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Rebecca L. Vivrette, Laurence Z. Rubenstein, Jennifer L. Martin, Karen R. Josephson and B. Josea Kramer

Objective:

To determine seniors’ beliefs about falls and design a fall-risk self-assessment and educational materials to promote early identification of evidence-based fall risks and encourage prevention behaviors.

Methods:

Focus groups with community-dwelling seniors, conducted in two phases to identify perceptions about fall risks and risk reduction and to assess face validity of the fall-risk self-assessment and acceptability of educational materials.

Results:

Lay perception of fall risks was in general concordance with evidence-based research. Maintaining independence and positive tone were perceived as key motivators for fall prevention. Seniors intended to use information in the educational tool to stimulate discussions about falls with health care providers.

Implications:

An evidence-based, educational fall-risk self-assessment acceptable to older adults can build on existing lay knowledge about fall risks and perception that falls are a relevant problem and can educate seniors about their specific risks and how to minimize them.

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Andrew T. Kaczynski and Karla A. Henderson

Background:

The purpose of this study was to review reported associations between parks and recreation settings (PRSs) as features of the built environment and various functions and intensities of physical activity (PA).

Methods:

By searching 4 major databases for the years 1998 to 2005, 50 articles were uncovered that reported quantitative relationships between PRSs and PA.

Results:

Most articles showed some significant positive relationships between PRSs and PA. PRSs were more likely to be positively associated with PA for exercise or utilitarian functions than for recreational PA. Mixed results were observed for the associations between PRSs and both moderate and vigorous PA, but PRSs were commonly associated with walking.

Conclusions:

The studies indicated links between PRSs and PA and provided evidence for the contributions parks and recreation makes as part of the “health care” system within communities. Because of the ubiquity of PRSs and their potential contributions to active living, these relationships merit further exploration.

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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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Troy R. Garrett and Peter J. Neibert

Clinical Scenario:

Injury to the plantar fascia, whether acute or chronic, is common among many populations. A conventional multiple-treatment approach is commonly administered by health care providers, consisting of controlling inflammation, managing pain, and promoting healing. Frequently, the initial treatment for plantar fasciitis is targeted at increasing dorsiflexion range of motion by stretching the gastroc-soleus musculature. It has been theorized that inflexibility of the gastroc-soleus complex can lead to excessive pronation and overcompensation of the plantar fascia at the first metatarsal phalangeal joint, therefore increasing the stress at the medial calcaneal insertion. Therefore, it is deemed that gastrocnemius–soleus stretches are a beneficial treatment in the initial stage of a plantar fasciitis treatment or rehabilitation program.

Focused Clinical Question:

Is a gastrocnemius–soleus stretching program, as a stand-alone treatment variable, effective in the treatment of plantar fasciitis?

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Dominic Malcolm

In this article I examine the role and working practice of rugby union club doctors in England. While medicine is widely perceived to be one of the most powerful professions in Western societies, sociologists of sport have argued that sport clinicians often wield relatively limited power over their athlete-patients. In this article I therefore attempt to shed further light on the “peculiar” character of sports medicine. Using data drawn from interviews and questionnaires, I argue that this phenomenon can be understood only by looking at the structure of the sports medicine profession, the specificities of the rugby club as a workplace setting, and the relationships club doctors have with clients (coaches and athletes) and other health care providers (physiotherapists).

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Anita L. Stewart, Melanie Grossman, Nathalie Bera, Dawn E. Gillis, Nina Sperber, Martha Castrillo, Leslie Pruitt, Barbara McLellan, Martha Milk, Kate Clayton and Diana Cassady

Diffusing research-based physical activity programs in underserved communities could improve the health of ethnically diverse populations. We utilized a multilevel, community-based approach to determine attitudes, resources, needs, and barriers to physical activity and the potential diffusion of a physical activity promotion program to reach minority and lower-income older adults. Formative research using focus groups and individual interviews elicited feedback from multiple community sectors: community members, task force and coalition members, administrators, service implementers, health care providers, and physical activity instructors. Using qualitative data analysis, 47 transcripts (N = 197) were analyzed. Most sectors identified needs for culturally diverse resources, promotion of existing resources, demonstration of future cost savings, and culturally tailored, proactive outreach. The program was viewed favorably, especially if integrated into existing resources. Linking sectors to connect resources and expertise was considered essential. Complexities of such large-scale collaborations were identified. These results may guide communities interested in diffusing health promotion interventions.

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Anna-Karin Welmer, Annika Mörck and Synneve Dahlin-Ivanoff

The aim of this study was to describe experiences of physical activity, perceived meaning, and the importance of and motives and barriers for participation in physical activity in people 80 years of age and older. A qualitative design with focus-group methodology was used. The sample consisted of 20 community-living people age 80–91 yr. Data analyses revealed 4 themes: physical activity as a part of everything else in life, joie de vivre, fear of disease and dependence, and perceptions of frailty. Our results suggest that physical activity was not seen as a separate activity but rather as a part of activities often rated as more important than the physical activity itself. Thus, when designing physical activity interventions for elderly people, health care providers should consider including time for social interaction and possibilities to be outdoors. Moreover, assessment of physical activity levels among elderly people should include the physical activity in everyday activities.

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Sandra O'Brien Cousins

This study analyzed older women's (age 57–92, N = 32) descriptions of motivating triggers for physical activity. Among active women, activity was triggered by situations such as declining fitness levels, low bone density, more free time, fears about inadequate health care leading to self-care, expectations for reduced aches and pains, awareness of new community programs, and public reports of the health benefits. Semiactive women had doubts about the appropriateness of being active. Inactive people also experienced triggers but seemed firmly committed to a less active lifestyle by reminding themselves that retirement requires no commitments, exercise is not needed if you are healthy, exercise is not appropriate if you are ill, being very busy is a substitute activity, and serving others is less selfish. The findings suggest that active-living interventions might be more effectively aimed at semi active seniors who seem positively disposed to participating but need help to get started or to stay involved.

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the Latest From the Health Care in Action Campaign After the success of NATA’s 2019 Own Your Impact campaign, the association is continuing the conversation in 2020 with the Health Care in Action campaign. Throughout this year-long campaign, NATA will provide resources to members that help them tell

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Colleen A. Cuthbert, Kathryn King-Shier, Dean Ruether, Dianne M. Tapp and S. Nicole Culos-Reed

Background:

Family caregivers are an important health care resource and represent a significant proportion of Canadian and US populations. Family caregivers suffer physical and psychological health problems because of being in the caregiver role. Interventions to support caregiver health, including physical activity (PA), are slow to be investigated and translated into practice.

Purpose:

To examine the evidence for PA interventions in caregivers and determine factors hampering the uptake of this evidence into practice.

Methods:

A systematic review and evaluation of internal and external validity using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted. Randomized controlled trials or pretest/posttest studies of PA interventions were included.

Results:

Fourteen studies were published between 1997 and 2015. Methodological quality of studies and risk of bias was variable. External validity criteria were often not reported. Mean reporting levels were 1) reach, 53%; 2) efficacy/effectiveness, 73%; 3) adoption, 18%; 4) implementation, 48%; and 5) maintenance, 2%.

Conclusions:

The lack of reporting of components of internal and external validity hinders the integration of caregiver PA interventions into clinical or community settings. Researchers should focus on standardized outcomes, accepted reporting criteria, and balancing factors of internal and external validity, to advance the state of the science.