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Sara Wilcox

There is strong evidence that older adults greatly benefit from regular physical activity. Yet, older age is consistently associated with lower levels of aerobic physical activity and strength training and higher levels of sedentary behavior, underscoring the need to better understand physical activity behavior in this population. Reviews of interventions to increase physical activity have overall yielded promising results. Interventions based on behavior theory appear to be more effective than non-theory-based interventions, yet strategies from these theories are underutilized in both research and practice. This paper discusses the importance of behavioral interventions, cites findings from the Active for Life initiative to illustrate several key concepts, and provides recommendations to address significant gaps in the literature, including the use of theory, mediation analyses, physical activity maintenance, diversity of participants, and dissemination and translational research.

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Meghan Baruth and Sara Wilcox

Background:

Understanding who is most and least likely to remain active after the completion of physical activity (PA) interventions can assist in developing more targeted and effective programs to enhance prolonged behavior change. The purpose of this study was to examine predictors of meeting PA recommendations 6 months postintervention in participants enrolled in Active for Life.

Methods:

Participants from 2 behavioral PA programs [158 Active Choices (AC); 1025 Active Living Every Day (ALED)] completed surveys 6 months after completion of the active intervention. Analyses examined predictors of meeting PA recommendations at follow-up.

Results:

The following were significant predictors: In ALED: self-report health status, satisfaction with body function, and self-efficacy at baseline; PA status at posttest; changes in self-efficacy, perceived stress, and satisfaction with body function and appearance from baseline to posttest. In AC: PA status at posttest.

Conclusions:

The ultimate goal of health promotion programs is to teach the behavioral skills necessary to sustain behavior change once an active intervention is complete. The findings from this study suggest that predicting PA behavior after cessation of PA interventions may not be straightforward, and predictor variables may operate differently in different intervention approaches.

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Sara Wilcox and Abby C. King

Associations of life events and interpersonal loss with participation in home-and group-based exercise were studied in 97 older adults (64% women, 70.2 ± 4.1 years). Life events were assessed with a modified Social Readjustment Rating Scale at baseline and 6 and 12 months. Exercise logs and class-attendance records documented exercise participation. Participants experienced 3.62 ± 3.56 unique life events over the course of the study, and 28 participants reported an interpersonal loss (5 men, 23 women). Number of life events was negatively associated with home-based exercise participation (p < .05); among women, this association approached significance (p = .06) for class-based exercise. Women who experienced an interpersonal loss had lower class-based participation than those who did not (p = .02), but home-based participation rates were unaffected. Life events, particularly interpersonal loss, appear to have a negative impact on exercise in women, and this effect appears greater for class-based than for home-based exercise.

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Rebecca Kyryliuk, Meghan Baruth, and Sara Wilcox

Background:

Understanding predictors of weight loss can assist in developing targeted evidence-based programs to reduce obesity in faith-based settings. The purpose of this study was to examine predictors of weight loss for a sample of African-American women taking part in in a church-based study.

Methods:

Participants (N = 350) completed physical assessments and comprehensive surveys at baseline and 15 months later. Analyses examined baseline variables and change in variables from baseline to posttest, as predictors of ≥ 5% weight loss at posttest. Demographic, health-related, and behavioral variables were examined.

Results:

Lower baseline stress predicted greater likelihood of weight loss. Increased leisure-time physical activity (LTPA) from baseline to posttest was predictive of greater weight loss. The odds of ≥ 5% weight loss was 38% lower for every 1-point increase in baseline stress (OR = 0.62, CI = 0.39, 0.98, P = .04) and 6% greater for every 1-hour increase in posttest LTPA (OR = 1.06, CI = 1.0, 1.12, P = .049).

Conclusions:

Increased LTPA appears to be an independent predictor of modest but meaningful reductions in weight among African-American women. African-American women reporting higher levels of stress at baseline may require more intense strategies emphasizing increased LTPA to lose weight.

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Sara Wilcox, Melinda Forthofer, Patricia A. Sharpe, and Brent Hutto

Background:

Walking interventions delivered by lay leaders have been shown to be effective. Knowing the characteristics of individuals who volunteer to be group leaders in walking programs could facilitate more efficient and effective recruitment and training.

Methods:

Walking group leaders were recruited into a community-based program and formed walking groups from existing social networks. Leaders and members completed a survey, participated in physical measurements, and wore an accelerometer. Regression models (adjusting for group clustering and covariates) tested psychosocial and behavioral differences between leaders and members.

Results:

The sample included 296 adults (86% women, 66% African American). Leaders (n = 60) were similar to members (n = 236) with respect to most sociodemographic and health characteristics, but were significantly older and more likely to report arthritis and high cholesterol (P-values < .05). Although leaders and members were similar in sedentary behavior and physical activity, leaders reported higher levels of exercise self-regulation, self-efficacy, and social support (P-values < .01). Leaders also reported greater use of outdoor trails (P = .005) and other outdoor recreation areas (P = .003) for physical activity than members.

Conclusion:

Although walking group leaders were no more active than members, leaders did display psychosocial characteristics and behaviors consistent with a greater readiness for change.

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Meghan Baruth, Sara Wilcox, Cheryl Der Ananian, and Sue Heiney

Background:

Adjuvant treatment for breast cancer may result in long-lasting, adverse emotional and physical side effects, and reduce quality of life (QOL). This pilot study examined the effects of a home-based walking program on QOL and fatigue in early stage breast cancer survivors and whether changes in walking behavior were associated with changes in outcomes.

Methods:

Participants (n = 32) were randomized to a 12-week home-based walking intervention plus brief telephone counseling (n = 20) or a wait-list control group (n = 12). Self-reported fatigue, QOL, and walking were assessed at baseline and 12-weeks. Results are presented as effect sizes.

Results:

Participants in the intervention had improvements in a majority of fatigue and QOL outcomes, whereas the control group had no change or worsened in many; effect sizes were generally in the small to medium range. Changes in fatigue/QOL outcomes were associated with changes in walking behavior, with effects generally in the small to medium range.

Conclusion:

Home-based physical activity (walking) programs may be an appropriate avenue for alleviating the adverse side effects that often accompany adjuvant treatment for breast cancer. These programs have potential for widespread dissemination, which may have considerable impact on the quality of life of women recently completing breast cancer treatment.

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Sara Wilcox, Patricia A. Sharpe, Brent Hutto, and Michelle L. Granner

Background:

Self-efficacy is a consistent correlate of physical activity, but most self-efficacy measures have not been validated in diverse populations. This study examined the construct, criterion-related, and convergent validity and internal consistency of the Self-Efficacy for Exercise Questionnaire.

Methods:

African American and Caucasian adults (N = 1919) from two adjacent counties in South Carolina were identified through a list-assisted random digit-dialed telephone survey. Psychometric properties of the measure were assessed by gender, race, age, education, and body weight subgroups.

Results:

Across all subgroups, a single-factor solution explained 93 to 98% of the common variance in an exploratory factor analysis, and all 14 items had factor loadings exceeding 0.40. Higher exercise self-efficacy was significantly associated with greater physical activity, younger age, male gender, higher education, and lower body weight, as predicted. Internal consistency was high for all subgroups (α = 0.90 to 0.94).

Conclusion:

The Self-Efficacy for Exercise Questionnaire appears to be a valid and reliable measure for use with diverse populations.

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Michelle L. Granner, Patricia A. Sharpe, Brent Hutto, Sara Wilcox, and Cheryl L. Addy

Background:

Few studies have explored associations of individual, social, and environmental factors with physical activity and walking behavior.

Methods:

A random-digit-dial questionnaire, which included selected individual, social, and environmental variables, was administered to 2025 adults, age 18 y and older, in two adjacent counties in a southeastern state. Logistic regressions were conducted adjusting for age, race, sex, education, and employment.

Results:

In multivariate models, somewhat different variables were associated with physical activity versus regular walking. Self-efficacy (OR = 19.19), having an exercise partner (OR = 1.47), recreation facilities (OR = 1.54), and safety of trails from crime (OR = 0.72) were associated with physical activity level; while self-efficacy (OR = 4.22), known walking routes (OR = 1.54), recreation facilities (OR = 1.57-1.59), and safety of trails from crime (OR = 0.69) were associated with regular walking behavior.

Conclusions:

Physical activity and walking behaviors were associated with similar variables in this study.

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Sara Wilcox, Deborah Parra-Medina, Gwen M. Felton, Mary Beth Poston, and Amanda McClain

Background:

Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers.

Methods:

Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity.

Results:

Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered.

Conclusions:

A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.

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Sara Wilcox, Abby C. King, Glenn S. Brassington, and David K. Ahn

Physical activity interventions are most effective when they are tailored to individual preferences. This study examined preferences for exercising on one’s own with some instruction vs. in a class in 1,820 middle-aged and 1,485 older adults. Overall, 69% of middle-aged and 67% of older adults preferred to exercise on their own with some instruction rather than in an exercise class. The study identified subgroups—5 of middle-aged and 6 of older adults—whose preferences for exercising on their own with some instruction ranged from 33–85%. Less educated women younger than 56, healthy women 65–71, and older men reporting higher stress levels were most likely to prefer classes. All other men and most women preferred exercising on their own. The identification of these subgroups enables us to tailor exercise recommendations to the preferences of middle-aged and older adults, with increased rates of physical activity adoption and maintenance a likely result.