Background: We previously reported no postintervention differences in quality of life and other psychosocial outcomes when comparing 12-month high versus moderate volume of aerobic exercise in postmenopausal women. Here, we report the 24-month follow-up for these outcomes. Methods: At 24-month follow-up, 333 out of 400 postmenopausal women were randomized to a year-long intervention of 150 (moderate) or 300 (high) minutes per week of aerobic exercise returned a battery of self-reported measures assessing quality of life, psychosocial outcomes, and sleep quality, also assessed at baseline and postintervention. Intention-to-treat analyses using linear models were conducted to determine the changes between baseline and 24-month follow-up. Results: No significant effects between moderate- and high-volume aerobic exercise groups were observed among any outcomes. There was some evidence of effect moderation by baseline body mass index in relation to quality of life, psychosocial outcomes, and sleep quality, where obese women benefitted from the moderate-volume exercise and nonobese women benefitted from the high-volume exercise prescription. Conclusion: Although high-volume aerobic exercise did not improve psychosocial outcomes when compared with moderate volume at the 24-month follow-up, we did observe potential effect of moderation between obese and nonobese women. Confirmation of these interactions is warranted in this population.
Megan S. Farris, Kerry S. Courneya, Rachel O’Reilly, and Christine M. Friedenreich
Heather K. Neilson, Ruth Ullman, Paula J. Robson, Christine M. Friedenreich, and Ilona Csizmadi
The qualitative attributes and quantitative measurement properties of physical activity questionnaires are equally important considerations in questionnaire appraisal, yet fundamental aspects such as question comprehension are not often described in the literature. Here we describe the use of cognitive interviewing to evaluate the Sedentary Time and Activity Reporting Questionnaire (STAR-Q), a self-administered questionnaire designed to assess overall activity energy expenditure and sedentary behavior.
Several rounds of one-on-one interviews were conducted by an interviewer trained in qualitative research methods. Interviewees included a convenience sample of volunteers and participants in the Tomorrow Project, a large cohort study in Alberta, Canada. Following each round of interviews the STAR-Q was revised and cognitively tested until saturation was achieved.
Six rounds of cognitive interviewing in 22 adults (5 males, 17 females) age 23−74 years, led to revisions involving 1) use of recall aids; 2) ambiguous terms; and 3) specific tasks, such as averaging across multiple routines, reporting time asleep and self-care, and reporting by activity domain.
Cognitive interviewing is a critical step in questionnaire development. Knowledge gained in this study led to revisions that improved respondent acceptability and comprehension of the STAR-Q and will complement ongoing validity testing.
Fabiola E. Aparicio-Ting, Christine M. Friedenreich, Karen A. Kopciuk, Ronald C. Plotnikoff, and Heather E. Bryant
Little is known about the intrapersonal and social factors associated with sufficient physical activity (PA) for cancer prevention, which is greater than for cardiovascular health.
1087 and 1684 randomly selected men and women, age 35–64, completed self-administered questionnaires on PA behavior and psycho-social characteristics. Using gender-stratified logistic regression, we investigated correlates of compliance with Canadian Society for Exercise Physiology PA guidelines for general health (150 min/wk), and the American Cancer Society (ACS; 225 min/wk) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AIRC; 420 min/wk) guidelines for cancer prevention.
Only 39% and 19% of men and women met ACS and WCRF/AICR guidelines, respectively. Self-efficacy, scheduling PA and friend social support were positively correlated with recommended PA for cancer prevention. In men, poor self-rated health and perceived negative outcomes were negatively correlated and hypertension was positively correlated with meeting cancer prevention guidelines. For women, not being married and having a companion for PA were positively correlated with meeting cancer prevention guidelines.
Few adults participate in sufficient PA for cancer risk reduction. Multidimensional public health strategies that incorporate intrapersonal and social factors and are tailored for each gender are needed to promote PA for cancer prevention.
Gavin R. McCormack, Christine M. Friedenreich, Billie Giles-Corti, Patricia K. Doyle-Baker, and Alan Shiell
The built and social environments may contribute to physical activity motivations and behavior. We examined the extent to which the Theory of Planned Behavior (TPB) mediated the association between neighborhood walkability and walking.
Two random cross-sectional samples (n = 4422 adults) completed telephone interviews capturing walking-related TPB variables (perceived behavioral control (PBC), attitudes, subjective norm, intention). Of those, 2006 completed a self-administered questionnaire capturing walkability, social support (friends, family, dog ownership), and neighborhood-based transportation (NTW) and recreational walking (NRW). The likelihood of undertaking 1) any vs. none and 2) sufficient vs. insufficient levels (≥150 vs. <150 minutes/week) of NTW and NWR, in relation to walkability, social support, and TPB was estimated.
Any and sufficient NTW were associated with access to services, connectivity, residential density, not owning a dog (any NTW only), and friend and family support. Any and sufficient NRW were associated with neighborhood aesthetics (any NRW only), dog ownership, and friend and family support. PBC partially mediated the association between access to services and NTW (any and sufficient), while experiential attitudes partially mediated the association between neighborhood aesthetics and any NRW.
Interventions that increase positive perceptions of the built environment may motivate adults to undertake more walking.
Joshua A. Nicholas, Geraldine Lo Siou, Brigid M. Lynch, Paula J. Robson, Christine M. Friedenreich, and Ilona Csizmadi
Sedentary behavior has been proposed as a risk factor for obesity that is distinct from physical inactivity. This study aimed to examine the association between occupational sedentary behavior and obesity, and to determine if this association is independent of leisure-time physical activity (LTPA).
Fully employed participants enrolled between 2001 and 2008 to Alberta’s Tomorrow Project, a prospective cohort study in Alberta, Canada, were studied (n = 12,409). Associations between occupational sedentary behavior and waist circumference (WC), waist-to-hip ratio (WHR), and body mass index (BMI) were examined using multiple binary and multinomial logistic regressions.
In men, a positive association was observed between daily occupational sedentary hours and WC, WHR, BMI, and with high risk profiles that incorporated both BMI and WC (P < .01). Controlling for vigorous-intensity LTPA in all models strengthened associations between sedentary behavior and measures of obesity. In contrast, inverse associations were observed for occupational sedentary hours and WHR for women (P < .05).
In fully employed men, occupational sedentary behavior was positively associated with obesity risk that was not attenuated by physical activity. In women, an increase in obesity risk was not observed with sedentary behavior. Gender differences in the health effects of sedentary behavior require further study.
Paddy C. Dempsey, Christine M. Friedenreich, Michael F. Leitzmann, Matthew P. Buman, Estelle Lambert, Juana Willumsen, and Fiona Bull
Background: In 2020, the World Health Organization (WHO) released global guidelines on physical activity (PA) and sedentary behavior, for the first time providing population-based recommendations for people living with selected chronic conditions. This article briefly presents the guidelines, related processes and evidence, and, importantly, considers how they may be used to support research, practice, and policy. Methods: A brief overview of the scope, agreed methods, selected chronic conditions (adults living with cancer, hypertension, type 2 diabetes, and human immunodeficiency virus), and appraisal of systematic review evidence on PA/sedentary behavior is provided. Methods were consistent with World Health Organization protocols for developing guidelines. Results: Moderate to high certainty evidence (varying by chronic condition and outcome examined) supported that PA can reduce the risk of disease progression or premature mortality and improve physical function and quality of life in adults living with chronic conditions. Direct evidence on sedentary behavior was lacking; however, evidence extrapolated from adult populations was considered applicable, safe, and likely beneficial (low certainty due to indirectness). Conclusions: Clinical and public health professionals and policy makers should promote the World Health Organization 2020 global guidelines and develop and implement services and programs to increase PA and limit sedentary behavior in adults living with chronic conditions.
Kerry S. Courneya, Kristina H. Karvinen, Margaret L. McNeely, Kristin L. Campbell, Sony Brar, Christy G. Woolcott, Anne McTiernan, Rachel Ballard-Barbash, and Christine M. Friedenreich
Few studies have examined the predictors of adherence separately for supervised and unsupervised exercise or in postmenopausal women over an extended time period. Here, we report the predictors of exercise adherence in the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial.
The ALPHA trial randomized 160 postmenopausal women in Calgary and Edmonton, Canada to an exercise intervention that consisted of an average of 200 min/wk of supervised (123 minutes) and unsupervised (77 minutes) exercise over a 1-year period. Baseline data were collected on demographic, health-related fitness, quality of life, and motivational variables from the theory of planned behavior.
Participants completed an average of 95% of their supervised exercise and 79% of their unsupervised exercise. In multivariate analyses, 8.1% (P = .001) of the variance was explained for supervised exercise by being from Edmonton (β = 0.22; P = .004) and older (β = 0.15; P = .050). For unsupervised exercise, 21.1% (P < .001) of the variance was explained by being from Calgary (β = –0.39; P < .001), having a family history of breast cancer (β = 0.21; P = .003), and having higher vitality (β = 0.19; P = .011).
Predictors of adherence may differ for supervised and unsupervised exercise, moreover, predicting adherence to supervised exercise may be particularly difficult in well-controlled efficacy trials.