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Kevin Patrick, Michael Pratt, and Robert E. Sallis

Background:

Healthcare professionals are influential sources of health information and guidance for people of all ages. However healthcare providers do not routinely address physical activity (PA). Engaging health professionals in a national plan for physical activity will depend upon whether proven strategies can be found to promote PA within clinical settings.

Methods:

The literature on promoting PA in healthcare settings was reviewed, as were recommendations from healthcare organizations and evidence-gathering entities about whether and how PA should be promoted in healthcare.

Key recommendations:

Evidence is mixed about whether interventions based in healthcare settings and offered by healthcare providers can improve PA behaviors in patients. Brief stand-alone counseling by physicians has not been shown to be efficacious, but office-based screening and advice to be active, followed by telephone or community support for PA has proven effective in creating lasting PA behavior improvement. Healthcare delivery models that optimize the organization of services across clinical and community resources may be very compatible with PA promotion in health care. Because of the importance of PA to health, healthcare providers are encouraged to consider adding PA as a vital sign for each medical visit for individuals aged 6 years and older.

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Maura Reilly, Guadalupe X. Ayala, John P. Elder, and Kevin Patrick

Background:

Research suggests that individuals who talk with their physicians about lifestyle behaviors are more physically active. Research on this topic is limited in the U.S. Latino population. This study examines doctor-patient communication from the perspective of enrollees in a physical activity (PA) intervention.

Methods:

Three hundred and eighty-seven Latinos were surveyed at program enrollment. Analysis examined the extent to which physician communication about healthy lifestyles and weight was associated with self-reported PA, including leisure-time PA (LTPA), transportation PA (TPA), and occupational PA (OPA). Physician communication included asking, advising, and assisting.

Results:

Most of the respondents reported no LTPA (46%) and no TPA (60%). The percent reporting no occupational activity, which included housework if a homemaker, was lower at 36%. Greater physician assistance was associated with a greater likelihood of doing any LTPA (P ≤ .05). A similar trend was observed for TPA (P ≤ .10).

Conclusions:

Latinos who reported physician assistance to engage in healthy lifestyle behaviors reported more LTPA. Providers who assist their patients in obtaining resources to support PA have the potential to increase levels of PA.

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Dori E. Rosenberg, Jacqueline Kerr, James F. Sallis, Gregory J. Norman, Karen Calfas, and Kevin Patrick

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.

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Suzanna M. Martinez, Elva M. Arredondo, Scott Roesch, Kevin Patrick, Guadalupe X. Ayala, and John P. Elder

Background:

U.S. Latinos engage in nonleisure-time walking (NLTW) more than other ethno-racial groups. Studies are needed to explore factors associated with NLTW to inform interventions for effective physical activity promotion.

Purpose:

To examine the social-ecological correlates of NLTW among Mexican-origin Latinos.

Methods:

Individual, social, and environmental level factors and PA were assessed in a telephone survey completed by 672 Mexican-origin adults randomly sampled in San Diego County. Data were collected in 2006 and analyzed in 2009.

Results:

Participants were mostly female (71%), with an average age of 39 years. Less than one-third met PA guidelines for NLTW (29%). Structural equation modeling showed that NLTW was positively associated with being female, but negatively associated with living in the U.S. ≥ 12 years, and being U.S.-born.

Conclusions:

In this sample NLTW differed by various indicators of acculturation and gender. These findings might help inform the development of interventions to promote NLTW and thus physical activity in Mexican-origin adults.

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Dori E. Rosenberg, Gregory J. Norman, Nicole Wagner, Kevin Patrick, Karen J. Calfas, and James F. Sallis

Background:

Sedentary behavior is related to obesity, but measures of sedentary behaviors are lacking for adults. The purpose of this study was to examine the reliability and validity of the Sedentary Behavior Questionnaire (SBQ) among overweight adults.

Methods:

Participants were 49 adults for the 2 week test-retest reliability study (67% female, 53% white, mean age = 20) and 401 overweight women (mean age = 41, 61% white) and 441 overweight men (mean age = 44, 81% white) for the validity study. The SBQ consisted of reports of time spent in 9 sedentary behaviors. Outcomes for validity included accelerometer measured inactivity, sitting time (International Physical Activity Questionnaire), and BMI. Intraclass correlation coefficients (ICCs) assessed reliability and partial correlations assessed validity.

Results:

ICCs were acceptable for all items and the total scale (range = .51–.93). For men, there were significant relationships of SBQ items with IPAQ sitting time and BMI. For women, there were relationships between the SBQ and accelerometer inactivity minutes, IPAQ sitting time, and BMI.

Conclusions:

The SBQ has acceptable measurement properties for use among overweight adults. Specific measures of sedentary behavior should be included in studies and population surveillance.

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Gregory J. Norman, Sandra K. Nutter, Sherry Ryan, James F. Sallis, Karen J. Calfas, and Kevin Patrick

Background:

Neighborhood-level environmental features have been associated with adult physical activity and weight status, but this link has not been established for adolescents.

Methods:

Community design and access to recreational facilities variables were derived using geographic information systems (GIS) for 799 adolescents (age 11 to 15 y, mean = 12.8 y, 53% girls, 43% ethnic minority). Environment variables were calculated for a 1-mile buffer around each participant’s residence. Accelerometers measured min/d of physical activity.

Results:

Number of nearby recreation facilities and number of nearby parks correlated positively with girls’ physical activity, and intersection density inversely related to girls’ physical activity. Retail floor area ratio correlated positively with boys’ physical activity. No community design or access to recreation variables were related to BMI-percentile.

Conclusions:

There was limited evidence that both community design and access to recreation facilities variables were associated with adolescent physical activity, but additional built environment variables need to be studied that have particular relevance for youth.

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Noe C. Crespo, Kirsten Corder, Simon Marshall, Gregory J. Norman, Kevin Patrick, James F. Sallis, and John P. Elder

Background:

Girls are less physically active than boys, yet no single study has examined the factors that may explain gender differences in children’s physical activity (PA).

Methods:

This study was a cross-sectional analysis of data from 116 caregivers and their children aged 5–8 years who participated in the MOVE study. Caregivers reported various factors that may relate to children’s PA (eg, encouragement for child PA and PA equipment at home). Child PA was measured by 7-day accelerometry. Linear regression tested for the variance in moderate-to-vigorous physical activity (MVPA) explained by gender and several variables. Gender and ethnicity interactions were examined.

Results:

Caregivers were mostly female (97%), mean age 38 ± 6 years, mean BMI 28 ± 6 (kg/m2). Child’s mean age was 8.1 ± 0.7, 54% were female and 40% were overweight/obese. Girls were less physically active than boys (54.1 ± 19.7 vs. 65.2 ± 28.0 daily minutes of MVPA, respectively). Among girls, more days of PE/week was associated with greater MVPA. Among boys, greater parent support for PA, greater parent modeling for PA, and greater number of PA equipment in the home were associated with greater MVPA.

Conclusions:

This study supports that boys and girls have different correlates for MVPA, which may partly explain gender differences in PA.

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Jordan A. Carlson, James F. Sallis, Nicole Wagner, Karen J. Calfas, Kevin Patrick, Lisa M. Groesz, and Gregory J. Norman

Background:

Psychosocial factors have been related to physical activity (PA) and are used to evaluate mediation in PA interventions.

Methods:

Brief theory-based psychosocial scales were compiled from existing measures and evaluated. Study 1 assessed factor structure and construct validity with self-reported PA and accelerometry in overweight/obese men (N = 441) and women (N = 401). Study 2 assessed 2-week reliability and internal consistency in 49 college students.

Results:

Confirmatory factor analysis indicated good fit in men and women (CFI = .90; RMSEA = .05). Construct validity was supported for change strategies (r = .29–.46), self-efficacy (r = .19–.22) and enjoyment (r = .21–.33) in men and women, and for cons in women (r = –.19 to –.20). PA pros (r = –.02 to .11) and social support (r = –.01 to .12) were not supported for construct validity. Test-retest reliability ICCs ranged from .49–.81. Internal consistency alphas ranged from .55–.90. Reliability was supported for most scales with further testing needed for cons (alphas = .55–.63) and enjoyment (ICC = 49).

Conclusions:

Many of the brief scales demonstrated adequate reliability and validity, while some need further development. The use of these scales could advance research and practice in the promotion of PA.

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Marc A. Adams, Sherry Ryan, Jacqueline Kerr, James F. Sallis, Kevin Patrick, Lawrence D. Frank, and Gregory J. Norman

Background:

Concurrent validity of Neighborhood Environment Walkability Scale (NEWS) items was evaluated with objective measures of the built environment using geographic information systems (GIS).

Methods:

A sample of 878 parents of children 10 to 16 years old (mean age 43.5 years, SD = 6.8, 34.8% non-White, 63.8% overweight) completed NEWS and the International Physical Activity Questionnaire. GIS was used to develop 1-mile street network buffers around participants’ residences. GIS measures of the built environment within participants’ buffers included percent of commercial and institutional land uses; number of schools and colleges, recreational facilities, parks, transit stops, and trees; land topography; and traffic congestion.

Results:

Except for trees and traffic, concordance between the NEWS and GIS measures were significant, with weak to moderate effect sizes (r = −0.09 to −0.36, all P ≤ 01). After participants were stratified by physical activity level, stronger concordance was observed among active participants for some measures. A sensitivity analysis of self-reported distance to 15 neighborhood destinations found a 20-minute (compared with 10- or 30-minute) walking threshold generally had the strongest correlations with GIS measures.

Conclusions:

These findings provide evidence of the concurrent validity of self-reported built environment items with objective measures. Physically active adults may be more knowledgeable about their neighborhood characteristics.