Improving measurement methods for behavior change interventions: opportunities for innovation.
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Health Behavior↗
Biomedical subjects
Andrea L Dunn
Publications and source records attributed to Andrea L Dunn.
Outcomes from the women's wellness project: a community-focused physical activity trial for women.
BACKGROUND: Given the low rates of physical activity participation, innovative intervention approaches are needed to make a public health impact. METHODS: The study was conducted at the Miriam Hospital/Brown Medical School in Providence, RI, and in communities of Southeastern Massachusetts from 2002 to 2005. Previously sedentary women (n = 280; mean age = 47.1; 94.6% Caucasian) were randomly assigned to one of three conditions: (1) Choose to Move, a self-help printed booklet (n = 93), (2) Jumpstart, a motivationally tailored, print based intervention (n = 95); or (3) Wellness, women's health materials (n = 92). Face-to-face contact at months 3 (M3) and 12 (M12) occurred within participants' communities in local libraries. RESULTS: At M3, participants in the Jumpstart condition reported significantly more minutes of physical activity per week (M = 140.4, SE = 14.82) than participants in the Wellness condition (M = 98.1, SE = 15.09), (t(275) = 2.00, p < 0.05). The Jumpstart arm showed a trend towards significance (t(275) = 1.93, p = 0.054) when compared with the CTM arm (M = 99.5, SE = 15.11); there was no significant difference between the CTM and Wellness arms (t(275) = 0.07, p = NS). At M12, there were no significant differences (F(2,275) = 0.147, p = NS) between any of the treatment arms. CONCLUSIONS: Results suggest that print-based programs for physical activity may be efficacious short-term, but more research is needed to find approaches that are effective long-term. It is possible to deliver print-based programs through existing community infrastructures, however these approaches need further evaluation to examine maintenance effects apart from the demand characteristics of a research study.
Adult↗
Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients.
BACKGROUND: Active for Life After Cancer is a randomized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program (Lifestyle) for prostate cancer patients to improve quality of life (QOL) including physical and emotional functioning compared to a group-based Educational Support Program and a Standard Care Program (no group). METHOD: A total of 134 prostate cancer patients receiving continuous androgen-ablation were randomly assigned to one of the three study conditions. RESULTS: Results indicated no significant improvements in QOL at 6 or 12 months. Both group-based programs were positively received and yielded good attendance and retention. Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity. Despite these improvements, no significant changes were found for most physical activity measures. CONCLUSIONS: Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients.
Adaptation, Psychological↗
Diffusion and dissemination for increasing physical activity in world populations.
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Diffusion of Innovation↗
Identifying subgroups that succeed or fail with three levels of physical activity intervention: the Activity Counseling Trial.
The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.
Adult↗
Inverse association between physical inactivity and mental health in men and women.
PURPOSE: The Aerobics Center Longitudinal Study (ACLS) provides the opportunity to evaluate associations between measures of physical activity and mental health in a large and well-characterized population of men and women. METHODS: Participants were 5451 men and 1277 women (20-88 yr) who completed a maximal fitness treadmill test and self-report measures of habitual physical activity, depressive symptoms (Center for Epidemiological Studies Scale for Depression; CES-D) and emotional well-being (General Well-Being Schedule; GWB). To evaluate the dose-response gradient of the association, we classified the sample, separately for men and women, into three levels of relative cardiorespiratory (CR) fitness (low, moderate, high) on the maximal treadmill test, and four levels on a physical activity index of weekly walking, jogging, and running. RESULTS: In both men and women, there was a significant inverse graded dose-response relationship between maximal CR fitness and the CES-D score (P < 0.0001), and a significant positive graded dose-response relationship between CR fitness and the GWB score (P < 0.0001). We also observed dose-response associations between the level of physical activity and both CES-D and GWB scores (P < 0.0001) that peaked at 11-19 miles per week. CONCLUSION: Among men and women in the ACLS, relative increases in maximal CR fitness and habitual physical activity are cross-sectionally associated with lower depressive symptomatology and greater emotional well-being. Prospective epidemiological studies and controlled clinical trials are needed to identify the minimal and optimal levels of physical activity and CR fitness associated with various mental health benefits in different segments of the general population.
Adult↗
Exercise treatment for depression: efficacy and dose response.
BACKGROUND: This study, conducted between 1998 and 2001 and analyzed in 2002 and 2003, was designed to test (1) whether exercise is an efficacious treatment for mild to moderate major depressive disorder (MDD), and (2) the dose-response relation of exercise and reduction in depressive symptoms. DESIGN: The study was a randomized 2x2 factorial design, plus placebo control. SETTING/PARTICIPANTS: All exercise was performed in a supervised laboratory setting with adults (n =80) aged 20 to 45 years diagnosed with mild to moderate MDD. INTERVENTION: Participants were randomized to one of four aerobic exercise treatment groups that varied total energy expenditure (7.0 kcal/kg/week or 17.5 kcal/kg/week) and frequency (3 days/week or 5 days/week) or to exercise placebo control (3 days/week flexibility exercise). The 17.5-kcal/kg/week dose is consistent with public health recommendations for physical activity and was termed "public health dose" (PHD). The 7.0-kcal/kg/week dose was termed "low dose" (LD). MAIN OUTCOME MEASURES: The primary outcome was the score on the 17-item Hamilton Rating Scale for Depression (HRSD(17)). RESULTS: The main effect of energy expenditure in reducing HRSD(17) scores at 12 weeks was significant. Adjusted mean HRSD(17) scores at 12 weeks were reduced 47% from baseline for PHD, compared with 30% for LD and 29% for control. There was no main effect of exercise frequency at 12 weeks. CONCLUSIONS: Aerobic exercise at a dose consistent with public health recommendations is an effective treatment for MDD of mild to moderate severity. A lower dose is comparable to placebo effect.
Adult↗
Self-management strategies mediate self-efficacy and physical activity.
BACKGROUND: Self-efficacy theory proposes that girls who have confidence in their capability to be physically active will perceive fewer barriers to physical activity or be less influenced by them, be more likely to pursue perceived benefits of being physically active, and be more likely to enjoy physical activity. Self-efficacy is theorized also to influence physical activity through self-management strategies (e.g., thoughts, goals, plans, and acts) that support physical activity, but this idea has not been empirically tested. METHODS: Confirmatory factor analysis was used to test the factorial validity of a measure of self-management strategies for physical activity. Next, the construct validity of the measure was tested by examining whether self-management strategies mediated the relationship between self-efficacy and self-reported physical activity, independently of several social-cognitive variables (i.e., perceived barriers, outcome expectancy value, and enjoyment), among cross-sectional samples of 6th grade (n=309) and 8th grade (n=296) girls tested between February 14 and March 17, 2002. Data were analyzed in 2004. RESULTS: Consistent with theory, self-efficacy had direct effects on the social-cognitive variables. The primary novel finding is that self-management strategies mediated the association of self-efficacy with physical activity in both samples. CONCLUSIONS: The measure of self-management strategies for physical activity yields valid scores among adolescent girls and warrants experimental study as a mediator of the influence of efficacy beliefs on physical activity.
Adolescent↗
Quality of life intervention for prostate cancer patients: design and baseline characteristics of the active for life after cancer trial.
Prostate cancer patients receiving androgen ablation therapy experience significant physical and psychological sequelae associated with their disease and treatment. Because physical activity improves physical and psychological well-being, a lifestyle physical activity intervention may help slow or reverse the associated decline in quality of life (QOL). No studies have evaluated an intervention to improve multiple QOL domains in patients receiving androgen ablation therapy. Active for Life After Cancer is a three-group randomized controlled trial designed to evaluate the effectiveness of a lifestyle physical activity intervention (Lifestyle Program) in improving QOL. The Lifestyle Program, a 6-month behavioral skills training group, is compared to an Educational Support Program and Standard Care. The purpose of this paper is to describe the design of the randomized trial and present baseline data that will characterize the QOL of the sample. Challenges to recruitment for the trial also will be presented and discussed.
Activities of Daily Living↗
Dose Response to Exercise in Women aged 45-75 yr (DREW): design and rationale.
INTRODUCTION AND PURPOSE: Physical inactivity in postmenopausal women contributes to a rise in atherogenic risk factors associated with the metabolic syndrome. Although regular physical activity positively contributes to health, inactivity progressively increases with age. The Dose Response to Exercise in Women aged 45-75 yr (DREW) study is designed to investigate the effect of different amounts of exercise training on cardiorespiratory fitness and risk factors for cardiovascular disease (CVD) in postmenopausal women at moderately increased risk of CVD. METHODS: DREW will recruit 450 sedentary, healthy, postmenopausal women with a body mass index of 25-40 kg.m-2, resting systolic blood pressure (BP) of 120-159 mm Hg, and a resting diastolic BP of < or = 99 mm Hg. Laboratory and self-report measures completed at baseline and 6 months include maximal oxygen consumption (.VO2max), resting BP, anthropometry, dietary habits, physical activity history, medication use, menstrual history, personal and family medical history, and fasting HDL cholesterol, LDL cholesterol, triglycerides, and glucose. Eligible participants are randomly assigned to a nonexercise group or one of three exercise groups. Participants exercise 3 to 4x wk-1 at a heart rate equivalent to 50% of .VO2max expending 4, 8, or 12 kcal.kg-1.wk-1, depending on group assignment. This study will allow quantification of possible dose-response relations (50%, 100%, and 150% of the consensus physical activity recommendation) between exercise training and study outcomes. CONCLUSION: DREW can make important contributions to our understanding of the effects of physical activity in postmenopausal women and help refine public health and clinical recommendations for this group.
Adaptation, Physiological↗
The DOSE study: a clinical trial to examine efficacy and dose response of exercise as treatment for depression.
The Depression Outcomes Study of Exercise (DOSE) was a randomized clinical trial to determine whether exercise is an efficacious treatment for mild to moderate major depressive disorder (MDD) in adults ages 20 to 45 years. The specific hypotheses under investigation were (1) active exercise is an efficacious monotherapy for mild to moderate levels of MDD, and (2) there is a dose-response relation between the exercise amount and reduction in depressive symptoms. The primary outcome measure was the Hamilton Rating Scale for Depression (HRSD) collected weekly over 12 weeks. Secondary outcome measures were the Inventory of Depressive Symptoms (clinician and self-report), HRSD scores at 24 weeks, cardiorespiratory fitness, self-efficacy, and quality of life. Eighty men and women who were diagnosed with a Structured Clinical Interview for Depression and who had mild (HRSD 12-16) to moderate (HRSD 17-25) MDD were randomized to one of five doses of exercise: 7.0 kcal/kg/week in 3 days/week; 7.0 kcal/kg/week in 5 days/week; 17.5 kcal/kg/week in 3 days/week; 17.5 kcal/kg/week in 5 days/week; or 3 days/week of stretching and flexibility exercises for 15 to 20 min/session. Participants exercised under supervision in our laboratory over the course of 12 weeks. Symptoms of depression were measured weekly by trained clinical raters blinded to the participant's treatment assignment. The design of the study restricted participant characteristics to mild to moderate MDD and controlled exercise features to permit the evaluation of exercise as a sole treatment for depression. This study is the first to examine dose-response effects of exercise in participants diagnosed with MDD.
Adult↗
Translating evidenced-based physical activity interventions into practice. The 2010 challenge.
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Evidence-Based Medicine↗
Psychosocial mediators of physical activity behavior among adults and children.
BACKGROUND: Researchers examining theory-based, physical activity (PA) interventions postulate that interventions are effective by changing theoretical constructs hypothesized to mediate the relationship between the intervention and PA behavior. Research indicates that PA interventions are effective for increasing PA behavior. However, whether effective interventions are due to predicted changes in theoretical constructs remains poorly understood. METHODS: Studies that examined theoretical constructs (i.e., mediators) in PA interventions of adults or children, which used experimental designs and met other criteria for evaluating mediation, were collected via literature searches, personal searches of files, and personal communications. Only studies examining the direct effect of the intervention on the hypothesized mediator were considered relevant for this study. RESULTS: Based on our criteria, the adult literature search yielded ten studies and the child literature search yielded two studies. The most common mediators examined included behavioral processes of change, cognitive processes of change, self-efficacy, decisional balance, social support, and enjoyment. Research indicates that behavioral processes are likely mediators. There was some support for the importance of self-efficacy as a mediator. CONCLUSIONS: Few studies have used statistically recommended methods to examine mediators in PA intervention studies. Therefore, definitive conclusions about the importance of the mediators reviewed are not possible at this time. Additional PA mediator-intervention studies using recommended statistical methods are necessary to truly test if theory-based PA interventions are effective due to predicted changes in theoretical constructs.
Adolescent↗
Exploring the effect of the environment on physical activity: a study examining walking to work.
BACKGROUND: Research on physical activity and the physical environment is at the correlates stage, so it is premature to attribute causal effects. This paper provides a conceptual approach to understanding how the physical design of neighborhoods may influence behavior by disentangling the potential effects of income, university education, poverty, and degree of urbanization on the relationship between walking to work and neighborhood design characteristics. METHODS: The study merges Canadian data from 27 neighborhood observations with information on walking to work from the 1996 census. Hierarchical linear modeling was used to create a latent environment score based on 18 neighborhood characteristics (e.g., variety of destinations, visual aesthetics, and traffic). The relationship between the environment score and walking to work was modeled at the second level, controlling for income, university education, poverty, and degree of urbanization. RESULTS: With the exceptions of visual interest and aesthetics, each neighborhood characteristic contributed significantly to the environment score. The environment score was positively associated with walking to work, both with and without adjustment for degree of urbanization. Controlling for university education, income, and poverty did not influence these relationships. CONCLUSIONS: The positive association between the environment score and walking to work, controlling for degree of urbanization supports the current movement toward the development of integrated communities for housing, shops, workplaces, schools, and public spaces. Given the need for research to guide environmental interventions, collaboration among public health practitioners, urban planners, and transportation researchers is essential to integrate knowledge across sectors.
Adult↗