Predictors of Physical Activity Levels in Community-Dwelling Older Adults: A Multivariate Approach Based on a Socio-Ecological Framework.

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors' housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors' housing units should be considered when developing PA programs for older adults.

Comparing Class-Based and Home-Based Exercise for Older Adults With Chronic Health Conditions: 12-Month Follow-Up of a Randomized Clinical Trial.

OBJECTIVE: To assess the maintenance of physical activity (PA) and health gains among participants in a class-based (CB) or home-based (HB) PA intervention over a 12-month study period. METHODS: A total of 172 adults aged 50 years and older were randomly allocated to either a CB or an HB intervention, each involving an intensive 3-month phase with a 9-month follow-up period. Measures at baseline, 3, 6, and 12 months included self-reported PA and health, body mass index, waist circumference (WC), blood pressure, cardiovascular endurance (6-min walk test), physical function, and functional fitness (senior fitness test). Outcomes were analyzed using generalized estimating equations. RESULTS: Maximum improvement was typically observed at 3 or 6 months followed by a modest diminution, with no differences between groups. For body mass index, waist circumference, 6-min walk test, and senior fitness test, there was progressive improvement through the study period. Greater improvement was seen in the CB group compared with the HB group on three items on the senior fitness test (lower body strength and endurance [29% vs. 21%, p < .01], lower body flexibility [2.8 cm vs. 0.4 cm, p < .05], and dynamic agility [14% vs. 7%, p < .05]). CONCLUSION: The interventions were largely comparable; thus, availability, preferences, and cost may better guide program choice.

An Investigation of Bilateral Symmetry in Softball Pitchers According to Body Composition.

Introduction: High body fat percentage (bf%) is considered a potential injury risk factor for softball pitchers amidst the already high rates of pitching-related injury. Similarly, research points out that large bilateral asymmetries are another risk factor for softball pitchers. As softball pitching is a highly asymmetric sport and the repetitive nature of the windmill pitch places high stress on the body while pitchers are in unbalanced and asymmetric positions, research examining body composition and asymmetry is necessary. Purpose: The purpose of this study was to compare functional characteristics of softball pitchers with a healthy and a high bf%. Bilateral symmetry was assessed for pitchers' hip and shoulder isometric strength (ISO) and range of motion (ROM) between the following two groups of softball pitchers: (1) those with a high bf% (≥32%) and (2) those with a healthy bf% (<32%). Methods: A total of 41 high school female softball pitchers from the southern United States agreed to participate (1.69 ± 0.07 m, 76.14 ± 17.08 kg, 15.1 ± 1.1 years). Pitchers completed a dual-energy X-ray absorptiometry (DEXA) scan and were grouped into one of the following two categories based on their bf%: healthy (<32 bf%) and high (≥32 bf%). Bilateral symmetry was assessed for pitchers' hip and shoulder ISO and ROM using a handheld dynamometer and inclinometer, respectively. Bilateral arm bone and lean mass was also measured via the DEXA. Results: Mixed analyses of variance revealed a significant interaction between bf% groups and side dominance for internal rotation shoulder ROM, F(1, 39) = 14.383, p < 0.001, η2 p = 0.269. Main effects for side dominance were also observed for shoulder external rotation ISO, F(1, 39) = 8.133, p = 0.007, η2 p = 0.173, hip internal rotation ISO, F(1, 39) = 4.635, p = 0.038, η2 p = 0.106, arm bone mass, F(1, 39) = 38.620, p < 0.001, η2 p = 0.498, and arm lean mass, F(1, 39) = 101.869, p < 0.001, η2 p = 0.723. Conclusion: Asymmetries and slight differences in functional characteristics exist between bf% groups. Altered functional characteristics may influence pitchers' windmill pitch movement and should be acknowledged by support staff to improve softball pitchers' health and longevity. Implications: Insight into asymmetries can help researchers and clinicians understand the implication of excess body fat and further theorize mechanisms of injury among this athlete population.

The relationship of chronic disease and demographic variables to physical activity in a sample of women aged 65 to 79 years.

This study explored the relationship between physical activity, marital status, income, education, and chronic disease in older women to determine which individuals are at risk of being inactive and to identify potential moderators of physical activity behavior. This was an analysis of cross-sectional data from a convenience sample of 271 community-dwelling women aged 65 to 79 years. Self-reported physical activity was measured using the Physical Activity Scale for the Elderly. Socio-demographic characteristics (including age, gender, marital status, education, employment, and income) and self-reported health were measured using previously validated instruments. To avoid seasonal variations in physical activity, data were collected during the summer months. Physical activity was negatively associated with age and the presence of cardio-respiratory disease and positively associated with income greater than $20,000 (p < 0.05). After controlling for other co-variates, no significant differences were observed in physical activity between married and unmarried individuals. Given the strong association between cardio-respiratory disease and income with physical activity, women 65 years of age and older in lower income brackets and suffering from these health conditions should be targeted for exercise counseling and support. Intervention research is needed to determine the most effective means to decrease inactivity among these women.

ParticipACTION: awareness of the participACTION campaign among Canadian adults--examining the knowledge gap hypothesis and a hierarchy-of-effects model.

BACKGROUND: ParticipACTION was a pervasive communication campaign that promoted physical activity in the Canadian population for three decades. According to McGuire's hierarchy-of-effects model (HOEM), this campaign should influence physical activity through intermediate mediators such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often develop within the population about the messages being conveyed. The purposes of this study were to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b) confirm if awareness of the ParticipACTION initiative varied as a function of levels of education and household income; and, (c) to examine whether awareness of ParticipACTION was associated with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION (unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity status. METHODS: A population-based survey was conducted on 4,650 Canadians over a period of 6 months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM included questions related to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to test the knowledge gap hypotheses and to examine whether awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age and older in 2007/2008 (N = 4424). RESULTS: Approximately 8% of Canadians were still aware of ParticipACTION unprompted and 82% were aware when prompted. Both education and income were significant correlates of awareness among Canadians. The odds of people being aware of ParticipACTION were greater if they were more educated and reported higher income. Awareness of ParticipACTION was also associated with outcome expectations, self-efficacy, intention, and LTPA status. CONCLUSION: Awareness of ParticipACTION is associated with LTPA. Knowledge gaps in awareness are associated with level of education and household income. Thus, future promotion campaigns should include specific strategies to target different segments of the population, especially people who are living in deprived conditions with lower levels of education.

ParticipACTION: Baseline assessment of the 'new ParticipACTION': A quantitative survey of Canadian organizational awareness and capacity.

BACKGROUND: ParticipACTION is a Canadian physical activity (PA) communications and social marketing organization that was relaunched in 2007 after a six-year hiatus. This study assesses the baseline awareness and capacity of Canadian organizations that promote physical activity, to adopt, implement and promote ParticipACTION's physical activity campaign. The three objectives were: (1) to determine organizational awareness of both the 'original' and 'new' ParticipACTION; (2) to report baseline levels of three organizational capacity domains (i.e., to adopt, implement and externally promote physical activity initiatives); and, (3) to explore potential differences in those domains based on organizational size, sector and primary mandate. METHODS: Organizations at local, provincial/territorial, and national levels were sent an invitation via email prior to the official launch of ParticipACTION to complete an on-line survey. The survey assessed their organization's capacity to adopt, implement and externally promote a new physical activity campaign within their organizational mandates. Descriptive statistics were employed to address the first two study objectives. A series of one-way analysis of variance were conducted to examine the third objective. RESULTS: The response rate was 29.7% (268/902). The majority of responding organizations had over 40 employees and had operated for over 10 years. Education was the most common primary mandate, followed by sport and recreation. Organizations were evenly distributed between government and not-for-profits. Approximately 96% of respondents had heard of the 'original' ParticipACTION while 54.6% had heard of the 'new' ParticipACTION (Objective 1). Findings indicate good organizational capacity in Canada to promote physical activity (Objective 2) based on reported means of approximately 4.0 (on 5-point scales) for capacity to adopt, implement, and externally promote new physical activity campaigns. Capacity to adopt new physical activity campaigns differed by organizational sector and mandate, and capacity to implement differed by organizational mandate (Objective 3). CONCLUSION: At baseline, and without specific details of the campaign, respondents believe they have good capacity to work with ParticipACTION. ParticipACTION may do well to capitalize on the existing strong organizational capacity components of leadership, infrastructure and 'will' of national organizations to facilitate the success of its future campaigns.

ParticipACTION: Baseline assessment of the capacity available to the 'New ParticipACTION': A qualitative study of Canadian organizations.

BACKGROUND: Evaluation of the original ParticipACTION campaign effects focused on individual awareness, recall, and understanding. Less studied has been the impact such campaigns have had on the broader organizational capacity to mobilize and advocate for physical activity. With the relaunch of ParticipACTION, the purpose of this study was to qualitatively explore baseline organizational capacity to promote physical activity messages, programs, and services within the Canadian context. METHODS: Using a purposeful sampling strategy, we conducted semi-structured telephone interviews with 49 key informants representing a range of national, provincial, and local organizations with a mandate to promote physical activity. Interview data were analysed using a thematic analytic approach. RESULTS: Key informants painted a generally positive picture of current organizational capacity to promote physical activity messages, programs, and services in Canada. Will and leadership were clear strengths while infrastructure limitations remained the greatest concern. Some specific challenges included: 1) funding issues: the absence of core funding in a climate of shifting funding priorities; 2) the difficulty of working without a national physical activity policy (lack of leadership); 3) inconsistent provincial and educational sector level policies; and 4) a persistent focus on obesity rather than physical inactivity. CONCLUSION: The data generated here can be utilized to monitor the future impact of ParticipACTION on enhancing and utilizing this organizational capacity. A range of indicators are suggested that could be used to illustrate ParticipACTION's impact on the broad field of physical activity promotion in the future.

Using a naturalistic ecological approach to examine the factors influencing youth physical activity across grades 7 to 12.

High levels of inactivity in youth have led researchers and practitioners to focus on identifying the factors that influence physical activity behaviors in young people. The present study employed a qualitative ecological framework to examine the intrapersonal, social, and environmental factors influencing youth physical activity. In grade-specific focus group settings, 160 youth in grades 7 through 12 (aged 12 to 18) were asked how they would increase the physical activity levels of youth their age. Participants identified eight factors that they felt should be addressed in programs and interventions designed to increase the physical activity behaviors of youth. These factors included the importance of fun, having the time to be physically active, the benefits of activity, being active with friends, the role of adults, and the importance of being able to access facilities in their neighborhood.

The health benefits of a physical activity program for older adults living in congregate housing.

BACKGROUND: In Saskatoon in 2002, as one of the key strategies for the in motion health promotion strategy, the Forever...in motion program was developed with the general goal of increasing opportunities for physical activity among older adults living in congregate housing. The three components of the program were a low-intensity exercise program, informal socialization and educational sessions. The objective of the present study was to examine whether participation in this program positively influenced participants' physical, emotional, psychological and social well-being. METHODS: A quasi-experimental, pretest/post-test design was employed to examine the impact of the program on various aspects of participant well-being. Thirty-six program participants and a comparison group of 22 non-participants from two congregate housing facilities took part in the study. The pretest was administered to the study and comparison groups before or shortly after the 12-week session commenced, and the post-test was administered after the 12-week session had concluded. Pretest and post-test assessment consisted of self-report measures of (1) vitality, (2) self-rated health, 3) mental health, (4) social functioning, (5) role limitations due to emotional problems, 6) physical activity-related knowledge, and (7) self-efficacy for exercise. A multivariate analysis of covariance (MANCOVA) was conducted using the seven post-test scores as dependent variables and the pretest scores as covariates. RESULTS: After adjusting for differences in baseline characteristics, the findings revealed statistically significant improvements in self-reported health and self-efficacy for exercise in the program participant group as compared with non-participants. CONCLUSION: The results of this study suggest that a relatively low-cost, low-intensity exercise program such as the Forever...in motion program may positively influence the well-being of older adults living in congregate housing. However, additional research with a larger number of participants and a more rigorous study design is needed to further elucidate the health benefits of the Forever...in motion program.

Examining physician counselling to promote the adoption of physical activity.

BACKGROUND: While the benefits of physical activity are generally recognized, over half of adult Canadians are not active enough to receive those benefits. Physicians may influence patient activity through counselling; however, research is inconsistent regarding their effectiveness in doing so. Increasing patients' use of self-regulatory skills in managing their activity and additional telephone support are suggested as two means of improving physician counselling. When assessing the effectiveness of physician counselling, it may be important to measure both outcome and treatment adherence. We compared physician-directed activity counselling (modified PACE protocol) with a modified PACE protocol augmented with telephone-based counselling for patient support for both outcome and treatment adherence. METHODS: Physicians counselled 90 patients using a modified PACE protocol that included self-regulatory skills. Physical activity was assessed by questionnaire at baseline (prior to counselling) and one month later. Participants were divided into two groups: counselling (modified PACE counselling) and enhanced counselling (modified PACE counselling plus telephone support). RESULTS: The main outcome (mean energy expenditure) and secondary outcomes of treatment adherence (frequency, frequency of moderate activity, and duration) significantly increased over time (p < 0.05). No significant interactions between group and time were found. INTERPRETATION: Our results support the effectiveness of physician counselling for activity that included the use of self-regulation skills. The effectiveness of telephone support over and above that of physician counselling was not supported. Our results demonstrate that assessing treatment adherence provides a means of discerning whether the counselling intervention was delivered as intended.

Youth and adolescent physical activity lapsers: examining self-efficacy as a mediator of the relationship between family social influence and physical activity.

The present study examined whether self-efficacy mediates the relationship between family social influence and physical activity among youth who have experienced a recent lapse in their physical activity participation. Using a prospective, longitudinal design, participants completed measures of social influence, self-regulatory efficacy and physical activity. Only those participants whose physical activity declined were retained for further analysis. Self-regulatory efficacy partially mediated the relationship between family social influence and physical activity, with self-efficacy mediating 36 percent of the total effect. The results provide support for self-regulatory efficacy as a mediator and provide preliminary insight into the potential mechanisms for preventing lapses in activity from developing into prolonged periods of inactivity within this population.

Factors that influence physical activity participation among high- and low-SES youth.

Researchers have rarely addressed the relationship between socioeconomic status (SES) and physical activity from the perspective of youth. To illuminate the factors that youth from low and high-SES areas consider important to increase physical activity participation among their peers, 160 youth (12-18 years) participated in small focus group interviews. Guiding questions centered on the general theme, "If you were the one in charge of increasing the physical activity levels of kids your age, what would you do?" Findings show that environmental factors (i.e., proximity, cost, facilities, and safety) are very important for youth living in low-SES areas to ensure participation in physical activity. Results also show that intrapersonal (i.e., perceived skill, competence, time) and social factors (i.e., friends, adult support) must be considered to help improve participation rates among both high- and low-SES youth.

Profile of physical activity levels in community-dwelling older adults.

PURPOSE: To examine relationships between selected sociodemographic, health-related and environmental factors and levels of physical activity in older adults across three age groups. METHODS: Seven hundred sixty-four older adults (mean age = 77.4 +/- 8.6 yr) from a midsize Canadian city completed a self-administered questionnaire under researcher supervision. Level of physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Correlates of physical activity were examined using previously validated questionnaires. The findings pertaining to personal and environmental factors are presented. RESULTS: Overall, significantly higher mean PASE scores were seen in those individuals in the following categories: male (P < 0.001), married or common-law (P < 0.001), not living alone (P < 0.001), not living in senior's housing (P < 0.001), higher levels of education (P < 0.001) and higher incomes (P < 0.001). Better physical health showed significant positive associations (P < 0.001) with PASE score. Individuals reporting at least four or more chronic health conditions had significantly lower PASE scores than those reporting no chronic conditions (P < 0.001). Significantly lower PASE scores were also reported in those using domestic services (P < 0.001). Higher PASE scores were related to the presence of hills, biking and walking trails, street lights, various recreation facilities, seeing others active and unattended dogs (P < 0.001 to P < 0.05). CONCLUSION: An understanding of the factors that influence physical activity behavior in older adults is critical to developing effective intervention strategies that will address the problem of physical inactivity in this population, and in doing so, improve the health status and quality of life of the older adult, while having a significant impact on healthcare expenditures.

Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey.

Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50-65-year-old individuals were 27% less likely to report any GP consultations (ORadj = 0.73; P < 0.001) and had 8% fewer GP consultations annually (IRRadj = 0.92; P < 0.01) than their inactive peers. Active persons aged 65-79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year (ORadj = 0.82, P < 0.05). Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services.

The relationship of social physique anxiety to risk for developing an eating disorder in young females.

PURPOSE: To examine the relationships of age, social physique anxiety, and body image dissatisfaction to preoccupation with body weight and shape in young females. METHODS: Height, weight, and skinfold measurements were obtained from 77 nonobese females (7 to 16 years). Social physique anxiety, body image, and preoccupation with body weight and shape were assessed from the Social Physique Anxiety Scale (SPAS), a Body Image Questionnaire (BIQ), and the Eating Disorder Inventory (EDI). Data were analyzed using Pearson correlations, Chi-square, and hierarchical and stepwise multiple regression. RESULTS: Social physique anxiety was moderately correlated to body image dissatisfaction and body weight and shape concerns. Young females who were more anxious about their physique preferred a smaller body shape and experienced more body weight and shape concerns than those less anxious. The SPAS was a stronger predictor for the EDI scales Body Dissatisfaction and Drive for Thinness than the BIQ or age. CONCLUSIONS: Social physique anxiety related to a negative body image and risk for developing an eating disorder as assessed by Body Dissatisfaction and Drive for Thinness in young females.

Children with Cerebral Palsy: Caregivers' Nutrition Knowledge, Attitudes and Beliefs.

Knowledge is lacking about the feeding relationship between caregivers and children with cerebral palsy (CP). In this relationship, the child's dependency and the caregiver's influence on the child's nutrition may be magnified. A questionnaire was developed to examine caregivers' nutrition knowledge, attitudes, and beliefs. Reliability and validity were pretested with groups independent of the study. The questionnaire was administered to CP caregivers (n=52, 34% response rate) and a comparison group of non-CP caregivers (n=35). Over half of the children with CP were mildly to moderately affected by physical disability and presented with few oral-motor difficulties. Caregivers' perceptions of children's feeding behaviour did not differ between the two groups (p>0.05). Significant differences were evident in nutrition knowledge, as well as on one of two attitude scales and one of two belief scales measured. Non-CP caregivers scored higher in nutrition knowledge (p<0.001), had a more positive attitude about the importance of nutrition (p<0.05), and had a more positive belief in the relationship between nutrition and health (p<0.05). Results suggest that non-nutritional factors may have a higher priority with those caring for children with CP. Further investigation is warranted to examine the role that nutrition has in the care of children with various degrees of disability from CP. and inflammatory modulation.

Physical activity attitudes, beliefs, and practices among women in a Woodland Cree community.

BACKGROUND: Overweight and obesity among Aboriginal women is a growing concern, with increasing prevalence rates linked to a sedentary lifestyle. Physical inactivity is a modifiable risk factor for unhealthy body weight; however before addressing health enhancing behaviors, understanding lifestyle practices, attitudes and beliefs are important. METHODS: A mixed methods approach assessed physical activity (PA) practices (n = 58), and attitudes and beliefs (n = 19) among First Nations women. The Modifiable Activity Questionnaire assessed PA, and a focused ethnography explored attitudes and beliefs. RESULTS: Self-reported PA was highest in the youngest age group. Both total and leisure-time PA decreased when house-related activities were not accounted for. Younger participants reported sport-related activities, while older participants reported traditional activities (eg, berry picking, fishing). Participants' believed PA promoted good health, yet personal (ie, lack of time), community-specific (ie, lack of opportunities/encouragement) and environmental (ie, inclement weather, safety) factors acted as barriers. Age-specific, women-only programs were highlighted as potential enablers. CONCLUSIONS: The findings highlight the need to assess cultural specific practices, attitudes and beliefs as PA programs that focus on reducing barriers identified in the community and are designed based on expressed interest and preferences may improve leisure-related PA levels among all age groups.

The confidence to get going: the moderating effects of depressive symptoms on the self-efficacy-activity relationship among youth and adolescents.

The purpose of this study was to examine whether the relationship between self-efficacy and physical activity was moderated by the presence of depressive symptoms in a sample of youth and adolescents. Participants (N = 688) from grades 7-12 completed measures of self-efficacy and depressive symptoms at baseline and self-report measures of physical activity 1 month later. Hierarchical regression analyses indicated a moderating effect of depressive symptoms on the self-efficacy-physical activity relationship, with this relationship being even more pronounced among those reporting depressive symptoms. These findings have important implications for the promotion of physical activity among youth and adolescents especially those suffering from depressive symptoms.

Assessment of total and central adiposity in Canadian Aboriginal children and their Caucasian peers.

OBJECTIVE: Although Aboriginal children seem to be more susceptible to developing obesity and metabolic disorders than other ethnic groups in Canada, few studies have examined adiposity comprehensively in this population. The purpose of this study was to assess total and central adiposity in Canadian Aboriginal and Caucasian children matched by age, gender and maturity. METHODS: A total of 212 Aboriginal and 204 Caucasian children (8-17 years) were recruited. Heights, weights and waist circumferences were measured and classified using international standards. Dual energy x-ray absorptiometry (DXA) indicated relative total body and trunk fatness. Age of peak height velocity was predicted from somatic growth. Descriptives with independent t-tests and Chi-square analyses were run to detect ethnic differences. ANCOVA was used to assess differences in total body and trunk fatness (covariates height, chronological age and biological age) in girls and boys separately. RESULTS: Overweight/obesity and central adiposity were more prevalent in Aboriginal children compared with Caucasian children (p < 0.05). Ethnic differences in total body and trunk fatness were also significant, with Aboriginal girls and boys presenting, on average, 5.4% and 6.0% more total body fatness and 7.6% and 8.3% more trunk fatness, than Caucasian girls and boys, respectively (p < 0.01). CONCLUSION: Canadian Aboriginal children have greater prevalence of overweight/obesity and central adiposity, and higher relative total body fatness and trunk fatness than their Caucasian peers, which may predispose them to cardiovascular and metabolic disorders at a very young age. Longitudinal research is needed to confirm the associated health risks in this population.