Enhancing equitable access to cancer information for culturally and linguistically diverse (CALD) communities to complement beliefs about cancer prognosis and treatment.

PURPOSE: Populations affected by cancer from culturally and linguistically diverse (CALD) backgrounds with low English proficiency have poorer health outcomes than the Australian population. They also have limited access to cancer information and may hold health beliefs that affect health-seeking behaviour. A leading cancer support organisation in Australia conducted research with the largest language groups in Australia with the lowest English proficiency to guide the development of appropriate translated resources. METHOD: Six focus groups were conducted with Arabic, Chinese (Mandarin and Cantonese) and Vietnamese speaking cancer survivors, carers and those significantly affected by cancer to understand their health beliefs, information needs and preferred modes of access. Thirteen interviews were also conducted with service providers supporting these communities. RESULTS: Communities lacked access to, and knowledge of, cancer information in their language on Australian cancer-related websites. They had easier access to information in their language from overseas health and local ethnic organisations, and from family and friends. Participants trusted health professionals but were dissatisfied with the information and care provided. Cultural beliefs, combined with a lack of information in their language, were not conducive to accessing appropriate information. The impact of beliefs about fate was significant, but they did not rule out using Western treatment or actively seeking cancer information. CONCLUSIONS: The results reinforce the need to fully explore the cultural beliefs and the structural barriers to accessing cancer information. They also demonstrate that religious-based fatalistic beliefs need not prevent access to information but can co-exist with Western medical treatments.

Developing Written Information for Cancer Survivors from Culturally and Linguistically Diverse Backgrounds: Lessons Learnt.

Australia is a multicultural nation with a large migrant population. Migrants with cancer report inferior quality of life and the need for more information in their own language. This paper describes lessons learnt from developing culturally appropriate written information resources with and for Arabic, Italian, and Vietnamese cancer survivors and carers. The information needs of survivors from these language groups as well as guidelines for the development of written resources for culturally diverse populations were identified through literature review. Community consultation was undertaken with focus groups. The content was developed and tested with health professionals who spoke the appropriate language and focus group participants, ensuring relevance and appropriateness. Resource design and dissemination were informed through community consultation. A number of key tasks for developing resources were identified as follows: (1) community engagement and consultation; (2) culturally sensitive data collection; (3) focus group facilitators (recruitment and training); (4) content development; (5) translation and review process; (6) design; and (7) sustainability. This project reinforced literature review findings on the importance of cultural sensitivity in the development of resources. Engaging with community groups and incorporating culturally appropriate recruitment strategies optimises recruitment to focus groups and facilitates content development. Stakeholders and lay persons from the intended ethnic-minority communities should be involved in the development and formative evaluation of resources to ensure appropriateness and relevance and in the dissemination strategy to optimize penetration. We believe the lessons we have learnt will be relevant to any group intending to develop health information for culturally and linguistic diverse groups.

Ethnic differences in the consistency and accuracy of perceived exertion.

OBJECTIVES: This study investigated the effect of weight loss and weight regain on accuracy of perceived exertion (APE) in previously overweight African American (AA) and European American (EA) women. METHODS: Formerly overweight women (n = 102, age 20-44 years) completed a weight loss program to achieve BMI < 25 kg/m(2) . Physiological variable of exertion and rating of perceived exertion (RPE, Borg's 6-20 Scale) were recorded during submaximal aerobic exercise prior to, immediately following, and approximately 1 year after weight loss. APE was defined as the composite score of physiological variables (heart rate, ventilation rate, and respiratory exchange ratio) minus RPE. RESULTS: APE was significantly different from the composite score of physiological variables at baseline and at 1-year follow-up for EA women (0.347 ± 0.88 P < 0.05 and 0.53 ± 0.92, P < 0.01, respectively) and at 1-year follow-up for AA (-0.37 ± 1.1, P < 0.01). EA women had lower physiological effort at baseline and 1-year follow-up states (-0.24 ± 0.66 P < 0.05; and, -0.27 ± 0.84 P < 0.05, respectively). AA women had higher physiological effort, at 1-year follow-up state (0.21 ± 0.61, P < 0.01). CONCLUSIONS: Physiologic effort and perceived exertion contributed independently to the racial differences in APE, and APE may be an important trait to evaluate before planning an exercise intervention. Am. J. Hum. Biol. 28:398-404, 2016. © 2015 Wiley Periodicals, Inc.

The effects of weight loss on relative bone mineral density in premenopausal women.

OBJECTIVE: This study compared BMD relative to body weight following a ∼6-month weight loss program and a 1-year weight maintenance phase in premenopausal women and determined whether African American (AA) and European-American (EA) women's BMD respond similarly during weight loss. DESIGN AND METHODS: Premenopausal women (n = 115, 34 ± 5 years) were evaluated in an overweight state (BMI between 27 and 30 kg/m(2) ), following an 800 kcal/day diet/exercise program designed to reduce BMI<25 kg/m(2) , and 1-year following weight loss. RESULTS: BMD relative to body weight (Z-scores) increased after weight loss, but decreased during the 1-year weight maintenance phase. All 1-year follow-up BMD Z-scores were increased (except L1) compared to baseline measurements (P < 0.05). These sites included the hip neck (+0.088, P = 0.014), total hip (+0.099, P = 0.001), L2 (+0.127, P = 0.013), L3 (+0.135, P = 0.014), and L4 (+0.199, P = 0.002). AAs had significantly higher absolute BMD at all sites (P < 0.05) compared to EAs, but no time by race interactions were evident during weight loss (except in L3). CONCLUSION: These results may indicate that weight loss is safe with regard to bone health for overweight premenopausal women.

Component analysis and initial validity of the exercise fear avoidance scale.

OBJECTIVES: To develop the Exercise Fear Avoidance Scale (EFAS) to measure fear of exercise-induced discomfort. METHODS: We conducted principal component analysis to determine component structure and Cronbach's alpha to assess internal consistency of the EFAS. Relationships between EFAS scores, BMI, physical activity, and pain were analyzed using multivariate regression. RESULTS: The best fit was a 3-component structure: weight-specific fears, cardiorespiratory fears, and musculoskeletal fears. Cronbach's alpha for the EFAS was α=.86. EFAS scores significantly predicted BMI, physical activity, and PDI scores. CONCLUSION: Psychometric properties of this scale suggest it may be useful for tailoring exercise prescriptions to address fear of exercise-related discomfort.

Potentiation of concentric force and acceleration only occurs early during the stretch-shortening cycle.

The purpose of this study was to determine where stretch-shortening cycle (SSC) potentiation of force, power, velocity, and acceleration occurs across the concentric phase of ballistic leg presses. Second, we examined the influence of late eccentric phase force and length of the amortization phase on potentiated concentric phase performance variables. Twenty-one male runners (age: 31.9 ± 4.7 years) performed SSC and concentric-only (CO) ballistic leg press throws. Potentiations of concentric actions were calculated as the difference between SSC and CO contractions. An analysis splitting the concentric range of motion (ROM) into 6 equal time intervals determined force and acceleration were potentiated (p < 0.05) only during the first one-sixth time interval of concentric motion, whereas velocity and power were potentiated (p < 0.05) at all time intervals over the entire concentric motion with the exception of power over the last one-sixth time interval. A more precise analysis examining 20-millisecond time intervals across the first 200 milliseconds of concentric motion determined force was potentiated only over the first 140 milliseconds and acceleration only over the first 160 milliseconds. Eccentric force measured during the last 100 milliseconds of eccentric motion was related to potentiated force during the initial 200 milliseconds of concentric motion (r = 0.44, p < 0.05) and potentiated mean power across the full concentric ROM (r = 0.62, p < 0.01). Results indicate that in contrast to power and velocity, potentiation of force and acceleration occurs only early during the concentric phase of SSC ballistic leg presses. Correlational findings imply late eccentric phase force is important for generating force and power during the concentric phase of the SSC and thus training focusing on enhancing late phase eccentric force appears important for developing explosive force and power during SSC movements.

Age and gender differences in hip extension and flexion torque steadiness.

BACKGROUND: Lower extremity torque steadiness has been shown to be an independent predictor of functional performance in older women. Hip muscle function is crucial for many types of activities of daily living, yet existing studies investigating torque steadiness for lower extremities are limited to assessing steadiness at the knee and ankle. OBJECTIVE: The purpose of this study was to compare age and gender differences in hip extension (HE) and flexion (HF) strength, torque steadiness, and torque accuracy (TA). METHODS: Twenty young adults (10 men, 10 women; age 24.0 ± 2.2 years) and 21 older adults (11 men, 10 women; age 65.4 ± 4.5 years) matched across age for height and body mass participated. Dominant leg HE and HF isometric strength was assessed by maximal voluntary contractions (MVC); relative (5, 25 and 50% MVC) and absolute (25 Nm) torque steadiness were assessed as standard deviation and coefficient of variation of torque fluctuations, and TA was determined as the mean deviation from target torque levels. RESULTS: MVC was lower for HF than HE (p = 0.007), but HE had greater torque fluctuations (p < 0.05). For HE, the coefficient of variation of 5% MVC was greater for older than young adults (p < 0.05) and greater for women than men (p < 0.05). For HF torque steadiness there were no age or gender differences (p > 0.05). For both HE and HF, older adults were less accurate (higher TA) than their young counterparts at 25 Nm (p < 0.022). CONCLUSIONS: Our results indicate older as compared to young adults, and women as compared to men are less steady (greater torque fluctuations) in HE at 5% MVC target torque levels, but not at higher torque levels. For HF, torque steadiness is similar across low to high target torque levels in both genders and across younger and older adults. For both HE and HF, TA is impaired in older compared to young adults at absolute target torque levels, but not at relative torque levels.

Associations among body size dissatisfaction, perceived dietary control, and diet history in African American and European American women.

European American (EA) women report greater body dissatisfaction and less dietary control than do African American (AA) women. This study investigated whether ethnic differences in dieting history contributed to differences in body dissatisfaction and dietary control, or to differential changes that may occur during weight loss and regain. Eighty-nine EA and AA women underwent dual-energy X-ray absorptiometry to measure body composition and completed questionnaires to assess body dissatisfaction and dietary control before, after, and one year following, a controlled weight-loss intervention. While EA women reported a more extensive dieting history than AA women, this difference did not contribute to ethnic differences in body dissatisfaction and perceived dietary control. During weight loss, body satisfaction improved more for AA women, and during weight regain, dietary self-efficacy worsened to a greater degree for EA women. Ethnic differences in dieting history did not contribute significantly to these differential changes. Although ethnic differences in body image and dietary control are evident prior to weight loss, and some change differentially by ethnic group during weight loss and regain, differences in dieting history do not contribute significantly to ethnic differences in body image and dietary control.

Perception of others' body size influences weight loss and regain for European American but not African American women.

OBJECTIVE: The authors investigated whether European American (EA) and African American (AA) women took longer to lose weight, and were less likely to maintain weight loss if they perceived others to be overweight. DESIGN: Overweight EA and AA women completed a Figure Rating Scale and the Three-Factor Eating Questionnaire prior to a weight loss intervention. Body composition was assessed by dual energy X-ray absorptiometry prior to and following weight loss. MAIN OUTCOME MEASURES: rate of weight loss, % body fat at follow-up. RESULTS: For EA, but not AA women, perception of others' body size was inversely associated with rate of weight loss and cognitive restraint, and positively associated with body fat gain following intervention. In linear regression modeling, EA, but not AA, women who perceived others as large, subsequently had greater percent body fat 1 year after weight loss than did those who perceived others as lean, independent of age, baseline body fat, and body size deemed "acceptable." Inclusion of cognitive restraint in the model weakened this effect. CONCLUSION: Among EA but not AA women, perception of others' body size influenced weight loss and maintenance. This effect may have been mediated by cognitive restraint.

Diet-induced changes in intra-abdominal adipose tissue and CVD risk in American women.

The aim of the study was to determine what effect weight loss had on intra-abdominal adipose tissue (IAAT) and cardiovascular disease (CVD) risk in 135 premenopausal overweight African-American (AA) and European-American (EA) women matched for BMI. Blood lipids, systolic blood pressure (SBP), diastolic BP (DBP), and IAAT (computed tomography determined) were examined prior to and after an 800 kcal/day diet producing 12 kg-weight loss. Significant decreases in IAAT (approximately 38%), total cholesterol (TC; 3%), low-density lipoproteins (LDLs: 6%), triglycerides (TGs: 27%), cholesterol/high-density lipoprotein ratio (C/HDL ratio: 18%), SBP (3%), and DBP (3%) occurred while HDL increased (16%), following weight loss and 1 month energy balance. Significant interactions between time and race showed that AA women decreased TG and increased HDL proportionately less than EA women. After adjusting for Delta IAAT, none of the CVD variables significantly changed after weight loss with the exception of HDL and C/HDL ratio. After adjusting for Delta LF (leg fat), Delta TC, Delta TG, Delta LDL, and Delta C/HDL ratio were significantly different. Multiple regression showed that independent of each other, Delta IAAT was significantly and positively related to Delta TC (adjusted beta = 0.24) and Delta TG (adjusted beta = 0.47), and Delta LF was negatively related to Delta TC (adjusted beta = -0.19) and Delta TG (adjusted beta = -0.18). Overweight and premenopausal AA and EA women benefitted from weight loss by decreasing IAAT and improving CVD risk. The changes in IAAT were significantly related to blood lipids, but loss of LF seems to be related to reduced improvement in TC and TG. Based on these results, interventions should focus on changes on IAAT.

Responses of health and physical educators to overweight children in Alabama.

The purpose of this article is to provide an overview of the increasing problem of overweight children in Alabama including clinical definition, risk factors, and prevalence data. Health and physical educators should become familiar with guidelines released by national organizations, such as the Centers for Disease Control and Prevention, the Institute of Medicine, and state departments of education and public health. These guidelines provide direction to health promotion program activities in schools, community, and recreational settings aimed at modifying predisposing, reinforcing, and enabling factors. Four examples are presented in the narrative to illustrate collaborative partnerships among health care organizations, a health insurer, public schools, an academic research university, and state agencies to enhance youth health. The final section provides practical recommendations for professional health and physical educators regarding obesity risk reduction.

Ecological strategies to promote healthy body image among children.

BACKGROUND: Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro- and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. METHODS: Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. RESULTS: For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. CONCLUSIONS: Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.

Body-shape perceptions and body mass index of older African American and European American women.

The prevalence of obesity is higher in African American compared to European American women. Ethnic differences in body-shape perceptions such as greater acceptance of overweight figures, higher levels of body shape satisfaction, or an underestimation of one's body-shape have been suggested as possible contributors. The purpose of this investigation was to compare body-shape perceptions and body mass index of older African American and European American women. Eighty-nine European American and 115 African American women (mean age, 72 years) completed a questionnaire, composed of three parts: general demographic and anthropometric information, and questions regarding body-shape perceptions. The results suggested an underestimation of body-shape in African American women as a possible contributor to obesity. The findings of the present study suggested that in order to enhance the effectiveness of dietary interventions in older African American women, measures to assess the accuracy of self-perceived body-shape should be included.

IAAT, catecholamines, and parity in African-American and European-American women.

OBJECTIVE: We have recently reported that parous European-American (EA) women have disproportionately more intra-abdominal adipose tissue (IAAT) than their nulliparous counterparts. Mediating mechanisms for IAAT accumulation remain unknown; however, some evidence suggests a possible catecholamine link. The objective of this study was to determine whether the IAAT-parity relationship found in EA women exists in African-American (AA) women and to determine whether catecholamines play a mediating role. METHODS AND PROCEDURES: Subjects included 44 EA and 47 AA premenopausal women. Free-living physical activity by doubly labeled water (activity-related time equivalent (ARTE)), body composition (air plethysmography, computed tomography), and 24-h fractionated urinary catecholamines were measured. RESULTS: Repeated measures ANOVA revealed parous EA and AA women had significantly higher IAAT than their nulliparous counterparts (100.1 +/- 28.5 and 76.2 +/- 34.8 cm(2) vs. 75.9 +/- 29.1 and 59.6 +/- 15.0 cm(2)). In AA women and nulliparous women, 24-h urinary dopamine was significantly higher (AA parous 260.8 +/- 88; EA parous 197.2 +/- 78.8; AA nulliparous 376.5 +/- 81; EA nulliparous 289.6 +/- 62). Multiple regression analysis for modeling IAAT indicated that race, parity, dopamine, ARTE, and VO(2max) were all significant and independent contributors to the model (Unstandardized betas: race -32.6 +/- 7.4; parity (number of births) 10.0 +/- 3.4; 24-h urinary dopamine 0.08 +/- 0.04; ARTE (min/day) -0.09 +/- 0.04; VO(2max) (ml/kg/min) -2.8 +/- 1.0). DISCUSSION: Independent of the potential confounders: age, race, percent body fat, IAAT, 24-h fractionated urinary catecholamines, physical activity, and VO(2max), parous EA and AA women had more IAAT than their nulliparous counterparts. Of the catecholamines, dopamine was found to be significantly lower in parous women and higher in AA's. Dopamine, however, did not explain racial or parity differences in IAAT.

Physiological responses of skilled players during a competitive wheelchair tennis match.

The purpose of this study was to determine heart rate (HR, b.min(-1)) response during competitive match play of 6 men who were skilled wheelchair (WC) tennis players. Each participant completed an arm crank ergometer test that measured HR via a telemetry device and O2 via open circuit spirometry from rest until fatigue (.V(O2)peak). Each athlete participated in 2 competitive singles matches during which HRs were recorded in 5-second intervals and O2 was estimated using the corresponding HR values recorded during the arm ergometer tests. Data analysis revealed an average playing intensity of 69.4 +/- 8.9% of HRpeak and 49.9 +/-14.5% of .V(O2)peak. In conclusion, it is recommended that skilled adult WC tennis players perform off-court aerobic conditioning as part of their training program, because the intensity of a competitive WC tennis match is sufficiently high enough to stress the cardiovascular system.

Cardiovascular factors explain genetic background differences in VO2max.

The purpose of this study was to further explore factors that may be related to ethnic differences in the maximum rate at which an individual can consume oxygen (VO2max) between 20 African American (AA) and 30 European American (EA) sedentary women who were matched for body weight (kg) and fat-free mass (FFM). VO2max (l/min) was determined during a graded treadmill exercise test. Submaximal steady-state heart rate and submaximal VO2 were determined at a treadmill speed of 1.3 m/sec and a 2.5% grade. Hemoglobin (Hb) was determined by the cyanide method, muscle oxidative capacity by 31P magnetic resonance spectroscopy (ADP time constant), and FFM (kg) by dual-energy x-ray absorptiometry. Genetic classification was self-reported, and in a subset of the sample (N = 32), the determinants of ethnicity were measured by African genetic admixture. AA women had significantly reduced VO2max, Hb levels, and muscle oxidative capacity (longer ADP time constants, P < or = 0.05) than EA women. Submaximal oxygen pulse (O2Psubmax), ADP time constant, Hb, and ethnic background were all significantly related to VO2max (ml/kg/min and ml/kg FFM/min, all P < or = 0.01). By multiple regression modeling, Hb, O2Psubmax, muscle oxidative capacity, and ethnicity were found to explain 61% and 57% of the variance of VO2max in ml/kg/min and ml/kg FFM/min, respectively. Muscle oxidative capacity and O2Psubmax were both significantly and independently related to VO2max in all three models (P < or = 0.05), whereas Hb and ethnicity were not. These results suggest that mitochondrial muscle oxidative capacity and oxygen delivery capabilities, as determined by O2Psubmax, account for most if not all of the ethnic differences in VO2max.

Percent body fat is related to body-shape perception and dissatisfaction in students attending an all women's college.

The purpose of this study was to examine the influence of aerobic fitness, physical activity, percent body fat, and socioeconomic status on body-shape perceptions among 153 Euro-American students attending an all women's college. Using a set of nine female figure silhouette drawings arranged on an ordinal scale from very thin to very heavy, subjects chose the figure that approximated their Current, Ideal, Most Attractive shapes, and the shape they believed men found the most attractive (Male Attractive). Body Shape Dissatisfaction was assessed by the difference between Current and Ideal shapes. Several significant relationships were noted for body-shape perceptions with percent body fat, aerobic fitness, and physical activity. Overall, data indicate these relationships except for Male Attractive were confounded by percent body fat, as participants with a higher percentage of body fat preferred larger shapes and were more dissatisfied with their shape.

Preferred body type of fitness instructors among university students in exercise classes.

This study examined the relationship between participants' physique anxiety, eating behaviors, somatotype, and the preferred qualifications and body type of a fitness instructor. Subjects were 171 students attending fitness classes at a university. Analysis indicated that the women preferred a thinner fitness instructor than men and that enthusiasm, motivation, and being physically fit were considered the most important characteristics overall. No significant racial differences in key variables were found.

Prediction of maximal VO2 from a submaximal StairMaster test in young women.

The StairMaster 4000 PT is a popular step ergometer which provides a submaximal test protocol (SM Predicted VO(2)max) for the prediction of VO(2)max (ml.kg(-1).min(-1)). The purpose of this study was to evaluate the SM Predicted VO(2)max protocol by comparing it to results from a VO(2)max treadmill test in 20 young healthy women aged 20-25 years. Subjects were 10 step-trained (ST) women who had performed aerobic activities and exercised on a step ergometer for 20-30 minutes at least 3 times per week for the past 3 months, and 10 non-step-trained (NST) women who had performed aerobic activities no more than twice a week during the past 3 months and had no previous experience on a step ergometer. The SM Predicted VO(2)max protocol used 2 steady state heart rates between approximately 115-150 b.min(-1) to estimate VO(2)max. The Bruce maximal treadmill protocol (Actual VO(2)max) was used to measure VO(2)max by open circuit spirometry. Each subject performed both tests within a 7-day period. The means and standard deviations for the Actual VO(2)max tests were 39.8 +/- 6.1 ml.kg(-1).min(-1) for the ST group, 37.6 +/- 6.3 ml.kg(-1).min(-1) for the NST group, and 38.7 +/- 6.2 ml.kg(-1).min(-1) for the Total group (N = 20); and for the SM Predicted VO(2)max tests, means and standard deviations were 40.78 +/- 14.0 ml.kg(-1).min(-1), 30.9 +/- 4.8 ml.kg(-1).min(-1) and 35.9 +/- 11.4 ml.kg(-1).min(-1). There was no significant difference (p > 0.05) between the means of the Actual VO(2)max and SM Predicted VO(2)max test for the Total group (N = 20) or the ST group (n = 10), but a significant difference (p < 0.05) was shown for the NST group. The coefficient of determination (R(2)) and standard error of estimate (SEE) for the SM Predicted VO(2)max and Actual VO(2)max tests were R(2) = 0.18, SEE = 5.72 ml.kg(-1).min(-1) for the Total group; R(2) = 0.00, SEE = 6.68 ml.kg(-1).min(-1) for the NST group; and R(2) = 0.33, SEE = 5.32 ml.kg(-1).min(-1) for ST group. In conclusion, the SM Predicted VO(2)max test has acceptable accuracy for the ST group, but significantly underpredicted the NST group by almost 7 ml; and, as demonstrated by the high SEEs, it has a low level of precision for both ST and NST subjects.