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PubMed2006

The family environment and American adolescents' risk of obesity as young adults.

In this article, the effects of the family environment and adolescents' behaviors while in school grades 7 through 12 on their weight status 6 years later are examined using data from the United States National Longitudinal Study of Adolescent Health. Ordinal regression models of 6378 adolescents reveal that their family environments exert an influence on their weight that lasts into young adulthood. Parental obesity puts both males and females at greater risk for being overweight or obese as young adults, as does already having excessive weight in adolescence. The findings also reveal significant gender differences in the intergenerational transmission of body weight within families. Higher parental educational attainment, a stronger perception that parents care about them, and a higher self-esteem reduce female adolescents' risk for excessive weight as young adults, while being African American or Native American increases it. In contrast, only a perception that their parents are trying to control their diets and a higher degree of closeness with a parent put male adolescents at greater risk for excessive weight as young adults. Adolescents' participation in physical activities does not predict subsequent weight for either males or females, although the amount of time spent in sedentary activities does for females, but not males. The only adolescent behavior examined that influenced male weight in young adulthood was eating breakfast.

Adolescent↗

PubMed2005

Education on the glycemic index of foods fails to improve treatment outcomes in a behavioral weight loss program.

The glycemic index (GI) may play an important role in weight management by helping to control appetite and insulin levels. The impact of adding education on the GI of foods to a behavioral weight loss program (BWLP) was examined. Fifty-three obese, sedentary participants were randomly assigned to receive either a BWLP or a BWLP+GI education. Pre- and posttreatment weight loss, body fat, and diet were assessed. Weight loss and body fat were assessed at 1-year posttreatment. GI education had no significant impact on weight loss treatment outcomes at posttreatment or 1-year follow-up. Average weight loss was 7.6 kg (p<0.05). Participants in the BWLP+GI education group had significantly greater GI knowledge (p<0.05) and consumed foods with a lower average daily GI (p<0.05), than participants in the BWLP at posttreatment. At 1-year posttreatment, participants regained 59% of their posttreatment weight loss and 34% of their lost body fat. GI education did not improve BWLP treatment outcomes in this investigation.

Adult↗

PubMedDate not supplied

Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia.

BACKGROUND: Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). OBJECTIVES: To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. METHODS: Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. RESULTS: Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01). DISCUSSION: Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.

Activities of Daily Living↗

PubMed2005

[Quantitative analysis of factors affected mortality trend in Chinese, 2002].

OBJECTIVE: To explain trend of death in Chinese by quantitative analysis of demographic and non-demographic factors and estimate the proportion of contribution of non-demographic and demographic factors. METHODS: Using census data and death causes data of National Disease Surveillance Points at 1991 and 2000 to calculate the proportion of contribution of demographic and non-demographic factors and to change on various death causes from 1991 to 2000 by methods of decomposing the differences of death rates. RESULTS: The death rate showed a rapid decrease during 1950 - 1975, mainly owing to the contribution of non-demographic factors, including economic development, popularization of education and health service, especially the "patriotic hygiene movement". During 1991 - 2000, the death causes of lung cancer, liver cancer, breast cancer, chronic heart disease, stroke, diabetes and traffic accident had been increasing. The increase of deaths caused by these diseases were contributed to the non-demographic factors including 63% of the increase on lung cancer and 88% of increase on death rate of traffic accidents. CONCLUSION: The study showed that the risk factors had contributed to the increase of death rates, including behavioral risk factors described in the preceding 5 papers as smoking and passive smoking, unhealthy diet, sedentary life style, violating traffic regulation etc. In order to reduce the death rates on cancer, heart diseases, diabetes, traffic accidents, emphasis should be also laid on the change of unhealthy behaviors.

Cause of Death↗

PubMed2005

[Study on diet, physical activities and body mass index in Chinese population in 2002].

OBJECTIVE: To describe the prevalence of behavior on diet, physical activities and body mass index (BMI) in different populations related to factors as education, occupation and geographical distribution. METHODS: Indicators including frequency of taking different foods, intake of cooking oil/fast foods, intensities of physical activities at work, proportion of taking physical exercises during the day, sedentary life style and BMI were calculated based on results from 17 questions of behavior risk factors surveillance (BRFS) questionnaire by weight on age structures from 2000 census. RESULTS: Seventy percentage of the people took vegetable and 40 percent took fruits 5-7 days per week, and over 50 percent of them ate pork/beef/mutton but few of them ate beans and eggs. 25 percent of the people ate chicken/duck/fish/and shrimps 5-7 times per week but another 40 percent ate them only less then once per week. 70% of the people almost never drank milk or milk-products. 15 percent of them consumed sweet and greasy foods 3-7 days per week and 30 percent of them ate smoked food 3-7 days per week in the past 30 days. The proportions of food intake were different under different geographical regions, education levels and occupations. 11.7% of the sample population cooked mainly with animal oil, and 33% of the students had ever been to McDonald's. 11.7%, 20.5%, 44.7% and 23.0% of the subjects engaged in sedentary, light, moderate or heavy physical activities respectively. 18.04% of the subjects took part in physical exercises with different proportions by gender, occupation, education and geographical settings. 8.3% people were slim which was defined as having BMI lower than 18.5 kg/m(2). 68.0% of the people had a BMI as 18.5-23.9 kg/m(2). 23.7% of the subjects were being overweight which was defined as having BMI greater than 24 kg/m(2), among which 8.5% people with a BMI of 24-24.9 kg/m(2). CONCLUSION: The prevalence of overweight and obesity will increase in the next 20-30 years, with the habits of taking more foods with high fat and energy but with less physical activities and keeping the idea as "fattier makes happier". Priorities should be given to changing the diet habit, avoiding over-intake of high fat and high energy plus increasing physical activities through publicity of knowledge on health, policy enforcement and development of supportive environment.

Adult↗

PubMed1999

The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial.

BACKGROUND: Smoking prevalence rates among women are declining at a slower rate than among men. OBJECTIVE: To determine if exercise, a healthful alternative to smoking, enhances the achievement and maintenance of smoking cessation. METHODS: Two hundred eighty-one healthy, sedentary female smokers were randomly assigned to either a cognitive-behavioral smoking cessation program with vigorous exercise (exercise) or to the same program with equal staff contact time (control). Subjects participated in a 12-session, group-based smoking cessation program. Additionally, exercise subjects were required to attend 3 supervised exercise sessions per week and control subjects were required to participate in 3 supervised health education lectures per week. Abstinence from smoking was based on self-report, was verified by saliva cotinine level, and was measured at 1 week after quit day (week 5), end of treatment (week 12), and 3 and 12 months later (20 and 60 weeks after quit day, respectively). RESULTS: Compared with control subjects (n = 147), exercise subjects (n = 134) achieved significantly higher levels of continuous abstinence at the end of treatment (19.4% vs 10.2%, P = .03) and 3 months (16.4% vs 8.2%, P=.03) and 12 months (11.9% vs 5.4%, P=.05) following treatment. Exercise subjects had significantly increased functional capacity (estimated VO2 peak, 25+/-6 to 28+/-6, P<.01) and had gained less weight by the end of treatment (3.05 vs 5.40 kg, P = .03). CONCLUSIONS: Vigorous exercise facilitates short- and longer-term smoking cessation in women when combined with a cognitive-behavioral smoking cessation program. Vigorous exercise improves exercise capacity and delays weight gain following smoking cessation.

Adult↗

PubMed2003

Exercise self-efficacy in older adults: social, affective, and behavioral influences.

A 6-month randomized controlled trial examined the effect of walking and stretching/toning activity on changes in self-efficacy to overcome barriers and engage in incremental periods of activity in older, formerly sedentary adults (N = 174, M age = 65.5 years). Additionally, we were interested in the extent to which social, affective, and behavioral influences contributed to self-efficacy at the end of the 6-month program. Multiple sample latent growth curve analyses revealed a nonsignificant curvilinear growth pattern for barriers efficacy with increases in efficacy occurring from baseline to 2 months and then declining at 4 and 6 months. In the case of efficacy related to continued activity participation, there was a significant growth pattern demonstrating declines in efficacy over the 4 time points. Structural modeling analyses revealed significant direct effects of physical activity, affect experienced during activity, and exercise social support on both types of self-efficacy. These relationships were not significantly different between modes of activity. The findings are discussed in terms of the need to target sources of efficacy information prior to program end and the implications that such an approach might have for long-term maintenance of physical activity in older adults.

Affect↗

PubMedDate not supplied

Self-care practices in women with diastolic heart failure.

BACKGROUND: For many patients with heart failure (HF), performing self-care is complicated by the complex medication regimen, symptom monitoring, and required decision-making. Women with HF are typically older and more physically debilitated, have more comorbidities, and may be at higher risk for poor self-care practices. Previous studies have largely excluded patients with diastolic heart failure (DHF), however, so little is known about their self-care practices. OBJECTIVES: The purposes of the study were to describe the (a) performance of self-care behaviors and (b) demographic and clinical characteristics that affected self-care practices in women with DHF. METHODS: Thirty-two women who were 50 years of age or older and diagnosed with DHF were recruited through cardiologist referral from an outpatient HF clinic in an academic health care setting. Data were collected using a semistructured interview guide. Descriptive statistics were used to analyze participant demographic and clinical characteristics. The responses were tabulated in order of frequency and then coded into categories. RESULTS: The mean age of the women was 68 +/- 11 years; 81% had annual incomes at or below the poverty level, 41% lived alone, and the majority had three or more comorbidities. Although most perceived their HF knowledge to be fair to good, and 62% had received HF educational information, only six (19%) weighed daily, few followed the recommended sodium restrictions, and 91% were sedentary at the time of the interview. The only self-care behavior that was consistently practiced (72%) was taking prescribed medications. Exertional intolerance often interfered with household chores and was cited most often as the reason for poorer quality of life. Decision-making about self-care activities such as taking diuretics was typically based on daily plans and social outings. Medical attention was sought only when acute or life-threatening symptoms occurred. Few women actively participated in ongoing symptom monitoring, and confusion over symptom recognition was a recurrent problem. CONCLUSIONS: Lower socioeconomic status and advancing age increase vulnerability for poor self-care and negative clinical outcomes in women with DHF. Recommendations to improve self-care practices among economically disadvantaged women with HF such as prescribing routine activities as exercise, screening for depression, and home visits to increase socialization are discussed along with areas for future research.

Aged↗

PubMed1997

Environmental factors affecting nutritional status in urban areas of developing countries.

The demographic and economic transition that many developing countries are undergoing is producing important changes in diet and lifestyle that greatly impact on disease risks. Among the risk behaviors associated with socioeconomic transition and urbanization are excessive dietary fat intake, sedentary lifestyle, smoking, and environmental contamination. Combined with a reduced infant mortality and increased life expectancy, those risk factors lead to an increasing prevalence of chronic disease like non-insulin dependent diabetes and coronary heart disease. This disease. This disease profile is a relatively new phenomenon in developing countries, where health programs have traditionally focused on "acute" interventions such as immunization or oral rehydration. A new approach will be needed to address chronic diseases, which frequently demand a life-long and technically complex medical management, and may have significant impact on the quality of life and productivity of the population. Efforts to address this situation should focus on a) expanding the information base on diet, nutritional status and lifestyle changes in populations migrating to urban areas; b) developing and evaluating approaches for improving diet quality in urban populations, including fortification and community-based supplementation programs; c) understanding better the social and behavioral determinants of nutritional status in the urban poor; and d) defining the role of the food industry and of agricultural production for improving the quality of the food supply in urban areas.

Asia↗

PubMed2002

Social environment influences the progression of atherosclerosis in the watanabe heritable hyperlipidemic rabbit.

BACKGROUND: Although there is evidence that emotionally stressful behavior can accelerate the progression of atherosclerosis, there is less data to support the notion that affiliative social behavior can slow disease progression. The present study examines the influence of social environment on the progression of atherosclerosis in the Watanabe Heritable Hyperlipidemic (WHHL) rabbit, a model that spontaneously develops lesions because of a genetic defect in lipoprotein clearance. METHODS AND RESULTS: WHHL rabbits were assigned to 1 of 3 social or behavioral groups: an unstable group, in which unfamiliar rabbits were paired daily, with the pairing switched each week; a stable group, in which littermates were paired daily for the entire study; and an individually caged group. The stable group exhibited more affiliative social behavior and less agonistic behavior than the unstable group and significantly less aortic atherosclerosis than each of the other 2 groups. Although the unstable and individually caged groups had comparable aortic lesion areas, the severity of the disease progressed faster in the unstable group, as indexed by a larger area of calcification and increased fibrous cap thickness in complex lesions. The unstable group showed increased agonistic behavior and signs of chronic adrenocortical and gonadal activation, whereas the individually caged group was relatively sedentary, had low glucocorticoid levels, and was hyperinsulinemic compared with the other groups. CONCLUSIONS: The present study demonstrates that social environment can slow, as well as accelerate, the progression of atherosclerosis. It also emphasizes the importance of behavioral factors in atherogenesis, even in a model of disease with strong genetic determinants.

Adrenal Glands↗

PubMed2002

Stages of exercise behavior and caloric expenditure.

BACKGROUND: This study assessed the ability of the stages of exercise behavior to differentiate caloric energy expenditure, by stage, based upon self-report of energy expenditure (EE). METHODS: Volunteer male and female participants (n=890) reported current stage of physical activity; physical activity mode, duration, and frequency; and demographic information (height and weight). Data calculated from reported information included EE, body mass index (BMI), and BMI category. EE profiles were established by average estimated EE (kcal/wk), average total time (min/wk) for physical activity, average activity frequency (times/wk), average session duration (min/session), moderate and vigorous EE levels (kcal/wk), and categorized activity level (sedentary, moderate, vigorous). RESULTS: There were no significant within gender differences across stages of exercise behavior for height. Terminators differed significantly for weight from all other groups, and BMI was significantly less across groups, by gender. All males were identified in the "Mildly Obese" BMI level, while only females in the non-active (precontemplation, contemplation, and preparation) groups were so identified. All other females were at the "Acceptable" BMI level. Regardless of gender, all groups were significantly different from the sedentary precontemplation and contemplation group for EE. Male and female preparation groups reported EE in the moderate level, and were significantly different from the action, maintenance, and termination groups, who reported EE in the vigorous level. Across subsequent stages of exercise behavior, female participants demonstrated increased EE. Male participants were similarly profiled, with the exception of one group (action stage), which was considerably greater than all other groups. CONCLUSIONS: This study confirmed the earlier examined premise, by Cardinal, that self-selected stage of exercise behavior differentiates EE by stage.

Adult↗

PubMed2004

Risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.

OBJECTIVE: To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis. METHODS: It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults (18-60 years) presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle. RESULTS: Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: sedentary life style 72%, family history 42%, dyslipidemia 31%, obesity 24%, hypertension 19% and diabetes mellitus 15%. Diabetes, hypertension and dyslipidemia were poorly controlled in the study population. Proportions of the three major risk factors (smoking, hypertension and dyslipidemia) occurring singly, doubly and all three together in the study population were found to be 39%, 11% and 1%, respectively. Data were also analyzed for risk factors by comparing those with and without family history of CAD to eliminate any bias. The results were not statistically significant except for the sedentary life style (P=0.016). CONCLUSION: There is a high prevalence of CAD risk factors in this study population. Modifiable risk factors like diabetes, hypertension and high cholesterol need better control. Preventive screening programs and healthy lifestyle behaviours need to be emphasized upon in the community.

Adolescent↗

PubMed2002

Using technology to teach health: a collaborative pilot project in Alabama.

The Centers for Disease Control and Prevention (CDC) identified six adolescent risk behaviors that contribute to chronic diseases and disorders, including poor dietary habits, sedentary lifestyle, and abuse of alcohol, tabacco, and other drugs. This project pilot-tested a "train-the-trainer" model to diffuse an interactive health education software program into Alabama middle schools during a school year. Developmentally appropriate content included nutrition, physical activity, and prevention of substance use. Twenty-four site facilitators selected from 18 public school systems trained 364 colleagues and 2,249 students to use the software. During a school year, facilitators created 150 student assignments; they reported increased interest among students in health instruction. An essential feature of the project involved an active partnership among the funder, state department of education, university, and public schools. Planners provided technical assistance through face-to-face interaction, distance learning, telephone and e-mail communications, and a Web site. Planners and facilitators worked together to overcome barriers to the use of technology for health instruction.

Alabama↗

PubMed2000

Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning.

BACKGROUND: Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial. METHODS: One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed. RESULTS: Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7-mm Hg systolic and a 5-mm Hg diastolic clinic BP reduction, compared with a 4-mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups. CONCLUSIONS: Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals.

Adult↗

PubMed2001

Distribution, habitat and behavior of grasshopper sparrows, Ammodramus savannarum (Passeriformes: Emberizidae) in northeastern Nicaragua.

During March and April of 1996, I made field observations of the sedentary subspecies of grasshopper sparrow (Ammodramus savannarum cracens), in 600 points of the pine savannas of northeastern Nicaragua. Isolated individuals were found in the humid depressions, but breeding populations were located exclusively in areas that had suffered a recent fire. Territorial behavior varied in intensity apparently as a function of territory size: the most aggressive males were those trying to defend smaller territories in populations close to Miskito villages, where most of the fires occur. In contrast to what is happening in other parts of Central America, the Nicaraguan grasshopper sparrow may be indirectly protected from extinction by the Miskito's traditional fire practices.

Agonistic Behavior↗

PubMed2004

Effects of chronic activity wheel running and imipramine on masculine copulatory behavior after olfactory bulbectomy.

We examined the effects of chronic activity wheel running and imipramine administration on appetitive behavior after olfactory bulbectomy (OBX). Male Long-Evans rats were randomly assigned to the following conditions using a 2 x 2 x 2 design: (1) bilateral OBX or sham surgery, (2) voluntary activity wheel running or sedentary home cage, and (3) daily imipramine or saline injections. After 21 days of treatment, animals underwent behavioral testing for copulatory activity and sucrose preference. Bulbectomized animals exhibited decrements in copulatory performance and reductions in sucrose intake compared to sham animals. Within the bulbectomized groups, imipramine-treated rats either did not copulate or had reduced ejaculation frequencies. However, activity wheel running attenuated the copulatory deficits induced by OBX. The findings encourage studies of physical activity and male sexual dysfunction among depressed men being treated by pharmacotherapy.

Animals↗

PubMed2005

Application of cluster analysis in prevention of coronary heart disease.

INTRODUCTION: Coronary heart disease is one of the principal causes of death and morbidity in the western world, and particularly in Portugal. OBJECTIVES: This study's aim was to investigate coronary disease risk factors, differentiating lifestyles and behavioral habits which are associated with onset of the disease. METHODS: The experimental population was divided into two groups: an experimental group (n=30)--male subjects, aged 40-75 years, who suffered a first coronary event in the previous 20 days; and a control group (n=30)--male subjects, aged 40-75 years, who presented no coronary problems. Individuals with a clinical history of any other chronic disease were excluded from the sample. Data were obtained through questionnaires. Data analysis consisted of both traditional statistical analysis (Student's t test) and cluster analysis. The latter technique enables behavioral patterns that will or will not induce coronary heart disease to be distinguished. RESULTS: The Student's t test revealed significant differences (p < or = 0.05) between the experimental and control groups for the following variables: nutrition and dietary habits, smoking, stress and psychosocial factors, hereditary factors and total risk factors. The risk level of all these factors was higher in the experimental group. Cluster analysis applied to 19 variables enabled three behavioral patterns to be identified that may induce the disease, characterized by high risk indices in specific variables, and one behavioral pattern that tends to prevent development of coronary heart disease, which is characterized by low levels of risk factors. CONCLUSIONS: Coronary heart disease appears to be related to lifestyle and habits. Analysis of the three high-risk behavioral patterns enabled priority areas to be established for preventive measures against coronary heart disease. These are: stress, irritability and depression, smoking, sedentary lifestyle and nutrition (excessive consumption of salt, sugar and alcohol).

Adult↗

PubMed2000

Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE.

BACKGROUND: Project ACTIVE was a randomized clinical trial comparing two physical activity interventions, lifestyle and traditional structured exercise. The two interventions were evaluated and compared in terms of cost effectiveness and ability to enhance physical activity among sedentary adults. DESIGN: This was a randomized clinical trial. SETTING/ PARTICIPANTS: The study included 235 sedentary but healthy community-dwelling adults. INTERVENTION: A center-based lifestyle intervention that consisted of behavioral skills training was compared to a structured exercise intervention that included supervised, center-based exercise. MAIN OUTCOME MEASURES: The main outcome measures of interest included cost, cardiorespiratory fitness, and physical activity. RESULTS: Both interventions were effective in increasing physical activity and fitness. At 6 months, the costs of the lifestyle and structured interventions were, respectively, $46.53 and $190.24 per participant per month. At 24 months these costs were $17.15 and $49.31 per participant per month. At both 6 months and 24 months, the lifestyle intervention was more cost-effective than the structured intervention for most outcomes measures. CONCLUSIONS: A behaviorally-based lifestyle intervention approach in which participants are taught behavioral skills to increase their physical activity by integrating moderate-intensity physical activity into their daily lives is more cost-effective than a structured exercise program in improving physical activity and cardiorespiratory health. This study represents one of the first attempts to compare the efficiency of intervention alternatives for improving physical activity among healthy, sedentary adults.

Adult↗