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Elizabeth Eakin

Physical inactivity continues to be a significant public health issue for middle-aged and older adults. This review focuses on physical activity interventions targeting older adults in health care settings. The literature in this area is limited and the results to date disappointing. Much remains to be done to develop effective interventions targeting older adults, especially those from underserved groups. Attention also needs to be paid to maintenance of initial treatment gains and to linking primary-care-based physical activity interventions to community-based resources. Recognition in the social and behavioral sciences of the importance of social-environmental influences on health and health behaviors mandates both a multidisciplinary and a multilevel intervention approach to the problem of physical inactivity.

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Elizabeth G. Eakin, Ben J. Smith and Adrian E. Bauman

Background:

This article evaluates the extent to which the literature on primary care-based physical activity interventions informs the translation of research into practice and identifies priorities for future research.

Methods:

Relevant databases were searched for: (1) descriptive studies of physician barriers to physical activity counseling (n = 8), and (2) reviews of the literature on primary care-based physical activity intervention studies (n = 9). The RE-AIM framework was used to guide the evaluation.

Results:

Lack of time, limited patient receptiveness, lack of remuneration, and limited counseling skills are the predominant barriers to physical activity counselling. Issues of internal validity (i.e., effectiveness and implementation) have received much more attention in the literature than have issues of external validity (i.e., reach and adoption).

Conclusions:

The research agenda for primary care-based physical activity interventions needs greater attention to the feasibility of adoption by busy primary care staff, generalizability, and dissemination.

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Wendy J. Brown, Kerry Mummery, Elizabeth Eakin and Grant Schofield

Objectives:

To describe the effectiveness of a multi-strategy physical activity (PA) intervention.

Methods:

Self-report data from random samples were collected prior to and following intervention. Social marketing, healthcare provider, and environmental strategies were concurrently implemented with a central coordinating theme of “10,000 Steps Rockhampton.”

Results:

There was evidence of significant project reach and awareness. The downward trend in PA seen in the comparison community (48.3% to 41.9% “active”) was not evident in Rockhampton. Women were the “early adopters” in this project; with an increase of 5% (95% CI: –0.6, 10.6) in the percent categorized as “active” (compared with decreases among women in the comparison community and among men in both communities).

Conclusions:

High levels of project awareness, combined with modest increases in activity levels in women, demonstrate initial project effects. Longer term interventions, focusing on sustainable individual, social, and environmental change strategies are needed to maintain and improve this result.

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Lauren Ashleigh Waters, Benedicte Galichet, Neville Owen and Elizabeth Eakin

Background:

Taking a representative snapshot of physical activity intervention trial findings published between 1996 and 2006, we empirically evaluated participant characteristics, response and retention rates, and their associations with intervention settings.

Methods:

A structured database search identified 5 representative health behavior journals, from which 32 research reports of physical activity intervention trials were reviewed. Interventions settings were categorized as workplace, healthcare, home- or community-based. Information on participant and intervention characteristics was extracted and reviewed.

Results:

The majority of participants were Caucasian (86%), women (66%), healthy but sedentary (63%), and middle-aged (mean age = 51 years). Intervention response rates ranged from 20% to 89%, with the greatest response rate for healthcare and home-based interventions. Compared with nonparticipants, study participants tended to be women, Caucasian, tertiary-educated, and middle-class. Participants in workplace interventions were younger, more educated, and healthier; in community-based interventions, participants were older and more ethnically diverse. Reporting on education and income was inconsistent. The mean retention rate was 78%, with minimal differences between intervention settings.

Conclusions:

These results emphasize the need for physical activity interventions to target men, socioeconomically disadvantaged, and ethnic minority populations. Consistent reporting of response rate and retention may enhance the understanding of which intervention settings best recruit and retain large, representative samples.

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Lauren Waters, Marina Reeves, Brianna Fjeldsoe and Elizabeth Eakin

Background:

Several recent physical activity intervention trials have reported physical activity improvements in control group participants. Explanations have been proposed, but not systematically investigated.

Methods:

A systematic review of physical activity intervention trials was conducted to investigate the frequency of meaningful improvements in physical activity among control group participants (increase of ≥ 60 minutes [4 MET·hours] of moderate-to-vigorous physical activity per week, or a 10% increase in the proportion of participants meeting physical activity recommendations), and possible explanatory factors. Explanatory factors include aspects of behavioral measurement, participant characteristics, and control group treatment.

Results:

Eight (28%) of 29 studies reviewed reported meaningful improvements in control group physical activity, most of which were of similar magnitude to improvements observed in the intervention group. A number of factors were related to meaningful control group improvements in physical activity, including the number of assessments, mode of measurement administration, screening to exclude active participants, and preexisting health status.

Conclusions:

Control group improvement in physical activity intervention trials is not uncommon and may be associated with behavioral measurement and participant characteristics. Associations observed in this review should be evaluated empirically in future research. Such studies may inform minimal contact approaches to physical activity promotion.

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Winnie Y.H. Lee, Bronwyn K. Clark, Elisabeth Winkler, Elizabeth G. Eakin and Marina M. Reeves

Background:

This study evaluated the responsiveness to change in physical activity of 2 self-report measures and an accelerometer in the context of a weight loss intervention trial.

Methods:

302 participants (aged 20 to 75 years) with type 2 diabetes were randomized into telephone counseling (n = 151) or usual care (n = 151) groups. Physical activity (minutes/week) was assessed at baseline and 6-months using the Active Australia Survey (AAS), the United States National Health Interview Survey (USNHIS) walking for exercise items, and accelerometer (Actigraph GT1M; ≥1952 counts/minute). Responsiveness to change was calculated as responsiveness index (RI), Cohen’s d (postscores) and Cohen’s d (change-scores).

Results:

All instruments showed significant improvement in the intervention group (P < .001) and no significant change for usual care (P > .05). Accelerometer consistently ranked as the most responsive instrument while the least responsive was the USHNIS (responsiveness index) or AAS (Cohen’s d). RIs for AAS, USNHIS and accelerometer did not differ significantly and were, respectively: 0.45 (95% CI: 0.26–0.65); 0.38 (95% CI: 0.20–0.56); and, 0.49 (95% CI: 0.23–0.74).

Conclusions:

Accelerometer tended to have the highest responsiveness but differences were small and not statistically significant. Consideration of factors, such as validity, feasibility and cost, in addition to responsiveness, is important for instrument selection in future trials

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Marina M. Reeves, Alison L. Marshall, Neville Owen, Elisabeth A.H. Winkler and Elizabeth G. Eakin

Background:

We compared the responsiveness to change (prepost intervention) of 3 commonly-used self-report measures of physical activity.

Methods:

In a cluster-randomized trial of a telephone-delivered intervention with primary care patients, physical activity was assessed at baseline and 4 months (n = 381) using the 31-item CHAMPS questionnaire; the 6-item Active Australia Questionnaire (AAQ); and, 2 walking for exercise items from the US National Health Interview Survey (USNHIS). Responsiveness to change was calculated for frequency (sessions/week) and duration (MET·minutes/week) of walking and moderate-to-vigorous intensity physical activity.

Results:

The greatest responsiveness for walking frequency was found with the USNHIS (0.45, 95% CI: 0.19, 0.72) and AAQ (0.43, 95% CI: 0.19, 0.67), and for walking duration with the USNHIS (0.27, 95%CI 0.13, 0.41) and CHAMPS (0.24, 95% CI: 0.12, 0.36). For moderate-to-vigorous activity, responsiveness for frequency was slightly higher for the AAQ (0.50, 95% CI: 0.30, 0.69); for duration it was slightly higher for CHAMPS (0.32, 95% CI: 0.17, 0.47).

Conclusions:

In broad-reach trials, brief self-report measures (USNHIS and AAQ) are useful for their comparability to population physical activity estimates and low respondent burden. These measures can be used without a loss in responsiveness to change relative to a more detailed self-report measure (CHAMPS).