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PubMedDate not supplied

Keeping all children healthy: challenges to leading an active lifestyle for preschool children qualifying for at-risk programs.

This study examined contextual factors associated with physical activity of urban African American preschoolers (N = 59). Qualitative research methodologies utilized data from home visits, caregiver and child interviews, field notes, and document collection. The primary finding suggested, "In underserved communities fundamental barriers exist that obstruct young children's ability to be physically active." Four themes were developed revealing that outside environments limited opportunities for physical activity, home environments resulted in sedentary behaviors, and communities had limited physical activity role models. Despite this, young children enjoyed being physically active.

Black or African American↗

PubMed1997

Associations among physical activity, television watching, and obesity in adult Pima Indians.

It has been suggested that television watching and physical activity are related to obesity. This association, however, has been investigated mainly in children. This study provided the opportunity to examine the relationship between television watching, physical activity, and body mass index in adult Pima Indians, a population with a high prevalence of obesity. Hours per day of television watched, past-year physical levels (MET-h/wk; leisure and occupational combined) and BMI (kg.m-2) were measured in 2452 men and women subjects 21-59 yr old. In adults between the ages of 21 and 39 yr, TV and physical activity levels were negatively correlated (r = -0.11 for men and -0.10 for women). Weaker associations were found between TV and BMI (r = 0.08 for men and 0.04 for women). There were no significant relationships among these variables in older adults (49-59 yr), possibly because of low reported levels of physical activity and TV. Multiple linear regression analysis revealed that physical activity and television watching in men and activity in women were significantly related to BMI. These data suggest that increasing activity levels and decreasing the time spent in sedentary behavior such as watching television should both be considered as potential intervention strategies in obesity prevention programs.

Adult↗

PubMed1999

Prevalence of physical inactivity and its relation to social class in U.S. adults: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

PURPOSE: This study examines the prevalence of physical inactivity during leisure time in a national representative sample of U.S. adults. METHODS: Data were obtained from the Third National Health and Nutrition Examination Survey, conducted between 1988 and 1994. A total of 18,825 adults aged 20 yr and older participated in a home interview where information about physical activity, education, income, occupation, employment, and labor force participation was obtained. RESULTS: The prevalence of physical inactivity among U.S. adults was 23%, with more women (28%) than men (17%) reporting being inactive during their leisure time. Additionally, inactivity is more common among in social class such as persons who are less educated, living below the poverty line, living in households with income below 20,000 dollars, and who are retired. In every category of social class, women experienced a higher prevalence of physical inactivity than men. CONCLUSIONS: We conclude that social class is associated with physical inactivity and that more research is needed to better understand the effect that other social and environmental factors have on sedentary behaviors in our society.

Adult↗

PubMed2004

Role of the physician in childhood obesity.

OBJECTIVE: To suggest the role of the practicing physician in examining and treating childhood obesity. How should obesity be determined at clinical examination? Is there an obesity epidemic? What is the likely influence of obesity upon current and future health? What are the causes of obesity, and what does this imply for prevention and treatment? DATA SOURCES: Relevant articles in Medline and personal files. DATA SYNTHESIS: The 80th and 95th percentiles of body mass index and skinfold readings provide the most commonly accepted indices of overweight and obesity in the child. Over the last 20 years, the proportions of overweight and obese children have increased in both indigenous populations and most developed societies. Current methods of assessing physical activity and diet during childhood lack the precision to establish the primary cause of the obesity epidemic, but correlational analysis shows a close relationship between body fat content and a decline in daily energy expenditures. Immediate consequences of childhood obesity include an increased prevalence of atherosclerotic plaques, hypertension, and an adverse lipid profile, with a poor self-image that limits participation in physical activity. Tracking is such that many obese children become obese adults, and in consequence, the long-term risks of cardiovascular and all-cause deaths are increased. The prevention of obesity is easier than its cure. A combination of increased lifestyle activities, less sedentary behavior, and dietary modification seems the most effective approach. This should be supported by the use of behavioral modification techniques and changes in the urban environment that encourage an active lifestyle. CONCLUSIONS: The pediatric physician can contribute to the control of obesity by monitoring body mass index and skinfold thicknesses in all patients. Children above the 50th percentile of body fat need dietary modification and a greater amount of moderate physical activity. Physicians should also advocate quality daily physical education and an environment that encourages adoption of an active lifestyle.

Adolescent↗

PubMed2001

Implications of gender differences on coronary artery disease risk reduction in women.

Differences in the clinical presentation and resultant treatment of coronary artery disease (CAD) for men and women have sensitized advanced practice nurses to the importance of addressing gender issues when caring for women with CAD. Certain patient characteristics and clinical conditions may place women at higher risk of CAD development or progression. These factors include depression, African American status, menopausal status, age, type 2 diabetes, and thyroid function. In addition, female gender may adversely influence the relative benefits of cholesterol lowering in elderly women with borderline high serum cholesterol levels and response to interventions for modification of sedentary behavior and for smoking cessation. This article addresses emerging knowledge regarding gender differences in CAD risk factors and responsiveness to risk reduction interventions, issues regarding patient management, the implications of emerging knowledge on early detection of CAD risk factors more prevalent in women, and the development of targeted intervention approaches.

Acute Disease↗

PubMedDate not supplied

Physical activity and risk of vasomotor symptoms in women with and without a history of depression: results from the Harvard Study of Moods and Cycles.

OBJECTIVE: To examine whether physical activity was associated with decreased risk of vasomotor symptoms in a prospective study of women transitioning through menopause. DESIGN: Hypotheses were evaluated in the Harvard Study of Moods and Cycles, a longitudinal study of women with and without a history of major depression (N = 523). Ordinal logistic regression models were utilized to assess the odds of vasomotor symptoms (none, mild, moderate/severe; Greene Climacteric Scale) associated with physical activity (quartiles of metabolic equivalent-hours per week) at study enrollment and over a 3- to 5-year follow-up period. RESULTS: No significant associations between physical activity and vasomotor symptoms were observed for the sample as a whole. However, exploratory analyses stratified by depression history revealed that among the 157 women with a lifetime history of major depression, high (odds ratio [OR] = 0.28, 95% CI: 0.09-0.83) or moderately high (OR = 0.33, 95% CI: 0.11-0.99) physical activity proximal to the vasomotor assessment, as well as consistently high (OR = 0.27, 95% CI: 0.10-0.75) or increasing (OR = 0.33, 95% CI: 0.12-0.92) physical activity over the duration of the 3- to 5-year follow-up period was associated with decreased vasomotor symptoms relative to sedentary behavior. No significant associations were observed for women without a history of depression. CONCLUSIONS: Physical activity may be associated with decreased risk of vasomotor symptoms among women with a history of major depression.

Adult↗

PubMed2004

Does a family history of coronary heart disease modify the relationship between physical activity and blood pressure in young adults?

BACKGROUND: The purpose of this study was to examine the relationships between physical activity, a family history (FH) of coronary heart disease (CHD), and blood pressure (BP) in young adults. We were specifically interested in determining whether the relationship between moderate-to-vigorous physical activity and BP was modified by a FH of CHD. METHODS: Subjects were 230 (103 males, 127 females) university students. Family history was self-reported and habitual physical activity was assessed with a 3-day activity diary. Indicators of habitual physical activity included estimated daily energy expenditure (EE) and EE in moderate-to-vigorous physical activity (MVPA) [median metabolic equivalent (MET) > or =4.8] and inactivity (IA) (MET<2.8). Blood pressure was measured by an automated device according to standard procedures. RESULTS: A large proportion of the sample (63% of males and 68% of females) reported a FH of CHD. In general, correlations between physical activity and BP were low (r<0.30), but in the expected direction (i.e., positive for IA and negative for MVPA and EE). In males IA was significantly related to BP (r =0.25-0.29), but MVPA was not significantly related to BP (r= -0.01 to -0.16). In females diastolic BP was significantly related to IA (r= -0.21) and total EE (r= -0.18). Total EE was significantly correlated to DBP (r= -0.22) in males and to mean arterial pressure (r= -0.18) in females. No significant differences in BP were found between subjects with or without a FH of CHD. Slightly stronger correlations emerged between MVPA and BP for subjects with a negative FH of CHD compared to those with a positive FH of CHD. CONCLUSION: These data show a significant association between sedentary behavior and blood pressure in young adults. It is suggestive that the magnitude of the relationship between MVPA and BP may be modified by a FH of CHD. Thus, individuals with a FH of CHD may not be as responsive to increased levels of MVPA compared to those without a FH of CHD.

Adult↗

PubMed2005

Risk factors for childhood overweight.

PURPOSE OF REVIEW: We review the 2004 literature on risk factors for childhood overweight. Given the steady increase in the prevalence of childhood overweight, the identification of risk factors is of increasing importance. RECENT FINDINGS: A number of studies confirmed that parental overweight is the most potent risk factor for childhood overweight. Childhood temperament was found to mediate the effects of parental overweight with a difficult temperament increasing the risk of overweight. Newer findings implicate regular consumption of fast food and sweetened drinks as risk factors, as well as sedentary behavior; although a meta-analysis suggested that the effects of the latter factor are small. Other work was consistent with the finding that parental overcontrol of children's feeding behavior, particularly for those at high risk of developing overweight, may lead to overweight. SUMMARY: Identification of groups of children at high risk for becoming overweight offers the potential for early intervention to reduce the intergenerational transfer of obesity. This is an area for future research because the nature of effective intervention is at present unclear. There is a suggestion that focused behavior change efforts on one target such as reducing the intake of sweetened beverages may be more successful than attempts to make broader dietary changes. There is also evidence that targeting parental behaviors may be more effective than interventions directed solely toward children, suggesting that modification of the environment that a child is exposed to during early development may have a lasting effect.

Breast Feeding↗

PubMedDate not supplied

Relationship between work stress and body mass index among 45,810 female and male employees.

OBJECTIVE: The proportion of overweight and obese people has grown rapidly, and obesity has now been widely recognized as an important public health problem. At the same time, stress has increased in working life. The 2 problems could be connected if work stress promotes unhealthy eating habits and sedentary behavior and thereby contributes to weight gain. This study explored the association between work stress and body mass index (BMI; kg/m2). METHODS: We used cross-sectional questionnaire data obtained from 45,810 female and male employees participating in the ongoing Finnish Public Sector Cohort Study. We constructed individual-level scores, as well as occupational- and organizational-level aggregated scores for work stress, as indicated by the demand/control model and the effort-reward imbalance model. Linear regression analyses were stratified by sex and socioeconomic status (SES) and adjusted for age, marital status, job contract, smoking, alcohol consumption, physical activity, and negative affectivity. RESULTS: The results with the aggregated scores showed that lower job control, higher job strain, and higher effort-reward imbalance were associated with a higher BMI. In men, lower job demands were also associated with a higher BMI. These associations were not accounted for by SES, although an additional adjustment for SES attenuated the associations. The results obtained with the individual-level scores were in the same direction, but the relationships were weaker than those obtained with the aggregated scores. CONCLUSIONS: This study shows a weak association between work stress and BMI.

Adolescent↗

PubMed2004

Type 2 diabetes: epidemiologic trends, evolving pathogenetic [corrected] concepts, and recent changes in therapeutic approach.

The prevalence of type 2 diabetes has assumed epidemic dimensions. Children are now vulnerable to a disease that was once the exclusive domain of adulthood. Increased body weight and sedentary behavior accelerate insulin resistance and beta-cell dysfunction, leading to the clinical manifestation of hyperglycemia. Other cardiovascular risk factors tend to cluster in this milieu, setting the stage for vastly increased macrovascular morbidity. Many more people have impaired glucose tolerance ('prediabetes'). They are not only at risk for frank diabetes but also for the recently recognized entity of 'metabolic syndrome,' which is further characterized by hypertension, dyslipidemia, and central adiposity. A multifactorial approach addressing these aspects in addition to intensive glycemic control is the most efficacious therapy, optimally achieved through a team effort comprising the clinician, diabetes nurse, dietitian, and other professionals. Early use of oral-agent combinations is gaining favor. Insulin is best utilized in a basal-bolus fashion to manage both fasting and postprandial glycemia, delivered with multiple-dose injections or continuously via the pump. In hospitalized patients, good diabetic control reduces mortality. Finally, recent trials show that optimal weight maintenance and regular exercise can prevent or delay type 2 diabetes. Such information can serve as the foundation for large-scale preventive endeavors at the community level.

Adolescent↗

PubMed2007

Promotion of physical activity in primary care for obesity treatment/prevention in children.

PURPOSE OF REVIEW: Physical activity has been highlighted internationally as a beneficial intervention for weight control and the improvement of physical and mental health. This review highlights findings from recent literature to guide office-based promotion of physical activity for obesity treatment and prevention. RECENT FINDINGS: Children worldwide participate in far less than the current physical activity recommendations. Family-based activity provides children with positive role modeling as well as motivational support for maintaining an active lifestyle. The integration of physical activity into daily life can be an effective alternative to sports and structured exercise programs. Decreasing sedentary behaviors is also a positive contribution, although its link to physical activity levels is still unclear. Some families may see neighborhood safety and access to recreational facilities as barriers to keeping their children physically active. SUMMARY: Research in the field of pediatric obesity and overweight treatment and prevention continues to find challenges and solutions. Promotion of physical activity by the pediatric provider is demonstrated by current evidence to be a positive intervention against this global problem.

Child↗

PubMed1998

Facilitators, barriers, and strategies for exercise in European American women in the community.

A qualitative study was undertaken to explore the facilitators, barriers, and strategies that contribute to exercise performance in European American (EA) women. Focus groups were used to obtain information about the experiences of EA women concerning physical activity in their daily lives. Sixteen women aged 35-50 were recruited to participate in one of two focus groups. Focus group transcripts were coded and content analyzed. Major facilitators identified were social support, accommodating schedule, self improvement, supportive environment, and individual factors. Major barriers were lack of family support, unaccommodating schedule, consequences of exercise, environmental barriers, and individual barriers. The findings of this study can be used to develop nursing interventions designed to decrease sedentary behavior in EA women.

Adult↗

PubMed2004

Obesity in youth: implications for the advanced practice nurse in primary care.

PURPOSE: To discuss the advanced practice nurse's diagnosis and management of obesity in youth in primary care. DATA SOURCES: Review of current scientific literature, practice guidelines, and a case study. CONCLUSIONS: Obesity in youth is difficult to manage. Recent research suggests a genetic and environmental etiology associated with impaired glucose tolerance, type 2 diabetes, hypertension, hyperlipidemia, and hypertriglyceridemia. Nutrition education, increasing physical activity, decreasing sedentary behaviors, and behavioral modification have been used with varying success. Management is directed at healthy lifestyle behavior change for youth and their families. IMPLICATIONS FOR PRACTICE: If obesity, impaired glucose tolerance, hypertension, hypercholesterolemia, and hypertriglyceridemia are left untreated, youth may develop type 2 diabetes and coronary artery disease later in life and suffer early morbidity and mortality.

Adolescent↗

PubMed2005

Physical activity and fitness among midlife and older rural women.

This study investigated physical activity and fitness of midlife and older rural women. Random-digit dialing was used to recruit 225 women (57.9 +/- 5.6 years old). Self-reported activity (moderate activity, flexibility, and strength) and fitness (body composition, flexibility, strength, and estimated VO(2max)) were assessed. The women demonstrated low daily energy expenditure (30.74 +/- 10.63 kcal x kg(-1) x day(-1)) and estimated VO(2max) (20.12 +/- 7.81 ml x kg(-1) x min(-1)), with 51.5% reporting fair or poor health. Few women reported meeting Healthy People 2010 targets for moderate activity (43.1%), flexibility (28.9%), or strength )14.2%). When classified by estimated VO(2max) into three categories, differences were observed for body-mass index, percent body fat, sit and reach, and timed chair stands, with the poorest performance by those with low cardiorespiratory fitness. Adherence to Healthy People 2010 targets for moderate activity and strengthening was associated with higher cardiorespiratory fitness. These rural women are targets for physical activity interventions because of their sedentary behaviors and low cardiorespiratory fitness.

Aged↗

PubMed2001

Preventing obesity in children and adolescents.

In this review, we address the natural history of obesity in children, the most promising family- and school-based approaches to the prevention of obesity, and the barriers and opportunities associated with secondary prevention. In childhood, the most important periods of risk appear to be the periods of adiposity rebound and adolescence. Caution regarding the period of adiposity rebound is still warranted, because it is not yet clear that early rebound is attributable to changes in body fat. Families and schools represent the most important foci for preventive efforts in children and adolescents. One productive approach is to proceed from an examination of factors that affect energy balance to the identification of more proximal influences on those factors. This approach may help to narrow the strategies necessary to prevent or treat childhood obesity. For example, television viewing affects both energy intake and energy expenditure, and therefore represents a logical target for interventions. Anticipatory guidance by pediatricians may offer an effective mechanism by which to change parental attitudes and practices regarding television viewing. A similar process is used to emphasize the potential influence of school-based interventions directed at changes in food choices and sedentary behavior.

Adolescent↗

PubMed2005

Integrating physical activity into mental health services for persons with serious mental illness.

This article reviews evidence supporting the need for interventions to promote physical activity among persons with serious mental illness. Principles of designing effective physical activity interventions are discussed along with ways to adapt such interventions for this population. Individuals with serious mental illness are at high risk of chronic diseases associated with sedentary behavior, including diabetes and cardiovascular disease. The effects of lifestyle modification on chronic disease outcomes are large and consistent across multiple studies. Evidence for the psychological benefits for clinical populations comes from two meta-analyses of outcomes of depressed patients that showed that effects of exercise were similar to those of psychotherapeutic interventions. Exercise can also alleviate secondary symptoms such as low self-esteem and social withdrawal. Although structured group programs can be effective for persons with serious mental illness, especially walking programs, lifestyle changes that focus on accumulation of moderate-intensity activity throughout the day may be most appropriate. Research suggests that exercise is well accepted by people with serious mental illness and is often considered one of the most valued components of treatment. Adherence to physical activity interventions appears comparable to that in the general population. Mental health service providers can provide effective, evidence-based physical activity interventions for individuals with serious mental illness.

Cardiovascular Diseases↗

PubMedDate not supplied

Increasing activity to reduce obesity in adolescent girls: a research review.

OBJECTIVE: To provide a systematic review of physical activity intervention research conducted with adolescent girls (12-19 years of age and/or in middle or high school) in the United States and Canada during the past two decades. DATA SOURCES: Published articles in English were identified in searches using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, EMBASE, Science Citation Index, and the Cochrane Controlled Trials Register, with the keywords adolescent health, obesity, physical activity, and exercise, between the dates of May 1980 and November 2003. STUDY SELECTION: Research studies with interventions that started within the adolescent time period. Only 7 studies met the inclusion criteria. DATA EXTRACTION: The publication year, sample description, study design, interventions used, and outcomes were extracted from each study. DATA SYNTHESIS: The 7 studies were published between 1989 and 2003, included girls and boys in the overall sample (no studies with girl-only samples), used randomized controlled trial or quasi-experimental designs, and included multicomponent interventions. Body mass index, fitness levels, exercise, and weight were measured as outcomes. CONCLUSIONS: Although the results were not consistent across studies, they suggest that school-based, multicomponent interventions that were also designed to decrease sedentary behavior were effective in increasing physical activity in adolescent girls. Future research should focus on determinants of long-term adherence and the duration and intensity of interventions necessary to prevent obesity in adolescent girls.

Adolescent↗

PubMed2006

If you build it, they will come: lessons from developing walking trails in rural Missouri.

Given the high rates of sedentary behaviors, attempts to increase physical activity have incorporated individual and, more recently, policy and environmental approaches for promotion of activity. This article presents a summary of the approaches being used by the Ozark Heart Health Coalitions in developing walking trails in rural Missouri. In summarizing these approaches the authors describe 10 lessons with the aim of articulating the process and, thereby, increasing interest and capacity in development of walking trails. Qualitative and quantitative data were used to show burden and priorities and build support with numerous stakeholders. Stakeholders were engaged to identify common objectives, obtain land and funding, and determine trail size, materials, and time needed for construction. Implementation activities focused on trail maintenance and addition of amenities (e.g., playgrounds, benches). In the area of evaluation, they collect data via interviews with walkers on trails and community telephone surveys.

Community-Based Participatory Research↗