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Physical Activity Guidelines for Adolescents: Consensus Statement

James F. Sallis and Kevin Patrick

The International Consensus Conference on Physical Activity Guidelines for Adolescents convened to review the effects of physical activity on the health of adolescents, to establish age-appropriate physical activity guidelines, and to consider how these guidelines might be implemented in primary health care settings. Thirty-four invited experts and representatives of scientific, medical, and governmental organizations established two main guidelines. First, all adolescents should be physically active daily or nearly every day as part of their lifestyles. Second, adolescents should engage in three or more sessions per week of activities that last 20 min or more and that require moderate to vigorous levels of exertion. Available data suggest that the vast majority of U.S. adolescents meet the first guideline, but only about two thirds of boys and one half of girls meet the second guideline. Physical activity has important effects on the health of adolescents, and the promotion of regular physical activity should be a priority for physicians and other health professionals.

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The Healthcare Sector’s Role in the U.S. National Physical Activity Plan

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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Overview of the International Consensus Conference on Physical Activity Guidelines for Adolescents

James F. Sallis, Kevin Patrick, and Barbara J. Long

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Physician Communication and Physical Activity Among Latinas

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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Intrapersonal Correlates of Sufficiently Active Youth and Adolescents

Kevin S. Spink, Karen Chad, Nazeem Muhajarine, Louise Humbert, Patrick Odnokon, Catherine Gryba, and Kristal Anderson

This study examined the relationship between intrapersonal correlates and being sufficiently active for health benefits in youth and adolescents (12-17 years of age). Participants completed questionnaires that assessed physical activity in the form of energy expenditure and intrapersonal correlates. Being in the sufficiently active group (> 8 kcal per day per kg of body weight) was associated with engaging in a greater array of physical activities, reporting greater levels of health, reporting a better home life, and spending less time in sedentary activities. The results provided preliminary evidence that selected intrapersonal correlates were associated with youth and adolescents who were sufficiently active to attain health benefits.

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Correlates of Structured and Unstructured Activity among Sufficiently Active Youth and Adolescents: A New Approach to Understanding Physical Activity

Kevin S. Spink, Christopher A. Shields, Karen Chad, Patrick Odnokon, Nazeem Muhajarine, and Louise Humbert

The present study examines whether the correlates of physical activity relevant to sufficiently active youth and adolescents differed as a function of type (structured or unstructured) of physical activity. Participants completed measures of physical activity and activity correlates. The most frequently cited correlates were enjoyment, friends’ participation, and friends’ support. Significant differences were found across type of activity for enjoyment, perceived competence, parental support, coaches’ support, and friends’ participation. The results provide insight into the correlates of physical activity in this population and provide preliminary evidence that different correlates may be associated with different activities.

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Promoting Walking Among Older Adults Living in Retirement Communities

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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Effects of Quercetin Supplementation on Markers of Muscle Damage and Inflammation after Eccentric Exercise

Kevin S. O’Fallon, Diksha Kaushik, Bozena Michniak-Kohn, C. Patrick Dunne, Edward J. Zambraski, and Priscilla M. Clarkson

The flavonoid quercetin is purported to have potent antioxidant and anti-inflammatory properties. This study examined if quercetin supplementation attenuates indicators of exercise-induced muscle damage in a doubleblind laboratory study. Thirty healthy subjects were randomized to quercetin (QU) or placebo (PL) supplementation and performed 2 separate sessions of 24 eccentric contractions of the elbow flexors. Muscle strength, soreness, resting arm angle, upper arm swelling, serum creatine kinase (CK) activity, plasma quercetin (PQ), interleukin-6 (IL-6), and C-reactive protein (CRP) were assessed before and for 5 d after exercise. Subjects then ingested nutrition bars containing 1,000 mg/d QU or PL for 7 d before and 5 d after the second exercise session, using the opposite arm. PQ reached 202 ± 52 ng/ml after 7 d of supplementation and remained elevated during the 5-d postexercise recovery period (p < .05). Subjects experienced strength loss (peak = 47%), muscle soreness (peak = 39 ± 6 mm), reduced arm angle (–7° ± 1°), CK elevations (peak = 3,307 ± 1,481 U/L), and arm swelling (peak = 11 ± 2 mm; p < .0001), indicating muscle damage and inflammation; however, differences between treatments were not detected. Eccentric exercise did not alter plasma IL-6 (peak = 1.9 pg/ml) or CRP (peak = 1.6 mg/L) relative to baseline or by treatment. QU supplementation had no effect on markers of muscle damage or inflammation after eccentric exercise of the elbow flexors.

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Community Design and Access to Recreational Facilities as Correlates of Adolescent Physical Activity and Body-Mass Index

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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Brief Physical Activity-Related Psychosocial Measures: Reliability and Construct Validity

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.