Nurse Faculty Scholars - Exercise

Pilot testing of the PRAISEDD intervention among African American and low-income older adults.

lsharp — Tue, 19 Oct 2010 13:12:50 +0000

Published Date:

Tue, 2009-09-01 (All day)

BACKGROUND AND RESEARCH OBJECTIVE: The incidence of cardiovascular disease (CVD) is particularly high among African American (AA) older adults, and these individuals are least likely to have access to CVD prevention activities. The purpose of this study was to test the feasibility of People Reducing Risk and Improving Strength through Exercise, Diet and Drug Adherence (PRAISEDD), which is geared at increasing adherence to CVD prevention behaviors among AA and low-income older adults.

METHODS: This feasibility study was conducted in a senior housing site, using a single-group repeated-measures design and testing physical activity, diet, medication adherence beliefs and behaviors, and blood pressure at baseline and after a 12-week intervention period. Of 22 participants, mean (SD) age was 76.4 (7.6) years, and most were female (64%) and AA (86%). An intention-to-treat analysis was used.

RESULTS: There were significant decreases in systolic (P = .02) and diastolic blood pressure (P = .01) and a nonsignificant trend toward improvement in cholesterol intake (P = .09). There were no changes in time spent in moderate-level physical activity, sodium intake, medication adherence, or self-efficacy and outcome expectations across all 3 behaviors.

CONCLUSION: The PRAISEDD intervention was feasible in a group of AA and low-income older adults and, after 12 weeks, resulted in improvements in blood pressure. Future research is needed to test a revised PRAISEDD intervention using a randomized controlled design, a larger sample, and a longer follow-up period. The PRAISEDD intervention should be revised to incorporate environmental and policy changes that influence CVD prevention behaviors and explore the impact of social networking as it relates to diffusion of the intervention among participants in low-income housing facilities.

Recruitment of African American Women to a Walking Program: Eligibility, Ineligibility, and Attrition During Screening

nfs — Wed, 29 Sep 2010 12:08:05 +0000

Published Date:

Sun, 2006-01-01 (All day)

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.

Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention

nfs — Tue, 28 Sep 2010 15:21:57 +0000

Published Date:

Fri, 2005-04-01 (All day)

Objectives. We examined a community-based participatory diabetes intervention to identify facilitators of and barriers to sustained community efforts to address social factors that contribute to health. Methods. We conducted a case study description and analysis of the Healthy Eating and Exercising to Reduce Diabetes project in the theoretical context of a conceptual model of social determinants of health. Results. We identified several barriers to and facilitators of analysis of social determinants of a community-identified disease priority (in this case, diabetes). Barriers included prevailing conceptual models, which emphasize health behavioral and biomedical paradigms that exclude social determinants of health. Facilitating factors included (1) opportunities to link individual health concerns to social contexts and (2) availability of support from diverse partners with a range of complementary resources. Conclusions. Partnerships that offer community members tangible resources with which to manage existing health concerns and that integrate an analysis of social determinants of health can facilitate sustained engagement of community members and health professionals in multilevel efforts to address health disparities.

Neighborhood environment and adherence to a walking intervention in African American women.

nfs — Mon, 27 Sep 2010 12:52:41 +0000

Published Date:

Sun, 2009-02-01 (All day)

This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban, midlife African American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women's neighborhoods included walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. The presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African American women who want to be more active.

Methods to Optimize Recruitment and Retention to an Exercise Study in Chinese Immigrants

nfs — Wed, 14 Jul 2010 17:37:45 +0000

Published Date:

Sun, 2007-04-01 (All day)

BACKGROUND: To counter pervasive disparities in healthcare and guide public health prevention programs, culturally sensitive recruitment and retention strategies for Chinese immigrants participating in health-related research studies are needed. OBJECTIVES: The aim of this study was to develop and implement recruitment and retention strategies with Chinese immigrants in a Tai Chi exercise study. METHODS: After substantial project planning and incorporating community-based research principles, a multidimensional approach was used to ensure minimal loss to follow-up. Recruitment strategies included partnering with a community-based agency, distributing study information using a multimedia approach, communicating in the native language, and demonstrating cultural sensitivity. Retention strategies included establishing a tracking method during recruitment, providing personalized feedback, maintaining the same location for all aspects of the study, eliminating potential linguistic barriers, providing personal attention and encouragement, monitoring attendance, utilizing a charismatic Tai Chi instructor, respecting Chinese culture, providing appropriate incentives, and maintaining good communication. RESULTS: Sixty persons showed interest in the study, 52 persons were screened, and 39 persons were enrolled. Recruitment was completed within 3 weeks. An advertisement in the Chinese newspaper was the most fruitful recruitment source, yielding approximately 60% of the study participants. Retention in the study was also very high (97%, n = 38). DISCUSSION: The successful recruitment and retention of Chinese immigrants in this Tai Chi exercise study are due to a variety of factors on many levels, including the participants, study investigator, and community-based agency.

Impact of a walking intervention on cardiorespiratory fitness, self-reported physical function, and pain in patients undergoing treatment for solid tumors

nfs — Tue, 08 Jun 2010 15:30:48 +0000

Published Date:

Thu, 2009-10-15 (All day)

BACKGROUND: Cancer treatment is associated with decline in measured and self-reported physical function and increased pain. In the current study, the authors evaluated the impact of a walking intervention on these outcomes during chemotherapy/radiation.

METHODS: Patients with breast, prostate, and other cancers (N¼126) were randomized to a home-based walking intervention (exercise) or usual care (control). Exercise dose during the intervention was assessed using a 5-item Physical Activity Questionnaire. Outcome measures were cardiorespiratory fitness, expressed as peak oxygen uptake (VO2) measured during treadmill testing (n ¼ 85) or estimated by 12-minute walk (n ¼ 27), and self-reported physical function, role limitations, and pain derived from Medical Outcomes Study Short Form 36. Linear regression was used to evaluate pre-to-post intervention change outcomes between groups.

RESULTS: The mean (standard deviation) age of the patients was 60.2 (10.6) years. Diagnoses included prostate (55.6%) and breast (32.5%) cancer. Treatment included external beam radiotherapy (52.3%) and chemotherapy (34.9%). Exercise patients reported worsening Medical Outcomes Study physical function role limitations by the end of cancer treatment (P ¼ .037). Younger age was associated with improved Medical Outcomes Study physical function (P ¼ .048). In all patients, increased exercise dose was associated with decreased Medical Outcomes Study pain (P ¼ .046), regardless of diagnosis. The percent change of VO2 between prostate and nonprostate cancer patients when adjusted for baseline VO2 and Physical Activity Questionnaire values was 17.45% (P ¼ .008), with better VO2 maintenance in the prostate group.

CONCLUSIONS: Exercise during cancer treatment improves cardiorespiratory fitness and self-reported physical function in prostate cancer patients and in younger patients, regardless of diagnosis, and may attenuate loss of those capacities in patients undergoing chemotherapy. Exercise also reduces the pain experience.