Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults.

BACKGROUND: Despite well-known benefits of physical activity for older adults, about two thirds are underactive. Community-based programs are needed to facilitate increased physical activity. We examine the effectiveness of CHAMPS II, an inclusive, choice-based physical activity promotion program to increase lifetime physical activity levels of seniors. CHAMPS guided participants to choose activities that took into account their health, preferences, and abilities. It offered information on ways for them to exercise safely, motivate themselves, overcome barriers, and develop a balanced exercise regimen. METHODS: A 1-year randomized controlled trial was conducted with physically underactive seniors in a multispecialty group practice. Changes in self-reported physical activity by group were evaluated using ANCOVA, controlling for age and sex. RESULTS: Of 173 randomized subjects, 164 (95%) completed the trial. Subjects were aged 65 to 90 years (M = 74, SD = 6); 66% were female. The intervention group increased estimated caloric expenditure by 487 calories/week in moderate (or greater) intensity activities (MET >/= 3.0; p <.001) and by 687 calories/week in physical activities of any intensity (p <.001). Control group changes were negligible. Between-group analyses found that the changes were significantly different in both measures (p values <.05). Overweight persons especially benefited from this program. The program was as effective for women, older adults (75+), and those who did not set aside time to exercise at baseline. CONCLUSIONS: The program led to meaningful physical activity increases. Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community settings.

CHAMPS physical activity questionnaire for older adults: outcomes for interventions.

PURPOSE: To evaluate effectively interventions to increase physical activity among older persons, reliable and valid measures of physical activity are required that can also detect the expected types of physical activity changes in this population. This paper describes a self-report physical activity questionnaire for older men and women, developed to evaluate the outcomes of the Community Healthy Activities Model Program for Seniors (CHAMPS), an intervention to increase physical activity. METHODS: The questionnaire assesses weekly frequency and duration of various physical activities typically undertaken by older adults. We estimated caloric expenditure/wk expended in physical activity and created a summary frequency/wk measure. We calculated measures of each of these for: 1) activities of at least moderate intensity (MET value >/= 3.0); and 2) all specified physical activities, including those of light intensity. Six-month stability was estimated on participants not likely to change (assessment-only control group, physically active cohort). Several tests of construct validity were conducted, and sensitivity to change was analyzed based on response to the CHAMPS intervention. RESULTS: The sample (N = 249) comprised underactive persons (N = 173 from the CHAMPS trial) and active persons (N = 76). The sample was aged 65-90 yr (mean = 74, SD = 6); 64% were women, and 9% were minorities. Six-month stability ranged from 0.58 to 0.67, using intraclass correlation coefficients. Nearly all construct validity hypotheses were confirmed, though correlations were modest. All measures were sensitive to change (P < or = 0.01), with small to moderate effect sizes (0.38-0.64). CONCLUSIONS: The CHAMPS measure may be useful for evaluating the effectiveness of programs aimed at increasing levels of physical activity in older adults.

Household appliance use and residential exposure to 60-hz magnetic fields.

We characterized the distribution of exposure to magnetic fields (MFs) during daily activities and during household appliance use, and estimated the relative contribution of various activities and appliances to total daily exposure. One hundred sixty-two subjects provided information on their patterns of appliance use and wore personal monitors for 24 h to collect MF exposure data. Of total exposure, 27% accumulated while subjects were in bed; 41% while at home but not in bed; 9% at work; and 24% elsewhere. Less than 2% of the total MF exposure accumulated during the use of each of the eight individual appliances considered, except computers, during the use of which 9% of the total exposure accumulated. Of the time subjects spent at exposure levels higher than 2 microT, 8% accumulated while they were using microwave ovens, and 4% and 3% while using computers and electric stoves, respectively. Mean MF measurements tended to be lowest when subjects were in bed and highest at work and during the use of microwave ovens, coffee grinders, hair dryers, and electric shavers. Results from questionnaires on household appliance use in the past year were not useful in predicting the total mean exposure level and over-threshold exposures measured by 24-h personal monitors. Significant MF exposure accumulates at home, at work, and elsewhere; therefore, accurate exposure assessment needs to consider residential, occupational, and other sources together. Questionnaire-based information on appliance use has limited value in the assessment of average and over-threshold exposure to MFs.

Reliability of proxy-reported and self-reported household appliance use.

Exposure assessment presents a major challenge for studies evaluating the association between household exposure to electric and magnetic fields and adverse health outcomes, especially the reliance on proxy respondents when study subjects themselves have died. We evaluated the reliability of proxy- and self-reported household appliance exposure. We recruited 92 healthy couples through either random-digit dialing or newspaper advertisements. Trained interviewers administered questionnaires to each member of a couple independently to assess the reliability of proxy-reported household appliance use. Eighty-five couples completed a second interview 2 months later to assess the reliability of self-reported appliance use. Reliability of proxy-reported appliance exposure was good when we inquired about having any exposure to each of the eight indicator appliances during the past year (range of kappa coefficients = 0.63-0.85; median = 0.76) but was lower with increased time to recall or increased detail. Reliability of self respondents reporting 2 months apart was excellent (range of kappa coefficients = 0.75-0.94; median = 0.87) for having any exposure to the eight indicator appliances during the past year, but reliability was again lower with increased detail. When we used self reports at the first interview as the standard, little systematic over- or underreporting occurred for proxy respondents or for self respondents reporting 2 months later. Because this study did not include cases of specific disease, these findings of no systematic differences in reporting do not refer to case or control status. In summary, reliability of self respondents' reports of appliance use is very good for recent time periods and good for broad aspects of exposure in distant time periods. Proxy respondents can provide information regarding broad aspects of appliance exposure in the past year, but detailed aspects of exposure or exposure in more distant time periods is not reliable.

Possible drug-associated pancreatitis after paclitaxel-cremophor administration.

Paclitaxel, a relatively new antineoplastic agent, is associated with numerous side effects, including two reported cases of pancreatitis. Our patient also developed paclitaxel-associated pancreatitis. Several companion drugs, including steroids, diphenhydramine, histamine2 blockers, serotonin type 3 antagonists, and other chemotherapeutic agents administered with paclitaxel, must be considered as possible causes of pancreatitis. In addition, paclitaxel is a hydrophobic agent that requires a vehicle, cremophor (CrEL), for solubility. Intravenous cyclosporine also requires CrEL and has been associated with pancreatitis. In the cerulein-induced pancreatitis rat model, paclitaxel with dimethyl sulfoxide as a vehicle prevents pancreatitis, suggesting that another causal agent is responsible. Animal studies of CrEL as a single agent may be required to settle this question, but for now, awareness that paclitaxel may be associated with pancreatitis may lead to earlier treatment of this potentially fatal complication.

Prevalence and correlates of physician recommendations to exercise among older adults.

BACKGROUND: This study explored the prevalence of and factors associated with physician suggestions to exercise in a sample of older adults. METHODS: We conducted telephone interviews of a random sample of members of two Medicare health maintenance organizations (HMOs) in Northern California. Participants were 893 community-dwelling older adults of whom 63% were women, 52% were married, and 12% were in a minority group. Mean years of education was 14.8 +/- (2.6) and mean years of age was 74.9 +/- (6.5). The associations between patient self-reports of ever receiving physician recommendations to exercise and the following categories of variables were assessed: demographics, health-related quality of life, medical conditions, health/risk behaviors, and health knowledge/interest/satisfaction. RESULTS: The prevalence of older adults in this study ever receiving a physician suggestion to exercise was 48.2%. In a multivariate logistic regression model, being younger, sedentary, and having a higher body mass index were independently (p < or = .05) and positively associated with increased reports of having ever received a physician's advice to exercise. Those who were precontemplators (not thinking about changing physical activity behavior), and those who reported greater frequency of endurance exercise were less likely to report receiving a physician recommendation to exercise (p < or = .05). CONCLUSIONS: Although physician advice appeared to be targeted to subgroups that could benefit, physician advice on exercise could be particularly increased for patients over 75 years of age, those currently not thinking about an increase in physical activity, and those currently active patients who may benefit from ongoing physician advice to promote maintenance.

Approximate entropy and point correlation dimension of heart rate variability in healthy subjects.

The contribution of nonlinear dynamics to heart rate variability in healthy humans was examined using surrogate data analysis. Several measures of heart rate variability were used and compared. Heart rates were recorded for three hours and original data sets of 8192 R-R intervals created. For each original data set (n = 34), three surrogate data sets were made by shuffling the order of the R-R intervals while retaining their linear correlations. The difference in heart rate variability between the original and surrogate data sets reflects the amount of nonlinear structure in the original data set. Heart rate variability was analyzed by two different nonlinear methods, point correlation dimension and approximate entropy. Nonlinearity, though under 10 percent, could be detected with both types of heart rate variability measures. More importantly, not only were the correlations between these measures and the standard deviation of the R-R intervals weak, the correlation among the nonlinear measures themselves was also weak (generally less than 0.6). This suggests that in addition to standard linear measures of heart rate variability, the use of multiple nonlinear measures of heart rate variability might be useful in monitoring heart rate dynamics.

Evaluation of CHAMPS, a physical activity promotion program for older adults.

We evaluated physical activity changes resulting from a six-month public health model intervention that encouraged seniors (N = 89) 62-91 years of age (mean = 76) living in two low-income congregate housing facilities to increase their physical activity by participating in existing community-based physical activity classes and programs of their choice. The program was offered to everyone regardless of their health problems. Enrollees were encouraged to adopt activities tailored to their preferences, physical abilities, health status, income, and transportation resources. Using a comparison-group design, the intervention group was more active for all comparison months of the intervention period (p values < .05). The intervention also was associated with improvements in self-esteem (p < .05), though not with an array of other measures of health-related quality-of-life. Those who adopted and maintained a new physical activity over the six-month intervention period experienced improvements in anxiety, depression, and overall psychological well-being relative to those who did not. The intervention was subsequently replicated through a senior center (N = 22). A much larger proportion of the senior center sample adopted and maintained a new activity for six months (68%) compared to the congregate facilities sample (35%), which may have been due to differences in recruitment methods and sample characteristics in the two settings. An intervention promoting increased physical activity through the use of existing community resources may help increase physical activity in older adults.

Factors associated with enrollment of older adults into a physical activity promotion program.

This article investigates the extent to which a proactive two-phased recruitment approach resulted in recruitment of a representative sample of older adults from two lower income congregate housing facilities into a physical activity promotion program. Enrollees were similar to nonenrollees with respect to education, gender, marital status, race/ethnicity, self-rated health, physical functioning, psychological distress, exercise frequency, level of social contact, having a confidant, use of alcohol, and smoking status. However, enrollees were younger, more likely to speak English as a primary language, less likely to be completely sedentary, and more likely to be overweight. Overall, 21% of the target population were recruited into the program. Recruitment strategies such as those used in this study appeared to enable enrollment of a reasonably representative sample of a small well-defined population.