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Biomedical subjects

A C King

Publications and source records attributed to A C King.

At least 19 recordsLinked to original sources
PubMed2005

Piloting the feasibility and effectiveness of print- and telephone-mediated interventions for promoting the adoption of physical activity in Australian adults.

This study examined the feasibility and effectiveness for increasing physical activity of a print-based intervention, and a print- plus telephone-mediated intervention among mid-life and older Australian adults. A randomised controlled trial study design was used. In mid-2002, 66 adults (18 men, 48 women) aged 45-78 years, who identified themselves as underactive, were recruited through advertisements and word-of-mouth at two sites (Melbourne and Brisbane), and randomised to either the print or print-plus-telephone mediated intervention group. Participants in both groups attended an initial briefing session, and over the 12-week intervention period received an instructional newsletter and use of a pedometer (both groups), and individualised telephone calls (print-plus-telephone group only). Self-reported physical activity data were collected at baseline, 12 and 16 weeks. Measures of self-reported global physical activity, moderate-vigorous intensity activity and walking all showed increases between baseline and 12 weeks for both intervention groups. These increases were generally maintained by 16 weeks, although participants in the print-plus-telephone group maintained slightly higher levels of global reported activity and walking (by approximately 30 mins/wk) than those in the print group. These interventions show potential for promoting initial increases in physical activity among mid-life and older Australian adults, and should be evaluated across more extended time periods.

Aged↗
PubMed2001

Do logistic regression and signal detection identify different subgroups at risk? Implications for the design of tailored interventions.

Identifying subgroups of high-risk individuals can lead to the development of tailored interventions for those subgroups. This study compared two multivariate statistical methods (logistic regression and signal detection) and evaluated their ability to identify subgroups at risk. The methods identified similar risk predictors and had similar predictive accuracy in exploratory and validation samples. However, the 2 methods did not classify individuals into the same subgroups. Within subgroups, logistic regression identified individuals that were homogeneous in outcome but heterogeneous in risk predictors. In contrast, signal detection identified individuals that were homogeneous in both outcome and risk predictors. Because of the ability to identify homogeneous subgroups, signal detection may be more useful than logistic regression for designing distinct tailored interventions for subgroups of high-risk individuals.

Adult↗
PubMed2001

Men gain additional psychological benefits by adding exercise to a weight-loss program.

OBJECTIVE: Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group. RESEARCH METHODS AND PROCEDURES: This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year. RESULTS: Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity. DISCUSSION: The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.

Adult↗
PubMed2001

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.

Aged↗
PubMed2001

Interventions to promote physical activity by older adults.

Physical inactivity has been established to be an independent risk factor for a range of chronic diseases and conditions that threaten the health of the nation. However, only a minority of the population is currently meeting the recommended levels of regular physical activity, which have been linked with important health and quality-of-life benefits. Older adults are at particular risk for leading sedentary lifestyles. This article provides an overview of factors associated with physical activity for older adults and also describes potentially promising interventions for promoting regular physical activity in this growing population segment. Examples of interventions undertaken at personal and interpersonal as well as broader levels of analysis (e.g., environmental) are provided. Major issues currently facing the field are discussed, including the ongoing challenge of developing assessment tools that are sensitive to the more moderate-intensity physical activities favored by older adults and the formidable task of combining clinical approaches with environmental and policy strategies aimed at combating this public health problem.

Aged↗
PubMed2001

The mediating effects of situational control on social support and mood following a stressor: a prospective study of dementia caregivers in their natural environments.

OBJECTIVES: The present study examined, prospectively and within the context of stress experienced in the natural environment, whether situational control served as a mediator between perceived social support and caregiver's mood. METHODS: Data came from baseline assessments of individuals participating in health promotion interventions for women caregivers. Participants were 49 female caregivers of dementia patients who monitored their own acute psychological states during the day. RESULTS: Results revealed that although the occurrence of a situational stressor increased negative mood, greater perceived support reduced the detrimental impact of a stressor on negative mood. Moreover, path analyses revealed that changes in situational control partially mediated the relationship between perceived support and stress-induced negative mood changes. However, changes in control did not serve as a mediator in analyses focused on happiness. DISCUSSION: Results suggest that caregivers with greater perceived support were less emotionally reactive to stress occurring in their natural environments because of, in part, sustained or increased situational control.

Adaptation, Psychological↗
PubMed2001

Gender differences in cardiovascular response to dementia caregiving.

PURPOSE: This study examined gender differences in cardiovascular responses to laboratory-based stress, as well as in ambulatory hemodynamic (i.e., blood pressure and heart rate) functioning among caregivers of persons with dementia. DESIGN & METHODS: Participants were 25 men and 25 women caregivers, matched on age, type of care recipient's dementia, and relationship to the care recipient. After cardiovascular reactivity to a laboratory-based caregiving stressor was assessed, the ambulatory hemodynamic functioning levels of caregivers were measured in caregivers' natural environments. RESULTS: Female caregivers displayed greater systolic and diastolic blood pressure reactivity to a laboratory-based stress task (i.e., discussing caregiving difficulties) compared with male caregivers (p < or =.01). In contrast, no gender differences were found for ambulatory hemodynamic functioning when aggregated overall or when in the presence of the care recipient. IMPLICATIONS: Laboratory-based findings suggest that female caregivers experience greater blood pressure reactivity to caregiving-related stress than do male caregivers. However, these laboratory-based gender differences may not generalize to differences in hemodynamic functioning in caregivers' daily lives.

Aged↗
PubMed2001

An evaluation of three self-report physical activity instruments for older adults.

PURPOSE: To assess the known-groups and construct validity of measures from the CHAMPS Physical Activity Questionnaire, Physical Activity Survey for the Elderly (PASE), and the Yale Physical Activity Survey (YPAS). METHODS: The three questionnaires were administered to a convenience sample of older adults (N = 87) recruited from community centers and retirement homes. Validation measures included the SF-36 measures of physical functioning, general health, mental health, and pain; body mass index; performance-based tests of lower body functioning and endurance; and Mini-Logger activity monitor data from ankle and waist sensors. Validity was estimated by testing hypotheses about associations between physical activity and validation measures. RESULTS: As hypothesized, differences in activity levels on all measures were found between older adults in retirement homes (less active) and community centers (more active) (P-values < 0.0001). Correlations of physical activity measures with performance-based measures ranged from 0.44 to 0.68, conforming to hypotheses; hypotheses regarding associations with the SF-36 measures were also confirmed. Body mass index was not correlated with any of the physical activity measures, contrary to hypotheses. Correlations of physical activity measures with Mini-Logger counts ranged from 0.36 to 0.59 (ankle) and 0.42 to 0.61 (waist) as hypothesized. Correlations among the measures from the three instruments ranged from 0.58 to 0.68. CONCLUSIONS: The PASE, YPAS, and CHAMPS each demonstrated acceptable validity, as all measures met nearly all hypotheses. Higher validity coefficients were found for subgroups (men, 65-74 yr, retirement home), suggesting that these instruments may perform better for certain segments of the older adult population.

Activities of Daily Living↗
PubMed2001

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.

Aged↗
PubMed2001

Stage of readiness to exercise in ethnically diverse women: a U.S. survey.

PURPOSE: To assess stage of readiness to exercise and readiness to be physically active in a national survey of women aged 40 yr and over from various racial/ethnic groups (the U.S. Women's Determinants Study). METHOD: The prevalence of each stage was determined and compared across race/ethnicity. In addition, the level of misclassification between self-report of stage of readiness to exercise/be physically active and self-reported participation in specific exercise behavior was evaluated. RESULTS: Data were collected from a total of 2912 U.S. women via telephone survey over a 1-yr period (black 26%, American Indians/Alaskan Natives 25%, Hispanics 23%, and whites 26%). Over half the total sample was staged as currently undertaking regular exercise (maintenance stage, 55%), 25% indicated they were in precontemplation, and 15% were in contemplation stage. Few women were in preparation and action stages. There were statistically significant differences between the minority groups. Specifically, black women (OR 0.53, 95% 0.31-0.91) were less likely to be in the active stages (e.g., preparation, action, maintenance) than Hispanics and Alaskan Native/American Native women, and this was true after controlling for important sociodemographic and health variables (age, education, BMI, and smoking). The additional analysis of a modified stage question developed to assess readiness to be more physically active (150 min.wk(-1)) may have provided inflated results (82% in maintenance), possibly due to the complexity of the questions. The level of misclassification between measures ranged from 5 to 20%. CONCLUSION: These results have important implications for the use of stage of change measures with populations of older ethnically diverse women particularly and the popularity of modifying stage questions to reflect "lifestyle" or moderate-intensity physical activity.

Adult↗
PubMed2001

Telephone versus mail interventions for maintenance of physical activity in older adults.

Although telephone and mail are often used to promote physical activity adoption, their ability to produce long-term maintenance is unclear. In this study, 140 men and women aged 50-65 years received 1 year of telephone counseling to adopt higher (i.e., more vigorous) versus lower intensity (i.e., moderate) exercise. After 1 year, participants were rerandomized to a 2nd year of contact via (a) telephone and mail or (b) predominantly mail. Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail. Both strategies were similarly effective in promoting maintenance in the lower intensity condition. Results suggest that after successful adoption of physical activity with the help of telephone counseling, less intensive interventions are successful for physical activity maintenance in older adults.

Aged↗
PubMed2000

Characteristics of inactive primary care patients: baseline data from the activity counseling trial. For the Activity Counseling Trial Research Group.

BACKGROUND: Although many primary care patients are inactive, being able to classify even small amounts and intensities of activity and factors associated with these activity levels could be helpful for physicians who are trying to motivate their patients to become more physically active. METHODS: Sociodemographics, physical activity, fitness, other cardiovascular risk factors, and psychosocial measures were measured at baseline in the 874 patients in the Activity Counseling Trial. Patients were categorized into three groups: (1) no moderate-to-vigorous physical activity (MVPA), (2) some moderate but no vigorous activity, and (3) some vigorous activity. Multiple logistic regression was used to determine factors cross-sectionally associated with activity intensity. RESULTS: One or more cardiovascular risk factors in addition to physical inactivity were present in 84% of participants. Maximal oxygen uptake averaged 25.2 ml/kg/min; 85% had poor to fair aerobic fitness. Physical activity averaged 32.7 kcal/kg/day, with 13.5 min of MVPA/day; 26% engaged in some vigorous activity, 11% engaged in no MVPA. In unadjusted analyses, gender, age, race, education, income, employment, smoking, alcohol use, and exercise self-efficacy were associated with activity intensity (P = 0.05-0.001). A greater percentage engaged in moderate than in vigorous activity in all subgroups. In multiple logistic regression analyses, odds ratios (95% confidence intervals) for engaging in vigorous activity were 0. 39 (0.28, 0.56) for women, 0.38 (0.19, 0.75) for 65+ compared with 35- to 44-year-olds, and 1.14 (1.06, 1.22) for 10-unit increases in performance self-efficacy score. CONCLUSIONS: Most primary care patients who are physically inactive have additional cardiovascular risk factors, particularly overweight and obesity. All subgroups pursue moderate-intensity activity more often than vigorous activity. Women, older persons, and those with lower exercise self-efficacy are less likely to engage in vigorous activity.

Adult↗
PubMed2000

Using direct mail to recruit Hispanic adults into a dietary intervention: an experimental study.

Identifying strategies for successful recruitment of ethnic minorities into scientific studies is critical. Without effective methods, investigators may fail to recruit the desired sample size, take longer to recruit than planned, and delay progress for research in minority health. Direct mail is an appealing recruitment method because of the potential for reaching large target populations and producing a high volume of inquiries about a study with relatively little staff effort. To determine which of three direct mail strategies yielded higher recruitment, 561 Hispanic employees were randomly assigned to receive either: (a) a flyer about a worksite dietary intervention; (b) the same flyer plus a personalized hand-signed letter containing heart disease risk statistics for the general American population; or (c) the flyer plus a personalized hand-signed letter containing statistics for Hispanics. Two orthogonal chi-square comparisons were examined. The personalized letters plus flyer yielded a significantly higher response rate (7.8%) than the flyer alone (2.1%), X2(1, N = 561) = 7.5, p = .006. However, the personalized letter with Hispanic heart disease risk statistics did not yield a statistically significant higher response rate (9.1%) than the letter with the general population risk statistics (6.5%), X2(1, N = 370) = 0.9, p > .34. These findings suggest that personalized approaches can increase the effectiveness of direct mail efforts for recruiting ethnic minorities into interventions and may be particularly helpful for large-scale interventions.

Adult↗
PubMed2000

The use of refusal postcards in recruiting older adults.

This article examines whether a refusal postcard makes recruitment more efficient or instead reduces response rates to a telephone survey of older adults. Medicare health maintenance organization (HMO) members were randomly sampled in sequential phases. All samples received an initial contact letter from a HMO geriatrician. A refusal postcard was included in the first sample (N = 178); however, the remaining six samples did not receive this postcard (N = 1,003). An overall refusal rate of 32% was observed when postcards were included versus a 14% rate of refusal when postcards were excluded (p < .001). When potential respondents were reached by telephone, refusal rates were similar (9% versus 10%). Despite the higher refusal rate among the sample receiving the refusal postcard, no significant differences in demographics, health, and health behaviors were observed between the two final sample groups completing the survey. We conclude that refusal postcards greatly increase the refusal rates without offering any prescreening advantage in the recruitment process of older adults and could increase the costs of recruitment for a telephone survey. Furthermore, use of a refusal postcard precludes individuals from making fully informed decisions about participating in research.

Aged↗
PubMed2000

Naltrexone alteration of acute smoking response in nicotine-dependent subjects.

There are mixed results on the effects of opioid antagonists on acute nicotine response in humans. The present study examined the effects of a single dose of 50 mg oral naltrexone relative to placebo on smoking response in 22 chronic smokers during short-term nicotine abstinence, after acute smoking and subsequent smoking deprivation, and on smoking behavior in a choice paradigm. The results showed that naltrexone significantly reduced immediate postcigarette ratings of smoking craving and desire to smoke and increased light-headedness, dizziness, and head rush (ps < 0.05). Reductions in craving and smoking desire persisted during a subsequent 1 h nonsmoking interval. Naltrexone also was found to significantly reduce the total number of cigarettes smoked in the choice interval, which was supported by objective measures of both reduced CO and plasma nicotine levels (ps < 0.01). Exploratory analyses on potential individual difference factors revealed that smokers with the highest levels of craving during abstinence showed the most pronounced naltrexone attenuation of smoking response. The results support the continued exploration of naltrexone as an adjunct to smoking cessation, especially in identified smoker subgroups most sensitive to the effects of opioid antagonism.

Adult↗
PubMed2000

Do changes in physical activity lead to dietary changes in middle and old age?

INTRODUCTION: Research examining the relationship between dietary factors and physical activity patterns has yielded conflicting findings. Few prospective studies have examined whether individuals who change their level of physical activity make corresponding changes in their diet. METHODS: The current study examined, in two randomized clinical trials of physical activity, whether self-report of dietary factors changed over a 1-year period, whether these changes differed by gender or exercise-intervention group, and whether changes in physical activity led to changes in dietary factors. Participants included 268 men and women aged 50-65 years who participated in the Stanford-Sunnyvale Health Improvement Project I (SSHIP-I) and 103 men and women aged 65-82 years who participated in SSHIP-II. In both trials we recruited participants through random-digit telephone dialing and citywide promotion. RESULTS: Overall, participants adopted healthier diets over the 1-year period. The SSHIP-I participants decreased their consumption of total calories, total fat, saturated fat, protein, and cholesterol. The SSHIP-II participants decreased their consumption of high-fat, high-cholesterol foods. The SSHIP-I women were more likely than men to decrease their intake of total fat and protein (p < 0.01), as well as total calories, saturated fat, and cholesterol (p < 0.05). However, we found that changes in physical activity were not associated with changes in self-report measures of dietary habits. CONCLUSIONS: We found no evidence to support the idea that changes in physical activity are a gateway for changes in dietary factors in middle-aged and older adults.

Aged↗