levels of chronic conditions and church attendance relative to the overall US population. Therefore, efforts have increased over the past decade to design church-based health promotion programs. The present study compared changes in religiosity, religious social support and general social support across time within a church-based physical activity study. In a clustered randomized controlled trial, 31 churches and ∼15 African-American women per church were recruited to participate. Churches were randomized to one of three 10-month programs to promote physical activity: faith-integrated (FI), non-faith integrated (NFI) or self-guided control program (C). Comparisons were made between baseline and 10-month time points to assess differences over time. A significant reduction in general social support was observed across all groups. Private religious practices and religious emotional support received increases in C and FI, respectively. Prior research findings and the current study highlight difficulty in demonstrating strong, unilateral changes in religiosity, social support and health. Additional research is needed to identify more accurate measures of these concepts. Findings from the current study have implications for the role of social support in future church-based health promotion studies.

Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life: A Church-Based Physical Activity Intervention - Baseline Participant Characteristics.

OBJECTIVE: Physical activity (PA) is beneficial for health, yet most African American women do not achieve recommended levels. Successful, sustainable strategies could help to address disparities in health outcomes associated with low levels of PA. The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-based and a secular intervention for increasing PA with a self-guided control group. DESIGN SETTING AND PARTICIPANTS: This cluster randomized, controlled trial was conducted from 2010 - 2011 in African American churches (n=31) in suburban North Carolina. Participants were 469 self-identified low active African American women. MEASURES: Baseline data were collected on participant demographics, objective and self-reported PA, and constructs related to social ecological theory and social cognitive theory. RESULTS: Complete baseline data were available for 417 participants who were aged 51.4 ± 12.9 years, with average BMI (kg/m2) 35.8 ± 9.9; 73% of participants were obese (BMI >30). Participants averaged 3,990 ± 1,828 pedometer-assessed daily steps and 23.9 ± 37.7 accelerometer-assessed minutes of daily moderate-to-vigorous PA, and self-reported 25.4 ± 45.4 minutes of weekly walking and moderate- and vigorous-intensity PA. Baseline self-reported religiosity and social support were high. CONCLUSIONS: L.A.D.I.E.S. is one of the largest PA trials focused on individual behavior change in African American women. Baseline characteristics suggest participants are representative of the general population. Findings from the study will contribute toward understanding appropriate strategies for increasing PA in high-risk populations.

Increasing Physical Activity in Black Women: Results from a Randomized Trial Conducted in Faith-Based Settings.

Objective: The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-integrated (FI) and a secular (SEC) intervention for increasing physical activity with a self-guided (SG) control group among African American women. Design/Setting/Participants: L.A.D.I.E.S. was a cluster randomized, controlled trial. Churches (n=31) were randomized and women within each church (n=12 - 15) received the same intervention. Interventions: FI and SEC participants received 24 group-based sessions, delivered over 10 months. SG participants received printed materials to review independently for 10 months. Participants were followed for 12-months post-intervention to assess long-term intervention impact. Main Outcome Measures: Data on participant characteristics, physical activity, and intervention-related constructs were collected at baseline, 10 months, and 22 months. Results: Intervention session attendance was greater for FI compared with SEC participants (15.7 + 5.7 vs 12.4 + 7.3 sessions, respectively, P<.01). After 10 months, FI and SEC participants significantly increased daily walking (+1,451 and +1,107 steps/day, respectively) compared with SG participants (-128 steps/day). Increases were maintained after 22 months in the FI group compared with the SG group (+1092 vs. +336 daily steps, P<.01). Between-group changes in accelerometer-assessed physical activity were not statistically significant at any time point. Conclusions: The FI intervention is a feasible strategy for short- and long-term increases in physical activity among African American women. Additional dissemination and evaluation of the strategy could be useful for reducing chronic disease in this high-risk population.

Recruiting African American Churches to Participate in Research: The Learning and Developing Individual Exercise Skills for a Better Life Study.

Physical activity among African Americans (AA) is low; effective intervention strategies are needed. Community-based settings are useful for delivering health-related interventions in racial/ethnic minority communities. This article describes strategies used to recruit churches for participation in a 22-month intervention designed to increase physical activity levels in AA women. Initial recruitment efforts, led by AA study staff, included direct mailers, phone calls, and in-person meetings with church representatives. After 10 months, only five churches were enrolled. Seven community members with existing partnerships/contacts in the faith community were subsequently hired and an additional 26 churches were enrolled within 6 months. Overall response rate was 45%, and churches required 3.5 ± 3.0 months of multiple contacts prior to enrollment. The main primary contacts within churches were individuals with personal interest in the program and pastors. Prior relationship between the research team and churches did not appear to influence church enrollment as much as community member recruiters. The current study identifies several potential strategies that may be useful for increasing success in efforts to recruit AA churches into studies. Additional research is warranted that tests and compares a variety of recruitment strategies to determine the most successful strategies for recruitment in different populations.

Exploring the Relationship of Religiosity, Religious Support, and Social Support Among African American Women in a Physical Activity Intervention Program.

Religious belief has been linked to a variety of positive mental and physical health outcomes. This exploratory study will address the relationship between religious involvement and social connectedness among African American women. Results from a physical activity intervention research project (N = 465) found that total religious support and social support were significantly negatively correlated with total religiosity, while total general social support was significantly positively correlated with total religious support. Overall, the study indicates that more research is needed on ways to encourage interaction between the positive dimensions of both religiosity and social support to bring about healthy behaviors.

Intervention fidelity in a teacher-led program to promote physical activity in preschool-age children.

OBJECTIVE: To examine protocol fidelity among teachers involved in a six-month cluster-randomized physical activity (PA) intervention. METHODS: In 2011, preschools in Springfield, MA were randomized to short bouts of structured PA (SBS-PA, n=5) or unstructured playtime (UPA, n=5). SBS-PA provided structured PA in the classroom during the first 10 min of gross-motor playtime followed by 20 min of unstructured playtime. UPA consisted of 30 min of unstructured playtime. All teachers (SBS-PA and UPA) received a written study protocol and 1.5h of training. SBS-PA also received videos to use to lead structured PA and 1.5 additional hours of training. Study fidelity and process evaluation were assessed twice weekly via semi-structured questionnaire. RESULTS: Only 56.6% of SBS-PA and 75.2% of UPA free playtimes lasted for 30 min; 86.3% of SBS-PA teachers implemented structured PA during the first 10 min of gross-motor playtime but only 67.2% delivered the intervention as instructed. Only 68.5% of SBS-PA teachers implemented the 20-minute unstructured playtime. SBS-PA teachers reported that time limitations was a major barrier in implementing the designed intervention. Pre-post changes in PA did not differ between groups. CONCLUSION: Limited fidelity to intervention protocol likely impacted study findings. Future studies should focus on strategies to improve adherence among intervention leaders.

2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities.

BACKGROUND: The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity (PA) across studies. The original version was updated in 2000, and again in 2011, and has been widely used to support PA research, practice, and public health guidelines. METHODS: This 2024 update was tailored for adults 19-59 years of age by removing data from those ≥60 years. Using a systematic review and supplementary searches, we identified new activities and their associated measured metabolic equivalent (MET) values (using indirect calorimetry) published since 2011. We replaced estimated METs with measured values when possible. RESULTS: We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers. We added 303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults. We added a Major Heading (Video Games). The 2024 Adult Compendium includes 1114 PAs (912 with measured and 202 with estimated values) across 22 Major Headings. CONCLUSION: This comprehensive update and refinement led to the creation of The 2024 Adult Compendium, which has utility across research, public health, education, and healthcare domains, as well as in the development of consumer health technologies. The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.

Translating the Dietary Approaches to Stop Hypertension (DASH) diet for use in underresourced, urban African American communities, 2010.

INTRODUCTION: Randomized trials have demonstrated the effectiveness of the Dietary Approaches to Stop Hypertension (DASH) program for lowering blood pressure; however, program participation has been limited in some populations. The objective of this pilot study was to test the feasibility of using a culturally modified version of DASH among African Americans in an underresourced community. METHODS: This randomized controlled pilot study recruited African Americans in 2 North Carolina neighborhoods who had high blood pressure and used fewer than 3 antihypertension medications. We offered 2 individual and 9 group DASH sessions to intervention participants and 1 individual session and printed DASH educational materials to control participants. We collected data at baseline (March 2010) and 12 weeks (June 2010). RESULTS: Of 152 potential participants, 25 were randomly assigned to either the intervention (n = 14) or the control (n = 11) group; 22 were women, and 21 were educated beyond high school. At baseline, mean blood pressure was 130/78 mm Hg; 19 participants used antihypertension medications, and mean body mass index was 35.9 kg/m(2). Intervention participants attended 7 of 9 group sessions on average. After 12 weeks, we observed significant increases in fruit and vegetable consumption and increases in participants' confidence in their ability to reduce salt and fat consumption and eat healthier snacks in intervention compared with control participants. We found no significant decreases in blood pressure. CONCLUSION: Implementation of a culturally modified, community-based DASH intervention was feasible in our small sample of African Americans, which included people being treated for high blood pressure. Future studies should evaluate the long-term effect of this program in a larger sample.

A biopsychosocial approach assessing pain indicators among Black men.

Introduction: The lack of empirical evidence documenting the pain experience of Black men may be the result of social messaging that men are to project strength and avoid any expression of emotion or vulnerability. This avoidant behavior however, often comes too late when illnesses/symptoms are more aggressive and/or diagnosed at a later stage. This highlights two key issues - the willingness to acknowledge pain and wanting to seek medical attention when experiencing pain. Methods: To better understand the pain experience in diverse raced and gendered groups, this secondary data analysis aimed to determine the influence identified physical, psychosocial, and behavioral health indicators have in reporting pain among Black men. Data were taken from a baseline sample of 321 Black men, >40 years old, who participated in the randomized, controlled Active & Healthy Brotherhood (AHB) project. Statistical models were calculated to determine which indicators (somatization, depression, anxiety, demographics, medical illnesses) were associated with pain reports. Results: Results showed that 22% of the men reported pain for more than 30 days, with more than half of the sample being married (54%), employed (53%), and earning an income above the federal poverty level (76%). Multivariate analyses showed that those reporting pain were more likely to be unemployed, earn less income, and reported more medical conditions and somatization tendencies (OR=3.28, 95% CI (1.33, 8.06) compared to those who did not report pain. Discussion: Findings from this study indicate that efforts are needed to identify the unique pain experiences of Black men, while recognizing its impact on their identities as a man, a person of color, and someone living with pain. This allows for more comprehensive assessments, treatment plans, and prevention approaches that may have beneficial impacts throughout the life course.

Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study.

BACKGROUND: Most preschool centers provide two 30-min sessions of gross-motor/outdoor playtime per preschool day. Within this time frame, children accumulate most of their activity within the first 10 min. This paper describes the design and baseline participant characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study. The STEP study is a cluster randomized controlled study designed to examine the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on during-school physical activity (PA) in preschoolers. METHODS/DESIGN: Ten preschool centers serving low-income families were randomized into SBS-PA versus unstructured PA (UPA). SBS-PA schools were asked to implement age-appropriate 10 min structured PA routines within the classroom setting, twice daily, followed by 20 min of usual unstructured playtime. UPA intervention consisted of 30 min of supervised unstructured free playtime twice daily. Interventions were implemented during the morning and afternoon designated gross-motor playtime for 30 min/session, five days/week for six months. Outcome measures were between group difference in during-preschool PA (accelerometers and direct observation) over six-months. Ten preschool centers, representing 34 classrooms and 315 children, enrolled in the study. The average age and BMI percentile for the participants was 4.1 ± 0.8 years and 69th percentile, respectively. Participants spent 74% and 6% of their preschool day engaged in sedentary and MVPA, respectively. DISCUSSION: Results from the STEP intervention could provide evidence that a PA policy that exposes preschoolers to shorter bouts of structured PA throughout the preschool day could potentially increase preschoolers' PA levels.

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.

¡Ojo! What to expect in recruiting and retaining older Latinos in physical activity programs.

Older Latinos are the fastest growing cohort among older adults in the USA, and their lives are often fraught with comorbidities, such as diabetes and obesity. Strong evidence has demonstrated health benefits of regular physical activity for older adults. In spite of this, older Latinos participate in low levels of physical activity. Interventions designed to increase the physical activity of older Latinos are lacking, yet more are emerging as the number of older Latinos grows. Unfortunately, older Latinos face many impediments to participating in physical activity interventions that researchers are unaware of. The purpose of the current article was to identify barriers that researchers are likely to face in conducting physical activity interventions for older Latinos, highlighting recently identified barriers, and providing barriers we encountered specifically with older Latino adults; and strategies to overcome these barriers to implementation.

Using a group development framework to maximize leadership strategies in the inaugural session of the Society of Behavioral Medicine Leadership Institute.

The 2016-2017 Inaugural Class of the Society of Behavioral Medicine Leadership Institute (SBM LI) debuted to an eager team of 36 mid-career fellows led by energetic mentors, professional coaches, and career development experts. Fellows were divided into learning communities of eight participants for deeper engagement. Our "Green Team" learning community bonded quickly and actively committed to our collective progress and projects. Upon returning home from the in-person sessions, our activities included monthly team conference calls and consultation with our mentors and selected coaches. The Green Team regularly communicated throughout the year, giving feedback to each other about our projects to be presented at the 2017 SBM Annual Meeting. We also discussed our mentoring and coaching experiences, leadership skills put to use at our institutions, and personal development. Contact continued via social media, email, teleconferencing, and collaborations at other professional meetings. The Green Team utilized the Tuckman and Jensen model of small group development to describe how we developed into a high-functioning group that maximized the resources afforded by the SBM LI to yield successful leadership outcomes. This commentary will offer an example of how a productive SBM LI team works collaboratively to utilize its mentors and resources for professional development.

The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis.

Prior reports regarding the association between physical activity and subclinical cardiovascular disease have not been consistent. The authors assessed physical activity and walking pace via questionnaire among 6,482 US adults aged 45-84 years without prior clinical cardiovascular disease participating in the Multi-Ethnic Study of Atherosclerosis from 2000 to 2002. Ankle-brachial index (ABI), coronary artery calcification, and internal and common carotid intima-media thickness (IMT) were measured. Metabolic equivalent-hours/week of physical activity were calculated. These data were analyzed by using multivariable linear or relative prevalence regression in gender-specific strata. After adjustment for age, race/ethnicity, clinic site, education, income, and smoking (model 1), increasing total, moderate + vigorous, and intentional-exercise physical activity were not associated with IMT or coronary artery calcification in either gender. These factors were associated with increased ABI (P<0.05) in women only. Walking pace was associated favorably with common carotid IMT, ABI, and coronary artery calcification in men and with common carotid IMT and ABI in women (all P<0.05) after adjustment for model 1 variables. These associations were attenuated and, for common carotid IMT, no longer significant when lipids, hypertension, diabetes, and body mass index were added to the model. These data suggest that walking pace is associated with less subclinical atherosclerosis; these associations may be mediated by cardiovascular disease risk factors.

Recommendations for advancing opportunities to increase physical activity in racial/ethnic minority communities.

We provide suggestions for advancing opportunities for effective and sustainable strategies for increasing physical activity in racial/ethnic minority populations.

Disparities in physical activity and sedentary behaviors among US children and adolescents: prevalence, correlates, and intervention implications.

Regular physical activity is important for health benefits among youth, but disparities exist. This paper describes disparities in physical activity participation and sedentary behaviors among youth in the United States, provides intervention implications, and offers recommendations for future research focused on reducing disparities related to levels of physical activity. Secondary analysis of national accelerometer data showed that achievement of recommended levels of physical activity ranged across subgroups from 2% to 61%. Mean hours per day spent in sedentary behavior ranged from 5.5 to 8.5. The largest disparities were by gender and age. An improved understanding of correlates may inform the design of interventions to increase physical activity in targeted subgroups. Additional theoretically based research is needed to elucidate which factors contributing to physical activity disparities are amenable to change via intervention. To eliminate health disparities, changes in policies that have an impact on physical activity may be necessary to promote physical activity among high-risk youth.

Systematic review of interventions to increase physical activity and physical fitness in African-Americans.

OBJECTIVE: To identify characteristics of effective interventions designed to increase physical activity (PA) or fitness among African-Americans. DATA SOURCES: Articles published between 1985 and 2006. STUDY INCLUSION CRITERIA: Studies reporting PA or fitness change data in African-American participants were included. DATA EXTRACTION: Information on study design, intervention, data collection methods, and outcomes was extracted using a standardized form. DATA SYNTHESIS: Studies were ranked on quality and were summarized separately for adults and children. RESULTS: We identified 29 studies in adults and 14 studies in children. Most were randomized controlled trials. All but six specifically targeted African-Americans; comparisons of effectiveness in African-Americans vs. others were not possible. Methodological heterogeneity limited comparisons of findings across studies. In adults, most studies showed significant within-group pre-post improvements in PA, but only 10 studies found differences between intervention and comparison groups. Most studies in children were null. CONCLUSIONS: Effective programs in adults were from randomized controlled trials and involved structured exercise programs. Studies with explicit cultural adaptations did not necessarily result in better PA outcomes. Additional studies are needed with larger sample sizes, longer follow-up, attention controls, strategies informed by proven behavior change theories, and objective PA assessment.