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PubMed2002

Dietary patterns and risk factors for type 2 diabetes mellitus in Fijian, Japanese and Vietnamese populations.

Diabetes mellitus is now a serious and increasing problem in Asian countries, where dietary patterns have shifted toward Westernized foods and people are becoming more sedentary. In order to elucidate the relationship of dietary habits to the development of diabetic risk factors, the dietary patterns of 200 Fijian, 171 Japanese and 181 Vietnamese women of 30-39 years of age were investigated using 3 day-24 h recall or dietary records. Anthropometric measurements and glycosuria tests were also conducted. The dietary trends of Fijians and Japanese have changed drastically in the past 50 years, while Vietnamese have been minimally influenced by Western dietary habits. The mean 24 h dietary intake showed that Fijians had the highest energy intake. Energy intake from fat was only 13% for Vietnamese, but over 30% for Japanese and Fijians. Percentage of body fat was higher in Vietnamese than in Japanese, though there were no significant differences in body mass index (BMI). In the overweight and obese women, Vietnamese had higher abdominal obesity than Japanese. The prevalence of obesity (BMI > or = 30 kg/m2) was 63.0% for Fijians, 1.8% for Japanese and 1.1% for Vietnamese. Glycosuria testing yielded the most positive cases among Fijians. Dietary transition and dietary excess appear to be potential risk factors for diabetes in Fijian women.

Adipose Tissue↗

PubMed1975

Plasma nicotine levels after smoking cigarettes with high, medium, and low nicotine yields.

Plasma nicotine three minutes after smoking a cigarette was measured in 10 sedentary workers in mid-morning and five hours later on four typical working days. The average mid-morning level after they had been smoking their usual cigarettes (mean nicotine yield 1-34 ng) was 150-4 nmol/l (24-4 ng/ml) (range 95-6-236-7 nmol/l (15-5-38-4 ng/ml)). Despite great variation between smokersthe mid-morning levels of each smoker were fairly consistent over the four mornings and correlated 0-82 with their carboxyhaemoglobin levels. After continuing to smoke their usual brand or switching to a high-nicotine brand (3-2 mg) average afternoon levels of 185-6 and 180-0 nmol/6 (30-1 and 29-2 ng/ml) respectively were not significantly higher than the morning levels, but after switching to low-nicotine cigarettes (0-14 mg) the plasma nicotine dropped to an average of 52-4 nmol/l (8-5 ng/ml). The changes between morning and afternoon while smoking usual or high-nicotine cigarettes showed marked individual variation. The findings suggest that the plasma nicotine level just after a cigarette depends more on the way the cigarette is smoked than on its nicotine yield or the number which have been smoked over the preceding few hours.

Adult↗

PubMed2006

[Prevalence of overweight, obesity and life style associated with cardiovascular risk among middle school students].

BACKGROUND: To study the prevalence of cardiovascular risk associated to the lifestyle of school children from the 5th to 8th grade, in public and private schools. METHODS: Eighty seven randomly selected school rooms were visited adding up to 2,125 students who completed the questionnaire and whose body mass index was calculated. This sample represents around 2% of students from two school districts in the city of Sao Paulo. RESULTS: Of the 2,125 students, 24% were overweight or obese, 53.3% presented inappropriate food habits, 15.4% were sedentary, 62.6% drank alcohol, and 23.1% smoked. Between the 5th and 8th grade, the number of students who drank alcohol doubled and the number of male and female adolescents who tried out smoking increased 3-fold and 5-fold, respectively. Conversely, inappropriate food habits decreased. This situation is found in 40% of students from public schools and in 58% of those in private schools, by the time they reach the 8th grade. Overweight and obesity are more prevalent in private schools and the reduction noted as grades progress did not reach a significance level. Sedentarism is more prevalent in public schools. In private ones, sedentarism is lower among older students, contrary to public schools, where it increases with age. Female adolescents attend fewer physical education classes. Inappropriate food habits were characterized by the habits of adding more salt to pre-prepared food, lower intake of dairy products, fruit and vegetables also a higher intake of soft drinks, butter and snacks. CONCLUSION: Early detection of these cardiovascular risks associated to the lifestyle of these school children endorses the preventive practice of providing health education in schools.

Adolescent↗

PubMed2006

Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study.

BACKGROUND: The Short Physical Performance Battery (SPPB), which includes walking, balance, and chair stands tests, independently predicts mobility disability and activities of daily living disability. To date, however, there is no definitive evidence from randomized controlled trials that SPPB scores can be improved. Our objective was to assess the effect of a comprehensive physical activity (PA) intervention on the SPPB and other physical performance measures. METHODS: A total of 424 sedentary persons at risk for disability (ages 70-89 years) were randomized to a moderate-intensity PA intervention or a successful aging (SA) health education intervention and were followed for an average of 1.2 years. RESULTS: The mean baseline SPPB score on a scale of 0-12, with 12 corresponding to highest performance, was 7.5. At 6 and 12 months, the PA versus SA group adjusted SPPB (+/- standard error) scores were 8.7 +/- 0.1 versus 8.0 +/- 0.1, and 8.5 +/- 0.1 versus 7.9 +/- 0.2, respectively (p < .001). The 400-meter walking speed was also significantly improved in the PA group. The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk (hazard ratio = 0.71, 95% confidence interval = 0.44-1.20). CONCLUSIONS: A structured PA intervention improved the SPPB score and other measures of physical performance. An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes, such as mobility disability.

Activities of Daily Living↗

PubMed2003

Evaluating the Fabreville Heart Health Program in Laval, Canada: a dialogue between two paradigms, positivism and constructivism.

As part of the Canadian Federal-Provincial Initiative in Heart Health, the goal of the Fabreville Heart Health Program was to sensitize a district of Laval, Quebec's second most populous city, to heart-healthy behaviours. The program was planned and implemented by a committee composed of Fabreville community leaders and professionals from the Public Health Department. Between 1992 and 1994, intervention objectives were defined by the department in terms of changing individual behaviours associated with cardiovascular risk factors, namely diet, sedentariness and smoking, as well as adapting physical and social environments to facilitate these changes. However, from 1994 to its conclusion in 1997, the program was re-oriented to engage the population in mobilizing their own community and taking charge of interventions themselves. Actions then became dependent on the interests and motivation of Fabreville residents to transform their lifestyles and aspects of their physical environment. The initial evaluation process, based on the positivist paradigm, was designed to measure changes in individual behaviours and certain physical environments, such as an increase in designated non-smoking areas. However, following the re-orientation towards community mobilization, it was decided that evaluation should go beyond the professional production of data to include a process of the collective construction of knowledge. Evaluation methodology then became based on the constructivist paradigm. Yet field constraints such as lack of community involvement in both leadership and process evaluation, and the need to ensure evaluation standards and fulfil sponsor obligations, compelled the Public Health Department to return to using a certain number of positivist methods. The ensuing inter-paradigm dialogue helped broaden the scope of evaluation and contributed to gaining a more in-depth understanding of the processes and outcomes of community mobilization.

Cardiovascular Diseases↗

PubMed2005

Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among older adults worldwide, including Europe, Asia, and North America. In the United States (US), CVD is also the leading cause of death among Asian-Americans. Physical activity has been shown to reduce CVD risk factors. Reduction in blood pressure (BP) in response to Tai Chi (TC) exercise in persons with CVD risk factors have been reported, though not in ethnic Chinese living in the US. AIM: Hemodynamic responses to a 12-week community-based TC exercise intervention among ethnic Chinese with CVD risk factors were examined. METHODS: Quasi-experimental design. Ethnic Chinese > 45 years old with at least 1 major CVD risk factor, living in the San Francisco Bay Area, attended a TC intervention three times a week for 12 weeks. A 2-min step-in-place test assessed aerobic endurance. BP and heart rate were measured at rest, and within 1-min after the step-test. Data were collected at baseline, 6 and 12 weeks. RESULTS: A total of 39 subjects (69% women), 66 +/- 8.3 years old, with hypertension (92%), hypercholesteremia (49%), and/or diabetes (21%), and 1 current smoker participated. Adherence to the intervention was high (87%). Subjects were sedentary at baseline, though had a statistically significant improvement in aerobic endurance over-time (eta2 = 0.39). At baseline, the average BP at rest was 150/86, while BP in response to the step-test was 178/99. Clinically and statistically significant reductions in BP at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed. CONCLUSIONS: This innovative, culturally relevant, community-based 12-week TC exercise intervention, appealed to Chinese adults with CVD risk factors, with significant reductions in BP and improvement in aerobic endurance. Given the number of persons estimated to have HTN and other CVD risk factors, the identification of new approaches to improve health, combined with risk factor reduction is needed. This is particularly important, given the rise in HTN among adults in the US and the associated public health burden of HTN. TC has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to exercise.

Adult↗

PubMed2005

Predictors of improvement in women's physical activity.

This study identified factors that predicted improved levels of physical activity in working women. Data were from a prospective, controlled trial. Sedentary women (N = 287) were recruited during an employer-sponsored health screening. The experimental group received a brief, tailored physical activity intervention as well as a booster phone call 2 weeks later. Participants were evaluated by comparing pre-test/post-test measures at 6-week follow-up. It was hypothesized that variables in the Transtheoretical Model (baseline stage of change, perceived pros, cons, and self-efficacy), as well as demographic variables and physical characteristics would predict improved physical activity. In addition, the study tested whether increased physical activity changed the variables of the Transtheoretical Model. Factors that correlated to improved physical activity were entered into regression models to determine predictors of improved physical activity. Being assigned to the intervention group was a significant predictor in all of the regression models. Women who increased their stage of change of physical activity had greater improvement in self-efficacy (p = .013). Minority women showed greater improvement in stage of change of physical activity (p = .001) as well as week-end physical activity (p = .042). Women with less education were more likely to increase total minutes walked per week (p = .038). The research suggests that these cognitive and demographic variables are important for improving levels of physical activity. The Transtheoretical Model was partially supported by the analyses.

Adult↗

PubMed2002

Weight criticism during physical activity, coping skills, and reported physical activity in children.

OBJECTIVE: National health guidelines advocate increased physical activity in children and adolescents, but specific goals are not being achieved. Data are needed on variables that influence children's decision to be active or sedentary. METHODS: We tested the association of weight criticism during physical activity (WCA) with attitudes toward physical activity and reported physical activity levels in children. We also tested whether these associations were moderated by children's ability to cope with weight criticism. Subjects were 576 fifth- through eighth-graders who completed a questionnaire on physical activity patterns, weight criticism history, and coping skills. RESULTS: WCA was more common among girls than boys and among heavier children. In multiple regression analyses, WCA was associated with reduced sports enjoyment, perceived activity compared with peers, and mild-intensity leisure activity. These associations, however, were moderated by problem-focused coping skills such that the relationships were attenuated in children who were better able to cope with weight criticism. Avoidant coping skills also moderated the relationship between WCA and sports enjoyment. CONCLUSIONS: Children who are the targets of weight criticism by family and peers have negative attitudes toward sports and report reduced physical activity levels, although these relationships may be buffered by certain coping skills. Assessing WCA and related coping skills may be clinically useful for identifying barriers to physical activity in certain children (eg, the obese) and may be a potential target for interventions.

Adaptation, Psychological↗

PubMed2004

Fitness consequences of allorecognition-mediated agonistic interactions in the colonial hydroid Hydractinia [GM].

In sessile and sedentary organisms, competition for space may have fitness consequences that depend strongly on ecological context. Colonial hydroids in the genus Hydractinia use an inducible defense when encountering conspecifics, and intraspecific competition is common in natural populations, often resulting in complete overgrowth of subordinate competitors. My goal in this study was to quantify the impacts of agonistic interactions in Hydractinia [GM] (an undescribed species from the Gulf of Mexico) in terms of three primary fitness components: colony survival, growth rate, and immature gonozooid production. The results demonstrate that the fitness consequences of intraspecific competition depend on the size at which competitive encounters are initiated and the growth form (an indicator of competitive ability) of the competitors. Moreover, some competing colonies consistently produced more immature gonozooids than the controls without competition, and they exhibited extremely low mortality even after 90 days of growth. These results have several ramifications. First, agonistic interactions do not always proceed to competitive elimination. Second, the increase in production of immature gonozooids--an investment in future reproduction--in response to intraspecific competition supports the hypothesis that indeterminately growing organisms increase sexual reproductive effort when growth becomes limiting. Lastly, in light of known ontogenetic variation in the ability of Hydractinia to differentiate among genetically related colonies, strongly size-dependent fitness consequences are consistent with an adaptive, kin-discriminating allorecognition system.

Agonistic Behavior↗

PubMed2004

Intervention centred on adolescents' physical activity and sedentary behaviour (ICAPS): concept and 6-month results.

OBJECTIVE: To evaluate the 6-month impact of a physical activity (PA) multilevel intervention on activity patterns and psychological predictors of PA among adolescents. The intervention was directed at changing knowledge and attitudes and at providing social support and environmental conditions that encourage PA of adolescents inside and outside school. SUBJECTS AND DESIGN: Randomised, controlled ongoing field trial (ICAPS) in middle-school's first-level adolescents from eight schools selected in the department of the Bas-Rhin (Eastern France) with a cohort of 954 adolescents (92% of the eligible students) initially aged 11.7+/-0.6 y. The 6-month changes in participation in leisure organised PA (LOPA), high sedentary (SED) behaviour (>3 h/day), self-efficacy (SELF) and intention (INTENT) towards PA were analysed after controlling for baseline measures and different covariables (age, overweight, socioprofessional occupation), taking into account the cluster randomisation design. RESULTS: The proportion of intervention adolescents not engaged in organised PA was reduced by 50% whereas it was unchanged among control students. After adjustment for baseline covariables, LOPA participation significantly increased among the intervention adolescents (odds ratio (95% confidence interval) (OR)=3.38 (1.42-8.05) in girls; 1.73 (1.12-2.66) in boys), while high SED was reduced (OR=0.54 (0.38-0.77) in girls; 0.52 (0.35-0.76) in boys). The intervention improved SELF in girls, whatever their baseline LOPA (P<10(-4)) and INTENT in girls with no baseline LOPA (P=0.04). SELF tended to improve in boys with no baseline LOPA, without reaching statistical significance. When included in the regression, follow-up LOPA was associated with improvement of SELF in girls (P=0.02) and of INTENT in girls with no baseline PA (P<0.02). The intervention effect was then attenuated. CONCLUSION: After 6 months of intervention, ICAPS was associated with a significant improvement of activity patterns and psychological predictors, indicating a promising approach for modifying the long-term PA level of adolescents.

Adolescent↗

PubMed2001

The physical activity, fitness and health of children.

It is clear that, despite their natural tendencies, children have become less physically active in recent decades, with children today expending approximately 600 kcal days' less than their counterparts 50 years ago. Although the health consequences of a reduced energy expenditure in adults is well documented, there is little direct evidence linking sedentariness with health in children. However, three main benefits arising from adequate childhood physical activity have been postulated. The first is direct improvements in childhood health status; evidence is accumulating that more active children generally display healthier cardiovascular profiles, are leaner and develop higher peak bone masses than their less active counterparts. Secondly, there is a biological carry-over effect into adulthood, whereby improved adult health status results from childhood physical activity. In particular, childhood obesity may be a precursor for a range of adverse health effects in adulthood, while higher bone masses in young people reduce the risk of osteoporosis in old age. Finally, there may be a behavioural carry-over into adulthood, whereby active children are more likely to become more active (healthy) adults. However, supporting evidence for this assertion is weak. Given this background, recent health guidelines suggesting that children should accumulate 60 min of moderate-intensity physical activity every day--supplemented by regular activities that promote strength flexibility and bone strength--appear to be justified. Future developments should include the implementation of large-scale, longitudinal studies spanning childhood and young adulthood, the further refinement of tools for measuring physical activity accurately in young people, and research into the relative strength of association between fitness--as well as activity--and health in children.

Energy Metabolism↗

PubMed2005

Are solitary and gregarious Mormon crickets (Anabrus simplex, Orthoptera, Tettigoniidae) genetically distinct?

Phase polyphenisms are usually thought to reflect plastic responses of species, independent of genetic differences; however, phase differences could correlate with genetic differentiation for various reasons. Mormon crickets appear to occur in two phases that differ in morphology and behaviour. Solitary individuals are cryptic and sedentary whereas gregarious individuals form bands, migrate, and are aposematically coloured. These traits have been thought to be phenotypically plastic and induced by environmental conditions. However, there has been no previous investigation of the extent of genetic differences between solitary and gregarious populations of this widespread North American species. We sequenced two mitochondrial genes, COII and COIII, in samples of Mormon crickets from gregarious populations west of the continental divide and solitary mountain populations primarily east of the divide. Sequencing revealed two genetically distinct clades that broadly correspond with the solitary eastern populations and the mainly gregarious western populations. We used coalescent modelling to test the hypothesis that the species consists of two deep genetic clades, as opposed to a series of equally distinct populations. Results allowed us to reject the null hypothesis that a radiation independent of phase produced these clades, and molecular clock estimates indicate the time of divergence to be approximately 2 million years ago. This work establishes that the solitary populations found in the mountains on the eastern slope are part of a clade that is genetically distinct from the western populations, which are primarily gregarious, and the implications of this apparent correlation between phase and genetic differentiation are discussed.

Animals↗

PubMed2006

The effects of stability ball training on spinal stability in sedentary individuals.

Stability ball training (SBT) is believed to improve spinal stability (SS) and could reduce the risk of back pain in sedentary individuals. The purpose of this study was to examine the effects of SBT on SS. Twenty sedentary individuals were randomly assigned to either an experimental group that performed SBT twice per week for 10 weeks or to a control group. Differences between groups were assessed by analysis of variance (ANOVA) with repeated measures. The experimental group improved significantly (p < 0.05) on the static back-endurance test from pretest (149.3 +/- 72.3 seconds) to posttest (194.6 +/- 56.7 seconds) and the side bridge test from pretest (45.4 +/- 39.4 seconds) to posttest (71.3 +/- 59.7 seconds). Back endurance for the control group did not change from pretest (123.4 +/- 64.9 seconds) to posttest (87.5 +/- 40.2 seconds), nor did the results of the side bridge test change for this group from pretest (41.8 +/- 26.4 seconds) to posttest (51.6 +/- 35.9 seconds). These findings illustrate that SBT may provide improvements in SS within this population. Practitioners might use SBT exercises where the position of the spine is maintained during the early phases of back-pain prevention programs. This type of programming might be beneficial to individuals who spend a good deal of time sitting (i.e., in corporate fitness programs) or for individuals who are prone to back pain and have been cleared to exercise. Also, the side bridge and static back endurance assessments may be good choices for measuring SS in field settings.

Adult↗

PubMed1987

Assessment by a microprocessor of adherence to home-based moderate-intensity exercise training in healthy, sedentary middle-aged men and women.

Research in exercise training of healthy persons, which has been conducted almost exclusively in supervised group programs, is relatively expensive for the investigator and inconvenient for the participant. To overcome these obstacles, self-monitored moderate-intensity home-based exercise training was prescribed for 28 middle-aged men and 26 middle-aged women. The median energy expenditure prescribed for each of 5 weekly exercise sessions was 4 cal/kg body weight, or 317 kcal for men and 265 kcal for women, corresponding to a median duration of 45 and 60 minutes, respectively. In the next 24 weeks, peak oxygen uptake increased 13.7% in men who exercised, from 31 +/- 4 to 37 +/- 4 ml/kg/min, and 10% in women who exercised, from 26 +/- 4 to 29 +/- 5 ml/kg/min (p less than 0.001 for both comparisons). The proportion of prescribed caloric expenditure per session, which was documented by a solid-state heart rate recorder, was 108% in men and 90% in women. The duration of training at heart rates above the prescribed range approximated 10 minutes per session for both men and women; the proportion of total caloric expenditure represented by exercise at heart rates exceeding the prescribed limit was 9% for men and 4% for women. The proportion of time spent within the prescribed heart rate range during training sessions was 76% for men and 84% for women. Training-induced musculoskeletal problems were reported by 6 men and no women. No subject sought medical attention and all resumed training within 1 week.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

Primary and secondary barriers to physically active healthy lifestyles for adults with learning disabilities.

PURPOSE: Evidence shows that those with a learning disability are typically amongst the most inactive and sedentary members of the population, yet few studies have focused on the determinants of physical activity. The aim of the present study was to establish whether a group of 24 adults with mild and moderate learning disabilities receive adequate support to be able to make choices to lead a physically active lifestyle. METHOD: A descriptive study was used based on interviews with 24 adults with learning disabilities (mean age of 34 years) triangulated by day time and residential care workers. Participants volunteered from two residential homes and one social education centre (SEC) in a city in the North of England. RESULTS: The participants face a set of primary barriers that prevent them from having a choice to adopt the Department of Health's recommendations for physical activity. Identified barriers included: unclear policy guidelines in residential and day service provision together with resourcing, transport and staffing constraints; participant income and expenditure; and limited options for physically active community leisure. CONCLUSIONS: These are barriers that are widely acknowledged and understood by day and residential staff and participants in the study, but are arguably poorly understood by policy makers, health promotion agencies, commissioners and providers of learning disability services. The current lack of resources and inadequately specified responsibilities associated with community care deny many people with learning disabilities real choices to live a physically active healthy lifestyle.

Adult↗

PubMedDate not supplied

Factors influencing the exercise behaviour of patients.

The sports physician faces major practical problems in stimulating the activity of sedentary patients, and also ensuring their subsequent adherence to a prescribed exercise regimen. Both individual and society bear some responsibility for poor exercise compliance. Patients are most likely to persist with programmes which are well-adapted to their physical, physiological, psychological and socioeconomic characteristics. The quality of leadership is also an important variable. Open-ended and structured questionnaires suggest that motivations to exercise include the improvement of health, the development of fitness, the control of bodyweight as well as an improvement in personal appearance, socialising, and simply a wish to 'feel better'. The main perceived reason why people 'drop out' of formal exercise classes is through lack of time, although often the individuals making this complaint appear to have substantial free time. Personality characteristics of the adherent depend on the type of programme that is offered and the degree of social support that is provided; extraversion, a high self-esteem and self-motivation are common findings. Modelling of exercise behaviour has drawn upon the concepts of Skinner, Becker and most recently Fishbein. Beliefs and their evaluation seem more influential than subjective norms, although exercise behaviour is also heavily influenced by past experience of physical activity. Programmes should be designed to maximise external reinforcement of the exercise habit until the early discomforts of training are overcome, and the patient discovers the internal rewards of a more active lifestyle.

Attitude to Health↗

PubMed2005

Endurance exercise regimens induce differential effects on brain-derived neurotrophic factor, synapsin-I and insulin-like growth factor I after focal ischemia.

The optimal amount of endurance exercise required to elevate proteins involved in neuroplasticity during stroke rehabilitation is not known. This study compared the effects of varying intensities and durations of endurance exercise using both motorized and voluntary running wheels after endothelin-I-induced focal ischemia in rats. Hippocampal levels of brain-derived neurotrophic factor, insulin-like growth factor I and synapsin-I were elevated in the ischemic hemisphere even in sedentary animals suggesting an intrinsic restorative response 2 weeks after ischemia. In the sensorimotor cortex and the hippocampus of the intact hemisphere, one episode of moderate walking exercise, but not more intense running, resulted in the greatest increases in levels of brain-derived neurotrophic factor and synapsin-I. Exercise did not increase brain-derived neurotrophic factor, insulin-like growth factor I or synapsin-I in the ischemic hemisphere. In voluntary running animals, both brain and serum insulin-like growth factor I appeared to be intensity dependent and were associated with decreasing serum levels of insulin-like growth factor I and increasing hippocampal levels of insulin-like growth factor I in the ischemic hemisphere. This supports the notion that exercise facilitates the movement of insulin-like growth factor I across the blood-brain barrier. Serum corticosterone levels were elevated by all exercise regimens and were highest in rats exposed to motorized running of greater speed or duration. The elevation of corticosterone did not seem to alter the expression of the proteins measured, however, graduated exercise protocols may be indicated early after stroke. These findings suggest that relatively modest exercise intervention can increase proteins involved in synaptic plasticity in areas of the brain that likely subserve motor relearning after stroke.

Analysis of Variance↗

PubMed2004

A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease.

BACKGROUND: Physical activity is a major modifiable risk factor for cardiovascular disease, but it is unclear what combination of feasible approaches, using existing resources in primary care, work best to initiate increased physical activity. AIM: To assess three approaches to initiate increased physical activity. DESIGN OF STUDY: Randomised controlled (2 X 2 X 2) factorial trial. SETTING: Four general practices. METHOD: One hundred and fifty-one sedentary patients with computer documented risk factors for cardiovascular disease were randomised to eight groups defined by three factors: prescription by general practitioners (GPs) for brisk exercise not requiring a leisure facility (for example, walking) 30 minutes per day, 5 days per week; counselling by practice nurses, based on psychological theory to modify intentions and perceived control of behaviour, and using behavioural implementation techniques (for example, contracting, 'rehearsal'); use of the Health Education Authority booklet 'Getting active, feeling fit'. RESULTS: Single interventions had modest effects. There was a trend from the least intensive interventions (control +/- booklet) to the more intensive interventions (prescription and counselling combined +/- booklet) for both increased physical activity and fitness (test for trend, P = 0.02 and P = 0.05, respectively). Only with the most intense intervention (prescription and counselling combined) were there significant increases in both physical activity and fitness from baseline (Godin score = 14.4, 95% confidence interval [CI] = 7.8 to 21, which was equivalent to three 15-minute sessions of brisk exercise and a 6-minute walking distance = 28.5 m, respectively, 95% CI = 11.1 to 45.8). Counselling only made a difference among those individuals with lower intention at baseline. CONCLUSION: Feasible interventions using available staff, which combine exercise prescription and counselling explicitly based on psychological theory, can probably initiate important increases in physical activity.

Analysis of Variance↗