Interpretation of Ecological Theory for Physical Activity with the Omaha System

Physical inactivity is a global health problem. Public health nurses (PHNs) have great potential to influence population health outcomes in this area. However, methods are needed to increase understanding of the problem and the impact PHNs may have on measuring and changing health behavior. One promising option is PHN documentation of client health data. However, literature examining how health behavior theories align with nursing documentation systems that use standardized terminology is sparse. The purpose of this article was to operationalize an ecological theory with the Omaha System standardized terminology using physical activity as an exemplar. The goal was to provide a method for using PHN clinical documentation to examine physical activity from a theoretical perspective in research and practice. We designed and used a three‐phase process informed by the literature to conceptually map the ecological model for health promotion and the Omaha System. The results of the mapping process reveal the ecological nature of the Omaha System and provide support for measuring and analyzing health‐related behavior problems from an ecological perspective with Omaha System data. This process could be replicated with other health‐related problems and standardized terminologies to guide theoretically based nursing care and research.     

Physical Activity in Low-Income Postpartum Women

PURPOSE: To validate the 7-day physical activity recall (PAR), including alternative PAR scoring algorithms, using pedometer readings with low-income postpartum women, and to describe physical activity patterns of a low-income population of postpartum women. METHODS: Forty-four women (13 African American, 19 Hispanic, and 12 White) from the Austin New Mothers Study (ANMS) were interviewed at 3 months postpartum. Data were scored alternatively according to the Blair (sitting treated as light activity) and Welk (sitting excluded from light activity and treated as rest) algorithms. Step counts based on 3 days of wearing pedometers served as the validation measure. FINDINGS: Using the Welk algorithm, PAR components significantly correlated with step counts were: minutes spent in light activity, total activity (sum of light to very hard activity), and energy expenditure. Minutes spent in sitting were negatively correlated with step counts. No PAR component activities derived with the Blair algorithm were significantly related to step counts. The largest amount of active time was spent in light activity: 384.4 minutes with the Welk algorithm. Mothers averaged fewer than 16 minutes per day in moderate or high intensity activity. Step counts measured by pedometers averaged 6,262 (SD = 2,712) per day. CONCLUSIONS: The findings indicate support for the validity of the PAR as a measure of physical activity with low-income postpartum mothers when scored according to the Welk algorithm. On average, low-income postpartum women in this study did not meet recommendations for amount of moderate or high intensity physical activity.     

Self-Silencing as a Predictor of Physical Activity Behavior

Self-silencing theory suggests that women ignore their own feelings and needs to attend to the desires of others. However, the impact of such self-silencing on physical activity behavior is unknown. This study examined the degree of self-silencing among a group of highly educated and relatively affluent African American women and the strength of self-silencing as a predictor of physical activity. The mean total self-silencing score for participants was 71.46. Overall, women reported spending approximately 193 min per week engaged in physical activity but only 36% met current recommendations for aerobic physical activity. Self-silencing did not predict physical activity behavior.     

Physical Activity and Exercise Adherence in People With Hematologic Malignancies

People with hematologic malignancies face serious physical and psychologic adverse health outcomes, such as fatigue and functional impairments, resulting from the underlying cancer, the cancer treatment, or both. Physical activity and exercise are widely recommended to address these concerns and optimize health during and after treatment. People with hematologic malignancies face critical health challenges, such as neutropenia and thrombocytopenia, which affect their ability to initiate or maintain a physical activity or exercise program; thus, adherence becomes problematic. This report discusses these health challenges and identifies potential strategies, such as removing barriers to exercise, to promote physical activity and exercise adherence.     

身体活动融入学校健康服务体系的国际政策架构与内容研究

目的 系统研究世界卫生组织(WHO)身体活动融入学校健康服务体系的相关政策架构与核心内容。方法 应用内容分析法和WHO健康服务体系理论,对WHO学校健康和身体活动相关领域的核心政策文件进行系统内容分析,构建身体活动融入学校健康服务体系的政策架构。WHO在学校健康领域核心政策文件包括《将每所学校建成健康促进学校的实施指南》《WHO关于学校健康服务指南》和《将每所学校建成健康促进学校的全球标准和指标》,在身体活动领域核心文件主要有《2018-2030年促进身体活动全球行动计划：加强身体活动,造就健康世界》《WHO关于身体活动和久坐行为的指南》(儿童青少年部分)。结果 身体活动作为一项健康战略和发展战略,是建设健康促进学校的重要手段之一。在健康和教育领域,建设健康促进学校的关键是关注儿童功能和发展,以促进学校健康包容性和公平性为目标。在学校环境中,将儿童青少年身体活动纳入以健康促进为主的学校健康服务连续体中。在宏观层面,国家和有关部门应建立身体活动融入学校健康服务体系的战略架构和战略规划;在中观层面,教育机构应依据WHO学校健康服务指南的要求来制定和改进学校健康服务政策和方案,完善学校健康服务手段。通过提供高质量体育课程和课后身体活动实现儿童青少年健康服务;在微观层面,以构建健康促进学校的全球标准为指导,将身体活动以课程和活动的形式,促进儿童青少年健康发展。将身体活动融入学校健康服务体系,需从学校健康领导力与治理、学校基础设施筹资、支持身体活动的学校健康服务提供、学校健康人力资源、学校健康相关医药技术以及学校健康信息系统六个领域入手,实施健康促进学校政策行动、加强多层级的学校领导力与治理,筹措必要资金,开发适应健康促进学校建设的人力资源并建设支持身体活动的方案。结论 学校健康服务是促进儿童健康与实现联合国可持续发展目标的重要领域,身体活动是学校健康服务的重要内容。WHO颁布的相关核心政策文件,构建了身体活动融入学校健康服务体系的政策架构,其核心内容是要通过教育和体育手段将身体活动融入健康促进学校健康服务体系中,构建健康促进学校服务体系,促进儿童青少年健康发展。根据WHO健康服务体系构成六要素,身体活动融入学校健康服务体系需要加强学校健康领导力与治理、完善学校基础设施筹资,发展学校健康人力资源,研发基于学校的健康相关医药技术,建立共享学生健康数据的健康信息系统。     

College Students’ Experiences and Attitudes Toward Physical Activity Counseling

College students’ experiences and attitudes toward physical activity counseling (PAC) from health care professionals were examined using an online survey. Few students had received PAC from health care professionals in the past 24 months. Most reported receiving useful information that they used, but few were referred to health and fitness professionals. Thus, there is considerable room for improvement with respect to the quality and quantity of PAC provided to students. Nurse practitioners, who are often the first health care professional with whom students interact, hold great potential to address this need.     

Perceptions of Barriers and Benefits to Physical Activity Among Outpatients in Psychiatric Rehabilitation

PURPOSE: To explore perceived barriers and benefits to physical activity in people with serious and persistent mental illness (SPMI) who were enrolled in community-based psychiatric rehabilitation. DESIGN AND METHODS: Four focus groups, two for men and two for women, were held with a total of 34 outpatients from two program sites. The investigators used a semistructured interview guide to facilitate the discussions. Audiotapes of the discussions were transcribed and analyzed for concepts and themes. FINDINGS: Significant barriers to physical activity were: mental illness symptoms, medications, weight gain from medications, fear of discrimination, and safety concerns. Being in a psychiatric rehabilitation program offered comfort and belonging, but it also had the effect of leaving activity initiation up to the program staff, which some participants perceived was part of required program compliance. However, participants viewed physical activity positively, and they linked being active to improved mental health. CONCLUSIONS: Outpatients in psychiatric rehabilitation valued physical activity, but mental illness symptoms, medication sedation, weight gain, fear of unsafe conditions, fear of discrimination, and interpretations of program compliance were barriers. Confronting how attitudes and barriers specific to this population can affect activity and reframing program compliance to include the independent initiation of activity as part of improving health might help clients of mental health services to become more active.     

Promoting Physical Activity and Exercise in Patients With Asthma and Chronic Obstructive Pulmonary Disease

Chronic lower respiratory diseases, including asthma and chronic obstructive pulmonary disease, are a significant public health burden owing to their high incidence and prevalence. Nurse practitioners in primary care routinely see patients with these diagnoses. Although inhaled pharmacotherapy is the mainstay of treatment for individuals with these diseases, providing an overall approach to health and wellness, which includes physical activity and exercise, is imperative in optimizing patient outcomes. The purpose of this article is to provide nurse practitioners in primary care with foundational information regarding the promotion of physical activity and exercise for patients with asthma and chronic obstructive pulmonary disease.     

世界卫生组织身体活动政策和指南的架构与核心内容研究

目的 研究分析身体活动政策和身体活动指南的理论、政策架构以及核心内容。 方法 运用政策研究和内容分析的方法以及世界卫生组织(WHO)健康服务体系六大构成要素的理论,具体分析WHO身体活动全球行动计划和WHO身体活动指南的理论、架构和核心内容。结果 《2018-2030年促进身体活动全球行动计划：加强身体活动,造就健康世界》(简称《行动计划》)是WHO颁布的有关身体活动的国际政策文件,该政策文件遵循以人权、全生命周期、循证实践、比例普遍性、政策协调性和将健康融入所有政策、参与和赋权、建立多部门伙伴关系的7个原则,将身体活动纳入健康服务和社会发展的范畴。《行动计划》由4项战略目标和20项政策行动构成,涉及WHO健康服务体系六个领域,身体活动政策融入健康服务,对于促进实现联合国可持续发展目标三健康全覆盖有着十分重要的意义。2020年《WHO关于身体活动和久坐行为的指南》(简称《指南》)作为贯彻落实《行动计划》的技术文件,采用PI/ECO方法架构,分析了各类人群的身体活动需求,针对儿童与青少年、成年人、老年人, 特殊人群孕妇和产后妇女、慢病患者和残疾人士等,提出了增加身体活动和减少久坐行为的活动指南,内容涉及身体活动的持续时间、频率、强度、身体活动类型、身体活动的关键和重要的健康结果,以及预防健康风险和相关的注意事项。《指南》贯彻落实《行动计划》的相关指导原则,旨在从微观层面提升整体人群参与身体活动程度,改善提高整体人群关键和重要的健康结果。结论 作为一项健康战略和发展战略,《行动计划》倡导将身体活动纳入健康服务体系,促进实现联合国2030可持续发展目标三全民健康覆盖。根据WHO健康服务体系六大构成要素,即领导力和治理、筹资、人力资源、服务提供、医药技术、健康信息,可以将《行动计划》4项战略目标和20项政策行动纳入上述六个领域。《指南》作为贯彻落实 《行动计划》的技术文件,基于PI/ECO方法架构,针对儿童与青少年、成年人、老年人、孕妇和产后妇女、慢病人群、残疾人等人群提供增加身体活动与减少久坐行为的指南建议。核心内容涉及针对的人群、身体活动的持续时间、频率、强度、身体活动类型、身体活动的关键和重要的健康结果,以及预防健康风险和相关的注意事项。     

Using Fitness Trackers in Clinical Research: What Nurse Practitioners Need to Know

Consumer-based wearable fitness trackers present a new array of opportunities and challenges to nurse practitioners engaged in health promotion research. Key advantages include the ability to provide continuous, objective, remote monitoring of physical activity and the potential to improve the efficacy of physical activity interventions. This article provides an overview of fitness trackers, including their functions and accuracy, and addresses the following key issues to consider before using trackers in research: 1) when to use a fitness tracker, 2) choosing a brand and model, 3) encouraging good compliance, and 4) extracting and using the data.     

Technology and Human Connection to Prevent Diabetes in Rural United States

This quality improvement pilot project implemented a diabetes prevention program using physical activity trackers and human connection to increase physical activity (PA) and reduce the risk of diabetes among adults with prediabetes from a rural primary care clinic. The outcomes included PA steps, PA minutes, the achievement of self-established PA goals, hemoglobin A1C level, weight, and body mass index. During the 3 months of the project, PA steps significantly increased, and most participants reached self-established PA goals. Overall, the program outcomes were positive. Participants and health care team members reported additional benefits and drawbacks to the project, confirming the study’s feasibility.