CE: The obesity epidemic, part 2: nursing assessment and intervention.

Although there are many gaps in our understanding of the mechanisms underlying obesity, several nursing strategies have proven effective in combating this public health crisis. This article, the second in a two-part series, presents a theoretical framework to guide nursing assessment of affected patients and their families, thereby informing intervention. The authors discuss the effects of stigma and bias on the treatment of obesity; how to conduct a thorough assessment of an obese patient; the effectiveness of the most common lifestyle, pharmacologic, and surgical interventions for obesity; and issues to consider in the treatment of obese children. Part 1, which appeared in last month's issue, provided background on the epidemic; defined terms used in obesity treatment; and described pathophysiologic, psychological, and social factors that influence weight control.

CE: The obesity epidemic, part 1: understanding the origins.

OVERVIEW: The obesity epidemic remains a significant health problem in the United States and worldwide, with multiple associated physical and societal costs. To contribute to obesity's treatment and prevention, nurses must be conversant in a wide range of theoretical and clinical perspectives on the problem. This article, the first in a two-part series, defines the terms used in the treatment of obesity and outlines pathophysiologic, psychological, and social factors that influence weight control. Part 2, which will appear in next month's issue, presents a theoretical framework that can be used to guide nursing assessment of both patient and family, thereby informing intervention.

Physical activity counseling intervention to promote weight loss in overweight rural women.

PURPOSE: To identify key behavioral factors that contribute to physical activity and weight management in overweight, rural women and determine the degree to which social support, stage of behavior change, and self-efficacy for physical activity and depressive symptoms are linked to physical activity, body weight, and body mass index (BMI). DATA SOURCES: Twenty-five overweight or obese rural women completed self-report scales and height and weight measurements; BMI was calculated. Self-report scales included the International Physical Activity Questionnaire (physical activity level), Social Support for Exercise and Social Support Questionnaire (social support), Stage of Exercise Adoption (stage of behavior change), Self-efficacy for Exercise (self-efficacy), and the Patient Health Questionnaire (depressive symptoms). CONCLUSIONS: Higher levels of physical activity were associated with greater self-efficacy and the self-esteem domain of social support. Rural women reported more depressive symptoms over the year. Women did not significantly increase physical activity and gained weight during the 1-year study. IMPLICATIONS FOR PRACTICE: Rural women have limited resources available to increase physical activity to facilitate weight loss. Routine screening and treatment for depression in rural women may need to be initiated concurrently with interventions to promote health behavior changes.

Choose to Move for Positive Living: physical activity program for obese women.

The Choose to Move for + (Positive) Living program was implemented to increase physical activity among obese women. A holistic approach was used to promote stage of health behavior change, social support, and quality of life and reduce depression. Within 6 months, physical fitness improved and depressive symptoms decreased.

One theoretical framework for cardiovascular disease prevention in women.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for women in the United States. Vulnerable and underserved women are even less likely to participate in healthy lifestyle behaviors to prevent CVD than the general US population. Many women are not aware that they are at risk for CVD and do not modify unhealthy lifestyle behaviors to reduce their risks for CVD. Healthcare providers may not promote awareness of CVD or consistently counsel female patients concerning lifestyle behavior modifications to reduce their risks for CVD. "The Evidence-Based Guidelines for the Prevention of Cardiovascular Disease in Women 2011 Update: A Guideline From the American Heart Association" provides a guide for healthcare providers to help women lower their risk for heart disease. By using a theoretical approach, nurses can facilitate implementation of these evidence-based guidelines to help women reduce their risks for CVD. Commonly used intrapersonal, interpersonal, and organizational- and community-level health behavior change theories that can be used to effectively promote CVD risk reduction in women will be discussed. The theoretical basis for changing CVD risk behaviors in women can be applied by using the PRECEDE-PROCEED Model to guide planning, implementing, and evaluating health behavior programs. The purpose of this article was to help nurses improve healthcare delivery by using the PRECEDE-PROCEED Model as a theoretical framework to guide CVD risk reduction efforts for women.

Evaluation of the Heart and Soul Physical Activity Program by African American women.

The purpose of this study was to determine the perceptions of African American (AA) women regarding an active lifestyle, and to evaluate the Heart and Soul Physical Activity Program (HSPAP) as a potential strategy to promote physical activity. The HSPAP is a church-based physical activity intervention conceptualized in appraisal, belonging, tangible and self-esteem domains of social support. Seven midlife, sedentary AA women from a Midwestern urban church participated in the group discussion after completing the HSPAP. Guiding questions were utilized to solicit their attitudes about physical activity and the HSPAP. The study participants believed that physical activity improves health and prevents chronic diseases however, their primary responsibility is to family and jobs, leaving little time or energy for their personal health needs. They further believed that physical activity would increase if recommended by health professionals and encouraged by family, friends, and church members; and, that spiritual messages and prayer would strengthen their commitment to attain an active lifestyle.

The uptake of Human Papillomavirus (HPV) vaccine among adolescent females in the United States: a review of the literature.

A comprehensive review of literature was conducted to identify the barriers and facilitators, from the parents'/guardians' and primary care providers' (PCPs) perspective, that are associated with the uptake of Human Papillomavirus (HPV) vaccine among adolescent females. Findings from 14 peer-reviewed articles indicate that 37% of adolescent females, 9 to 17 years of age, initiated the HPV vaccine, compared to the national average of 13- to 15-years-olds, which is 50%. The overall uptake and completion rates of the vaccine were low across all racial and ethnic groups. Barriers included parents'/guardians' knowledge, perceptions, and attitudes toward the HPV disease and the vaccine, along with the convenience in receiving the vaccine. Six studies reported that HPV vaccine initiation was highly likely if the parents/guardians had received a doctor's recommendation. Learning what interventions school nurses currently utilize could positively affect the HPV vaccine uptake and completion rates by other nursing disciplines realizing this ongoing effort.

Minimize urinary incontinence: maximize physical activity in women.

Urinary incontinence (UI) is a common problem for women. Many women do not seek professional help for UI because of embarrassment or they believe UI is a normal part of aging. Research findings have shown that pelvic floor muscle strengthening is effective in reducing UI in middle-aged and older women. Women engaging in regular, moderately intense physical activity have a lower incidence of UI than sedentary women. Health care providers have a responsibility to facilitate an active lifestyle in their patients and teach the proper techniques to perform effective pelvic floor exercises. With health behavior changes, including moderately intense physical activity, use of pelvic floor strengthening exercises and weight management, as well as avoidance of constipation, women can reduce the incidence of UI.

Heart and soul physical activity program: social support outcomes.

OBJECTIVE: To examine changes in specific social support domains following the Heart and Soul Physical Activity Program (HSPAP). METHODS: This experimental repeated-measures nested-design study tested the church-based HSPAP, a social support intervention to promote physical activity in women. RESULTS: HSPAP participants revealed greater increases in perceived appraisal and esteem support, received tangible support and in the number of physical activity supporters than did the comparison group. HSPAP participants had a borderline significant increase in received appraisal support. CONCLUSION: As conceptualized, the HSPAP intervention enhanced several domains of social support and the number of physical activity supporters in midlife women.

Get moving! Physical activity counseling in primary care.

PURPOSE: The purpose of this article is to present strategies to improve the effectiveness of physical activity counseling for adults in primary care settings. Adoption of physical activity can be part of a healthy lifestyle to prevent or manage many chronic and debilitating conditions, including cardiovascular disease, diabetes, hypertension, and obesity. DATA SOURCES: Original research articles reporting results from descriptive studies and clinical trials testing the effectiveness of physical activity counseling in primary care. Journal articles and Web sites are cited as patient and professional resources. CONCLUSIONS: Despite conflicting research findings on the effectiveness of physical activity counseling in primary care, the importance of an active lifestyle in promoting health and well-being is well known. Yet, only one third of all Americans attain adequate daily physical activity. Implementing physical activity counseling in primary care is one method to promote active lifestyles. Some strategies to promote physical activity counseling in primary care settings are identified, including use of the Five A's approach and printed materials. Suggestions to manage the barriers primary care providers experience with physical activity counseling include brief counseling sessions involving all members of the health team. IMPLICATIONS FOR PRACTICE: The implementation of a brief physical activity counseling intervention in primary care settings is presented as a promising method to promote physical activity in adults. Nurse practitioners can deliver this counseling in a succinct, well-planned session to promote physical activity and reduce the potential devastating consequences associated with a sedentary lifestyle.

Effects of a physical activity intervention for women.

Physical activity is associated with health and reduced mortality risk, yet only 15% of U.S. adults achieve adequate activity. This study is an experimental repeated measures nested design randomizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program (HSPAP) (Peterson, 2002) in promoting physical activity in midlife women (n=42) aged 35 to 65 years. The HSPAP, an innovative church-based health promotion intervention, is conceptualized in social support and designed to increase physical activity, energy expenditure (EE), and cardiorespiratory fitness (VO2 max), measured over time. A significant interaction (p<.001) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week. HSPAP participants increased their VO2 max level by 75% (p<.001) and 10%; comparison groups stayed the same or declined 16%. Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary, rural, midlife women.