The reliability of a survey question on television viewing and associations with health risk factors in US adults.

Research into the accuracy of self-reported measures used to quantify physical inactivity has been limited. The purposes of the current report were to examine the reliability of a survey question assessing time spent watching television and to describe associations between television watching and physical activity and health risk factors. Data from this cross-sectional investigation were obtained from a study designed to evaluate a physical activity module for potential use in the 2001 Behavioral Risk Factor Surveillance System. Participants were 93 men and women (aged 45.9 (15.4) years) who answered the question pertaining to television watching during an initial visit and three follow-up visits to the study center. Intra-class correlation coefficients (ICCs) between administrations of the survey question were used to assess test-retest reliability. Spearman rank order correlation coefficients were used to examine the associations of television viewing with physical activity and health risk factors. The test-retest reliability of the television-watching question suggested moderate agreement (ICCs of 0.42 and 0.55 over a 3-week and 1-week period, respectively). After adjustment for age and sex, reported television-watching hours were positively associated with BMI (P = 0.0002), percentage fat (P = 0.0001), and light-intensity physical activity (P = 0.006) and negatively associated with cardiorespiratory fitness (P = 0.004) and moderate-intensity and hard-intensity physical activity (P = 0.03 and P = 0.003, respectively). Increased time spent in sedentary behaviors has been identified as a major modifiable risk factor in the development of chronic diseases and conditions. The single-item survey question evaluated in this study was shown to be a reliable measure of television watching and was associated with physical activity and health risk factor outcomes.

Psychometric properties of the commitment to physical activity scale.

OBJECTIVE: To assess psychometric properties of the Commitment to Physical Activity Scale (CPAS). METHODS: Girls in third to fifth grades (n = 932) completed the CPAS before and after a physical activity intervention. Psychometric measures included internal consistency, factor analysis, and concurrent validity. RESULTS: Three CPAS factors emerged: values, attitudes, and motivation, with reliability coefficients ranging from .429 to .821. Significant correlations existed between subscales and physical activity frequency. CONCLUSIONS: The CPAS was reliable and valid and in a sample of third-to fifth-grade girls. Findings support using the CPAS for measuring overall commitment to physical activity in girls.

Monthly variation in physical activity levels in postmenopausal women.

INTRODUCTION: Month-to-month variation in physical activity levels in a cohort of postmenopausal women participating in a single site clinical trial undergoing lifestyle intervention was investigated before and after lifestyle intervention. METHODS: Participants were Caucasian and African American women (mean age = 57.0 +/- 3.0 yr) from the Women on the Move through Activity and Nutrition study. Physical activity was measured subjectively by questionnaire (past week and past year) and objectively by pedometer at the baseline and at the 18-month follow-up. RESULTS: At baseline, before intervention, pedometer steps were highest in the summer months (7616 steps per day), lower in the fall (6293 steps per day), lowest in winter (5304 steps per day), and then rebounded in the spring (5850 steps per day). Physical activity estimates from the past-week subjective measure followed the same seasonal pattern. After 18 months, the lifestyle change group significantly increased their pedometer step counts when compared with the health education group (P < 0.0001). At 18 months, pedometer step counts for the health education group appeared to fluctuate from month to month, whereas month-to-month step counts for the lifestyle change group appeared to remain consistent throughout the year. CONCLUSIONS: These results confirm previous reports that suggest physical activity levels fluctuate throughout the year. Lifestyle intervention, which includes a physical activity component, not only increases step counts but appears to reduce some of variation in physical activity levels over the course of a year in postmenopausal women.

Weight regain and health-related quality of life in postmenopausal women.

Weight loss improves health-related quality of life (HRQoL). However, regain after loss is common; little is known about the impact of weight regain on HRQoL in postmenopausal women. Woman on the Move through Activity and Nutrition (WOMAN) is a randomized lifestyle intervention trial of diet, physical activity, and weight loss in 508 postmenopausal women aged 52-62 years. This analysis focused on the women who lost > or =5 lb during the initial phase of the study, baseline to 6 months (n = 248). This cohort was divided into three groups based on subsequent weight change between 6 and 18 months: weight loss (WL; > or =5 lb loss), weight stable (WS; <+/-5 lb change), and weight regain (WR; > or =5 lb gain). HRQoL was measured at baseline, 6, and 18 months using the Short Form-36. Of the 248 women studied, 51 (21%) continued to lose weight after initial weight loss, while 127 (51%) maintained a stable weight, and 70 (28%) regained weight. Between baseline and 6 months, women in WR group had decreased mental health and social-functioning scores, while the WL and WS groups improved in these subscales. Between baseline and 18 months, energy improved most significantly in those with continued weight loss (P = 0.0003). Weight loss was correlated with a small to moderate improvement in perceived general health and energy, which was reversed by weight gain. Further study is needed to investigate the impact of a decline in mental health and social functioning on future weight regain.

Gait speed and step-count monitor accuracy in community-dwelling older adults.

UNLABELLED: Accurate assessment of physical activity (PA) is necessary to identify the sedentary older individual who is in need of activity intervention. Activity monitors are quite popular, although it has been suggested that they are less accurate at slow gait speeds. PURPOSE: To examine the accuracy of the three activity monitors in older individuals who walk at various gait speeds. METHODS: Participants were 34 community-dwelling older men and women (mean age 79.2) who were asked to simultaneously wear three activity monitors: the Yamax DigiWalker (DW) pedometer (hip), the Actigraph (AG) accelerometer (hip), and the StepWatch activity monitor (SAM) (ankle). Monitor accuracy was evaluated against observed steps taken during a 100-step walking test. Percent error of the monitors was calculated as [(monitor steps - observed steps)/observed steps] x 100. Participants were categorized into three groups (< 0.80, 0.80-1.0, > 1.0 m x s(-1)) according to gait speed, which was determined by a timed 4-m walk. RESULTS: Overall, the DW and AG failed to detect 16% and 7% of observed steps, respectively, and the SAM overestimated by 5.5%. When stratified by gait speed, all three monitors faired well at the gait speeds > 1.0 m x s(-1). For gait speeds between 0.80 and 1.0 m x s(-1), the SAM overestimated steps by 6.6%, and the AG and DW underestimated steps by 5.7% and 12.7%, respectively. However, at gait speeds < 0.80 m x s(-1), the AG and DW performed poorly, underestimating steps by 19.1% and 31.2%, whereas the SAM performed better, having overestimated steps by 6.5%. CONCLUSIONS: All three objective activity monitors performed well at moderate and higher walking speeds, but at decreased gait speeds, the SAM seemed to be the most accurate.

Lapses and psychosocial factors related to physical activity in early postmenopause.

PURPOSE: After menopause, leisure physical activity (PA) levels seem to decline for reasons that are not completely understood. This study examines the associations between PA, lapses in PA, and psychosocial factors in early postmenopausal women. METHODS: This cross-sectional analysis included 497 women from the Women on the Move through Activity and Nutrition study. PA was assessed with a past-year, interviewer-administered Modifiable Activity Questionnaire. Measures of activity lapses of >or= 2 wk in the past 6 months, exercise decision making, processes of change, and self-efficacy were collected along with Beck Depression Inventory, State-Trait Anxiety Inventory, Cohen Perceived Stress Scale, and Short Form-36. RESULTS: Mean age of participants was 56.9 yr. Compared with less active women, women with significantly higher activity levels reported greater exercise self-efficacy (r = 0.31), more frequent use of behavioral exercise processes of change (r = 0.31), greater perceived benefits for PA (r = 0.22), and better physical quality of life (r = 0.16) (all P < 0.001). Women reporting no activity lapses had higher reported activity levels than regularly active women with lapses or occasionally active women with lapses (P < 0.0001 for trend). Of the women who reported lapses, 24% reported low self-confidence, 43% reported difficulty controlling their weight, and 55% reported difficulty maintaining their diet when they lapsed from PA. Thirty-nine percent of women reporting lapses did not resume PA (i.e., relapsed to inactivity). Higher anxiety and depressive symptoms, and less frequent use of behavioral exercise processes of change, were associated with relapse to inactivity. CONCLUSIONS: Future interventions for early postmenopausal women should consider psychosocial factors when attempting to encourage and maintain higher levels of PA. Addressing and preventing PA lapses may help to achieve PA goals in this population.

Associations among walking performance, physical activity, and subclinical cardiovascular disease.

An objective measure of walking performance could have several potential applications in clinical settings. The cross-sectional relationships among long distance corridor walk (LDCW) time, physical activity, and subclinical cardiovascular disease (CVD) measures were examined before group randomization in 492 participants (mean age, 57.0+/-2.9 years) from the Women On the Move Through Activity and Nutrition (WOMAN) study, a randomized clinical trial involving postmenopausal women. Longer walk times were significantly associated with higher body mass index (P<0001), average waist circumference (P<0001), and lower levels of physical activity (P<002). The proportion of detectable coronary artery calcification and median aortic pulse wave velocity levels were significantly higher among those with slower walk times (P<002 and P<.001, respectively). Findings from the current report support the utility of the LDCW to identify women at higher risk for CVD who may be candidates for further cardiovascular testing or intensive lifestyle intervention.

Discontinuing hormone replacement therapy: attenuating the effect on CVD risk with lifestyle changes.

BACKGROUND: Concern about the potential risks associated with hormone replacement therapy (HRT) has left post-menopausal women and healthcare providers searching for safe and effective means for cardiovascular disease (CVD) risk factor reduction. METHODS: The Woman On the Move through Activity and Nutrition study is a 5-year clinical trial (2002-2006) designed to test whether a lifestyle intervention will reduce measures of subclinical CVD. Participants were randomized at baseline to a health education or lifestyle change group. The impact of lifestyle intervention on CVD risk factors was examined in 240 women who were initially on HRT at baseline and either continued (n = 110) or discontinued (n = 130) by 18 months. RESULTS: The lifestyle-change group significantly decreased weight, body mass index, waist circumference (all p<0.0001), total cholesterol (p=0.02), and LDL cholesterol (LDL-C) (p= 0.01), improved fat intake (p<0.0001), and increased leisure physical activity (p=0.005) when compared with the health education group. HRT discontinuation resulted in increased total cholesterol (p=0.04) and LDL-C (p=0.009). CVD risk factor changes were further explored by the HRT group, stratified by randomized group assignment. Within the health education arm, HRT discontinuers averaged over a 22-mg/dL increase in total cholesterol and LDL-C, while HRT continuers averaged less than 4 mg/dL (p=0.004 and 0.002, respectively). No such differences were noted in the lifestyle-change group (p=0.78 and 0.90, respectively). CONCLUSIONS: Lifestyle modification was effective for CVD risk factor reduction in post-menopausal women. HRT discontinuation resulted in increased total cholesterol and LDL-C, which were successfully attenuated by a lifestyle intervention incorporating weight loss, physical activity, and dietary modification.

The relationship between physical activity and lipoprotein subclasses in postmenopausal women: the influence of hormone therapy.

OBJECTIVE: This study's objective was to determine if the association between physical activity and lipids and lipoprotein subclasses in postmenopausal women varies by hormone therapy (HT) use. DESIGN: The cross-sectional relationship between physical activity and lipid and lipoprotein subclass relationship was examined before group randomization in 485 postmenopausal (mean age 56.9 [2.9] y) white and African American women from the Woman On the Move through Activity and Nutrition study. This study is a randomized clinical trial designed to test whether a lifestyle intervention will reduce subclinical cardiovascular disease measures. RESULTS: Hormone therapy users (n = 286) were significantly (P < 0.05) younger, less likely to be African American, reported higher levels of physical activity, large very low-density lipoprotein particles (VLDL-P), and medium high-density lipoprotein particles (HDL-P), had a larger mean HDL-P size, and lower levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, small HDL-P, and small VLDL-P than nonusers (n = 196). Physical activity was significantly associated with favorable lipoprotein and lipid levels, regardless of HT use. Some relationships were found to vary significantly by HT use. In nonusers, mean HDL-P and LDL particles (LDL-P) size was significantly larger (P = 0.01 and 0.05, respectively) and total and small LDL-P were significantly lower (both P = 0.02) as activity increased. These relationship were not found in HT users. CONCLUSIONS: Physical activity was significantly related to some lipoprotein subclasses regardless of HT; however, several key lipoprotein subclasses were associated with higher levels of activity only among non-HT users.

Lifestyle intervention and coronary heart disease risk factor changes over 18 months in postmenopausal women: the Women On the Move through Activity and Nutrition (WOMAN study) clinical trial.

OBJECTIVES: In this paper, we present the results of changes in risk factors by use of hormone therapy (HT) at 18 months in the Women On the Move through Activity and Nutrition (WOMAN) randomized trial. METHODS: The trial was designed to test the hypothesis that aggressive dietary changes and increased physical activity to reduce weight, waist circumference (WC), glucose, insulin, and lipoproteins would reduce progression of subclinical atherosclerosis, carotid intimal media thickness and plaque, coronary artery calcification, and pulse wave velocity (PWV). The study focused on postmenopausal women (n = 508), mean age of 57, who were randomized to the Lifestyle Change (LC) or Health Education (HE) group. RESULTS: At 18 months of follow-up, there was significant, 17 lb, weight loss and 10 cm WC decrease in the LC group. There were significant differences in changes in low-density lipoprotein cholesterol (LDL-C), insulin, glucose, large LDL, and LDL particles between the LC and HE groups. Risk factor changes were greater for women in the LC who lost a significant amount of weight (>or=18.8 lb). Participants at 18 months were subdivided into women who had stayed on HT, 125 (28%); stopped HT after randomization, 145 (33%); and not on HT at baseline but stopped an average of 7 months prior to randomization, 173 (39%). Weight loss in the LC was similar for all three groups, but LDL lipoprotein response was better for women who stopped HT after randomization or were not on HT at baseline. CONCLUSIONS: The trial has been successful in increasing exercise and diet changes and reduction in weight and WC and variables related to metabolic syndrome.

Influence of marital status on physical activity levels among older adults.

PURPOSE: The purpose of these analyses was to describe the levels and types of activity in relationship to current marital status among older adults and determine if the physical activity level of the husband was related to the physical activity level of his wife. METHODS: Participants included 3075 well-functioning white and black men and women aged 70-79 yr with further examination of 345 spousal pairs. Marital status was self-reported and participants were grouped as married versus not married. Based on responses to a leisure-time questionnaire, total physical activity was calculated and participants were classified as low or high active. Descriptive statistics were used to describe level and proportions of type of activity by marital status. Logistic regression was used to determine if marital status was an important determinant of physical activity participation. Regression models were adjusted for demographics, body mass index (BMI), and chronic disease conditions. RESULTS: When compared with their single counterparts, married men reported higher median levels of exercise participation (P = 0.008) and married women reported higher levels of total (P < 0.0001) and nonexercise activity (P < 0.0001) with a trend toward higher exercise participation (P = 0.05). In spousal pairs, compared with men in the low active group, highly active men were almost three times as likely (OR = 2.97; 95% CI = 1.73, 5.10) to have a similarly active spouse. The model only modestly attenuated when adjusted for age, BMI, and health status of the husband [OR = 2.49 (1.41, 4.42)]. CONCLUSIONS: Marital status and spousal physical activity (PA) levels are important determinants for PA participation among older adults.

Lifestyle intervention for the prevention of type 2 diabetes: translation and future recommendations.

The effectiveness of lifestyle intervention for the prevention of type 2 diabetes has recently been demonstrated. Four clinical trials using lifestyle interventions comprised of weight loss, physical activity, and diet have successfully prevented or delayed the onset of diabetes development in high-risk individuals. As we attempt to translate these results from the clinical trial to the community, it is important to understand the various components of the lifestyle intervention efforts used. After a description of the key lifestyle components of these clinical trials is provided, a discussion of possible suggestions for implementing these findings in the broader community setting is presented.