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Megan S. Farris, Kerry S. Courneya, Rachel O’Reilly and Christine M. Friedenreich

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.

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JoEllen Wilbur, Michael E. Schoeny, Susan W. Buchholz, Louis Fogg, Arlene Michaels Miller, Lynne T. Braun, Shannon Halloway and Barbara L. Dancy

Background:

For interventions to be implemented effectively, fidelity must be documented. We evaluated fidelity delivery, receipt, and enactment of the 48-week Women’s Lifestyle Physical Activity Program conducted to increase physical activity and maintain weight in African American women.

Methods:

Three study conditions all received 6 group meetings; 1 also received 11 motivational interviewing personal calls (PCs), 1 received11 automated motivational message calls (ACs), and 1 received no calls. Group meeting delivery was assessed for adherence and competence. PC delivery was assessed with the Motivational Interviewing Treatment Integrity Code. Receipt was defined as group meeting attendance, completion of PCs, and listening to ACs. Enactment was number of weeks an accelerometer was worn.

Results:

For group meeting delivery, mean adherence was 80.8% and mean competence 2.9 of 3.0. Delivery of PCs did not reach criterion for competence. Receipt of more than one-half the dose was achieved for 84.9% of women for group meetings, 85.5% for PCs, and 42.1% for ACs. Higher group meeting attendance was associated with higher accelerometer steps at 24 weeks and lower BMI at 24 and 48 weeks.

Conclusions:

Fidelity measurement and examination of intervention delivery, receipt, and enactment are important to explicate conditions in which interventions are successful.

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Susanne James-Burdumy, Nicholas Beyler, Kelley Borradaile, Martha Bleeker, Alyssa Maccarone and Jane Fortson

Background:

The Playworks program places coaches in low-income urban schools to engage students in physical activity during recess. The purpose of this study was to estimate the impact of Playworks on students’ physical activity separately for Hispanic, non-Hispanic black, and non-Hispanic white students.

Methods:

Twenty-seven schools from 6 cities were randomly assigned to treatment and control groups. Accelerometers were used to measure the intensity of students’ physical activity, the number of steps taken, and the percentage of time in moderate-to-vigorous physical activity (MVPA) during recess. The impact of Playworks was estimated by comparing average physical activity outcomes in treatment and control groups.

Results:

Compared with non-Hispanic black students in control schools, non-Hispanic black students in Playworks schools recorded 338 more intensity counts per minute, 4.9 more steps per minute, and 6.3 percentage points more time in MVPA during recess. Playworks also had an impact on the number of steps per minute during recess for Hispanic students but no significant impact on the physical activity of non-Hispanic white students.

Conclusions:

The impact of Playworks was larger among minority students than among non-Hispanic white students. One possible explanation is that minority students in non-Playworks schools typically engaged in less physical activity, suggesting that there is more room for improvement.

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Ikuyo Imayama, Catherine M. Alfano, Caitlin E. Mason, Chiachi Wang, Liren Xiao, Catherine Duggan, Kristin L. Campbell, Karen E. Foster-Schubert, Ching-Yun Wang and Anne McTiernan

Background:

Regular exercise increases exercise self-efficacy and health-related quality of life (HRQOL); however, the mechanisms are unknown. We examined the associations of exercise adherence and physiological improvements with changes in exercise self-efficacy and HRQOL.

Methods:

Middle-aged adults (N = 202) were randomized to 12 months aerobic exercise (360 minutes/week) or control. Weight, waist circumference, percent body fat, cardiopulmonary fitness, HRQOL (SF-36), and exercise self-efficacy were assessed at baseline and 12 months. Adherence was measured in minutes/day from activity logs.

Results:

Exercise adherence was associated with reduced bodily pain, improved general health and vitality, and reduced role-emotional scores (Ptrend ≤ 0.05). Increased fitness was associated with improved physical functioning, bodily pain and general health scores (Ptrend ≤ 0.04). Reduced weight and percent body fat were associated with improved physical functioning, general health, and bodily pain scores (Ptrend < 0.05). Decreased waist circumference was associated with improved bodily pain and general health but with reduced role-emotional scores (Ptrend ≤ 0.05). High exercise adherence, increased cardiopulmonary fitness and reduced weight, waist circumference and percent body fat were associated with increased exercise self-efficacy (Ptrend < 0.02).

Conclusions:

Monitoring adherence and tailoring exercise programs to induce changes in cardiopulmonary fitness and body composition may lead to greater improvements in HRQOL and self-efficacy that could promote exercise maintenance.

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David P. French, Catherine D. Darker, Frank F. Eves and Falko F. Sniehotta

The Theory of Planned Behavior (TPB) has been extensively used in predictive studies, but there have been considerably fewer experimental tests of the theory. One reason for this is that the guidance on developing concrete intervention strategies from the abstract theory is vague, and there are few exemplars of how to do this. The aim of this article is to provide such an exemplar. The development of an intervention to increase walking in the general public is described, based on the TPB, extended to include postvolitional processes. Identification of target constructs, elicitation of key salient beliefs underpinning these constructs, selection of appropriate behavior change techniques, and technique refinement. Each step is based on available evidence and consistent with theory. Perceived behavioral control (PBC) was identified as the key determinant of walking intentions, with an “intention-behavior gap” noted. A brief intervention was developed, using techniques to increase PBC by rehearsal of previous successful performance of behavior, along with planning techniques to translate motivation into behavior. This systematic approach taken should provide a model for others. The intervention has demonstrated efficacy in producing large changes in objectively measured walking behavior, in 2 separate evaluations reported elsewhere.

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Ryan D. Burns, Timothy A. Brusseau and James C. Hannon

Background:

Comprehensive School Physical Activity Programming (CSPAP) has the potential to increase physical activity (PA) in children over time. The purpose of this study was to examine the effect of CSPAP on school day step counts in children.

Methods:

Participants were 327 fourth and fifth grade children recruited from 4 elementary schools. The study was conducted within an Interrupted Time-Series Design framework. School day step counts were collected for 5 days across preintervention and postintervention time-points (10 days total) using NL-1000 piezoelectric pedometers. Robust piecewise regression examined pre- and postintervention intercepts and slopes, and the change in these parameters using postestimation statistics.

Results:

The slope coefficient was statistically significant across preintervention (β = –105.23, P < .001) but not postintervention time-points (β = –63.23, P = .347), suggesting decreases in steps counts across preintervention and stability of step counts across postintervention school days. Postestimation statistics yielded increases in school day step counts from the end of preintervention (day 5) to the start of postintervention (day 6; t(319) = –4.72, P < .001, Cohen’s d = 4.72).

Conclusions:

The CSPAP intervention increased average school day step counts and attenuated decreases in step counts throughout the school week in children.

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Cevdet Cengiz and Mustafa Levent Ince

Background:

The purpose of the study was to determine the effects of a social-ecologic intervention on health-related fitness (HRF) knowledge and behaviors of students (n = 62) living in rural areas.

Methods:

A prepost test control group design was constructed. In addition, qualitative data were collected by focus group discussions in the experimental group. Physical activity environment of a middle school was changed based on the social-ecologic model (SEM) with a focus on intrapersonal, interpersonal, community level, organizational factors, and public policies related to physical activity behavior. Health related fitness knowledge (HRFK) test, pedometer, and perceived physical activity self-efficacy and social support questionnaires were used for data collection.

Results:

Experimental group had significant improvement in HRF knowledge scores, physical activity levels, and social support compared with the control school students. The focus group results also supported the quantitative findings by indicating a perceived increase in physical activity opportunities; knowledge sources; and support from others.

Conclusions:

This study underlines the importance and positive outcomes of SEM in improving HRF knowledge, physical activity level, and social support of students in rural middle school settings.

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Lisa M. Quintiliani, Marci K. Campbell, J. Michael Bowling, Susan Steck, Pamela S. Haines and Brenda M. DeVellis

Background:

A better understanding of identifying tailoring variables would improve message design. Tailoring to a behavior that a participant selects as one they would like to work on may increase message relevance, and thus effectiveness. This trial compared 3 groups: message tailored to physical activity as a participant-selected topic (choice), message tailored to physical activity as an expert-determined topic (expert), or nontailored message (comparison).

Methods:

408 female college students received web-delivered computer-tailored messages on physical activity. Outcomes were immediate and 1-month follow-up changes in psychosocial, goal-related, and behavioral variables related to physical activity.

Results:

Participants were predominately non-Hispanic White (73.8%). Change in self-efficacy and goal commitment at immediate follow-up and vigorous physical activity at 1-month follow-up was greater in the expert versus comparison group. Change in goal commitment at immediate follow-up was lower in the choice versus expert group. In the expert group, those choosing physical activity as their selected topic perceived the goal to be easier at immediate follow-up compared with those receiving unmatched messages.

Conclusions:

Findings supported tailoring to an expert-determined topic. However, based on the beneficial change in perceived goal difficulty when topics matched, future research should encourage synchrony between participant-selected topics and expert recommendations.

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Arto Gråstén, Anthony Watt, Jarmo Liukkonen and Timo Jaakkola

Background:

The study examined the effects of school-based program on students’ self-reported moderate to vigorous physical activity and physical competence, and associated links to gender, grade, body mass index, and physical education assessments.

Methods:

Participants were 240 middle school students (143 intervention, 97 control) from 3 small cities in North-East Finland. The intervention group received task-involving climate support in physical education classes and additional physical activities during school days across 1 year.

Results:

The intervention group’s physical competence increased, whereas the control group’s competence remained stable across the period. However, physical activity levels were stable in both groups. The findings also showed that body mass index was negatively associated with physical competence and activity in the intervention group at the follow-up measure. Physical education assessments were positively related with only the baseline scores of physical competence in the intervention group. In contrast, the assessments had positive relationships with physical competence and activity of control group students.

Conclusions:

The present program was an effective protocol to increase student’s perceptions of physical competence. Since the quantity of school physical education including recess activities cannot be dramatically increased, positive learning experiences should be provided, and thus, support perceptions of physical competence.

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

Background: Social network–driven approaches have promise for promoting physical activity in community settings. Yet, there have been few direct investigations of such interventions. This study tested the effectiveness of a social network–driven, group-based walking intervention in a medically underserved community. Methods: This study used a quasi-experimental pretest–posttest design with 3 measurement time points to examine the effectiveness of Sumter County on the Move! in communities in Sumter County, SC. A total of 293 individuals participated in 59 walking groups formed from existing social networks. Participants were 86% females, 67% black, and 31% white, with a mean age of 49.5 years. Measures included perceptions of the walking groups; psychosocial factors such as self-regulation, self-efficacy, and social support; and both self-reported and objectively measured physical activity. Results: The intervention produced significant increases in goal setting and social support for physical activity from multiple sources, and these intervention effects were sustained through the final measurement point 6 months after completion of the intervention. Nonetheless, few of the desired changes in physical activity were observed. Conclusion: Our mixed results underscore the importance of future research to better understand the dose and duration of intervention implementation required to effect and sustain behavior change.