Physical Activity Among Rural Men: Barriers and Preferences.

INTRODUCTION: Physical activity positively affects health. Although 94% of Americans know the health benefits of regular physical activity, more than 75% do not achieve recommended levels. The objective of our study was to identify and define the key components of a physical activity intervention tailored to rural American men. METHODS: We recruited rural men (N = 447) via Amazon's Mechanical Turk online platform to complete a needs assessment survey focused on their interest in a physical activity intervention, preferred intervention features, and potential intervention objectives. Data were summarized by using descriptive statistics. A cumulative logistic regression model examined associations between the men's perceived importance of physical activity to health and their interest in a physical activity intervention. RESULTS: Almost all participants (97.7%) rated physical activity as "at least somewhat important" to their health, and 83.9% indicated they would be "at least somewhat interested" in participating in a physical activity intervention. On a scale of 1 (not at all a barrier) to 5 (very much a barrier), motivation (mean 3.4; 95% CI, 3.3-3.5), cold weather (mean, 3.4; 95% CI, 3.3-3.5), and tiredness (mean, 3.3; 95% CI, 3.2-3.4) were rated the biggest barriers to physical activity. Becoming fitter (54.1%) was the top reason for joining a physical activity program. Preferred delivery channels for receiving an intervention were mobile application (ranked from 1 being the most preferred and 9 being the least preferred: mean, 2.8; 95% CI, 2.70-3.09) and e-mail (mean, 4.2; 95% CI, 3.92-4.36). Rural men preferred interventions that taught them how to exercise and that could be done from home. CONCLUSION: Our findings suggest US men in rural areas are receptive to physical activity programs. A systematic approach and a clear model of development are needed to tailor future physical activity interventions to the special needs of rural men.

Mortality risk and physical activity across the lifespan in endometrial cancer survivors.

PURPOSE: Physical activity (pre- and post-diagnosis) has been studied in prevention and survivorship contexts for endometrial cancer. However, the association of physical activity (PA) across the lifespan on mortality risk among endometrial cancer survivors is understudied. The study's objective was to identify the association of lifetime PA on mortality risk in endometrial cancer survivors. METHODS: Seven hundred forty-five endometrial cancer survivors drawn from a population-based cancer registry (diagnosed between 1991 and 1994) reported the frequency (sessions/week) of moderate- and vigorous intensity physical activity (MVPA) at age 12, age 20, and 5 years pre-interview (post-diagnosis). Cox proportional hazards were used to estimate hazard ratios (HR) and 95% confidence intervals for the association between PA, all-cause, and cardiovascular disease mortality as assessed in 2016. MVPA was modeled using natural cubic splines. RESULTS: Diagnosis age, body mass index, and smoking (pack-years) were each positively associated with increased all-cause mortality risk. Those who did one session of MVPA 5 years pre-interview had a lower mortality risk (HR 0.61; 95% CI 0.41-0.92) compared to those with no MVPA. Those reporting one session of MVPA was similarly observed at age 12 (HR 0.95; 95% CI 0.86-1.06) and at age 20 (HR 0.87; 95% CI 0.65-1.16). CONCLUSION: Those who participated in PA, compared to those who did not, in the 5 years before diagnosis had a lower mortality risk. While PA was not independently protective against mortality risk at ages 12 or 20, PA is still important for endometrial cancer survivors for other non-mortality outcomes.

Understanding the physical activity needs and interests of inactive and active rural women: a cross-sectional study of barriers, opportunities, and intervention preferences.

Despite the health benefits of physical activity, many women remain inactive and the needs of rural women are understudied. To understand access to physical activity barriers, opportunities, and intervention preferences in rural women and determine how these differ by self-reported activity level. A mailed questionnaire was distributed to 900 rural women and included measures of physical activity, health status, barriers, opportunities for exercise, and preferences for intervention type, components, and delivery. Questionnaires were completed by 507 women; 72.0% reported meeting the physical activity guideline. Inactive women reported greater barriers to activity (higher scores on 18 of 22 barriers; p < 0.05), less access to or usage of 8 of 9 places to exercise (p < 0.05), and less belief in the relevance of physical activity to personal health (p < 0.001). Both inactive and active women were most interested in programs that use walking, yoga, or strength training. Physical activity interventions for rural women need to address their specific needs, including barriers to physical activity and lower access to places in which to be physically active.

Knowledge, Attitudes, and Beliefs of Youth Sports Coaches Regarding Sport Volume Recommendations and Sport Specialization.

Post, EG, Trigsted, SM, Schaefer, DA, Cadmus-Bertram, LA, Watson, AM, McGuine, TA, Brooks, MA, and Bell, DR. Knowledge, attitudes, and beliefs of youth sports coaches regarding sport volume recommendations and sport specialization. J Strength Cond Res 34(10): 2911-2919, 2020-Overuse injuries in youth athletes are becoming increasingly common, which may be a result of the prevalence of year-round specialized sport participation. Previous research has identified sport volume recommendations related to months per year, hours per week, and simultaneous participation in multiple sports leagues. Coaches are a primary influence on a youth athlete's decision to specialize in a single sport. Therefore, identifying coaches' baseline beliefs and perceptions is important for developing strategies to educate coaches about safe sport participation. A total of 253 youth sport coaches (207 males) completed an anonymous online questionnaire regarding knowledge of sport volume recommendations and attitudes and beliefs regarding sport specialization. Eligible participants were required to serve as a head or assistant coach of a youth sport team in the past 12 months whose members were between the ages of 12 and 18 years. Most coaches were unaware of recommendations regarding the maximum number of months per year (79.4%), hours per week in 1 sport (79.3%), or number of simultaneous leagues for an athlete to participate in to reduce injury (77.6%). Fewer than half (43.2%) of all coaches were "very" or "extremely" concerned about the risk of injury in youth sports. A majority (60.1%) believed that sport specialization was either "quite a bit" or "a great deal" of a problem. Two-thirds (67.2%) responded that year-round participation in a single sport was either "very" or "extremely" likely to increase an athlete's risk of injury. Although the responses to this survey were predominantly from coaches from 1 state, our results suggest that coaches are unaware of sport volume recommendations but are concerned about specialization. Future efforts are needed to communicate these recommendations to coaches to reduce the risk of overuse injury in youth sports.

A Comparison of Emergency Preparedness Between High School Coaches and Club Sport Coaches.

CONTEXT: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown. OBJECTIVE: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams. DESIGN: Cross-sectional survey. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training. MAIN OUTCOME MEASURE(S): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid). RESULTS: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001). CONCLUSIONS: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.

The Fitbit One Physical Activity Tracker in Men With Prostate Cancer: Validation Study.

BACKGROUND: Physical activity after cancer diagnosis improves quality of life and may lengthen survival. However, objective data in cancer survivors are limited and no physical activity tracker has been validated for use in this population. OBJECTIVE: The aim of this study was to validate the Fitbit One's measures of physical activity over 7 days in free-living men with localized prostate cancer. METHODS: We validated the Fitbit One against the gold-standard ActiGraph GT3X+ accelerometer in 22 prostate cancer survivors under free-living conditions for 7 days. We also compared these devices with the HJ-322U Tri-axis USB Omron pedometer and a physical activity diary. We used descriptive statistics (eg, mean, standard deviation, median, interquartile range) and boxplots to examine the distribution of average daily light, moderate, and vigorous physical activity and steps measured by each device and the diary. We used Pearson and Spearman rank correlation coefficients to compare measures of physical activity and steps between the devices and the diary. RESULTS: On average, the men wore the devices for 5.8 days. The mean (SD) moderate-to-vigorous physical activity (MVPA; minutes/day) measured was 100 (48) via Fitbit, 51 (29) via ActiGraph, and 110 (78) via diary. The mean (SD) steps/day was 8724 (3535) via Fitbit, 8024 (3231) via ActiGraph, and 6399 (3476) via pedometer. Activity measures were well correlated between the Fitbit and ActiGraph: 0.85 for MPVA and 0.94 for steps (all P<.001). The Fitbit's step measurements were well correlated with the pedometer (0.67, P=.001), and the Fitbit's measure of MVPA was well correlated with self-reported activity in the diary (0.84; P<.001). CONCLUSIONS: Among prostate cancer survivors, the Fitbit One's activity and step measurements were well correlated with the ActiGraph GT3X+ and Omron pedometer. However, the Fitbit One measured two times more MVPA on average compared with the ActiGraph.

Objectively Measured Physical Activity in Patients After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Returning to a healthy level of physical activity is among the most commonly discussed clinical goals for patients recovering from anterior cruciate ligament reconstruction (ACLR). However, physical activity has not been objectively measured in this population. PURPOSE: To investigate differences in the mean time (min/d) spent in moderate-to-vigorous physical activity (MVPA) as well as the daily step count (steps/d) between patients who underwent ACLR and matched controls. A second purpose was to investigate relationships between MVPA and objective assessments of the daily step count and Tegner and Marx activity scales. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Physical activity was assessed using ActiGraph accelerometers in 33 participants with a history of primary unilateral or bilateral ACLR (mean time from surgery, 27.8 ± 17.5 months; range, 6-67 months) as well as in 33 healthy controls (matched on age, sex, and activity level). Participants wore the accelerometer for 7 days and completed the International Knee Documentation Committee subjective form and the Tegner and Marx activity scales. Independent t tests were used to determine differences in each dependent variable per group. RESULTS: Patients who underwent ACLR spent less time in MVPA (ACLR: 79.37 ± 23.95 min/d; control: 93.12 ± 23.94 min/d; P = .02) and had a lower daily step count (ACLR: 8158 ± 2780 steps/d; control: 9769 ± 2785 steps/d; P = .02) compared with healthy matched controls. However, the Marx (ACLR median: 11.0 [interquartile range (IQR), 7-14]; control median: 12.0 [IQR, 8-13]; P = .85) and Tegner (ACLR median: 6.0 [IQR, 5-8]; control median: 7.0 [IQR, 6-8]; P = .12) scores did not differ between the groups, and no relationships were observed between objectively measured physical activity and scale measures ( P > .05), except for a moderate relationship between the Tegner score and daily step count in the ACLR group ( r = 0.36, P = .04). Only 24% of patients who underwent ACLR met the guideline of 10,000 steps per day compared with 42% of controls. CONCLUSION: Patients who underwent ACLR spent less time in MVPA and had a lower daily step count compared with highly matched controls (age, sex, and activity level) with no history of knee injuries. This was true despite being similar in activity levels, which brings into question the utility of the Tegner and Marx activity scales.

Technology- and Phone-Based Weight Loss Intervention: Pilot RCT in Women at Elevated Breast Cancer Risk.

INTRODUCTION: For women with an increased breast cancer risk, reducing excess weight and increasing physical activity are believed to be important approaches for reducing their risk. This study tested a weight loss intervention that combined commercially available technology-based self-monitoring tools with individualized phone calls. DESIGN: Women were randomized to a weight loss intervention arm (n=36) or a usual care arm (n=18). SETTING/PARTICIPANTS: Participants were women with a BMI ≥ 27.5 kg/m2 and elevated breast cancer risk recruited from the mammography clinic at the Moores Cancer Center at the University of California San Diego. INTERVENTION: Intervention participants used the MyFitnessPal website and phone app to monitor diet and a Fitbit to monitor physical activity. Participants received 12 standardized coaching calls with trained counselors over 6 months. Usual care participants received the U.S. Dietary Guidelines for Americans at baseline and two brief calls over the 6 months. MAIN OUTCOME MEASURES: Weight and accelerometer-measured physical activity were assessed at baseline and 6 months. Data were collected in San Diego, CA, from 2012 to 2014 and analyzed in 2015. RESULTS: Participants (n=54) had a mean age of 59.5 (SD=5.6) years, BMI of 31.9 (SD=3.5), and a mean Gail Model score of 2.5 (SD=1.4). At 6 months, intervention participants had lost significantly more weight (4.4 kg vs 0.8 kg, p=0.004) and a greater percentage of starting weight (5.3% vs 1.0%, p=0.005) than usual care participants. Across arms, greater increases in moderate-to-vigorous physical activity resulted in greater weight loss (p=0.01). CONCLUSIONS: Combining technology-based self-monitoring tools with phone counseling supported weight loss over 6 months in women at increased risk for breast cancer.

Mobile and Wearable Device Features that Matter in Promoting Physical Activity.

BACKGROUND: As wearable sensors/devices become increasingly popular to promote physical activity (PA), research is needed to examine how and which components of these devices people use to increase their PA levels. AIMS: (1) To assess usability and level of engagement with the Fitbit One and daily SMS-based prompts in a 6-week PA intervention, and (2) to examine whether use/ level of engagement with specific intervention components were associated with PA change. METHODS: Data were analyzed from a randomized controlled trial that compared (1) a wearable sensor/ device (Fitbit One) plus SMS-based PA prompts, and (2) Fitbit One only, among overweight/ obese adults (N = 67). We calculated average scores from Likert-type response items that assessed usability and level of engagement with device features (e.g., tracker, website, mobile app, and SMS-based prompts), and assessed whether such factors were associated with change in steps/day (using Actigraph GT3X+). RESULTS: Participants reported the Fitbit One was easy to use and the tracker helped to be more active. Those who used the Fitbit mobile app (36%) vs. those who did not (64%) had an increase in steps at 6-week follow-up, even after adjusting for previous web/app use: +545 steps/ day (SE = 265) vs. -28 steps/ day (SE = 242) (p = .04). CONCLUSIONS: Level of engagement with the Fitbit One, particularly the mobile app, was associated with increased steps. Mobile apps can instantly display summaries of PA performance and could optimize self-regulation to activate change. More research is needed to determine whether such modalities might be cost-effective in future intervention research and practice.

Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial.

BACKGROUND: Studies have shown self-monitoring can modify health behaviors, including physical activity (PA). This study tested the utility of a wearable sensor/device (Fitbit(®) One™; Fitbit Inc., San Francisco, CA) and short message service (SMS) text-messaging prompts to increase PA in overweight and obese adults. MATERIALS AND METHODS: Sixty-seven adults wore a Fitbit One tracker for 6 weeks; half were randomized to also receive three daily SMS-based PA prompts. The Fitbit One consisted of a wearable tracker for instant feedback on performance and a Web site/mobile application (app) for detailed summaries. Outcome measures were objectively measured steps and minutes of PA by intensity using two accelerometers: Actigraph™ (Pensacola, FL) GT3X+ (primary measure) at baseline and Week 6 and Fitbit One (secondary measure) at baseline and Weeks 1, 2, 3, 4, 5, and 6. RESULTS: Mixed-model repeated-measures analysis of primary measures indicated a significant within-group increase of +4.3 (standard error [SE]=2.0) min/week of moderate- to vigorous-intensity PA (MVPA) at 6-week follow-up (p=0.04) in the comparison group (Fitbit only), but no study group differences across PA levels. Secondary measures indicated the SMS text-messaging effect lasted for only 1 week: the intervention group increased by +1,266 steps (SE=491; p=0.01), +17.8 min/week MVPA (SE=8.5; p=0.04), and +38.3 min/week total PA (SE=15.9; p=0.02) compared with no changes in the comparison group, and these between-group differences were significant for steps (p=0.01), fairly/very active minutes (p<0.01), and total active minutes (p=0.02). CONCLUSIONS: These data suggest that the Fitbit One achieved a small increase in MVPA at follow-up and that the SMS-based PA prompts were insufficient in increasing PA beyond 1 week. Future studies can test this intervention in those requiring less help and/or test strategies to increase participants' engagement levels.

Randomized Trial of a Fitbit-Based Physical Activity Intervention for Women.

INTRODUCTION: Direct-to-consumer mHealth devices are a potential asset to behavioral research but rarely tested as intervention tools. This trial examined the accelerometer-based Fitbit tracker and website as a low-touch physical activity intervention. The purpose of this study is to evaluate, within an RCT, the feasibility and preliminary efficacy of integrating the Fitbit tracker and website into a physical activity intervention for postmenopausal women. METHODS: Fifty-one inactive, postmenopausal women with BMI ≥25.0 were randomized to a 16-week web-based self-monitoring intervention (n=25) or comparison group (n=26). The Web-Based Tracking Group received a Fitbit, instructional session, and follow-up call at 4 weeks. The comparison group received a standard pedometer. All were asked to perform 150 minutes/week of moderate to vigorous physical activity (MVPA). Physical activity outcomes were measured by the ActiGraph GT3X+ accelerometer. RESULTS: Data were collected and analyzed in 2013-2014. Participants were aged 60 (SD=7) years with BMI of 29.2 (3.5) kg/m(2). Relative to baseline, the Web-Based Tracking Group increased MVPA by 62 (108) minutes/week (p<0.01); 10-minute MVPA bouts by 38 (83) minutes/week (p=0.008); and steps by 789 (1,979) (p=0.01), compared to non-significant increases in the Pedometer Group (between-group p=0.11, 0.28, and 0.30, respectively). The Web-Based Tracking Group wore the tracker on 95% of intervention days; 96% reported liking the website and 100% liked the tracker. CONCLUSIONS: The Fitbit was well accepted in this sample of women and associated with increased physical activity at 16 weeks. Leveraging direct-to-consumer mHealth technologies aligned with behavior change theories can strengthen physical activity interventions.

Baseline Depressive Symptoms, Completion of Study Assessments, and Behavior Change in a Long-Term Dietary Intervention Among Breast Cancer Survivors.

BACKGROUND: Depressive symptoms can lower adherence and change in dietary studies. Behavioral activation may reduce these effects. PURPOSE: This study aims to assess relationships among depressive symptoms on adherence and dietary change in the Women's Healthy Eating and Living (WHEL) Study METHODS: Secondary analyses from the WHEL Study, which achieved major dietary change in breast cancer survivors (N = 2817), were conducted. Logistic regressions were undertaken of baseline depressive symptoms (six-item Center for Epidemiologic Studies Depression Scale (CES-D)) with (1) completion of 1- and 4-year study assessments and (2) validated change in dietary behavior in the intervention group. RESULTS: In the comparison group (vs. intervention), depressive symptoms lowered completion of dietary recalls and clinic visits [4 years: odds ratio (OR) = 2.0; 95 % confidence interval (CI) = 1.4-3.0]. The behaviorally oriented intervention achieved major change in those furthest from study targets, although changes were lower in those with depressive symptoms: fruit/vegetable (+37.2 %), fiber (+49.0 %), and fat (-22.4 %). CONCLUSIONS: Behavioral activation in dietary change interventions can overcome the impact of depressive symptoms.

Metabolism and breast cancer risk: frontiers in research and practice.

Fifty years ago the causes of cancer were largely unknown. Since then, it has become clear that a strong relationship exists between obesity and many cancers, particularly postmenopausal breast cancer. A major challenge in understanding the link between obesity and cancer risk has been elucidating the biological basis underlying the association. Although this remains unresolved, the main candidate systems linking adiposity and cancer risk are insulin and the insulin-like growth factor-1 axis, endogenous reproductive hormones, and chronic inflammation. Our purpose is to provide a mechanistic overview of the hypothesized relationship between diet, physical activity, and obesity with breast cancer risk and progression. In addition, we will provide examples of recently funded randomized clinical trials examining metabolic risk factors in relation to breast cancer risk and survival. Additional research is warranted to validate the strength and consistency of the relationships among diet, these biomarkers, and breast cancer risk. As these relationships become clearer, future studies will be needed to develop effective intervention programs to prevent breast cancer and improve cancer prognosis by promoting a healthy lifestyle.

Feasibility of institutional registry-based recruitment for enrolling newly diagnosed breast cancer patients in an exercise trial.

BACKGROUND: The purpose of this study was to determine the feasibility of using a tumor registry to recruit newly diagnosed survivors into a randomized controlled exercise trial and to discuss issues related to this recruitment strategy. METHODS: A tumor registry-based rapid ascertainment system was used to recruit breast cancer survivors into a 6-month home-based, telephone-administered intervention of moderate-to-vigorous intensity exercise or a usual care group. RESULTS: 468 newly diagnosed cases were identified. Of these, 50 women (15.4% of those for which screening calls were made) were enrolled in the study. Women were randomized, on average, 11 weeks after diagnosis (SD = 4.8). Sixty-four percent were randomized before beginning treatment or within the first week of treatment. Time required to obtain physician consent was the primary determinant of diagnosis-to-randomization latency. Enrolled women were more likely than nonenrolled women to be non-Hispanic White and to have a college degree (P < .05). CONCLUSION: Tumor registries present a feasible means of recruiting breast cancer survivors before or early in adjuvant treatment. The success of recruiting survivors promptly after diagnosis is largely dependent on ability to rapidly obtain physician consent. Specific effort is needed to counteract self-selection effects that may lead to under-representation of minorities.

Effects of 12-month exercise on health-related quality of life: a randomized controlled trial.

OBJECTIVE: We investigated exercise effects on health-related quality of life (HRQOL) and exercise self-efficacy, and tested effect modification by baseline body mass index (BMI) and gender. METHODS: Middle-aged women (n=100) and men (n=102) were randomly assigned to either exercise (360 min/week of moderate-to-vigorous aerobic exercise) or control in Seattle, WA, from 2001 to 2004. Demographics, anthropometrics, exercise self-efficacy (5-item self-efficacy questionnaire) and HRQOL (SF-36) were assessed at baseline and 12 months. Analysis of covariance adjusting for baseline scores was used to compare HRQOL and exercise self-efficacy scores between the exercise and control groups. RESULTS: At 12 months, exercisers demonstrated higher exercise self-efficacy than controls (percent change from baseline: -6.5% vs. -15.0%, p < 0.01), without differences in HRQOL. Baseline BMI category and gender did not modify these effects. In exploratory analyses comparing exercisers and controls within subgroups defined by gender and BMI, 12-month HRQOL scores [role-physical (+7.0% vs. -13.1%), vitality (+15.6% vs. -4.2%), social functioning (+10.0% vs. -3.5%), and mental health (+6.8% vs. -2.9%)] were higher only among overweight male exercisers (p < 0.05, vs. control). CONCLUSION: Three hundred and sixty minutes per week of exercise, recommended for weight maintenance, did not have negative effects on exercise self-efficacy or HRQOL. This level of exercise may increase HRQOL among overweight men.