Stage of exercise and health-related quality of life among overweight and obese adults

AIM: This paper reports a study whose main aim was to understand the correlation between stages of exercise and health-related qualities of life among overweight and obese adults in Taiwan. BACKGROUND: Regular exercise has been shown to improve health-related quality of life in the general population and among patients with chronic diseases. Nevertheless, systematic investigations of the correlation between exercise stages and the health-related quality of life among overweight and obese adults are lacking in Taiwan. METHOD: A cross-section of people from the weight loss clinics of a medical centre in Taipei was recruited to the study. The Chinese version of the Stages of Exercise and the Taiwanese version of Short Form 36 questionnaires were used to collect data from those whose body mass indexes were equal to or >24 kg/m2. The data were collected in 2003. RESULTS: In total, 212 overweight and obese adults participated in the study. The majority were in the preparation (38.2%) or contemplation (31.6%) stages of exercise; relatively few were in the action (14.2%) or maintenance (11.3%) stages, and the smallest number (4.7%) were in the precontemplation stage. Although over 70% of respondents were not in the habit of taking regular exercise, their motivations were very high. For the Short Form 36 scales, the highest scores were for physical functioning (84.5 +/- 17.3), while the lowest were for general health (55.5 +/- 20.9), vitality (59.8 +/- 18.1), and mental health (MH) (66.0 +/- 17.9). Different stages of exercise showed statistically significant differences within the eight domains of Short Form 36 (Wilks = 0.733, P = 0.001); a statistically significant difference was also found for physical functioning (P < or = 0.001), general health (P = 0.003), and vitality (P = 0.005). CONCLUSION: Since stages of exercise are correlated with health-related quality of life among overweight and obese adults, healthcare providers need to understand what stages people are at in order to educate them to achieve a better quality of life and to motivate those who are inactive to do more exercise on a regular basis.     

Resilience and successful aging. Comparison among low and high income older adults

1 Resilience, a personality characteristic that moderates the negative effects of stress and promotes adaptation, has been associated with better health in prior studies. 2 Successful aging can be defined as the enjoyment of health and vigor of the mind, body, and spirit into middle age and beyond. 3 Individuals with lower incomes may be less likely to achieve successful aging because of a higher prevalence of health risk factors. 4 Resilience appears to be positively and significantly associated with indicators of successful aging regardless of income.     

The feasibility and acceptability of a diet and exercise trial in overweight and obese black breast cancer survivors: The Stepping STONE study

PurposeBlack breast cancer survivors have high rates of obesity and low physical activity levels. Little is known about the acceptability and feasibility of interventions in this population.ObjectiveA two-arm RCT was launched to assess the efficacy of a culturally targeted 12-week multimodal lifestyle intervention in overweight and obese black survivors.MethodsIntervention components included nutrition education, exercise groups, and survivor-led motivational interviewing phone sessions. The analytic sample included women who completed the trial (intervention n = 10; control n = 12). Anthropometric measures, physical activity, and VO_2max were assessed at baseline and follow-up. Change scores (intervention vs. control) were assessed with Wilcoxon rank-sum tests. A process evaluation assessed intervention acceptability.ResultsOverall adherence was 70% and overall satisfaction was high (86%). Despite the 5% weight loss target, the intervention group lost 0.8% but BMI improved. Total physical activity levels increased in the intervention vs. control arm (+ 3501 MET min/week vs. + 965 MET min/week, respectively). VO_2max improved in the intervention group (+ 0.10 ± 1.03 kg/L/min). Intervention participants reduced energy intake (− 207.3 ± 31.5 kcals) and showed improvements in fat intake (− 15.5 ± 3.8 g), fiber (+ 3.2 ± 1.2 g) and % energy from fat (− 4.8 ± 3.1%). Survivors suggested providing diet/exercise information within a cancer context.ConclusionsGroup and individualized intervention strategies are acceptable to black survivors. Observed differences between self-report and objective outcomes may suggest reporting bias or changes in body composition. Increasing supervised intervention components and assessment of body composition will be important for future trials.     

Social incentives to encourage physical activity and understand predictors (STEP UP): Design and rationale of a randomized trial among overweight and obese adults across the United States

BackgroundLess than half of adults in the United States (US) obtain the recommended level of physical activity. Social incentives, the influences that impact individuals to adjust their behaviors based on social ties or connections, are ubiquitous and could be leveraged within gamification interventions to provide a scalable, low-cost approach to increase engagement. Gamification, or the use of game design in non-game situations, is commonly used in the real world, but in most cases has not appropriately leveraged principles from theories of health behavior.MethodsWe are conducting a four-arm, randomized, controlled trial of 602 overweight and obese adults to evaluate the effectiveness of gamification interventions that leverage insights from behavioral economics to enhance either supportive, competitive, or collaborative social incentives. Daily step counts are monitored using wearable devices that transmit data to the study platform. Participants established a baseline step count, selected a step goal increase, and then were randomly assigned to control or one of three interventions for a 24-week intervention and 12-week follow-up period. To understand predictors of strong or poor performance, we had participants complete validated questionnaires on a range of areas including their personality, risk preferences, social network, and habits relating to physical activity, eating, and sleep. Trial enrollment was conducted in partnership with Deloitte Consulting and included employees from 40 states across the US.ConclusionThe STEP UP Trial represents a scalable model and interventions found to be effective could be deployed more broadly to increase physical activity.Trial registrationClinicaltrials.gov Identifier: NCT03311230     

Perceptions of older Latino adults regarding physical fitness, physical activity, and exercise

Healthy People 2000 has identified the importance of physical activity for healthy aging, but little is known about what motivates older individuals, older Latino adults, in particular, to be physically active. The purpose of this research was to examine the perceptions of older Latino adults toward physical fitness, physical activity, and exercise. This study used a qualitative focus group design. The sample of Latino adults age 60 and older resided in Northeast Massachusetts and was recruited from community settings which serve older Latino adults. Three focus groups, consisting of four to eight individuals in each group, were conducted and audiotaped. Data analysis used a combination of open, axial, and selective coding procedures. Focus group participants viewed physical fitness as being able to do anything; the mind and body working together; and feeling "light," being healthy. Support was viewed as a motivator of physical activity and exercise and included community resources, group support, cultural unity, and health provider assistance Barriers of fear and a feeling of inappropriateness were identified by focus group participants. Although the study was exploratory and the sample size small, it provides useful cultural knowledge and information for community health and gerontological nurses. Knowledge about older Latino adults' perceptions of motivators and barriers to physical activity and exercise is a necessary first step for nurses to prescribe activities that will help improve functional independence and quality of life. Nurses can serve as links for older Latino adults in accessing community resources. Sociocultural factors that influence Latino adult perceptions must be assessed if health promotion program planning is to be tailored to meet individual and group needs.     

A tailored program for the promotion of physical exercise among Korean adults with chronic diseases.

This study evaluated the effect of a tailored stage-matched intervention designed to increase exercise among Korean adults with chronic diseases. A physician and a nurse collaborated to deliver the intervention to 21 patients; the control group (CG) consisted of 20 patients. A nonequivalent CG pretest-posttest design was used. On follow-up, commitment to a plan for exercise was significantly greater in the intervention group (IG) than in the CG. Furthermore, the proportion of the IG in the active stage was significantly increased compared to that of the CG. The results suggest the potential of a stage-matched intervention program for increasing commitment to physical activity and for promoting progress through stages of exercise among patients with chronic diseases in a physician-based Korean clinic.     

A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS)

Background

Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population.

Objectives

STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods.

Design

A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes.

Methods

Participants 25–50 years who had a BMI ≥ 25 kg/m² and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment.

Results

Participants (N = 155; n = 80 intervention, n = 75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m² and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants.

Summary

STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.     

Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: A randomized controlled pilot trial

Hospitalization induces functional decline in older adults. Many geriatric patients fail to fully recover physical function after hospitalization, which increases the risk of frailty, disability, dependence, re-hospitalization, and mortality. There is a lack of evidence-based therapies that can be implemented following hospitalization to accelerate functional improvements. The aims of this Phase I clinical trial are to determine 1) the effect size and variability of targeted interventions in accelerating functional recovery from hospitalization and 2) the feasibility of implementing such interventions in community-dwelling older adults. Older patients (≥ 65 years, n = 100) will be recruited from a single site during hospitalization for an acute medical condition. Subjects will be randomized to one of five interventions initiated immediately upon discharge: 1. protein supplementation, 2. in-home rehabilitation plus placebo supplementation, 3. in-home rehabilitation plus protein supplementation, 4. single testosterone injection, or 5. isocaloric placebo supplementation. Testing will occur during hospitalization (baseline) and at 1 and 4 weeks post-discharge. Each testing session will include measures of muscle strength, physical function/performance, body composition, and psychological function. Physical activity levels will be continuously monitored throughout study participation. Feasibility will be determined through collection of the number of eligible, contacted, and enrolled patients; intervention adherence and compliance; and reasons for declining enrollment and study withdrawal. This research will determine the feasibility of post-hospitalization strategies to improve physical function in older adults. These results will also provide a foundation for performing larger, multi-site clinical trials to improve physical function and reduce readmissions in geriatric patents.     

Using the Theory of Planned Behaviour to predict exercise intention in obese adults.

The purpose of this cross-sectional study was to use Ajzen's Theory of Planned Behaviour (TPB) as a theoretical framework for understanding the intention to be physically active among a group of obese individuals. Individuals (n = 96) classified as obese (BMI > or = 30 kg/m2) completed a self-administered questionnaire assessing intention to be physically active and its theoretically related variables. The TPB explained 66% of the variance in physical activity intentions. Significant independent predictors of intention were perceived behavioural control (beta = .40) and attitude (beta = .36). The consideration of past behaviour (beta = .32) explained an additional 7% of the variance. These findings support the idea that, in designing interventions for obese individuals, nurses should focus on developing skills to overcome barriers to physical activity and on developing a positive attitude towards this behaviour.     

Prepare,a randomized trial to promote and evaluate weight loss among overweight and obese women planning pregnancy: Study design and rationale

BackgroundWomen who are overweight or have obesity at pregnancy onset, and those who gain excessive weight during pregnancy, are at increased risk of pregnancy-related complications and large for gestational age infants.ObjectiveThis report describes methodology for the Prepare study, a randomized, controlled clinical trial testing a preconception and pregnancy weight management program for women who are overweight or have obesity (BMI ≥ 27 kg/m²).OutcomesThis trial examines multiple pregnancy and neonatal outcomes, with the primary outcome being gestational weight gain (GWG). Secondary outcomes include change in weight before conception, offspring birth weight adjusted for gestational age, offspring weight for length, and pregnancy diet quality and physical activity level.MethodsNonpregnant women who anticipate becoming pregnant in the next 2 years are randomly assigned to an intervention program or a usual care control condition. Intervention participants receive weight management counseling by telephone before and during pregnancy, with weekly contacts during the first 6 months and monthly contacts for the next 18 months. Intervention participants also have unlimited access to a study website that provides self-management tools. All participants who become pregnant are contacted at 20 weeks' gestation to assess physical activity levels and dietary habits. All other outcome data are obtained from medical records. Intervention satisfaction is assessed via questionnaire.SummaryThis clinical trial tests the efficacy of an intervention program designed to help overweight and obese women achieve healthy lifestyle changes that will result in a healthy weight prior to pregnancy and appropriate weight gain during pregnancy.